Schizophrenia accounts for achronic mental disorder that severely affects an individual. For instance, anindividual can fail to differentiate between reality and illusion due toauditory and visual hallucinations.
The hallucinations and mood fluctuationsmay hinder a person social life in a negative way. The typical symptoms ofschizophrenia, as per DSM-IV, are comprised of delusions, hallucinations,incoherent speech, catatonic behavior and affective flattening. However, onlyone criterion is required to be met to indicate the prevalence ofschizophrenia.
The onset of schizophrenia reduces the performance of anindividual in academics, personal and professional activities (Patrick et al.,2009).The continuous prevalence ofconfused thinking, false beliefs, decreased emotional expression, and inadequatesocial behavior, and dissuasion is in accordance with the DSM criteria. For atleast six months the DSM criteria indicates that symptoms stated previously arethe manifestation of schizophrenia. The context of mood disorders, mainlycomprising of depressive or manic episodes are excluded from the features,whereas the prevalence of drug abuse and medication resulting in hallucinationsis also eliminated from the DSM criteria. Furthermore, autistic individualsalso tend to have dysfunctional social behavior, due to which the prevalence ofschizophrenia becomes valid with the occurrence of hallucinations (Miller etal.
, 2002).Schizophrenia has been categorizedon account of its subtypes, mainly comprising of paranoid, disorganized,catatonic, undifferentiated and residual types. The paranoid type iscategorized by the occurrence of hallucinations, whereas the disorganized typeis categorized by the occurrence of disorganized speech and behavior. Thecatatonic type incorporates the inadequate motor ability, whereas the residualtype incorporates the prevalence of odd beliefs and inadequate perceptualexperiences (Patrick et al., 2009). Historyand Development of SchizophreniaThe term Schizophrenia was proposedby Eugen Bleuler in the year 1908 as a means to distinguish between thinking,memory, perception, and personality.
The historical prevalence of schizophreniais found to be complicated. It was reported to be observed in the 19th century,whereas schizophrenia was considered as a cluster of psychological disorders inthe 20th century. Afterwards, it was classified by Emil Kraepelin as adelusional disorder that accounted for dementia praecox. In the 19th century,the observations regarding irrational behavior prevailed, and the early caseswere observed in 1809 in the asylum. Furthermore, these cases were reported in1886 by Heinrich Schule, who was working as a physician at the asylum; andschizophrenia was determined as the ‘wrecked behavior’ (Jablensky, 2010). The cases of schizophrenia werecharacterized as the dementia praecox, it was believed to be the antecedent ofa lifelong metabolic disorder that hinders the brain activity. The context ofdementia praecox was interchangeably used with mental weakness, mentaldeterioration, and mental defect.
Hence, Kraepelin’s classification replacedthe context of adolescent insanity. Moreover, in 1908, the patients withdementia praecox showed improvement in behavior, which resulted in theelimination of the term dementia. However, the context of split personality wasnot identified by 1916, where the split personality cases were reported andassessed by Stanley Hal (Tandon et al., 2013). In the 20th century, first-ranksymptoms were identified to differentiate schizophrenia from other diseases andunderstand its antecedents. Furthermore, schizophrenia was classified as ahereditary disease and the individuals with this disease were considered unfit.
Those who were diagnosed were murdered in accordance with the Nazi Action T4program. In the 1970s, controversies were reported regarding the diagnosis,treatment, and outcome of individuals with schizophrenia, due to whichschizophrenia was addressed in the DSM-III in the year 1980. It resulted inmaking the diagnosis more reliable with the prevalence of 40 diagnosticscriteria as a means to evaluate the prevalence of schizophrenia (Jablensky,2010). Schizophrenia was addressed inDSM-I, which resembles the DSM-IV criteria, but it was extended on account ofchildhood type and residual type. Initially, schizophrenia was considered as adisorder that occurred among adolescents, due to which childhood and residualcontext was included.
In DSM-II, the criteria for the diagnosis ofschizophrenia account for the split personality, was misdiagnosed with thedissociative identity disorder with latent subtypes. Thus, the validity ofdiagnostic criteria was hindered under the DSM-II in the 1970s. That resultedin the publication of schizophrenia in DSM-III that addressed the context ofsanity in the diagnosis. However, controversies in the theoretical underpinningsand improvements in the mental condition of patients with schizophreniaresulted in the revision of DSM-III (Tandon et al., 2013).
