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Rathod S, Irfan M, Bhargava R, Pinninti N, Scott J, Mohammad Algahtani H, Guo Z, Gupta R, Nadkarni P, Naeem F, Howells F, Sorsdahi K, Thorne K, Osman-Hicks V, Pallikadavath S, Phiri P, Carr H, Graves L, Kingdon D. Multinational comparative cross-sectional survey of views of medical students about acceptable terminology and subgroups in schizophrenia. BMJ Open 2018; 8:e021461. [PMID: 29880569 PMCID: PMC6009566 DOI: 10.1136/bmjopen-2017-021461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM The aim of this study was to inform thinking around the terminology for 'schizophrenia' in different countries. OBJECTIVES The objective of this study was to investigate: (1) whether medical students view alternative terminology (psychosis subgroups), derived from vulnerability-stress models of schizophrenia, as acceptable and less stigmatising than the term schizophrenia; (2) if there are differences in attitudes to the different terminology across countries with different cultures and (3) whether clinical training has an impact in reducing stigma. DESIGN This is a cross-sectional survey that examined the attitudes of medical students towards schizophrenia and the alternative subgroups. SETTING The study was conducted across eight sites: (1) University of Southampton, UK; (2) All India Institute of Medical Science, India; (3) Rowan University, USA; (4) Peshawar Medical College, Pakistan; (5) Capital Medical University, China; (6) College of Medicine and Medical sciences, Bahrain; (7) Queens University, Kingston, Canada and (8) University of Cape Town, South Africa. METHOD This study extended an initial pilot conducted by the Royal College of Psychiatrists on the term schizophrenia and psychosis subgroups to assess whether the subgroup terminology might have an effect on the attitudes of a convenience sample of medical students from eight different countries and potentially play a role in reducing stigmatisation. RESULTS 1873 medical students completed a questionnaire recording their attitudes to schizophrenia and the psychosis subgroups. A reduction in negative perceptions were found for the psychosis subgroups, especially for the stress sensitivity psychosis and anxiety psychosis subgroups. Negative perceptions were found for drug-related psychosis. Participants who had undergone clinical training had overall positive attitudes. Differences across different countries were found. CONCLUSION The attitudes towards psychosis subgroups used in this study have shown mixed results and variation across countries. Further research is warranted to investigate acceptability of terminology. Methods of reducing stigma are discussed in line with the findings. ETHICS The study received ethical approval from ERGO (Ethics and Research Governance Online; ID: 15972) and subsequently from the ethics committee at each site.
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Affiliation(s)
- Shanaya Rathod
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, UK
| | | | - Rachna Bhargava
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Narsimha Pinninti
- School of Osteopathic Medicine, Rowan University, Stratford, New Jersey, USA
| | - Joseph Scott
- Maine Behavioural Health Organization, Biddeford, Maine, USA
| | | | - Zhihua Guo
- Capital Medical University, Beijing, China
| | - Rishab Gupta
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Fleur Howells
- Translational Neuroscience Group, Division of Psychopharmacology and Biological Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahi
- Division of Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kerensa Thorne
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Victoria Osman-Hicks
- Department of Psychiatry, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sasee Pallikadavath
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, UK
| | - Peter Phiri
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Hannah Carr
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Lizi Graves
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
| | - David Kingdon
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
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Maguire S, Surgenor LJ, Le Grange D, Lacey H, Crosby RD, Engel SG, Fromholtz KM, Bamford B, Touyz S. Examining a staging model for anorexia nervosa: empirical exploration of a four stage model of severity. J Eat Disord 2017; 5:41. [PMID: 29209500 PMCID: PMC5702958 DOI: 10.1186/s40337-017-0155-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An illness staging model for anorexia nervosa (AN) has received increasing attention, but assessing the merits of this concept is dependent on empirically examining a model in clinical samples. Building on preliminary findings regarding the reliability and validity of the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN), the current study explores operationalising CASIAN severity scores into stages and assesses their relationship with other clinical features. METHOD In women with DSM-IV-R AN and sub-threshold AN (all met AN criteria using DSM 5), receiver operating curve (ROC) analysis (n = 67) assessed the relationship between the sensitivity and specificity of each stage of the CASIAN. Thereafter chi-square and post-hoc adjusted residual analysis provided a preliminary assessment of the validity of the stages comparing the relationship between stage and treatment intensity and AN sub-types, and explored movement between stages after six months (Time 3) in a larger cohort (n = 171). RESULTS The CASIAN significantly distinguished between milder stages of illness (Stage 1 and 2) versus more severe stages of illness (Stages 3 and 4), and approached statistical significance in distinguishing each of the four stages from one other. CASIAN Stages were significantly associated with treatment modality and primary diagnosis, and CASIAN Stage at Time 1 was significantly associated with Stage at 6 month follow-up. CONCLUSIONS Provisional support is provided for a staging model in AN. Larger studies with longer follow-up of cases are now needed to replicate and extend these findings and evaluate the overall utility of staging as well as optimal staging models.
