Controversies surrounding the diagnosis of schizophrenia and other psychoses

Psychiatric Unit, Virgen del Camino Hospital, C/ Irunlarrea 4, E-31008 Pamplona, Spain.
Expert Review of Neurotherapeutics (Impact Factor: 2.78). 10/2009; 9(10):1475-86. DOI: 10.1586/ern.09.102
Source: PubMed


The diagnosis of schizophrenia and other psychotic disorders in current psychiatric classifications identifies individuals who are severely ill but who have few clinical characteristics in common. The usual picture of psychotic patients is a mixture of mood and psychotic symptoms. Fortunately, clinicians do not base their therapeutic strategies exclusively on diagnosis, but also on symptom predominance. Thus, clinicians' treatments have been dimensional in nature for years, although, until recently, their psychiatric classifications had been mainly categorical. The main principle in psychosis classification has been the Kraepelinian dichotomy, despite its lack of enduring empirical validation. Without doubt, current psychiatric classifications have made great strides in reliability and clinical utility, although these advantages have not been enough to compensate for their shortcomings concerning validity. It has recently been suggested that the Kraepelinian dichotomy may be hindering progress in neurobiological research within psychosis. Mounting evidence is now fuelling a paradigm shift in the ongoing process of review of psychiatric classifications toward the introduction of complementary dimensional indicators of psychiatric categorical diagnoses. This new approach will allow us to understand psychosis as prototypical extremes of a severity continuum. The gradients of this continuum may begin with subtle expressions in the general population, continue with milder forms in relatives of psychotic patients and subclinical cases and finally reach the prototypical forms of psychosis at the other extreme. Future complementary dimensional indicators will require sound instruments capable of reflecting a multidimensional assessment of psychopathological symptoms, polydiagnostic interviews and the assessment of a wide range of nonsymptomatic domains. These new methods of assessment merging created by the shift toward a dimensional paradigm will be applied in the forthcoming new diagnostic criteria and may allow for a phenome-wide scanning for psychosis.

1 Follower
374 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The deinstitutionalisation reform in Spain started after 1980 with the aim of reducing the need for hospitalisation, length of stay and the number of psychiatric hospital beds, as well as fostering psychiatric patient's involvement in the community. The aim of this study was to review how this reform process has affected the management of schizophrenic patients from 1980 to 2004. Longitudinal (1980-2004) study describing variables related to hospital morbidity in schizophrenia patients. Hospital admission rate has gradually increased from 1980 to 2004 from 3.71 admissions per 10,000 inhabitants to 5.89, respectively. Considering the type of admission, emergency or elective, whilst the latter has slightly decreased from 2.24 in 1980 to 1.72 in 2004, the first has almost tripled from 1.47 to 4.17. The point-prevalence of schizophrenic patients receiving inpatient treatment each year has decreased 78% in this period. Length of stay, in days per admission episode, has also decreased from 148 days in 1980 to 35 days in 2004. One of the main impacts of the psychiatric health care reform in Spain has been the considerable reduction in hospital capacity devoted to schizophrenic patients, based on the significant decrease in point-prevalence. Thus, it seems relevant to design new studies to quantify the resource reallocation to other areas of care, such as pharmacological treatment and community services.
    Social Psychiatry 10/2010; 46(11):1095-101. DOI:10.1007/s00127-010-0289-9 · 2.54 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Genetic association studies explore the association between genetic polymorphisms and a certain trait, disease or predisposition to disease. It has long been acknowledged that many genetic association studies fail to replicate their initial positive findings. This raises concern about the methodological quality of these reports. Case-control genetic association studies often suffer from various methodological flaws in study design and data analysis, and are often reported poorly. Flawed methodology and poor reporting leads to distorted results and incorrect conclusions. Many journals have adopted guidelines for reporting genetic association studies. In this review, some major methodological determinants of genetic association studies will be discussed.
    Clinical Chemistry and Laboratory Medicine 11/2010; 48 Suppl 1(Suppl 1):S115-8. DOI:10.1515/CCLM.2010.366 · 2.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: It was recently hypothesized by Lake (Schizophrenia Bulletin 2008; 34: 109-117) that Formal Thought Disorder (FTD) can be accounted for by a single disorder that is currently diagnosed as bipolar disorder. This study aimed to analyze the underlying dimensions of FTD and to examine to what extent FTD factors can be accounted for by clinical distractibility, attentional impairment, severity of mania, and familial liability of bipolar disorder and schizophrenia. Methods: Six hundred and sixty inpatients were assessed using a semistructured interview, and FTDs were assessed with the Thought, Language, and Communication scale. "Inattentiveness during Mental Status Testing" item of the Scale for the Assessment of Negative Symptoms scale and a composite mania score were used. The Family History-Research Diagnostic Criteria was used. FTD is a multidimensional construct comprised at least 5 dimensions: disorganization, verbosity, poverty of speech, idiosyncratic thinking, and blocking. Clinical distractibility loadings split in 2 factors, disorganization and blocking, but it did not load on the mania-related (verbosity) factor. Attentional disturbance was significantly associated with each FTD factor except for idiosyncratic thinking, and these associations were largely independent from the severity of mania. The associations of FTDs with mania and attentional disturbances were independent from each other. FTD factors were not significantly associated with familial liability to bipolar or to schizophrenia. Disorganization was the main FTD component. Distractibility was a core feature of FTD factors but it was not specifically accounted for by mania-related attentional impairment. The hypothesis of mutual interdependence between mania and attentional disturbance leading to FTDs could not be confirmed.
    Schizophrenia Bulletin 08/2011; 37(6):1136-46. DOI:10.1093/schbul/sbr092 · 8.45 Impact Factor
Show more