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Chapter V

Schizophrenia - F20


The schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained although certain cognitive deficits may evolve in the course of time. The most important psychopathological phenomena include thought echo; thought insertion or withdrawal; thought broadcasting; delusional perception and delusions of control; influence or passivity; hallucinatory voices commenting or discussing the patient in the third person; thought disorders and negative symptoms.

The course of schizophrenic disorders can be either continuous, or episodic with progressive or stable deficit, or there can be one or more episodes with complete or incomplete remission. The diagnosis of schizophrenia should not be made in the presence of extensive depressive or manic symptoms unless it is clear that schizophrenic symptoms antedate the affective disturbance. Nor should schizophrenia be diagnosed in the presence of overt brain disease or during states of drug intoxication or withdrawal. Similar disorders developing in the presence of epilepsy or other brain disease should be classified under F06.2, and those induced by psychoactive substances under F10-F19 with common fourth character .5.
    Excludes:
  • schizophrenia:
  • acute (undifferentiated) ( F23.2 )
  • cyclic ( F25.2 )
  • schizophrenic reaction ( F23.2 )
  • schizotypal disorder ( F21 )
F20.0 Paranoid schizophrenia
Paranoid schizophrenia is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition and speech, and catatonic symptoms, are either absent or relatively inconspicuous.
Paraphrenic schizophrenia
    Excludes:
  • involutional paranoid state ( F22.8 )
  • paranoia ( F22.0 )
F20.1 Hebephrenic schizophrenia
A form of schizophrenia in which affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable, and mannerisms common. The mood is shallow and inappropriate, thought is disorganized, and speech is incoherent. There is a tendency to social isolation. Usually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flattening of affect and loss of volition. Hebephrenia should normally be diagnosed only in adolescents or young adults.
Disorganized schizophrenia
Hebephrenia
F20.2 Catatonic schizophrenia
Catatonic schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. Constrained attitudes and postures may be maintained for long periods. Episodes of violent excitement may be a striking feature of the condition. The catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic hallucinations.
Catatonic stupor
Schizophrenic:
  • catalepsy
  • catatonia
  • flexibilitas cerea
  • F20.3 Undifferentiated schizophrenia
    Psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the subtypes in F20.0-F20.2, or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics.
    Atypical schizophrenia
      Excludes:
    • acute schizophrenia-like psychotic disorder ( F23.2 )
    • chronic undifferentiated schizophrenia ( F20.5 )
    • post-schizophrenic depression ( F20.4 )
    F20.4 Post-schizophrenic depression
    A depressive episode, which may be prolonged, arising in the aftermath of a schizophrenic illness. Some schizophrenic symptoms, either "positive" or "negative", must still be present but they no longer dominate the clinical picture. These depressive states are associated with an increased risk of suicide. If the patient no longer has any schizophrenic symptoms, a depressive episode should be diagnosed (F32.-). If schizophrenic symptoms are still florid and prominent, the diagnosis should remain that of the appropriate schizophrenic subtype (F20.0-F20.3).
    F20.5 Residual schizophrenia
    A chronic stage in the development of a schizophrenic illness in which there has been a clear progression from an early stage to a later stage characterized by long- term, though not necessarily irreversible, "negative" symptoms, e.g. psychomotor slowing; underactivity; blunting of affect; passivity and lack of initiative; poverty of quantity or content of speech; poor nonverbal communication by facial expression, eye contact, voice modulation and posture; poor self-care and social performance.
    Chronic undifferentiated schizophrenia
    Restzustand (schizophrenic)
    Schizophrenic residual state
    F20.6 Simple schizophrenia
    A disorder in which there is an insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance. The characteristic negative features of residual schizophrenia (e.g. blunting of affect and loss of volition) develop without being preceded by any overt psychotic symptoms.
    F20.8 Other schizophrenia
    Cenesthopathic schizophrenia
    Schizophreniform:
  • disorder NOS
  • psychosis NOS
      Excludes:
    • brief schizophreniform disorders ( F23.2 )
  • F20.9 Schizophrenia, unspecified


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