Revisiting the concept of nuclear schizophrenia: A case series from North India

Abstract

Schizophrenia is a chronic illness characterized by a disorder of thought, perception, emotion, and behavior. The common presentation in patients with schizophrenia is delusion, hallucination, disorganized speech, and behavior. A rare variety of schizophrenia known as nuclear schizophrenia which was described by Langfeldt presents as depersonalization, derealization, emotional blunting, and autistic features. Currently, the concept of nuclear schizophrenia is no longer described in prevalent classification systems of ICD-10 or the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5). We present cases of three male patients, aged between 16 and 25 years who presented to us in the outpatient department with the chief complaints of depersonalization, derealization, social aloofness, and a decline in social and academic and/or occupational functioning. The patients had an insidious and unremitting illness. These patients had different diagnoses during their course of illness and all had been diagnosed with depersonalization-derealization disorder once. We diagnosed them with unspecified schizophrenia spectrum and other psychotic disorders as per the current classification, but all of them had nuclear schizophrenia symptoms based on Langfeldt’s description. We started them on second-generation antipsychotics in adequate doses to which they showed a response. The phenomenology of each of the three cases takes us back to the concept of nuclear schizophrenia which has been lost to a time in the current diagnostic criteria of ICD-10 and DSM-5. Such cases are often not reported or diagnosed under the dissociative disorder spectrum. Our case series is a sincere attempt to highlight nuclear schizophrenia and the approach we took for its management.

Keywords

• depersonalization
• derealization
• nuclear symptoms
• schizophrenia