Schizophrenia - signs, symptoms and therapy

Schizophrenia - signs, symptoms and therapy

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What is schizophrenia?

Schizophrenia is a mental disorder that usually occurs in late puberty or early adulthood, but can break out at any age. About 1% of people develop such a mental illness in their lifetime. You will also learn everything about signs, therapies and causes.

Men as well as women are affected, but the disorder appears earlier in men, usually in the last teens or early 20s - unlike women who usually have their first flare in the 20s or 30s.

The term “schizophrenia” describes a split psyche, that is, someone who wants one and the opposite at the same time - not integrated ambivalence. The casual "everyday are you schizophrenic?" is unfortunate because it describes a multiple personality or psychological disorders in which the personality is fragmented as in borderline.

However, this does not characterize the disorder in the clinical sense. The disease is characterized by the fact that personality, thinking, memory and perception are not coordinated.

Suffering usually begins with a pre-psychotic phase of increasing negative symptoms such as social withdrawal, neglected hygiene, unusual behavior, outbursts of anger and disinterest in school and professions.

A few months or even years later, the psychotic phase develops with deceptions, hallucinations, bizarre speech without connection and disorganized behavior.

Individuals who experience an onset of the disease in later years are firstly women more often, and secondly have fewer structural brain abnormalities or cognitive impairments. Schizophrenia usually lasts a lifetime, continuously or in batches.

People who suffer from the disorder often hear voices that are not there. Some are convinced that others read their minds, control how they think, or conspire against them. They feel invisible powers of "black magic" in their bodies. This exposes those affected to extreme stress; they alternately withdraw or react wildly.

Schizophrenia symptoms and early warning signs

In some people, the disease appears suddenly and without warning. But for most, it starts slowly, with subtle warning signs and a gradual loss of functionality - long before the first serious phase begins.

Families often report that they did nothing even though they realized that their child was unable to think clearly or was withdrawing from social situations. They did not consider these early symptoms to be serious mental illness.

The most important early sign is “weird” behavior that makes no logical sense. However, the pre-psychotic episode often breaks out in late adolescence, and adolescents without this disorder often behave in an unusual and illogical way.

Schizophrenics in this early phase, however, show a clear decline compared to normal puberty problems in implementing experiences mentally. They can no longer cope with difficulties in everyday life and fail in school as in life. They also suffer from a lot of confusion and keep losing things.

Sufferers usually show signs of depression before schizophrenia develops. They look emotionless and deeply desperate.

Already in the early phase, many affected people use narcotics to relieve their psychological pain. Some consciously view this as self-treatment.

At this stage, it is very difficult for laypersons to recognize the beginning disorder. On the one hand, various other factors can trigger similar mental states in adolescents: lovesickness, social exclusion, or a harmful peer-goup.

On the other hand, cause and effect are difficult to distinguish: drugs and their withdrawal symptoms, heroin as well as alcohol, meta-amphetamines, or the “sniffing” of solvents sometimes lead to psychotic symptoms - especially in adolescents.

Unstable teenagers who fall in love unhappily and drown their grief quickly find themselves in conditions that fluctuate between depression and psychosis.

In addition, the depressive phases suggest clinical depression rather than schizophrenic disorder, and if the hallucinations do not come to the fore, it is difficult for experts to separate the one from the other.


Patients look emotionally numb - as if they feel no feelings. They also look like "lost" - like uprooted people. They don't seem to be feeling any happiness or excitement. Her language often lacks expression.

But be careful: traumatized people suffer something similar. This includes people suffering from borderline syndrome as well as all diseases from the dissociative form, post-traumatic stress syndrome and clinically depressed people.

Hallucinations, however, are a hallmark. Borderliners or post-traumatized suffer from the fact that they hear voices as well as other noises and see things that do not actually exist - the degree of imagination of schizophrenics differs significantly.

Most patients experience acoustic hallucinations - these sounds and tones that only exist in their brains are perceived as real. Hallucinations can affect all five senses, but acoustic perceptions are most common, followed by visual ones.