Schizophrenia was included in theDSM-IV criteria in the 2000 version, in which the patients were required to meetat least two or more conditions during the duration of 1 month. Theseconditions included hallucinations, disorganized speech, catatonic behavior,affective flattening, and demotivation. However, the diagnostic criteria forSchizophrenia have been changed in DSM-V in the year 2013. The changes in thesubsequent version of the DSM account for the prevalence of hallucinations,delusions and disorganized speech is required for the minimum duration of onemonth. The symptoms are required to affect the social or professionalactivities of an individual for the duration of six months (Kyziridis, 2005). DSM-V requires that the individualmay have the catatonic symptoms; however, schizophrenia can be diagnosed onlywith the prevalence of catatonic symptoms.
Similarly, the definition ofschizophrenia remains the same as per the DSM-IV standards, whereas changes arebased on the classifications of schizophrenia. In this instance, paranoid andcatatonic subtypes are eliminated, and emphasis has been implied on the schizo-affectivedisorder. The catatonic and paranoid subtypes are eliminated due to theirhindered significance and reliability in addressing the prevalence ofschizophrenia. Schizoaffective disorder accounts for affective flattening anddemotivation, and it has become a major predictor of schizophrenia due to thedifferential behavior of individuals (Kyziridis, 2005). The overall assessment of eightdomains is incorporated as a means to support the clinical decision-makingmechanism.
DSM-V implies that the prevalence of symptoms for 1 to 6 months isconsidered as the diagnosis of schizophreniform disorder, whereas the symptomsidentified for less than 1-month account for the brief psychotic disorder.Similarly, mood disorders observed during the period of 1-month account forschizoaffective disorder, whereas it is eliminated when the individual issubject to the use of prior medications. Hence, schizophrenia is confirmed whenhallucinations or delusions are observed along with the occurrence of pervasivedevelopmental disorder (Kyziridis, 2005). Review of Empirical Studies Overviewof Schizophrenia Over the Past CenturyThe study conducted by Oshima et al.
(2010)addressed the context of Schizophrenia in accordance with its symptoms, mainlycomprising of hallucinations and disease duration. The study was objectified todetermine the reliability and validity of diagnostics with respect to theDSM-IV diagnosis criteria. The results of the study indicated that the DSM-IVdiagnosis criteria entail the biological and physiological disturbances andthese clusters were significant in differentiating the context ofschizophrenia. The results indicated that schizophrenia was predicted bythinking, information processing disturbance and inadequate tolerance tostress.
The study concluded that these clusters are not in accordance with thediagnosis criteria of DSM-IV and hence, the identified clusters can help inenhancing the perspective to direct the diagnosis of schizophrenia. Similarly,it can help the clinicians to conduct the correct diagnosis of patients withmental disorders and can enhance their inter-judge ability by using effectivediagnostics. The context of schizophrenia hasbeen refined in DSM-V; however, the validity of schizophrenia remainsunidentified due to the lack of the fundamental nature of mental disorder. Inthis instance, schizophrenia is not considered as an absolute construct due towhich its pathology cannot be delineated. Thus, it is proposed that proximalindicators are required to be incorporated in the context of schizophrenia toenhance the reliability of diagnosis criteria (Allardyce et al., 2007).Pihlajamaa et al.
(2008) investigated the validity of Schizophrenia by usingthe sample size of 877 individuals. The diagnostic criteria address themulti-diagnostic approach, in which DSM III and IV, and ICD-10 wereincorporated. The results of the study indicated that the individuals initiallycategorized with the prevalence of schizophrenia were found to have this mentaldisorder with the possibility of 75% as per DSM-III, 74% as per DSM-IV and 78%as per ICD-10. However, the sample size was also comprised of the cases thatwere reported before 1982, which indicates that the sample size may not becomprised of the actual schizophrenia case, which caused a decreased level ofreliability. The study conducted by Miller etal. (2002) was aimed to enlighten the validity and reliability of diagnosticcriteria on account of schizophrenic psychosis. In this instance, 18 patientswith the uncertain diagnosis of schizophrenia were included in the study,whereas raters conducted an independent diagnosis.
Afterwards, with theduration of 6 and 12 months, validity study was conducted by assessing29patients. The results of the study indicate that the 93% prodromal differencewas observed among patients. Similarly, the prodromal features were found to bein accordance with schizophrenic features with 46%. Therefore, the studyconcluded that the diagnostic criteria for prodromal and schizophreniasignificant in predicting the occurrence of the respective disorders. Patrick et al.
(2009) conducted anempirical study to determine the effectiveness of Personal and SocialPerformance (PSP) scale as a means to identify acute schizophrenia. The datawere obtained from the pooled studies that accounted for 1665 sample size,where 299 cross-sectional studies were included. The results of the studyindicated that the PSP was highly related to the results determined by PANSSscale.