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Affiliation(s)
- Sarah Maguire
- Centre for Eating and Dieting Disorders, University of Sydney, Sydney, Australia
| | - Lois J Surgenor
- Department of Psychological Medicine, University of Otago at Christchurch, Christchurch, New Zealand
| | - Daniel Le Grange
- Department of Psychiatry, University of California, Christchurch, USA
| | - Hubert Lacey
- St Georges University of London, Eating Disorders Research Group, London, UK
| | - Ross D Crosby
- Neuropsychiatric Research Institute, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota USA
| | - Kirsty M Fromholtz
- Centre for Eating and Dieting Disorders, University of Sydney, Sydney, Australia
| | - Bryony Bamford
- The London Centre for Eating Disorders and Body Image, London, UK
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
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McLean D, Barrett R, Loa P, Thara R, John S, McGrath J, Gratten J, Mowry B. Comparing schizophrenia symptoms in the Iban of Sarawak with other populations to elucidate clinical heterogeneity. Asia Pac Psychiatry 2015; 7:36-44. [PMID: 24038814 PMCID: PMC3932150 DOI: 10.1111/appy.12093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/25/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The symptom profile of schizophrenia can vary between ethnic groups. We explored selected symptom variables previously reported to be characteristic of schizophrenia in the Iban of Sarawak in transethnic populations from Australia, India, and Sarawak, Malaysia. We tested site differences to confirm previous research, and to explore implications of differences across populations for future investigations. METHODS We recruited schizophrenia samples in Australia (n = 609), India (n = 310) and Sarawak (n = 205) primarily for the purposes of genetic studies. We analyzed seven identified variables and their relationship to site using logistic regression, including: global delusions, bizarre delusions, thought broadcast/insertion/withdrawal delusions, global hallucinations, auditory hallucinations, disorganized behavior, and prodromal duration. RESULTS We identified a distinct symptom profile in our Sarawak sample. Specifically, the Iban exhibit: low frequency of thought broadcast/insertion/withdrawal delusions, high frequency of auditory hallucinations and disorganized behavior, with a comparatively short prodrome when compared with Australian and Indian populations. DISCUSSION Understanding between-site variation in symptom profile may complement future transethnic genetic studies, and provide important clues as to the nature of differing schizophrenia expression across ethnically distinct groups. A comprehensive approach to subtyping schizophrenia is warranted, utilizing comprehensively ascertained transethnic samples to inform both schizophrenia genetics and nosology.
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Affiliation(s)
- Duncan McLean
- Queensland Centre for Mental Health Research, The Park – Centre for Mental Health, Wacol, Queensland, 4076, Australia
| | - Robert Barrett
- Department of Psychiatry, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Peter Loa
- Department of Psychiatry, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Rangaswamy Thara
- Schizophrenia Research Foundation, R-7A North Main Road, AnnaNagar West (Extn.), Chennai 600 101, Tamil Nadu, India
| | - Sujit John
- Schizophrenia Research Foundation, R-7A North Main Road, AnnaNagar West (Extn.), Chennai 600 101, Tamil Nadu, India
| | - John McGrath
- Queensland Centre for Mental Health Research, The Park – Centre for Mental Health, Wacol, Queensland, 4076, Australia
- Queensland Brain Institute, Building # 79, Upland Road, University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Jake Gratten
- Queensland Centre for Mental Health Research, The Park – Centre for Mental Health, Wacol, Queensland, 4076, Australia
- Queensland Brain Institute, Building # 79, Upland Road, University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Bryan Mowry
- Queensland Centre for Mental Health Research, The Park – Centre for Mental Health, Wacol, Queensland, 4076, Australia
- Queensland Brain Institute, Building # 79, Upland Road, University of Queensland, Brisbane, Queensland, 4072, Australia
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McLean D, Thara R, John S, Barrett R, Loa P, McGrath J, Mowry B. DSM-IV "criterion A" schizophrenia symptoms across ethnically different populations: evidence for differing psychotic symptom content or structural organization? Cult Med Psychiatry 2014; 38:408-26. [PMID: 24981830 PMCID: PMC4140994 DOI: 10.1007/s11013-014-9385-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n = 776), India (n = 504) and Sarawak, Malaysia (n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.