The hallucinations of schizophrenics are usually significant for those affected. This distinguishes them, for example, from hallucinations that arise from disorders in the nervous system but are not pathological in the sense of a mental disorder. Someone who, for example, has a regular beeping is annoyed by it, but knows that it is a hallucination.

Borderliners also usually know when the hallucinations are ebbing away that they are hallucinations. However, schizophrenics not only hear voices that often whisper obscene sentences or give absolute commands, they are also firmly convinced that it is reality in every sense.

Moreover, those affected often develop a system of conspiracy fantasies and irrational models to rationalize these voices: some believe that spirits take possession of them, and many are believed to be "demon-possessed" who drove out the exorcists of the churches to suffer from schizophrenia. Others even believe that they have received divine orders to accomplish tasks that save the world.

The danger of thinking magically is great for those affected. It becomes fatal when in times of crisis - and every outbreak of schizophrenia is a life crisis - they come across psychosects and / or esoteric salvation teachings, which they confirm in this magical thinking.

Schizophrenics notice very well that their perception separates them from “the others” as well as their behavior - and they suffer massively from it. The magical thinking then reinforces that the “normal” are jealous of their “supernatural abilities”. In doing so, those affected cement their separation from reality.

They also express inappropriate feelings; for example, they laugh when their relatives mourn because a loved one died.

Sufferers often believe that others are talking about them behind their backs. Or they suspect others of secretly poisoning them. Or they accuse others of intruding on their thoughts. They think that burglars will plunder their home at home. Missing items that the victims themselves lost serve as “evidence”.

Paranoid schizophrenics develop complex as well as fantastic “theories”: intelligence agencies, governments, the mafia and other conspiracy groups have their sights on them. Everywhere sufferers recognize “secret signs” that confirm their paranoia.

A major hallmark of the disease is the obsession with religion and the occult. If relatives find a new and fanatic interest in a young person, they should watch it closely.

Social neglect

In a broken out schizophrenia, personal hygiene goes down a steep slope. For example, those affected do not shower, do not comb their hair, and do not care about their clothes. This neglect is very different from "sloppy behavior": it is not about someone not washing for three days because they feel like "hanging around"; many schizophrenics smell and look like they have been living on the street for months.

The social relationships of sick people break down - schizophrenia makes it hard to form close bonds. Even for confidants who know about the disease and are sensitive to those affected, it is becoming increasingly difficult to find access.

Those affected withdraw from social activity - they isolate themselves from society. They avoid school, work and generally anything that forces them to talk to other people.

Sleep disorders are part of the disease. Those affected are often awake for days, or they sleep for many hours without feeling recovered afterwards.

The patients often harm themselves. On the one hand, they suffer accidents from their behavior - they run into a car, break their feet or injure themselves in the household because their distorted perception of reality does not allow behavior to be adapted to reality.

On the other hand, they actively attack each other and cut themselves with razor blades, for example, to drive the “evil spirits” out of their bodies. Attempts to commit suicide are also symptoms.

Causes of schizophrenia

A family history of schizophrenics has been known for a long time. People with close relatives who suffer from schizophrenia are more at risk than people without such relatives.

A child with schizophrenic parents develops schizophrenia in 10%. An identical twin even has a 40% to 65% chance of becoming ill. Second degree relatives such as uncles, aunts or grandparents are still at increased risk.

Complications during pregnancy and childbirth also play a role: heavy physical work during pregnancy, or a low weight of the newborn. Viruses and infections in babies also have an effect.

New studies suggest that children of old fathers are at higher risk. One hypothesis was that damaged sperm triggers up to 20% of all schizophrenia. Statistically, 1 in 121 children of a 29 year old father is at risk of developing schizophrenia, but 1 in 47 in a 54 year old.

However, certain situations increase the risk of suffering from schizophrenia: stressful life events are considered the most important social trigger of the disease - from job loss to divorce to abuse.

Drug abuse is also suspected of promoting schizophrenia: cannabis as well as cocaine, LSD and amphetamines.

