Renaming schizophrenia? A survey among psychiatrists, mental health service users and family members in Italy

The impact of renaming schizophrenia on destigmatization: The Asian experience

The term "schizophrenia" can indeed carry stigmatizing connotations. Proposals to rename schizophrenia have emerged as a potential strategy to alleviate this stigma, but the impact of such a change is not yet fully understood. In several Asian countries that have adopted a new name for schizophrenia, there is evidence that renaming is associated with improved attitudes towards individuals with schizophrenia and an increased willingness to disclose diagnoses. However, the portrayal of schizophrenia in the media seems unaffected by these name changes. In other countries where "schizophrenia" is still the standard term, alternative names have been suggested, but research on their effectiveness in reducing stigma shows mixed results. Mental health professionals frequently support a name change, recognizing the term's negative implications. However, it is crucial to recognize that a mere semantic revision, devoid of substantial conceptual alterations, may only offer a temporary decrease in stigma. Thus, renaming schizophrenia, coupled with a re-conceptualization of the disorder, may be a constructive step toward reducing its stigmatization.

Linguistic and (micro)cultural differences in the global debate about re-naming 'schizophrenia': A mixed-methods survey from Switzerland

BACKGROUND AND HYPOTHESIS

This survey explores Swiss mental health professionals', users', and relatives' opinions on re-naming schizophrenia exploiting Switzerland's specific multilingualism to examine possible effects of linguistic and microcultural differences on the issue.

STUDY DESIGN

Opinions on 'schizophrenia' were collected using a self-rated online questionnaire incl. Freetext answers available in the three main Swiss languages, German, French and Italian. It was distributed to the main professional and self-help organizations in Switzerland between June and October 2021.

STUDY RESULTS

Overall, 449 persons completed the questionnaire, 263 in German, 172 in French and 14 in Italian. Of the total sample, 339 identified as mental health professionals, 81 as relatives and 29 as users. Considering the whole sample, almost half favored a name-change with a significant difference between stakeholder- and between language groups. Also, the name 'schizophrenia' was evaluated more critically than the diagnostic concept. Qualitative analysis of freetext answers showed a highly heterogenous argumentation, but no difference between language groups.

CONCLUSIONS

Our results suggest the attitude towards re-naming might itself be subject to (micro)cultural difference, and they highlight the nature of 'schizophrenia' as not only a scientific, but also a linguistic and cultural object. Such local factors ought to be taken into consideration in the global debate.

A 20-year review comparing the use of 'schizophrenia' and 'psychosis' in UK newspapers from 2000 to 2019: Implications for stigma reduction

BACKGROUND

There have been increasing calls for schizophrenia to be renamed to reduce negative associations with the diagnosis. 'Psychosis' is one proposed alternative, yet some research suggests this has greater negative connotations. This study compared the use of both terms within UK newspapers longitudinally to assess which is more negatively portrayed in the media.

STUDY DESIGN

Using LexisLibrary News, six UK newspaper archives were searched for the terms 'schizophrenia' and 'psychosis' in articles published between 2000 and 2019; the included article total was n = 9802. Articles were analysed using Linguistic Inquiry and Word Count software.

STUDY RESULTS

A two-level multilevel model was created of newspaper articles nested within newspapers. Adding predictors revealed that diagnostic term was a significant predictor of the emotional tone of articles (β = -2.30, SE = 0.51, p < .001, 95 % CI -3.30 to -1.30), with 'psychosis' having a more negative tone than 'schizophrenia.' Tabloids were shown to have a significantly more negative tone than broadsheets (β = -9.32, SE = 1.04, p < .001, 95 % CI -11.36 to -7.28), and emotional tone of writing had become more negative over time (β = -0.26, SE = 0.04, p < .001, 95 % CI -0.34 to -0.18).

CONCLUSIONS

These findings suggest 'psychosis' is associated with greater negativity than 'schizophrenia' within UK newspapers, and may be a poor substitute term to reduce stigma. As article tone worsened for both diagnoses over time, increased stigma reduction campaigns are required to target negativity within the media.

Diagnostic terms psychiatrists prefer to use for common psychotic and personality disorders

OBJECTIVE

There are ongoing discussions on updating various standard psychiatric terms, including schizophrenia, which can be confusing, and personality disorders, which can be pejorative. To contribute to this process, suggestions and recommendations on terminology were sought from academic psychiatrists with substantial clinical experience.

METHODS

In an online survey, 263 psychiatrists were asked how often they used alternative instead of standard terms for the diagnosis or symptom description of psychotic disorders and DSM Cluster B personality disorders. They were also asked what specific terms they preferred to use. Reasons for their views and choices were obtained.

RESULTS

125 clinicians (48%) responded. Only a minority of clinicians (31%) tended to use the term schizophrenia often, preferring to say psychosis or to refer to thinking and perceptual problems. Even lower proportions of clinicians (7-14%) often use the terms for Cluster B personality disorder subtypes: antisocial, narcissistic, histrionic, and borderline. Alternatives suggested for these disorders included discussing emotional dysregulation, traits of sensitivity and reactivity, and relational difficulties. Reasons cited for choosing alternative terms were to avoid miscommunication (71% of responders) and to avoid offending the patient (78% of responders).