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Affiliation(s)
- Duncan McLean
- Queensland Centre for Mental Health Research (Queensland Health), University of Queensland, Brisbane, Queensland, Australia
| | - Rangaswamy Thara
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India Ph: +91 44 2615 3971
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India Ph: +91 44 2615 3971
| | - Robert Barrett
- University of Adelaide, Department of Psychiatry, Royal Adelaide Hospital, Adelaide, South Australia, Australia No contact details as author is deceased
| | - Peter Loa
- Canberra Hospital, Canberra, Australian Capital Territory, Australia Ph: +61 2 6244 2222
| | - John McGrath
- Queensland Brain Institute and Queensland Centre for Mental Health Research (Queensland Health), University of Queensland, Brisbane, Queensland, Australia Ph: +61 7 3346 6372
| | - Bryan Mowry
- Queensland Brain Institute and Queensland Centre for Mental Health Research (Queensland Health), University of Queensland, Brisbane, Queensland, Australia Ph: +61 7 3346 6351
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Chew LJ, Fusar-Poli P, Schmitz T. Oligodendroglial alterations and the role of microglia in white matter injury: relevance to schizophrenia. Dev Neurosci 2013; 35:102-29. [PMID: 23446060 PMCID: PMC4531048 DOI: 10.1159/000346157] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/07/2012] [Indexed: 12/12/2022] Open
Abstract
Schizophrenia is a chronic and debilitating mental illness characterized by a broad range of abnormal behaviors, including delusions and hallucinations, impaired cognitive function, as well as mood disturbances and social withdrawal. Due to the heterogeneous nature of the disease, the causes of schizophrenia are very complex; its etiology is believed to involve multiple brain regions and the connections between them, and includes alterations in both gray and white matter regions. The onset of symptoms varies with age and severity, and there is some debate over a degenerative or developmental etiology. Longitudinal magnetic resonance imaging studies have detected progressive gray matter loss in the first years of disease, suggesting neurodegeneration; but there is also increasing recognition of a temporal association between clinical complications at birth and disease onset that supports a neurodevelopmental origin. Presently, neuronal abnormalities in schizophrenia are better understood than alterations in myelin-producing cells of the brain, the oligodendrocytes, which are the predominant constituents of white matter structures. Proper white matter development and its structural integrity critically impacts brain connectivity, which affects sensorimotor coordination and cognitive ability. Evidence of defective white matter growth and compromised white matter integrity has been found in individuals at high risk of psychosis, and decreased numbers of mature oligodendrocytes are detected in schizophrenia patients. Inflammatory markers, including proinflammatory cytokines and chemokines, are also associated with psychosis. A relationship between risk of psychosis, white matter defects and prenatal inflammation is being established. Animal models of perinatal brain injury are successful in producing white matter damage in the brain, typified by hypomyelination and/or dysmyelination, impaired motor coordination and prepulse inhibition of the acoustic startle reflex, recapitulating structural and functional characteristics observed in schizophrenia. In addition, elevated expression of inflammation-related genes in brain tissue and increased production of cytokines by blood cells from patients with schizophrenia indicate immunological dysfunction and abnormal inflammatory responses, which are also important underlying features in experimental models. Microglia, resident immune defenders of the central nervous system, play important roles in the development and protection of neural cells, but can contribute to injury under pathological conditions. This article discusses oligodendroglial changes in schizophrenia and focuses on microglial activity in the context of the disease, in neonatal brain injury and in various experimental models of white matter damage. These include disorders associated with premature birth, and animal models of perinatal bacterial and viral infection, oxygen deprivation (hypoxia) and excess (hyperoxia), and elevated systemic proinflammatory cytokine levels. We briefly review the effects of treatment with antipsychotic and anti-inflammatory agents in models of perinatal brain injury, and comment on the therapeutic potential of these strategies. By understanding the neurobiological basis of oligodendroglial abnormalities in schizophrenia, it is hoped that patients will benefit from the availability of targeted and more efficacious treatment options.
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Affiliation(s)
- Li-Jin Chew
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC 20010, USA.