Triggers of the social environment are almost always associated with the onset of the disease - but they are not the only cause. Many people experience the same or worse crises without falling ill - biological disposition is of crucial importance.

Different types of schizophrenia

Schizophrenia is divided into five types: the paranoid, the disorganized, the catatonic, the undifferentiated and the residual. The diagnosis is based on the characteristics that are the focus of those affected. These symptoms can change as the disease progresses, and then the diagnosis changes.

The paranoid schizophrenia is the most common form and laypeople often equate it to disease in general. Those affected suffer excessively from hallucinations, conspiracy and persecution. They hear voices, they think they are cursed, and they cling to a horror world in which they are surrounded by invisible enemies.

The paranoids can usually work better than other schizophrenics. Your thinking and behavior is less disorganized. For example, in less psychotic phases you can talk clearly with “normals” about “God and the world”.

The "normals" only wonder at a certain point in the conversation, for example, why Angela Merkel and the BND should be responsible for the fact that the lock on the letter box of those affected is broken.

In paranoid schizophrenics, however, these “quieter” phases alternate with episodes in which the psychoses become apparent. Those affected then roar in public, for example, to expel the “invisible forces” that “nest in their bodies”.

They make obscure movements and obscene gestures to "fight the ghosts", sometimes twitch their arms, tear off their clothes or scratch themselves, and vomit dry.

Some sufferers also rationalize this psychotic behavior, call themselves action artists and mix their constructions with memories and quotes from the real outside world.

This behavior is reminiscent of political sects or classic conspiracy theories. People who mistrust everyone and everyone, just as they blame certain groups for working with hidden fears, often suffer from anxiety disorders - but most of them are not schizophrenic. Perhaps the analysis of conspiracy thinking offers approaches to understand suffering.

Unlike other types, the paranoids can usually organize their language. On the other hand, they share anger, confusion and extreme fear with other victims. Paranoia can even turn into violence - towards things and people.

The dominant symptoms of disorganized schizophrenia circle around the disorganization. They cannot control their behavior, language and thinking. What they say makes no sense, not even for them, and their thinking finds no focus.

Those affected cannot organize the simplest everyday things. Obscure gestures and surprising behavior are common. Hallucinations, on the other hand, are less haunting than paranoids.

The disorganization develops gradually and at an earlier age than the symptoms of other sufferers. They find it difficult to wash and put on; they don't understand why they should take care of personal hygiene.

Unfortunately, the prognosis for this form of the disease is difficult: the symptoms begin in teenagers and increase slowly; To a lesser extent, however, many “normal” adolescents show this behavior - out of defiance or because they do not know where they are in life.

The catatonic schizophrenia indicates motor disorders. Those affected reduce their physical actions to the point that voluntary movements stop abruptly. Or their movements increase without the people affected being able to draw an arbitrary boundary. For example, they row with their arms while talking, or they jerk their heads to one side.

They involuntarily imitate the facial expressions and behavior of others and repeat the words that others say.

These people either seem clearly disturbed to others or as provocateurs who make fun of their fellow human beings. If the social environment recognizes that something is wrong with the person concerned, the risk of a misdiagnosis is still high: The catatonic behavior also shows clinically depressed and bipolar people - rarely does it also occur in diseases of the central nervous system, for example in Parkinson's . The abrupt movements and the mimicking of facial expressions, gestures and the words of other people also points to Tourette's syndrome.

Undifferentiated schizophrenia is the diagnosis if those affected show different symptoms but do not clearly correspond to one of the four defined types. Hallucinations, disorganized speech, and motor disorders occur.

The symptoms can change: Affected people behave like paranoids for a while, then more like disorganized ones and then like catatonic ones.

Residual schizophrenia occurs when the active symptoms disappear. For example, those affected no longer have hallucinations. However, passive symptoms remain, for example emotional indifference or the lack of targeted interests, and now and then the active symptoms reappear in a mild form. This mild form of the disease can last a lifetime or disappear completely.

Misuse of the diagnosis

There is hardly a psychological disorder that can be so politically exploited as schizophrenia, especially in the paranoid form.

