Disorders in the Schizophrenia and Other Psychotic Disorders category include Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, Delusional Disorder, Shared Psychotic Disorder, Brief Psychotic Disorder, Psychotic Disorder due to a General Medical Condition, Substance Induced Psychotic Disorder, and Psychotic Disorder Not Otherwise Specified....
(Gur & Johnson, 2006) Symptoms of schizophrenia can be divided into five categories: psychotic symptoms, negative symptoms, cognitive impairment, mood problems, and behavioral disturbances....
Schizophrenia is the most common and the most potentially sever and disabling of the psychosis, a term encompassing several severe mental disorders that result in the loss of contact with reality along with major personality derangements.
No matter what happens during the first visit to the doctor, the diagnosis of schizophrenia usually takes a long time. This is because it can be a very difficult diagnosis to make: the symptoms necessary for diagnosis either go unrecognized, or do not show themselves fully, until the illness is advanced. There are also many differences among individuals in the way in which symptoms present themselves. Most doctors, well aware of the stigma that still surrounds this illness, don’t like to voice their suspicions until they are sure that this diagnosis is correct.
During a crisis episode, your relative will exhibit some or all of the following symptoms: hallucinations, delusions, thought disorder, and disturbances in behavior and emotions. Families who have been through these psychotic episodes warn that no amount of preparation can fully protect you from the shock, panic, and sickening dread you will feel when your relative enters this stage of schizophrenia. Understand also that your relative may be as terrified as you are by what is happening: “voices” may be giving life-threatening commands; snakes may be crawling on the window; poisonous fumes may be filling the room. You must get medical help for your relative as quickly as possible, and this could mean hospitalization. If your relative has been receiving medical help, phone the doctor or psychiatrist immediately. Ask which hospital you should go to and for advice about what to do.
There is, as yet, no simple lab test to make a diagnosis. Therefore, the diagnosis is based on the symptoms – what the person says and what the doctor observes. To reach a diagnosis of schizophrenia, other possible causes such as drug abuse, epilepsy, brain tumor, thyroid or other metabolic disturbances, as well as other physical illnesses that have symptoms like schizophrenia, such as hypoglycemia and Wilson’s disease, must be ruled out. The condition must also be clearly differentiated from bipolar (manic-depressive) disorder (see Glossary). Some patients show the symptoms of both schizophrenia and manic depression. This condition is termed “schizoaffective” disorder. Its relation to schizophrenia is unclear at present.
Although schizophrenia is usually discussed as if it were a single disease, this diagnostic category can include a variety of disorders that present with somewhat similar behavioral symptoms....
As an illustration of this form of disorganized speech, consider the following example. In a study of nearly 300 schizophrenic patients conducted by Christopher Frith and his colleagues, different groups were asked to perform a verbal fluency task. The task was to name animals. Whereas the group of patients with poverty of speech tended to commit errors of omission, the group of patients with the disorganization syndrome tended to make errors of commission. As an example of the latter type of error, Frith and Johnstone quote a patient who produced the sequence, ‘emu, duck, swan, lake, Loch Ness monster, bacon …’ (, 63). This strongly suggests that Kant’s explanation of derailment and loose association in terms of an impairment of the power of judgment is correct.
Because there are many symptoms of the disease and because the symptoms can vary quite dramatically among several individuals and even within the same individual over time, the diagnosis of schizophrenia can be quite difficult.
However even with its popularity heightened through movies and headline news stories, schizophrenia is still one of the most enigmatic and least understood disorders of the brain.
Just as there is a form of schizophrenia that begins early in childhood, there is also a form that begins later in life. Late on-set schizophrenia is variously defined as beginning after the age of 40 or 45. Almost all studies of it have been done by Europeans, with little interest having been shown by American researchers.
Clinically, late-onset schizophrenia is similar to the earlier- onset variety except for having a predominance of females affected; having more schizoid and paranoid personality traits in the person before he/she becomes sick; and having more paranoid delusions and more visual, tactile, and olfactory (smell) hallucinations. Neuropsychological tests and MRI scans shows deficits similar to early- onset schizophrenia. The other way in which late- onset schizophrenia differs is in having a more chronic course and less favorable prognosis that would be expected that the later the onset of the disease, the better the prognosis is likely to be.
At the extreme, the loss of public sense could give way to illusion in such a way that the mentally deranged person experiences things that others do not experience. Kant gives the example of a person who ‘in broad daylight sees a light burning on his table which, however, another person standing nearby does not see, or hears a voice that no one else hears’ (Anth 7: 219). In passing, Kant here touches upon another key symptom of schizophrenia, namely hallucination. While hallucination is the clearest case in which a person loses a sense of a shared world, Kant claims that the loss of a shared world is a general aspect of mental derangement. The mentally deranged person, he notes, ‘is abandoned to a play of thoughts in which he sees, acts, and judges, not in a common world, but rather in his own world’ (Anth 7: 219).
The ingenious aspect of Kant’s discussion of mental derangement is his explanation of its symptoms in terms of the impairment of the cognitive faculties necessary for experiential cognition that he laid out in the Critique of Pure Reason. Kant distinguishes four different types of mental derangement. They are related to the impairment of respectively the faculty of the understanding, the power of imagination, the power of judgment and the faculty of reason. I will discuss them in a somewhat different order. I will first discuss two symptoms that are associated with the so-called paranoid type of schizophrenia and then proceed to two symptoms associated with the so-called disorganized type.