Article
Movement disorders in nonpsychotic siblings of patients with nonaffective psychosis.
Psychiatric Centre Symfora Group, Amersfoort, The Netherlands.
Psychiatry Research (impact factor:
2.52).
01/2011;
188(1):133-7.
DOI:10.1016/j.psychres.2011.01.005
pp.133-7
Source: PubMed
- Citations (23)
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Cited In (0)
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Article: Diagnosis and classification of schizophrenia.
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ABSTRACT: Schizophrenia is a clinical syndrome of both extraordinary importance and extraordinary complexity. Its conceptual history contains many perspectives on the "essential" nature of the illness. For example, Kraepelin in 1919 emphasized primarily onset and course, although he also stressed the importance of some symptoms such as changes in affect and volition. Bleuler in 1911 took a more cross-sectional approach and attempted to identify fundamental characteristic symptoms, especially stressing fragmenting of thought processes. Schneider's (1959) approach was cross-sectional, stressing a group of "first-rank symptoms." DSM-III and its successors attempted to achieve a synthesis of these concepts. Nevertheless, heterogeneity in the clinical presentation of schizophrenia is certain, and heterogeneity in pathophysiology and etiology is likely. Although we can now define a particular construct of schizophrenia with reasonable agreement, the construct must be recognized as provisional and based on a need to achieve consensus about definitions rather than on an understanding of pathophysiology and etiology. The major challenge confronting the student of schizophrenia is to identify its mechanisms and causes in order to develop improved strategies for treatment and prevention. Several different approaches have been proposed to achieve this goal. Early attempts to explore and validate the construct of schizophrenia stressed descriptive and epidemiological techniques; the "validity" of a given construct of schizophrenia would be determined by evaluation of familial aggregation, course and outcome, response to treatment, and laboratory tests. This earlier approach to validation is now complemented by one that draws on techniques from neuroscience and attempts to understand schizophrenia in terms of underlying neural mechanisms. While the earlier approach conceptualized schizophrenia primarily in terms of a single disease entity, the second approach is particularly useful for the exploration of subtypes or dimensions. Research strategies for the study of schizophrenia have been developed to explore its heterogeneity. Three different competing models are discussed: (1) A single etiopathological process leading to diverse manifestations, similar to multiple sclerosis; (2) multiple disease entities leading to schizophrenia by different etiopathological processes, similar to the syndrome of mental retardation; and (3) specific symptom clusters within schizophrenia reflecting different disease processes that come together in different ways in different patients. Each of these models has strengths and weaknesses for the identification of etiology and pathophysiology.Schizophrenia Bulletin 02/1993; 19(2):199-214. · 8.80 Impact Factor -
Article: Diagnosing schizophrenia circa 2005: how and why?
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ABSTRACT: Since the introduction of the third edition of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition in 1980, schizophrenia has been widely diagnosed with good to excellent levels of reliability. This is no small feat, as prior to the 1970s the reliability of this diagnosis over time and place was very poor. Although there have been some changes in the diagnostic algorithm for schizophrenia with subsequent revisions of the Diagnostic and Statistical Manual of Mental Disorders, there has been little change in the overall classification scheme. However, there has also been relatively little movement toward enhancing the validity of this diagnosis. Although there is broad consensus that what we now call schizophrenia is probably very heterogeneous with respect to underlying etiology and pathophysiology, attempts to identify more valid subtypes or dimensions have not progressed to the point that they are likely to be incorporated into diagnostic systems any time soon. The limited progress in defining more valid disease categories has increasingly important clinical implications as the field moves more and more to treatment by preset algorithms that are typically driven by diagnosis.Current Psychiatry Reports 09/2005; 7(4):311-5. · 2.71 Impact Factor -
Article: Tardive dyskinesia and the 3-year course of schizophrenia: results from a large, prospective, naturalistic study.
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ABSTRACT: The objective of this study was to compare the 3-year course of schizophrenia between persons with tardive dyskinesia (TD) and persons without TD on multiple outcome measures. Data were drawn from a large, prospective, naturalistic study of persons treated for schizophrenia-spectrum disorders (DSM-IV criteria) in the United States, conducted between July 1997 and September 2003. Treatment outcomes were assessed at enrollment and at 12, 24, and 36 months postenrollment using measures of symptoms, functioning, productivity, activity, and quality of life. Participants who had TD at enrollment (fulfilling Schooler-Kane criteria, N = 637) were compared with those who did not (N = 1538) on clinical and functional measures at enrollment and across the 3 years of follow-up. Additional analyses examined those with persistent TD compared to those without persistent TD. With adjustment for known correlates of TD, participants with TD compared to those without TD had significantly more severe psychopathology, were less likely to experience symptom remission, had more severe extrapyramidal side effects, and had lower levels of quality of life and functioning, lower productivity, and fewer activities (all p < .001) across the 3-year follow-up. Findings were essentially unchanged when the subgroup of participants with persistent TD (at enrollment and at 1 year) was examined. These results indicate that, in the long-term treatment of schizophrenia, persons with TD have a significantly more severe and more refractory course of illness than those without TD, suggesting poorer prognosis and the need for specialized interventions.The Journal of Clinical Psychiatry 12/2008; 69(10):1580-8. · 5.80 Impact Factor
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Keywords
38 controls
42 non-psychotic siblings
clinical assessments
clinical rating scales
dyskinesia
mechanical instrument measurement
mechanical instruments
motor abnormalities
motor signs
movement disorders
nonaffective psychosis
Parkinsonism signs
schizophrenia
screening programs
sensitive
severity
Siblings
standard observation-based clinical rating scales
Subtle forms
vulnerability