A political critic, for example, who is monitored by the secret services and whom the government uses hidden means to make life hell is not schizophrenic. On the contrary, when he makes the abuses public, he shows facts. Even if he only suspects that the government is controlling his internet, eavesdropping on his apartment, or that secret service personnel are breaking into him, it is a well-founded suspicion.

"Outing" him now as a sick man is a proven way to freeze the opposition. Attacks by the state then appear as delusions with no basis in reality.

The ritual practitioners of so-called primitive peoples also saw the European colonial masters as mentally ill, and shamans were considered schizophrenics. As a result, the people who took the advice of these spiritual teachers seriously were mentally retarded who followed the madmen.

A shaman goes through phases in his career, whose behavior is reminiscent of the paranoid schizophrenic, they hear voices, they see "ghosts", they perform extreme gestures and move in a "different world" than the normal.

But their job is to provide spiritual support to their community - from medicine to hunting, the right position for the camp, weather forecasts and everything that the West calls pastoral care.

They will only be recognized as teachers if they show success in social issues. After the painful phase of irritation, they also deliberately go into extraordinary psychological states - in contrast to schizophrenics.

Paul Watzlawick mentions family censure as the basis of supposed schizophrenic behavior. When parents reject a child for how the child sees themselves, the child eventually mistrusts its own senses.

The child becomes insecure, and parents are now increasingly pushing them to think “correctly”. But if the child keeps his “strange views”, the parents describe him as crazy.

For the child, the parents are vital, so it is now looking for supposedly hidden contexts of meaning that seem to be clear to others, but not to itself - the search for such non-existent orders becomes more and more cranky, the more the parents resist, the Right to recognize the child's own perception.

If you do not know this social background of behavior, but only see the person affected, you could erroneously make the diagnosis.

Schizophrenia in men and women

The disorder is approximately equally common in men and women, but the sexes differ at the age of the onset of the disease. Men usually develop the disease between 15 and 20 years, women between 20 and 25.

However, men not only develop the disease earlier, but their symptoms are worse. This is probably because the female hormone estrogen protects women against some aspects of the disorder.

In addition, the age of the first outbreak, the course of the disease, the clinical symptoms and the effect of treating people with schizophrenia are different in men than in women. Women develop the first psychotic surge especially when the estrogen level is low, for example during menstruation and menopause. However, the symptoms can also occur during pregnancy, when your body produces a lot of estrogen.

Men are usually affected by the disease earlier, have a worse course, less affective symptoms, more frequent mother complications, and less family disposition.

Affected women show more fear, illogical thinking, disproportionate affects and bizarre behavior than men, i.e. more affective symptoms. Antisocial behavior, on the other hand, is more common in affected men than in women.

Men often only go to a clinic and are often only taken seriously when they show severe symptoms. This difference in clinical care shows the stigma of men seeking help.

The social pressure on men to be “strong” may make it harder for them to seek help.

Women are generally more successful in cultivating close friendships, so they can rely on a network of support. Many men lack the ability to make intimate friendships, and therefore lack support.

In general, it is easier for women suffering from the disease to deal with the onset of the disease than for men.

Suicide risk

Affected people usually die earlier than people without this disease. 40% of them also die from an unnatural death - especially from suicide. The risk of committing suicide is 4.9% for schizophrenics. Recognizing those at risk is essential for clinical treatment, but uncertain despite all efforts.

Compared to attempted suicide by people without a diagnosis, suicide attempts by those affected are very serious and require medical treatment. “Suicide attempts” as cries for help or as extortion hardly occur in schizophrenics. The urge to commit suicide is generally great, and the methods chosen are more likely to be fatal than the general population.

The typical suicide candidate among schizophrenics is young, white and unmarried, he can still function reasonably well in everyday life, has had a post-psychotic depression and a history of substance abuse, and has tried to get out of life a few times.

So the greatest danger of suicide is not acute psychosis, but when the person concerned thinks relatively clearly again.

