Introduction
Early in July 1995, a severely agitated and depressed young woman came into my office. She complained that she was experiencing visual and auditory hallucinations, the voices coming from outside of her head. A few days before, she had been seen in the Emergency of the hospital and was diagnosed as borderline personality disorder. The night before she saw me, she "flipped out" and began to break up the furniture in her apartment. Thirty minutes later she ran from her apartment to seek help, and she decided she would not go back until she was better. She had all the classical symptoms and signs of schizophrenia, including hearing voices and seeing visions. The voices laughed at her. She showed her husband where the visions were, and asked if he could see and hear them. It was like looking at a TV box hung in the air with a person's face, usually a woman's, on the screen. The world was very unreal. She was delusional, paranoid, had thought blocking, and her memory and concentration were very poor. She was disturbed by the hostile ideas.
I started her on niacin 1 gram tid, ascorbic acid 1 g tid, Mycostatin (1) 1.5 mcg. tid, and Neuleptil (2) 10 mg hs. At the next visit I changed the drug to Etrafon D (3), 2 at bedtime. September 25, 1995 she told me she had gone off the program for six weeks and her symptoms returned four days before the interview. She resumed the regimen. October 23, 1995, she was much better and had gone back to work. She was now on niacin 2 g tid and folic acid 5 mg tid. December 7, 1995 she was normal. The HOD Test (4) is a diagnostic aid for schizophrenia. The higher the scores, the greater the probability the disease is present. This patient had the following scores.
The average score for schizophrenics, obtained from several thousand tests, is around 65. Scores for all other diagnostic groups, excluding patients with delirium, are under 30, and most normal subjects score less than 15. As the patient improves, the scores decrease. The test is a diagnostic aid and also helps to determine whether or not improvement is occuring. Decreasing scores with repeated tests shows that the patient is improving, while rising scores show they are getting worse. Patients have a right to be given the most accurate diagnosis, because their lives will surely depend upon that.There is an increasing tendency for psychiatrists to avoid diagnosing schizophrenia. This reminds me of the state of diagnosis before 1960 when it was considered a breach of ethics to tell patients that they had schizophrenia. Today, this has been replaced by the avoidence of the diagnosis altogether, unless that person fits some stereotype of the chronic schizophenic.
Usually a combination of thought disorder and perceptual disturbances such as voices and visions is enough to make the diagnosis. But this has been replaced by two other terms, one being bipolar, because this allows the psychiatrist to use lithium. They consider that the response to lithium is proof that the bipolar disorder was present, and ignore all the perceptual changes which schizophrenics have. If they complain of depression they are lumped in with the mood disorders. The second habit - more and more common - is to call them BPD. This has the advantage that they no longer have to be treated, since no one expects that a personality disorder can be treated with medication.