Catastrophic schizophrenia

In psychiatry, catastrophic schizophrenia or schizocaria is an obsolete[1] term for a rare[2][3] and acute form of schizophrenia leading directly to a severe and unremitting chronic psychosis[4] (the long term occurrence of psychosis) and deterioration of the personality.[2] Catastrophic schizophrenia was thought to be the most severe subtype of schizophrenia, as it had "an acute onset and rapid decline into a chronic state without remission".[5] Catastrophic schizophrenia was also referred to as schizocaria, which was defined by Gerhard Mauz as a psychosis that caused the absolute destruction of the core of one's being.[6] The term "catastrophic schizophrenia" has fallen out of use due to a number of reasons, including advances in psychiatric treatment, which led to a significant decline in patients that fit the diagnosis as their symptoms did not reach the severity of catastrophic schizophrenia, along with modern refinement of the definition and subtypes of schizophrenia.[7] This term has not been included in any version of the DSM. In modern terms, catastrophic schizophrenia would likely be defined as 'acute-onset chronic schizophrenia with poor prognosis'.

History

Schizophrenia evolved from Kraepelin's dementia praecox, which was first defined in 1893. Using dementia praecox as a base, Eugen Bleuler defined and differentiated subtypes of schizophrenia at the turn of the century. He stated that catastrophic schizophrenia was characterized by an acute onset of a severe psychosis, followed with little improvement by a severe chronic psychosis lasting until death.[8]

Young adults (aged 16–25) were at the highest risk of developing catastrophic schizophrenia. It was almost entirely exclusive to upper class and intellectuals.[6] Other risk factors included difficulty adapting to change, individualism, and introversion.[6]

E.B. Strauss stated that schizophrenia could come about in two ways: either catastrophically or through a series of 'attacks'.[6] Strauss used catastrophic to refer to schizophrenia that ran a rapidly progressing and continuous course.[6] According to Strauss, catastrophic schizophrenia took a similar course to catatonic schizophrenia and hebephrenia, with all three ending in the total collapse into psychosis within two to four years.[6]

Decline

Eugen Bleuler found that catastrophic schizophrenia affected 10-15% of people with schizophrenia.[7] However, over time, the number of patients that fit this diagnosis declined significantly. The outcome of a study by Luc Ciompi and Christian Müller in 1976 has shown that only 6 percent of patients with schizophrenia were judged to be suffering from catastrophic schizophrenia.[4][9][10]

In longitudinal studies begun in the 1930s and ending in the 1980s, Manfred Bleuler (Eugen's son) found the incidences of catastrophic schizophrenia had declined significantly since his father's study.[11] Manfred Bleuler posited that improved hospitals, nursing care, and rehabilitation efforts led to this decline.[7] The decline of electroconvulsive therapy (ECT), chlorpromazine, and insulin shock therapy, used extensively in the 1940s and 1950s, could have also played a role in eliminating catastrophic schizophrenia.[7] The term was not included in the DSM-I and is now no longer used, due to changes in how the sub-types of schizophrenia are defined.

References
  1. Corsini, Raymond J. (2002). Dictionary of Psychology. Psychology Press. p. 864. ISBN 978-1583913284.
  2. Robert Jean Campbell, Campbell's Psychiatric Dictionary, 2009, page 872
  3. Bleuler, M.; Huber, G.; Gross, Gisela; Schüttler, R. (August 1976). "The long-term course of schizophrenic psychoses: The combined results of two research studies". Der Nervenarzt. 47 (8): 477–481.
  4. Richard P. Bentall, Reconstructing schizophrenia, 1992, page 62
  5. Alan S. Bellack (1984). Schizophrenia: treatment, management, and rehabilitation. Boston: Pearson Allyn & Bacon. ISBN 978-0-15-869400-9.
  6. Strauss, E.B. (July 1931). "Some Principles Underlying Prognosis in Schizophrenia". Proceedings of the Royal Society of Medicine. 24 (9): 1217–1222. doi:10.1177/003591573102400941. PMC 2183090. PMID 19988249.
  7. McGlashan, Thomas H.; Jan Olav Johannessen (1996). "Early Detection and Intervention with Schizophrenia: Rationale" (PDF). Schizophrenia Bulletin. 22 (2): 201–222. doi:10.1093/schbul/22.2.201. PMID 8782282. Retrieved 6 March 2013.
  8. Irving B. Weiner, Donald K. Freedheim, George Stricker & Thomas A. Widiger, Handbook of Psychology: Clinical psychology, 2003, page 74
  9. George Stein, Greg Wilkinson, Seminars in General Adult Psychiatry, 2007, Page 301
  10. Luc Ciompi, Christian Müller: Lebensweg und Alter der Schizophrenen. Eine katamnestische Langzeitstudie bis ins Senium (Life and age of schizophrenics. A longitudinal study catamnestic down to senility). Springer, Berlin, Heidelberg, New York, NY (USA), 1976
  11. "Introduction to Manfred Bleuler's "The Offspring of Schizophrenics"" (PDF).

Further reading
  • Luc Ciompi, Christian Müller, Lebensweg und Alter der Schizophrenen. Eine katamnestische Langzeitstudie bis ins Senium (The Life-course and Aging of Schizophrenics: A Long-term Follow-up Study into Old Age). Springer, Berlin, Heidelberg, New York, NY (USA), 1976
  • Richard P. Bentall, Reconstructing Schizophrenia, 1992
  • Alan S. Bellack, Schizophrenia—Treatment, Management, and Rehabilitation, 1984
  • Irving B. Weiner, Donald K. Freedheim, George Stricker & Thomas A. Widiger, Handbook of Psychology: Clinical psychology, 2003
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