What the...?! Man rips out own eyes in church

[LadyLazarus]

Re: What the...?! Man rips out own eyes in church

That's why I was asking the HC clinician and not you. I'm asking if a person is hearing voices, but otherwise isn't showing impairment, then do they get the diagnosis (dx) or no.

Also, the legal system would disagree with you as far as the insanity defense goes. Schizophrenics who obey a voice knowing that what their actions will cause harm and are otherwise wrong, wouldn't be able to successfully plead insanity. This much I know from mental health law, however since I'm not a clinician, I don't know what they'd require for the dx of schizophrenia.

There is an entire range of diagnosable disorders to which some form of psychosis is key. Schizophrenia and Psychotic Disorders is its own section in the diagnostic manual. Naturally, all of these disorders have their own diagnostic criteria (sometimes with minor differences). Also, all diagnosis is based on a cluster of possible symptoms, not a single symptom. For example, if someone is only hearing voices, that's not enough for any kind of a diagnosis. For a diagnosis of schizophrenia, 2 or more of the following have to be present regularly during a 1 month period (called the active phase), and the entire range of symptoms (including prodormal, non-active phase symptoms) has to be present over a 6 month period to formally qualify for a Dx of Schizophrenia: 1. delusions, 2. hallucinations, 3. disorganized speech, 4. catatonic behavior, 5. negative symptoms (My apologies if all of that is too technical). Also, there are different subtypes of schizophrenia, all with their own additional symptomalogical caveats. In short, the whole thing is entirely too complicated!

[LadyLazarus]

Re: What the...?! Man rips out own eyes in church

Would the destructive message with C have an effect? I don't mean for you specifically per se, but generally in your experience.

I can't (nor do I pretend to) speak for everyone in the field, but in my opinion, it wouldn't become important until that person decided they were going to act on it (intent to harm).

[Siggie]

Re: What the...?! Man rips out own eyes in church

There is an entire range of diagnosable disorders to which some form of psychosis is key. Schizophrenia and Psychotic Disorders is its own section in the diagnostic manual. Naturally, all of these disorders have their own diagnostic criteria (sometimes with minor differences). Also, all diagnosis is based on a cluster of possible symptoms, not a single symptom. For example, if someone is only hearing voices, that's not enough for any kind of a diagnosis. For a diagnosis of schizophrenia, 2 or more of the following have to be present regularly during a 1 month period (called the active phase), and the entire range of symptoms (including prodormal, non-active phase symptoms) has to be present over a 6 month period to formally qualify for a Dx of Schizophrenia: 1. delusions, 2. hallucinations, 3. disorganized speech, 4. catatonic behavior, 5. negative symptoms (My apologies if all of that is too technical). Also, there are different subtypes of schizophrenia, all with their own additional symptomalogical caveats. In short, the whole thing is entirely too complicated!

No, it's not too technical; I'm aware of the different types of schizophrenia and various symptoms. I think maybe it's kind of taken for granted that schizophrenia would present functional impairment. Perhaps this is why I haven't specifically read/heard about impairment being necessary in this instance. Though of course, I know this is broadly said and that's what I've been taught. No Dx without impairment. I suppose I could dig out my old copy of the DSM, but I'd much rather ask you. You don't mind, do you?

[LadyLazarus]

Re: What the...?! Man rips out own eyes in church

No, it's not too technical; I'm aware of the different types of schizophrenia and various symptoms. I think maybe it's kind of taken for granted that schizophrenia would present functional impairment. Perhaps this is why I haven't specifically read/heard about impairment being necessary in this instance. Though of course, I know this is broadly said and that's what I've been taught. No Dx without impairment. I suppose I could dig out my old copy of the DSM, but I'd much rather ask you. You don't mind, do you?

Not at all. If anything, I had answered without looking it up, but now you done did it and made me dig out my own DSM. So... the diagnostic criteria for schizophrenia include criterions A-F, of which D-F are exclusionary (and not relevant here). Criterion A includes the characteristic symptoms, which is what I had presented above (and what most people think of as schizophrenia symptoms anyway). Criterion C is duration (the 1 and 6 months I had mentioned). I hadn't overtly mentioned Criterion B--social/occupational dysfunction--because like you said, functional impairment sort of goes without saying in schizophrenia. Social/occupational dysfunction here is defined as "....for a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset" (and that's straight from the DSM-IV TR)

[Siggie]

Re: What the...?! Man rips out own eyes in church

Hmm... What if someone had auditory hallucinations then, but for religious/cultural reasons attributes it to God and sees it as a good thing. For instance, believes God is communicating through him/her. Now, if the pt is happy about it, but it causes a rift with some personal relationships (perhaps people who are alarmed and advise psychiatric intervention?), but not much beyond that, could someone successfully get someone like that admitted against their will? Arguing that they don't recognize it as illness because of the psychosis? Even that quote seems a little ambiguous. Below the level achieved before. It seems like a value judgment in some cases.

I dunno... I just find it fascinating how today we'd call someone like this mentally ill, while a few hundred years ago they may have been viewed as a prophet.