Therefore, the study provided empirical evidence regarding the efficacyof PSP in the diagnosis of schizophrenia and its contribution in integratingwith the DSM criteria. Ekholm et al. (2005) investigatedthe efficacy of medical records, structured interviews, and diagnostic criteriato determine the lifetime prevalence of schizophrenia among patients. In thisinstance, 143 patients with schizophrenia were interviewed and examined onaccount of DSM-IV criteria by using the OPCRIT algorithm. An independentdiagnosis was incorporated by the psychiatrists, and the findings wereindependent of the OPCRIT algorithm.
The results of the study indicated thatthe diagnosis based on DSM-IV criteria indicated efficacious agreement with thefindings from medical records and interviews. Similarly, DSM-IV criteria werefound to be as effective in the prediction of schizophrenia as the Swedishregister diagnosis. A total of 94% of the patients who showed somewhatinclination towards the developing schizophrenia were found to be identifiedwith similar disorders determined by DSM-IV.
Hence, the study providedconclusions by indicating the analysis of medical records and structuredinterviews as an effective means to diagnose schizophrenia. Keefe et al. (2004) addressed thevalidity and reliability of the Brief Assessment of Cognition in Schizophrenia(BACS) as a means to determine its efficacy in the diagnosis of schizophrenia.The comparative study conducted in this respect indicated that BACS requiresless than thirty-five minutes to assess patients and provide diagnosticresults. It also correlates with a higher completion rate among patients andprovides a high empirical reliability of results. BACS were compared with thestandard battery of tests, which requires the assessment duration of 2 hours,as a means to determine cognitive impairment in patients with schizophrenia.The results acquired from BACS and standard battery of tests indicated that theresults were highly correlated with the DSM criteria, whereas these testsprovided significant results in the control group, which indicates the validityof the diagnosis. Hence, these tools are found to be effective in theassessment of patients with schizophrenia.
Kim et al. (2004) were focused onthe development of a holistic diagnostic instrument by means of integratingKiddie-Schedule for Affective Disorders and Schizophrenia (K-SAD-S). In thisinstance, 90 patients were recruited for the study from the child psychiatricclinic. The clinical diagnosis of schizophrenia was conducted by using K-SAD-Sscale and the results were compared with the Korean Child Behavior Checklist.The results of the study indicated that K-SAD-S is an effective means ofdiagnosing the prevalence of schizophrenia as it can provide significantresults.
It can help in providing assistance to the clinicians to developadequate intervention plans as a means to address the wellbeing of patientswith schizophrenia. Value of DSM DiagnosisSchizophrenia is a mental disorderwhich causes hallucinations, affective flattening, catatonic behavior and mooddisorders, which eventually reduces the wellbeing of the individual withdecreased performance and concentration in academic, professional and personalactivities. DSM diagnosis provides the effective criteria to help theclinicians with the diagnosis of schizophrenia among individuals.
It also helpsin determining the extent of schizophrenia, which helps in the development ofadequate treatment plans. The usefulness of DSM diagnosis is found to besignificant in numerous clinical settings, which indicates that the DSM is asignificant predictor of schizophrenia. Continuous improvements in the DSMcriteria are observed over the period of years, which indicates that the DSMcriteria is focused towards the evidence based findings to make the diagnosiscriteria concise and reliable. Similarly, the review of studies conducted inthis paper indicates that the DSM criteria provides valid results across alarge number of the population and is considered as a significant predictor ofschizophrenia. The screening tests account for the constructs that areaddressed in the DSM criteria, which indicates the validity of DSM diagnostic.Furthermore, these screening tests have provided significant results inclinical trials across a large number of population, which eventually indicatesthe reliability of DSM diagnostic. From the point of view of aclinical social worker, it is concluded that DSM diagnostic providessignificant and reliable results that can be comprehended in the diagnosis ofpatients. It also provides the social workers with the quantitative assessmentmethods to screen the individuals and identify the extent to whichschizophrenic symptoms prevail among the patients.
It can help the socialworkers to focus on the specific characteristics, refer adequate clinicians andhelp in the development and implementation of effective interventions toaddress the wellbeing of schizophrenic patients. It can help in the identificationof concise findings that can help the clinical practitioners to determineadequate treatment plans. Hence, the overall value of DSM diagnostic is foundto be significant as a means to screen the patients with schizophrenicsymptoms.
However, schizophrenia is a complex mental condition which makes itdifficult to be differentiated from other mental disorders. Thus, the clinicalpractitioner or social worker should have an adequate knowledge of mentaldisorders and schizophrenia to differentiate schizophrenia and otherdissociative personality disorders.