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Articles

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Scientific and Consumer Models of Recovery in Schizophrenia: Concordance, Contrasts, and Implications (2006)

What’s in a name? Client participation, diagnosis and the DSM-5 (2010)

Being informed and involved in treatment: what do psychiatric patients think? A review (2004)

A Review of Consumer-Provided Services on Assertive Community Treatment and Intensive Case Management Teams: Implications for Future Research and Practice

Stigma, Schizophrenia and the Media: Exploring Changes in the Reporting of Schizophrenia in Major U.S. Newspapers


Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms

Why we need more debate on whether psychotic symptoms lie on a continuum with normality.

Cognitive and Meta-cognitive Dimensions of Psychoses

How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association.

Social Predictors of Psychotic Experiences: Specificity and Psychological Mechanisms


Prediction and prevention of schizophrenia: what has been achieved and where to go next?


Rare structural variants in schizophrenia: one disorder, multiple mutations; one mutation, multiple disorders.

After GWAS: searching for genetic risk for schizophrenia and bipolar disorder.

Cognitive control deficits nia: mechanisms and meaning


Sz end 2009

Controversies and research directions

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The validity of schizophrenia as a diagnostic entity has been criticised as lacking in scientific validity and diagnostic reliability.[1][2] In 2006, a group of patients and mental health professionals from the UK, under the banner of Campaign for Abolition of the Schizophrenia Label, argued for a rejection of the diagnosis of schizophrenia based on its heterogeneity and associated stigma, and called for the adoption of a bio-psychosocial model. Other UK psychiatrists opposed the move arguing that the term schizophrenia is a useful, even if provisional concept.[3][4]

The discrete category of schizophrenia used in the DSM has also been criticized.[5] As with other psychiatric disorders, some psychiatrists have suggested that the diagnosis would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill.[clarification needed] This approach appears consistent with research on schizotypy, and with a relatively high prevalence of psychotic experiences, mostly non-distressing delusional beliefs, among the general public.[6][7][8] In concordance with this observation, psychologist Edgar Jones, and psychiatrists Tony David and Nassir Ghaemi, surveying the existing literature on delusions, pointed out that the consistency and completeness of the definition of delusion have been found wanting by many; delusions are neither necessarily fixed, nor false, nor involve the presence of incontrovertible evidence.[9][10][11]

Nancy Andreasen, a leading figure in schizophrenia research, has criticized the current DSM-IV and ICD-10 criteria for sacrificing validity for the sake of improving diagnostic reliability. She argues that overemphasis on psychosis in the diagnostic criteria, while improving diagnostic reliability, ignores more fundamental cognitive impairments that are harder to assess due to large variations in presentation.[12][13] This view is supported by other psychiatrists.[14] In the same vein, Ming Tsuang and colleagues argue that psychotic symptoms may be a common end-state in a variety of disorders, including schizophrenia, rather than a reflection of the specific etiology of schizophrenia, and warn that there is little basis for regarding DSM’s operational definition as the "true" construct of schizophrenia.[5] Neuropsychologist Michael Foster Green went further in suggesting the presence of specific neurocognitive deficits may be used to construct phenotypes that are alternatives to those that are purely symptom-based. These deficits take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving.[15][16]

The exclusion of affective components from the criteria for schizophrenia, despite their ubiquity in clinical settings, has also caused contention. This exclusion in the DSM has resulted in a "rather convoluted" separate disorder—schizoaffective disorder.[14] Citing poor interrater reliability, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity.[17][18] The categorical distinction between mood disorders and schizophrenia, known as the Kraepelinian dichotomy, has also been challenged by data from genetic epidemiology.[19]

recovery

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Rates are not always comparable across studies because exact definitions of remission and recovery have not been widely established. A "Remission in Schizophrenia Working Group" has proposed standardized remission criteria involving "improvements in core signs and symptoms to the extent that any remaining symptoms are of such low intensity that they no longer interfere significantly with behavior and are below the threshold typically utilized in justifying an initial diagnosis of schizophrenia".[20] Standardized recovery criteria have also been proposed by a number of different researchers, with the stated DSM definitions of a "complete return to premorbid levels of functioning” or "complete return to full functioning" seen as inadequate, impossible to measure, incompatible with the variability in how society defines normal psychosocial functioning, and contributing to self-fulfilling pessimism and stigma.[21] Some mental health professionals may have quite different basic perceptions and concepts of recovery than individuals with the diagnosis, including those in the consumer/survivor movement.[22] One notable limitation of nearly all the research criteria is failure to address the person's own evaluations and feelings about their life. Schizophrenia and recovery often involve a continuing loss of self-esteem, alienation from friends and family, interruption of school and career, and social stigma, "experiences that cannot just be reversed or forgotten".[23] A model defines recovery as a process, and emphasizes a personal journey involving factors such as hope, choice, empowerment, social inclusion and achievement.[23]

