This chronic, progressively deteriorating psychotic disorder often begins in late teenage years or young adulthood. The symptoms are a rapid cognitive decline and disintegration, from which very few people recover. Having been described first by Arnold Pick, a professor at the German sector of Charles University in Prague, knowledge of the condition was later disseminated in papers by influential German psychiatrist Emil Kraepelin. Kraepelin simplified the classification of psychiatric disorders into just two classes, manic depressive psychosis or dementia praecox. During the 1890s he wrote the first clinical descriptions of patients suffering from symptoms of the latter condition, which would eventually be renamed as schizophrenia.
The onset of symptoms is gradual, with sufferers undergoing changes in personality, and losing the ability to pay attention and to reason. Patients may have strange hallucinations and delusions. The early signs may be subtle and difficult to spot. Alienation from family and friends, struggling at school or work, appearing emotionless, restless or anxious and losing the ability to stay focussed in a topic are all symptoms of the disorder.
Kraepelin defined dementia praecox as being characterized by cognitive disintegration, or disruption of thinking, rather than disturbances of mood such as those that occur in depressive and bi-polar disorders. He believed that the illness was triggered by the brain being poisoned or auto-toxified by sex hormones. He saw it as a whole-body disease, in which many organs of the body were affected before a terminal cascade of attacks on the brain. The disease was divided into several sub-types: catatonia began with depression and nervousness and patients often showed unusual movements; this led to delusions and hallucinations. Paranoia was characterized by auditory hallucinations and delusions of persecution or grandeur while hebephrenic patients suffered from poor concentration and disorganized speech and thought. At first he thought the disease incurable, but by 1920, he acknowledged that it was possible for patients to show signs of remission. However, the prognosis remained very grim for anyone suffering from this severe form of madness.
Because Kraepelin did not agree with Freud's and Jung's assumptions that mental disorders were the result of psychological trauma, he did not find hypnosis to be a viable treatment for dementia praecox. As no exact cause could be discovered, his patients were treated with therapies such as long baths and activities considered suitable for institutionalized patients. Barbiturates and opiates were also used to relieve distress. Believing the disease to be hormonal in origin, he experimented with injections with injections of gonad and thyroid gland extracts, but without success.
With the growing influence of Freudian perspectives in America and Europe during the 1920s, the disease was relabelled as schizophrenia and redefined as a psychogenic disorder. Treatment by psycho-analysis was fashionable on both sides of the Atlantic up to the 1970s.
Doctors now once more consider the condition to be biological in origin and caused by a combination of genetic and environmental factors. It is still an incurable disease, but treatment with antipsychotic drugs such as clorazine and chlorpromazine, in conjunction with counseling and support, enables many patients to lead fulfilling lives.