Studies in Schizophrenia, V.

The problems of diagnosis, pathogenesis, aetiology and successful treatment of the idiopathic schizophrenias is one of the most urgent and formidable ones which psychiatry has still to tackle. It is most urgent because of the large number of sufferers struck by the disease, made unfit for a successful life at an early age, and the distress imposed on them and their relatives. It is most formidable because our essential knowledge of the nature of this disease, or possibly group of diseases, is scanty and disorderly and opinions are conflicting and contradictory. This unsatisfactory state is made worse by the fact that there is quite an amount of disagreement on diagnosis, so that often the findings of different workers do not refer to comparable groups of patients (and conditions in which they are examined) which must add to the confusion, particularly when metabolic examinations are carried out. Too often “marginal psychoses“, and also not rarely, paranoid hallucinatory states with and without changes of the personality are called “schizophrenia”. The last-named states are not infrequently schizophrenoid reactions (or reactions of a schizoid person) to psychogenic causes or to potentially diagnosable physical disorders. On close clinical examination one would also find that the symptomatology of such cases is not that of idiopathic schizophrenia. In the “classical” schizophrenias of Kraepelin, Bleuler and Kleist, despite some discrepancies, the typical para-functions of feeling, willing, thinking and activity, usually accompanied by hallucinations, mainly auditory, and paranoid delusions are present and also a disturbance of the albumin/globulin ratio in C.S.F. and serum. In the absence of this mental and physical symptomatology the diagnosis of idiopathic schizophrenia should not be made (Fleischhacker et al. (7, 8)).