Predictors

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Several factors have been associated with a better overall prognosis: Being female, rapid (vs. insidious) onset of symptoms, older age of first episode, predominantly positive (rather than negative) symptoms, presence of mood symptoms, and good pre-illness functioning.[24][25] The strengths and internal resources of the individual concerned, such as determination or psychological resilience, have also been associated with better prognosis.[26] The attitude and level of support from people in the individual's life can have a significant impact; research framed in terms of the negative aspects of this—the level of critical comments, hostility, and intrusive or controlling attitudes, termed high 'Expressed emotion'—has consistently indicated links to relapse.[27] Most research on predictive factors is correlational in nature, however, and a clear cause-and-effect relationship is often difficult to establish.

poor diet, little exercise and the negative health effects of psychiatric drugs.[28]

Main refs

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Picchioni & Murray BMJ 2007[29]

Van Os & Kapur (2009)[30]

Sources

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  1. ^ Boyle, Mary (2002). Schizophrenia: a scientific delusion?. New York: Routledge. ISBN 0-415-22718-6.
  2. ^ Bentall, Richard P.; Read, John E; Mosher, Loren R. (2004). Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. Philadelphia: Brunner-Routledge. ISBN 1-58391-906-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
  3. ^ "Schizophrenia term use 'invalid'". United Kingdom: BBC News online. BBC. 9 October 2006. Retrieved 16 May 2007.
  4. ^ "CASL Biography". Retrieved 2009-02-01. and "CASL History". Retrieved 2009-02-01.
  5. ^ a b Tsuang, Ming T.; Stone, William S.; Faraone, Stephen V. (2000). "Toward reformulating the diagnosis of schizophrenia". American Journal of Psychiatry. 157 (7): 1041–50. doi:10.1176/appi.ajp.157.7.1041. PMID 10873908.
  6. ^ Verdoux, Hélène; Van Os, Jim (2002). "Psychotic symptoms in non-clinical populations and the continuum of psychosis". Schizophrenia Research. 54 (1–2): 59–65. doi:10.1016/s0920-9964(01)00352-8. PMID 11853979. S2CID 33168322.
  7. ^ Johns, Louise C.; Van Os, Jim (2001). "The continuity of psychotic experiences in the general population". Clinical Psychology Review. 21 (8): 1125–41. doi:10.1016/s0272-7358(01)00103-9. PMID 11702510.
  8. ^ Peters, E.; Joseph, S.; Day, S.; Garety, P. (2004). "Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI)". Schizophrenia Bulletin. 30 (4): 1005–22. doi:10.1093/oxfordjournals.schbul.a007116. PMID 15954204.
  9. ^ Edgar Jones (1999). "The Phenomenology of Abnormal Belief: A Philosophical and Psychiatric Inquiry". Philosophy, Psychiatry and Psychology. 6 (1): 1–16. doi:10.1353/ppp.1999.0004 (inactive 2022-06-26). Retrieved 2008-02-24.{{cite journal}}: CS1 maint: DOI inactive as of June 2022 (link)
  10. ^ David AS (1999). "On the impossibility of defining delusions". Philosophy, Psychiatry and Psychology. 6 (1): 17–20. doi:10.1353/ppp.1999.0006 (inactive 2022-06-26). Retrieved 2008-02-24.{{cite journal}}: CS1 maint: DOI inactive as of June 2022 (link)
  11. ^ S. Nassir Ghaemi (1999). "An Empirical Approach to Understanding Delusions". Philosophy, Psychiatry and Psychology. 6 (1): 21–24. doi:10.1353/ppp.1999.0007 (inactive 2022-06-26). Retrieved 2008-02-24.{{cite journal}}: CS1 maint: DOI inactive as of June 2022 (link)
  12. ^ Andreasen NC (March 2000). "Schizophrenia: the fundamental questions". Brain Res. Brain Res. Rev. 31 (2–3): 106–12. doi:10.1016/S0165-0173(99)00027-2. PMID 10719138. S2CID 8545249.{{cite journal}}: CS1 maint: date and year (link)
  13. ^ Andreasen NC (September 1999). "A unitary model of schizophrenia: Bleuler's "fragmented phrene" as schizencephaly". Arch. Gen. Psychiatry. 56 (9): 781–7. doi:10.1001/archpsyc.56.9.781. PMID 12884883.{{cite journal}}: CS1 maint: date and year (link)
