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'.
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]
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 have 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[ spelling?] 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.
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'.
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]
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 have 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[ spelling?] 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.