The social consequences of the disease, not the symptoms themselves, pose the greatest risk: hopelessness, social isolation, an episode of illness after a stable phase, lack of support, family stress, professional and psychological instability.

However, the link between substance abuse and suicide in schizophrenics is unclear, and there are hardly any valid studies. For example, one study showed a link between illicit drug abuse, disorder and suicide, but no link to alcoholism. The question of whether it was the chicken or the egg first can hardly be answered. Is drug abuse a reaction to suffering, as is suicide?

In any case, alcohol and substance abuse worsen the situation of those affected: violence, aggressiveness, homelessness are often only the result of substance abuse, the psychiatric symptoms become worse as a result of substance abuse, the drugs promote comorbidities such as depression and anxiety disorders, and those affected also slip into crime .

A higher IQ and level of education increases the risk of suicide among those affected. They probably make the sufferer more aware of the fact that their illness will limit them for life. A stronger self-awareness, a realistic assessment of the disease and the need to be treated lead to a higher risk of suicide. This is especially true when self-reflection leads to hopelessness.

Cannabis and schizophrenia

Cannabis contains the substance tetrahydrocannabinol (THC). THC migrates through the bloodstream into the brain and has a psychoactive effect: consumers feel relaxed, feel an urge to speak, their perception of space and time is confused, they are sedated and their ability to concentrate and remember decreases. For some, consumption also leads to diffuse fears and even paranoia.

Regular use of cannabis has been shown to increase the risk of developing schizophrenia.

Schizophrenia and culture

Studies show that the number of sufferers in different cultures is similar. The first batch at a young age coincides.

Some researchers suspect that the disease stems from the human ability to communicate with symbols. It is therefore linked to the human peculiarity of using language as a disturbance. While the disease itself exists in many cultures, how it is dealt with differs considerably.

The core characteristics of the paranoid form, namely hallucinations and the idea of ​​being possessed by invisible powers, mean the loss of the ability to adapt symbols to the social environment and to develop them in communication with other people.

The disease is generally more severe in developed countries than in traditional societies. Traditional societies interpret mental disorders as acts of supernatural powers, and so those affected are not considered to be sick individuals. For them, this has the positive side effect that they do not suffer from a social stigma like those affected in industrialized countries - and social isolation is decisive for the severity of the disease.

In traditional societies, the sick are firmly integrated into their families, and thus they have a source to stabilize themselves. In addition, the lack of specialized jobs makes it easier for those affected to find their way back to the community after a psychotic boost.

Behaviors that are considered symptoms in the Western world characterize spiritual rapture in traditional societies. A person who claims to be a god on earth would probably be schizophrenic in the West, but in India he was considered a human incarnation of a Hindu god.

People who have experienced psychosis are often considered to be spiritual media in traditional societies, and shamans who serve as mediators between the natural and the spiritual world are highly regarded for their experiences in the "supernatural world". Communicating with ancestors and spirits is not a hallucination, but part of the cultural heritage.

Mental states that resemble temporary psychoses bring about traditional cultures through drumming, singing, praying, fasting and meditation. In South America, indigenous people use hallucinogens like Ayahuasca and invite animal spirits like the jaguar to get into their souls. In this state, they perform healing rituals for the members of their community.

However, people suffering from symptoms diagnosed as a schizophrenic disorder in the West are not considered shamans even in indigenous cultures. Rather, a shaman is someone who has experienced and mastered such conditions. In contrast to schizophrenics, he can clearly differentiate between the material world and the “invisible world”. He is not a sick person, but the therapist of his society.

American Indians are familiar with the "ghost disease". They describe symptoms of weakness, emotional cold, fear, hallucinations, confusion and loss of appetite. The victims may be schizophrenics. Against this cultural background, they are considered victims of evil spirits.

Patients in industrialized nations differ from those in traditional societies over the course of the disease. In the West, the condition is usually a chronic condition and not a sudden onset of symptoms. In traditional societies, short-lived psychotic reactions are common.

