Schizophrenia accounts for a
chronic mental disorder that severely affects an individual. For instance, an
individual can fail to differentiate between reality and illusion due to
auditory and visual hallucinations. The hallucinations and mood fluctuations
may hinder a person social life in a negative way. The typical symptoms of
schizophrenia, as per DSM-IV, are comprised of delusions, hallucinations,
incoherent speech, catatonic behavior and affective flattening. However, only
one criterion is required to be met to indicate the prevalence of
schizophrenia. The onset of schizophrenia reduces the performance of an
individual in academics, personal and professional activities (Patrick et al.,
2009).

The continuous prevalence of
confused thinking, false beliefs, decreased emotional expression, and inadequate
social behavior, and dissuasion is in accordance with the DSM criteria. For at
least six months the DSM criteria indicates that symptoms stated previously are
the manifestation of schizophrenia. The context of mood disorders, mainly
comprising of depressive or manic episodes are excluded from the features,
whereas the prevalence of drug abuse and medication resulting in hallucinations
is also eliminated from the DSM criteria. Furthermore, autistic individuals
also tend to have dysfunctional social behavior, due to which the prevalence of
schizophrenia becomes valid with the occurrence of hallucinations (Miller et
al., 2002).

Schizophrenia has been categorized
on account of its subtypes, mainly comprising of paranoid, disorganized,
catatonic, undifferentiated and residual types. The paranoid type is
categorized by the occurrence of hallucinations, whereas the disorganized type
is categorized by the occurrence of disorganized speech and behavior. The
catatonic type incorporates the inadequate motor ability, whereas the residual
type incorporates the prevalence of odd beliefs and inadequate perceptual
experiences (Patrick et al., 2009).

 

History
and Development of Schizophrenia

The term Schizophrenia was proposed
by Eugen Bleuler in the year 1908 as a means to distinguish between thinking,
memory, perception, and personality. The historical prevalence of schizophrenia
is found to be complicated. It was reported to be observed in the 19th century,
whereas schizophrenia was considered as a cluster of psychological disorders in
the 20th century. Afterwards, it was classified by Emil Kraepelin as a
delusional disorder that accounted for dementia praecox. In the 19th century,
the observations regarding irrational behavior prevailed, and the early cases
were observed in 1809 in the asylum. Furthermore, these cases were reported in
1886 by Heinrich Schule, who was working as a physician at the asylum; and
schizophrenia was determined as the ‘wrecked behavior’ (Jablensky, 2010).

 

 

 

 

 

The cases of schizophrenia were
characterized as the dementia praecox, it was believed to be the antecedent of
a lifelong metabolic disorder that hinders the brain activity. The context of
dementia praecox was interchangeably used with mental weakness, mental
deterioration, and mental defect. Hence, Kraepelin’s classification replaced
the context of adolescent insanity. Moreover, in 1908, the patients with
dementia praecox showed improvement in behavior, which resulted in the
elimination of the term dementia. However, the context of split personality was
not identified by 1916, where the split personality cases were reported and
assessed by Stanley Hal (Tandon et al., 2013).

 

In the 20th century, first-rank
symptoms were identified to differentiate schizophrenia from other diseases and
understand its antecedents. Furthermore, schizophrenia was classified as a
hereditary disease and the individuals with this disease were considered unfit.
Those who were diagnosed were murdered in accordance with the Nazi Action T4
program. In the 1970s, controversies were reported regarding the diagnosis,
treatment, and outcome of individuals with schizophrenia, due to which
schizophrenia was addressed in the DSM-III in the year 1980. It resulted in
making the diagnosis more reliable with the prevalence of 40 diagnostics
criteria as a means to evaluate the prevalence of schizophrenia (Jablensky,
2010).

Schizophrenia was addressed in
DSM-I, which resembles the DSM-IV criteria, but it was extended on account of
childhood type and residual type. Initially, schizophrenia was considered as a
disorder that occurred among adolescents, due to which childhood and residual
context was included. In DSM-II, the criteria for the diagnosis of
schizophrenia account for the split personality, was misdiagnosed with the
dissociative identity disorder with latent subtypes. Thus, the validity of
diagnostic criteria was hindered under the DSM-II in the 1970s. That resulted
in the publication of schizophrenia in DSM-III that addressed the context of
sanity in the diagnosis. However, controversies in the theoretical underpinnings
and improvements in the mental condition of patients with schizophrenia
resulted in the revision of DSM-III (Tandon et al., 2013). 