  14. ^ a b Jansson LB, Parnas J (September 2007). "Competing definitions of schizophrenia: what can be learned from polydiagnostic studies?". Schizophr Bull. 33 (5): 1178–200. doi:10.1093/schbul/sbl065. PMC 3304082. PMID 17158508.{{cite journal}}: CS1 maint: date and year (link)
  15. ^ Green MF, Nuechterlein KH (1999). "Should schizophrenia be treated as a neurocognitive disorder?". Schizophr Bull. 25 (2): 309–19. doi:10.1093/oxfordjournals.schbul.a033380. PMID 10416733.
  16. ^ Green, Michael (2001). Schizophrenia revealed: from neurons to social interactions. New York: W.W. Norton. ISBN 0-393-70334-7. {{cite book}}: Unknown parameter |lay-source= ignored (help); Unknown parameter |lay-url= ignored (help)
  17. ^ Lake CR, Hurwitz N (July 2007). "Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease—there is no schizoaffective disorder". Curr Opin Psychiatry. 20 (4): 365–79. doi:10.1097/YCO.0b013e3281a305ab. PMID 17551352. S2CID 37664803.{{cite journal}}: CS1 maint: date and year (link)
  18. ^ Malhi GS, Green M, Fagiolini A, Peselow ED, Kumari V (February 2008). "Schizoaffective disorder: diagnostic issues and future recommendations". Bipolar Disord. 10 (1 Pt 2): 215–30. doi:10.1111/j.1399-5618.2007.00564.x. PMID 18199238.{{cite journal}}: CS1 maint: date and year (link) CS1 maint: multiple names: authors list (link)
  19. ^ Craddock N, Owen MJ (May 2005). "The beginning of the end for the Kraepelinian dichotomy". Br J Psychiatry. 186 (5): 364–6. doi:10.1192/bjp.186.5.364. PMID 15863738. S2CID 1429221.{{cite journal}}: CS1 maint: date and year (link)
  20. ^ Andreasen NC, Carpenter WT, Kane JM, Lasser RA, Marder SR, Weinberger DR (March 2005). "Remission in schizophrenia: proposed criteria and rationale for consensus". The American Journal of Psychiatry. 162 (3): 441–9. doi:10.1176/appi.ajp.162.3.441. PMID 15741458. Retrieved 2008-07-07.{{cite journal}}: CS1 maint: date and year (link) CS1 maint: multiple names: authors list (link)
  21. ^ Liberman RP, Kopelowicz A (June 2005). "Recovery From Schizophrenia: A Concept in Search of Research". Psychiatric Services. 56 (6): 735–742. doi:10.1176/appi.ps.56.6.735. PMID 15939952. Retrieved 2008-07-07.{{cite journal}}: CS1 maint: date and year (link)
  22. ^ Davidson L, Schmutte T, Dinzeo T, Andres-Hyman R (January 2008). "Remission and recovery in schizophrenia: practitioner and patient perspectives". Schizophrenia Bulletin. 34 (1): 5–8. doi:10.1093/schbul/sbm122. PMC 2632379. PMID 17984297. Retrieved 2008-07-07.{{cite journal}}: CS1 maint: date and year (link) CS1 maint: multiple names: authors list (link)
  23. ^ a b Bellack, AS. (Jul 2006). "Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications.". Schizophr Bull 32 (3): 432–42. doi:10.1093/schbul/sbj044.
  24. ^ Davidson L, McGlashan TH (February 1997). "The varied outcomes of schizophrenia". Canadian Journal of Psychiatry. 42 (1): 34–43. doi:10.1177/070674379704200105. PMID 9040921. S2CID 9924992.{{cite journal}}: CS1 maint: date and year (link)
  25. ^ Lieberman JA, Koreen AR, Chakos M; et al. (1996). "Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the pathophysiology of schizophrenia". Journal of Clinical Psychiatry. 57 Suppl 9: 5–9. PMID 8823344. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  26. ^ Harrow M, Jobe TH (May 2007). "Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study". Journal of Nervous and Mental Disease 195 (5): 406–414. doi:10.1097/01.nmd.0000253783.32338.6e (inactive 2009-12-08). PMID 17502806.
  27. ^ Bebbington P, Kuipers L (August 1994). "The predictive utility of expressed emotion in schizophrenia: an aggregate analysis". Psychological Medicine. 24 (3): 707–18. doi:10.1017/S0033291700027860. PMID 7991753.{{cite journal}}: CS1 maint: date and year (link)
  28. ^ Brown S, Barraclough B, Inskip H (2000). "Causes of the excess mortality of schizophrenia". British Journal of Psychiatry 177: 212–7. doi:10.1192/bjp.177.3.212. PMID 11040880.
  29. ^ Picchioni MM, Murray RM. Schizophrenia. BMJ. 2007;335(7610):91–5. doi:10.1136/bmj.39227.616447.BE. PMID 17626963.
  30. ^ van Os J, Kapur S. Schizophrenia. Lancet. 2009;374(9690):635–45. doi:10.1016/S0140-6736(09)60995-8. PMID 19700006.
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