These psychotic reactions characterize paranoia and hallucinations, accompanied by an intense fear of being followed by witches and wizards. In contrast to classic schizophrenia with its phases of lack of feeling and withdrawal from reality, psychotic reactions in traditional cultures are expressed through excitement, confusion and extreme feelings.

Investigations into whether these psychotic conditions correspond directly are still pending. In any case, it turns out that the way society deals with the symptoms significantly influences the course of the disease.

The emotional coldness and social withdrawal of those affected may not be a “biological” symptom, but rather a reaction to the social stigma of being crazy.

In traditional societies, where these "crazies" have their place as "working of the spirits", it would be easier for those affected to live with these symptoms.

Treatment of schizophrenia

Schizophrenia is a chronic disease that affects all aspects of life of those affected. Treating them therefore requires medical, psychological and psychosocial methods at the same time.

An interdisciplinary team is required to treat schizophrenics: a psychopharmacist, a therapist, social work, a nurse, a language trainer and a case manager. Clinical pharmacists and internists also play a role.

The medication is necessary. Because the medication for the symptoms can have serious side effects, some people reject them.

Antipsychotic drugs are the most commonly used drugs to treat schizophrenia. Sie beeinflussen die Botenstoffe Dopamin und Serotonin.

In einer Gesprächstherapie arbeiten die Betroffenen mit einem Therapeuten, um mehr über die Gedanken, Gefühle und das Verhalten zu lernen, die mit ihrem Zustand verbunden sind.

Psychosoziale Behandlungen sollten auf die individuellen Bedürfnisse abgestimmt sein. Es geht darum, mit der Störung zu leben und trotz der Krankheit das Leben zu genießen, aber auch um sehr praktische Organisation des Alltags.

Wer nach einem psychotischen Schub in die Klinik kommt, hat oft seine Wohnung verloren, keine Arbeit, muss sich ein soziales Leben erst wieder aufbauen, den Sinn im Leben finden, Partnerschaften aufbauen, Freundschaften aufrechterhalten und seine Karriere starten. Ihr professioneller Helfer darf dabei nicht als Kontrolleur erscheinen, sondern sollte zu den Betroffenen eine Beziehung pflegen, die auf Vertrauen und Optimismus basiert.

In der psychosozialen Behandlung lassen sich die sozialen Fähigkeiten trainieren, aber auch Arbeitsförderung und Familientherapie gehören dazu.

In individuellen Therapien trifft sich der Patient regelmäßig mit seinem Therapeuten und bespricht aktuelle Gedanken, Probleme, Gefühle und Beziehungen. Die Betroffenen lernen dabei mehr über ihre Krankheit wie sich selbst und können so besser mit ihren spezifischen Problemen im täglichen Leben umgehen. Die regelmäßigen Treffen sind wichtig, damit die Betroffenen besser unterschieden, was wirklich und unwirklich ist und trainieren, sich auf die Realität zu konzentrieren.

Rollenspiele gehören zur Therapie dazu. Betroffene spielen soziale Interaktionen durch, während der Therapeut sie leitet und ihnen positives Feedback gibt.

Schizophrene lernen so zum Beispiel Smalltalk. Die Symptome werden nämlich umso schlimmer, je mehr sich die Betroffenen selbst isolieren, und da Schizophrene besondere Probleme haben, ihre inneren Symbolwelten auf die soziale Umwelt abzustimmen, hilft ihnen Smalltalk, ihre Symbolwelten zusammen mit anderen zu entwickeln.

Die Familie sollte sich, so weit möglich, an der psychosozialen Behandlung beteiligen. Die Aufklärung über die Krankheit in betroffenen Familien lindert sowohl den sozialen Stress innerhalb der Familie wie es Angehörigen hilft, die Erkrankten zu unterstützen. Zur praktischen Lebenshilfe gehört Geldmanagement und Jobtraining. (Somayeh Khlaeseh Ranjbar, übersetzt von Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


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ICD-Codes für diese Krankheit:F20, F21ICD-Codes sind international gültige Verschlüsselungen für medizinische Diagnosen. You can find e.g. in doctor's letters or on disability certificates.

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