 

Schizophrenia was included in the
DSM-IV criteria in the 2000 version, in which the patients were required to meet
at least two or more conditions during the duration of 1 month. These
conditions included hallucinations, disorganized speech, catatonic behavior,
affective flattening, and demotivation. However, the diagnostic criteria for
Schizophrenia have been changed in DSM-V in the year 2013. The changes in the
subsequent version of the DSM account for the prevalence of hallucinations,
delusions and disorganized speech is required for the minimum duration of one
month. The symptoms are required to affect the social or professional
activities of an individual for the duration of six months (Kyziridis, 2005).

DSM-V requires that the individual
may have the catatonic symptoms; however, schizophrenia can be diagnosed only
with the prevalence of catatonic symptoms. Similarly, the definition of
schizophrenia remains the same as per the DSM-IV standards, whereas changes are
based on the classifications of schizophrenia. In this instance, paranoid and
catatonic subtypes are eliminated, and emphasis has been implied on the schizo-affective
disorder. The catatonic and paranoid subtypes are eliminated due to their
hindered significance and reliability in addressing the prevalence of
schizophrenia. Schizoaffective disorder accounts for affective flattening and
demotivation, and it has become a major predictor of schizophrenia due to the
differential behavior of individuals (Kyziridis, 2005). 

 

The overall assessment of eight
domains is incorporated as a means to support the clinical decision-making
mechanism. DSM-V implies that the prevalence of symptoms for 1 to 6 months is
considered as the diagnosis of schizophreniform disorder, whereas the symptoms
identified for less than 1-month account for the brief psychotic disorder.
Similarly, mood disorders observed during the period of 1-month account for
schizoaffective disorder, whereas it is eliminated when the individual is
subject to the use of prior medications. Hence, schizophrenia is confirmed when
hallucinations or delusions are observed along with the occurrence of pervasive
developmental disorder (Kyziridis, 2005).

 

 

 

 

Review of Empirical Studies Overview
of Schizophrenia Over the Past Century

The study conducted by Oshima et al. (2010)
addressed the context of Schizophrenia in accordance with its symptoms, mainly
comprising of hallucinations and disease duration. The study was objectified to
determine the reliability and validity of diagnostics with respect to the
DSM-IV diagnosis criteria. The results of the study indicated that the DSM-IV
diagnosis criteria entail the biological and physiological disturbances and
these clusters were significant in differentiating the context of
schizophrenia. The results indicated that schizophrenia was predicted by
thinking, information processing disturbance and inadequate tolerance to
stress. The study concluded that these clusters are not in accordance with the
diagnosis criteria of DSM-IV and hence, the identified clusters can help in
enhancing the perspective to direct the diagnosis of schizophrenia. Similarly,
it can help the clinicians to conduct the correct diagnosis of patients with
mental disorders and can enhance their inter-judge ability by using effective
diagnostics.

The context of schizophrenia has
been refined in DSM-V; however, the validity of schizophrenia remains
unidentified due to the lack of the fundamental nature of mental disorder. In
this instance, schizophrenia is not considered as an absolute construct due to
which its pathology cannot be delineated. Thus, it is proposed that proximal
indicators are required to be incorporated in the context of schizophrenia to
enhance the reliability of diagnosis criteria (Allardyce et al., 2007).
Pihlajamaa et al. (2008) investigated the validity of Schizophrenia by using
the sample size of 877 individuals. The diagnostic criteria address the
multi-diagnostic approach, in which DSM III and IV, and ICD-10 were
incorporated. The results of the study indicated that the individuals initially
categorized with the prevalence of schizophrenia were found to have this mental
disorder 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 that
were reported before 1982, which indicates that the sample size may not be
comprised of the actual schizophrenia case, which caused a decreased level of
reliability.

The study conducted by Miller et
al. (2002) was aimed to enlighten the validity and reliability of diagnostic
criteria on account of schizophrenic psychosis. In this instance, 18 patients
with the uncertain diagnosis of schizophrenia were included in the study,
whereas raters conducted an independent diagnosis. Afterwards, with the
duration of 6 and 12 months, validity study was conducted by assessing29
patients. The results of the study indicate that the 93% prodromal difference
was observed among patients. Similarly, the prodromal features were found to be
in accordance with schizophrenic features with 46%. Therefore, the study
concluded that the diagnostic criteria for prodromal and schizophrenia
significant in predicting the occurrence of the respective disorders.