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McLean D, John S, Barrett R, McGrath J, Loa P, Thara R, Mowry B. Refining clinical phenotypes by contrasting ethnically different populations with schizophrenia from Australia, India and Sarawak. Psychiatry Res 2012; 196:194-200. [PMID: 22401968 DOI: 10.1016/j.psychres.2011.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 01/02/2023]
Abstract
We contrasted demographic and clinical characteristics in transethnic schizophrenia populations from Australia (n=821), India (n=520) and Sarawak, Malaysia (n=298) and proposed cultural explanations for identified site differences. From these we aimed to identify candidate variables free from significant cultural confounding that are hence suitable for inclusion in genetic analyses. We observed five phenomena: (1) more individuals were living alone in Australia than India or Sarawak; (2) drug use was lower in India than Australia or Sarawak; (3) duration of untreated psychosis (DUP) was longer in India than Australia or Sarawak; (4) the rate of schizoaffective disorder was lower in India than Australia or Sarawak; and (5) age at psychosis onset (AAO) was older in Sarawak than Australia or India. We suggest that site differences for living arrangements, drug use and DUP are culturally confounded. The schizoaffective site difference likely results from measurement bias. The AAO site difference, however, has no obvious cultural or measurement bias explanation. Therefore, this may be an ideal candidate for use in genetic studies, given that genetic variants affecting AAO have already been proposed.
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Affiliation(s)
- Duncan McLean
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland, Australia
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Koychev I, El-Deredy W, Deakin JFW. New visual information processing abnormality biomarker for the diagnosis of Schizophrenia. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2011; 5:357-368. [PMID: 22003364 PMCID: PMC3191521 DOI: 10.1517/17530059.2011.586029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION: Schizophrenia is currently diagnosed on the basis of patient reports and clinical observations. A diagnosis based on aetiology is inherently more reliable due to being closer to the disease process than the overt clinical manifestations. Accordingly, recent research in schizophrenia has focused on the development of biomarkers in a bit to improve the reliability and neurobiological relevance of the diagnosis. Visual information processing is one of these promising fields of recent biomarker research. AREAS COVERED: This article provides an overview of the available literature regarding deficits in schizophrenia detectable through psychophysical (contrast and motion sensitivity, visual backward-masking), ERP (P1 and N1 visual evoked potentials) and oscillatory (signal power and phase-locking factor of evoked oscilations) measures and their validity as trait or state biomarkers of the disease. The methodology included a search on articles related to visual information processing in schizophrenia on the PubMed database. EXPERT OPINION: Biomarker research in schizophrenia is a rapidly expanding area. Evidence exists to suggest that both psychotic and manic symptoms are associated with visual processing abnormalities. A specific impairment confined to the magnocellular component of the visual system might be a trait biomarker of schizophrenia.
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Affiliation(s)
- Ivan Koychev
- Neuroscience and Psychiatry Unit, School of Community Based Medicine, The University of Manchester, Manchester, M13 9PT, UK
| | - Wael El-Deredy
- The University of Manchester, School of Psychology, Manchester, United Kingdom
| | - John Francis William Deakin
- Neuroscience and Psychiatry Unit, School of Community Based Medicine, The University of Manchester, Manchester, M13 9PT, UK
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Archer T, Beninger RJ, Palomo T, Kostrzewa RM. Epigenetics and biomarkers in the staging of neuropsychiatric disorders. Neurotox Res 2010; 18:347-66. [PMID: 20237880 DOI: 10.1007/s12640-010-9163-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 01/29/2010] [Accepted: 02/18/2010] [Indexed: 01/05/2023]
Abstract
Epigenetics, or alterations in the phenotype or gene expression due to mechanisms other than changes in the underlying DNA sequence, reflects the sensitivity and responsiveness of human and animal brains in constantly varying circumstances regulating gene expression profiles that define the biomarkers and present the ultimate phenotypical outcomes, such as cognition and emotion. Epigenetics is associated with functionally relevant alterations to the genome in such a fashion that under the particular conditions of early, adolescent, and adult life, environmental signals may activate intracellular pathways that remodel the "epigenome," triggering changes in gene expression and neural function. Thus, genetic influences in neuropsychiatric disorders that are subject to clinical staging, epigenetics in schizophrenia, epigenetic considerations in the expression of sensorimotor gating resulting from disease conditions, biomarkers of drug use and addiction, current notions on the role of dopamine in schizophrenia spectrum disorders, and the discrete interactions of biomarkers in persistent memory were to greater or lesser extents reflected upon. The relative contributions of endophenotypes and epistasis for mediating epigenetic phenomena and the outcomes as observed in the analysis of biomarkers appear to offer a multitude of interactive combinations to further complicate the labyrinthine machinations of diagnosis, intervention, and prognosis.
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Affiliation(s)
- Trevor Archer
- Department of Psychology, University of Gothenburg, Box 500, 405 30, Gothenburg, Sweden.