Patrick et al. (2009) conducted an
empirical study to determine the effectiveness of Personal and Social
Performance (PSP) scale as a means to identify acute schizophrenia. The data
were obtained from the pooled studies that accounted for 1665 sample size,
where 299 cross-sectional studies were included. The results of the study
indicated that the PSP was highly related to the results determined by PANSS
scale. Therefore, the study provided empirical evidence regarding the efficacy
of PSP in the diagnosis of schizophrenia and its contribution in integrating
with the DSM criteria.

 

Ekholm et al. (2005) investigated
the efficacy of medical records, structured interviews, and diagnostic criteria
to determine the lifetime prevalence of schizophrenia among patients. In this
instance, 143 patients with schizophrenia were interviewed and examined on
account of DSM-IV criteria by using the OPCRIT algorithm. An independent
diagnosis was incorporated by the psychiatrists, and the findings were
independent of the OPCRIT algorithm. The results of the study indicated that
the diagnosis based on DSM-IV criteria indicated efficacious agreement with the
findings from medical records and interviews. Similarly, DSM-IV criteria were
found to be as effective in the prediction of schizophrenia as the Swedish
register diagnosis. A total of 94% of the patients who showed somewhat
inclination towards the developing schizophrenia were found to be identified
with similar disorders determined by DSM-IV. Hence, the study provided
conclusions by indicating the analysis of medical records and structured
interviews as an effective means to diagnose schizophrenia.

Keefe et al. (2004) addressed the
validity 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 requires
less than thirty-five minutes to assess patients and provide diagnostic
results. It also correlates with a higher completion rate among patients and
provides a high empirical reliability of results. BACS were compared with the
standard 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 the
results were highly correlated with the DSM criteria, whereas these tests
provided significant results in the control group, which indicates the validity
of the diagnosis. Hence, these tools are found to be effective in the
assessment of patients with schizophrenia.

 

Kim et al. (2004) were focused on
the development of a holistic diagnostic instrument by means of integrating
Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SAD-S). In this
instance, 90 patients were recruited for the study from the child psychiatric
clinic. The clinical diagnosis of schizophrenia was conducted by using K-SAD-S
scale 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 of
diagnosing the prevalence of schizophrenia as it can provide significant
results. It can help in providing assistance to the clinicians to develop
adequate intervention plans as a means to address the wellbeing of patients
with schizophrenia.

 

Value of DSM Diagnosis

Schizophrenia is a mental disorder
which causes hallucinations, affective flattening, catatonic behavior and mood
disorders, which eventually reduces the wellbeing of the individual with
decreased performance and concentration in academic, professional and personal
activities. DSM diagnosis provides the effective criteria to help the
clinicians with the diagnosis of schizophrenia among individuals. It also helps
in determining the extent of schizophrenia, which helps in the development of
adequate treatment plans. The usefulness of DSM diagnosis is found to be
significant in numerous clinical settings, which indicates that the DSM is a
significant predictor of schizophrenia.

 

Continuous improvements in the DSM
criteria are observed over the period of years, which indicates that the DSM
criteria is focused towards the evidence based findings to make the diagnosis
criteria concise and reliable. Similarly, the review of studies conducted in
this paper indicates that the DSM criteria provides valid results across a
large number of the population and is considered as a significant predictor of
schizophrenia. The screening tests account for the constructs that are
addressed in the DSM criteria, which indicates the validity of DSM diagnostic.
Furthermore, these screening tests have provided significant results in
clinical trials across a large number of population, which eventually indicates
the reliability of DSM diagnostic.

From the point of view of a
clinical social worker, it is concluded that DSM diagnostic provides
significant and reliable results that can be comprehended in the diagnosis of
patients. It also provides the social workers with the quantitative assessment
methods to screen the individuals and identify the extent to which
schizophrenic symptoms prevail among the patients. It can help the social
workers to focus on the specific characteristics, refer adequate clinicians and
help in the development and implementation of effective interventions to
address the wellbeing of schizophrenic patients.

It can help in the identification
of concise findings that can help the clinical practitioners to determine
adequate treatment plans. Hence, the overall value of DSM diagnostic is found
to be significant as a means to screen the patients with schizophrenic
symptoms. However, schizophrenia is a complex mental condition which makes it
difficult to be differentiated from other mental disorders. Thus, the clinical
practitioner or social worker should have an adequate knowledge of mental
disorders and schizophrenia to differentiate schizophrenia and other
dissociative personality disorders.