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Abstract
The major psychotic disorders schizophrenia and bipolar disorder are etiologically complex involving both heritable and nonheritable factors. The absence of consistently replicated major genetic effects, together with evidence for lasting changes in gene expression after environmental exposures, is consistent with the concept that the biologic underpinnings of these disorders are epigenetic in form rather than DNA sequence based. Psychosis-associated environmental exposures, particularly at key developmental stages, may result in long-lasting epigenetic alterations that impact on the neurobiological processes involved in pathology. Although direct evidence for epigenetic dysfunction in both schizophrenia and bipolar disorder is still limited, methodological technologies in epigenomic profiling have advanced. This means that we are at the exciting stage where it is feasible to start investigating molecular modifications to DNA and histones and examine the mechanisms by which environmental factors can act upon the genome to bring about epigenetic changes in gene expression involved in the etiology of these disorders. Given the dynamic nature of the epigenetic machinery and potential reversibility of epigenetic modifications, the understanding of such mechanisms is of key relevance for clinical psychiatry and for identifying new targets for prevention and/or intervention.
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Affiliation(s)
- Bart P. F. Rutten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, European Graduate School of Neuroscience, South Limburg Mental Health Research and Teaching Network, Vijverdalseweg 1, Maastricht 6226 NB, The Netherlands,To whom correspondence should be addressed; tel: +31-43-3688697, fax: +31-43-3688669, e-mail:
| | - Jonathan Mill
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK
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Tandon R, Nasrallah HA, Keshavan MS. Schizophrenia, "just the facts" 4. Clinical features and conceptualization. Schizophr Res 2009; 110:1-23. [PMID: 19328655 DOI: 10.1016/j.schres.2009.03.005] [Citation(s) in RCA: 629] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 02/28/2009] [Accepted: 03/03/2009] [Indexed: 12/20/2022]
Abstract
Although dementia praecox or schizophrenia has been considered a unique disease entity for the past century, its definitions and boundaries have continued to vary over this period. At any given time, the changing concept of schizophrenia has been influenced by available diagnostic tools and treatments, related conditions from which it most needs to be distinguished, extant knowledge and scientific paradigms. There is significant heterogeneity in the etiopathology, symptomatology, and course of schizophrenia. It is characterized by an admixture of positive, negative, cognitive, mood, and motor symptoms whose severity varies across patients and through the course of the illness. Positive symptoms usually first begin in adolescence or early adulthood, but are often preceded by varying degrees of negative and cognitive symptomatology. Schizophrenia tends to be a chronic and relapsing disorder with generally incomplete remissions, variable degrees of functional impairment and social disability, frequent comorbid substance abuse, and decreased longevity. Although schizophrenia may not represent a single disease with a unitary etiology or pathogenetic process, alternative approaches have thus far been unsuccessful in better defining this syndrome or its component entities. The symptomatologic, course, and etio-pathological heterogeneity can usefully be addressed by a dimensional approach to psychopathology, a clinical staging approach to illness course, and by elucidating endophenotypes and markers of illness progression, respectively. This will allow an approach to the deconstruction of schizophrenia into its multiple component parts and strategies to reconfigure these components in a more meaningful manner. Possible implications for DSM-V and ICD-11 definitions of schizophrenia are discussed.
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, University of Florida College of Medicine, P.O. Box 100256, Gainesville, FL 32610, USA.
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Nosological status and definition of schizophrenia: Some considerations for DSM-V and ICD-11. Asian J Psychiatr 2008; 1:22-7. [PMID: 23050991 DOI: 10.1016/j.ajp.2008.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 10/09/2008] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Although dementia praecox or schizophrenia has been considered a unique disease entity for the past century, its definitions and boundaries have varied over this period. In this article, we examine the changing conceptualization of schizophrenia over the past 100 years and make some recommendations with regards to its definition in DSM-V and ICD-11. METHODS We summarize clinical features of schizophrenia in terms of symptomatology, course, and outcome. We examine factors that lead to changing definitions of a disorder such as schizophrenia, with specific reference to the evolution of its definition from DSM-1 (American Psychiatric Association, Washington, DC, 1952) to the current DSM-IV-TR. RESULTS Efforts to elucidate the etiology and pathophysiology of schizophrenia have been hampered by its imprecise definition and continuing transformations in its conceptualization. The definition of schizophrenia, at any given time, has been influenced by available diagnostic tools and treatments, other clinical considerations, extant knowledge and scientific paradigms. It is now clear that schizophrenia does not represent a single disease with a unitary etiology or pathogenetic process. Despite limitations in the concept, however, alternative approaches thus far have been unsuccessful in better defining the syndrome of schizophrenia or its component entities. CONCLUSIONS Whereas changing definitions of schizophrenia might impede research into its nature and development of more effective treatments, only a better understanding of schizophrenia can lead to its more precise definition. We consider the implications of our observations for DSM-V and ICD-11 definitions of schizophrenia and summarize some emerging preliminary recommendations.
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