CONCLUSIONS

There are practical alternatives to standard psychiatric terminology that may improve communication with patients and be more respectful choices, as well. The suggestions of the psychiatrists responding to this survey might be of immediate value to others in their practices and might be worthy of consideration by those writing the next versions of the standard manuals, both the DSM and the ICD.

What do psychiatrists think about renaming schizophrenia in Turkey?

In this study, it was aimed to evaluate the opinions of psychiatrists in Turkey on whether to change the name of schizophrenia in order to reduce stigma. This cross-sectional survey was conducted with psychiatrists (resident in psychiatry, specialist, and lecturer) in Turkey. An online survey was created via the Google Forms public web address. Online questionnaires were delivered through Google Forms by emailing and messaging on WhatsApp, Telegram, Google and Yahoo groups and asking them to pass the questionnaire to other possible participants in their network. The study was performed between June 20, 2021 and July 10, 2021. 460 psychiatrists participated in the study. Forty-five-point 2 % of psychiatrists think that the name of schizophrenia should be renamed to reduce stigma. Forty-two-point 8 % of those who support the name change state that this change should be done as soon as possible. While 64.1 % of psychiatrists stated that naming the disease with another (new) name instead of schizophrenia could increase the hopes of patients and their relatives for recovery, 12.6 % stated that renaming would not cause any positive or negative changes. There is no statistical difference between psychiatrists who have a relative diagnosed with schizophrenia and psychiatrists who do not, in terms of thinking that the name of schizophrenia should be renamed to reduce stigma. In order to remove the stigma on schizophrenia, many interventions are required in social, cultural, economic and political fields. Renaming schizophrenia may be a good start for interventions.

Eliminate schizophrenia

“Schizophrenia” is used as a unitary diagnostic term for an illness that is extremely heterogeneous in its etiology, pathophysiology, presentation, and trajectory. Furthermore, the presence of psychosis—its hallmark characteristic—can be observed in individuals with other diagnoses, and biologically- and computationally-defined psychosis biotypes differ from those associated with DSM diagnoses and yield different treatment predictions. We argue that schizophrenia is not only stigmatizing as a label, it is not useful as a diagnostic term, a disease concept, or a construct for scientific research. Until we are able to delineate a range of dysfunctions across molecular/cellular and/or macrocircuit levels that map onto psychosis-proneness and indicate optimal treatment pathways, we propose to eliminate schizophrenia and replace it with a new nomenclature as an interim solution. Similar to what is done with other broad descriptive disease concepts in medicine which are defined by hallmark clinical features and then further subtyped (e.g., sickle cell anemia, iron deficiency anemia), we propose that psychosis spectrum illnesses (PSIs) be characterized by their temporal characteristics, relevant modifying/causal and symptom features, and treatment responsiveness.

Are we ready for a name change for schizophrenia? A survey of multiple stakeholders

About one in 100 people worldwide are diagnosed with schizophrenia. Many people advocate for a name change for the condition, pointing to the stigma and discrimination associated with the term "schizophrenia", as well as to how the name poorly characterizes features of the illness. The purpose of this project was to collect opinions from a broad, diverse sample of stakeholders about possible name changes for schizophrenia. The project represented a partnership between researchers, clinicians, and those with lived experience with psychosis. The group developed a survey to assess opinions about the need for change in the name schizophrenia as well as potential alternate names. We accumulated 1190 responses from a broad array of community stakeholders, including those with lived experience of mental illness, family members, clinicians, researchers, government officials, and the general public. Findings indicated that the majority of respondents (74.1%) favored a name change for schizophrenia. Most (71.4%) found the name stigmatizing. Of the proposed alternate names, those with the most support included "Altered Perception Syndrome", "Psychosis Spectrum Syndrome", and "Neuro-Emotional Integration Disorder". Survey findings provide strong support for renaming schizophrenia. Most expressed hope that a name change will reduce stigma and discrimination.

Late ‘Early Intervention in Psychosis’: A Family School for Learning How to Live with Schizophrenia

The paper describes a family school for learning how to live with schizophrenia, which was founded in 1986 in Vienna, Austria, and is still running today. It was established in cooperation between professionals and the Austrian self-help association HPE of the relatives of persons with mental disorders. It addresses the needs of 10 families at a time, in cases where a son or a daughter was diagnosed with schizophrenia and had already experienced one or several episodes of the illness. The course lasts one and a half years and is organized according to the model of a weekly boarding school, where 10 children, the residents, stay in the school overnight from Sunday evening to Friday and take part in a structured program on cognitive, social and practical life skills. Ambulatory psychiatric treatment is taking place concurrently outside the school through local routine services. On weekends residents stay with their parents since the school is closed. Parents visit the school regularly to take part in joint activities with the residents. They also undertake night shifts in the school and attend a weekly parents group. In the regular encounters during everyday activities in the school, learning by doing occurs parents get to know the daughters and sons of other families and can learn to distinguish between disease-related and personality-related behavior. Residents can have similar learning experiences in relation to the parents of other residents. The main aim of the school is that parents learn to provide protected autonomy for the daughters or sons in question, in order to assist them after the end of the course in leading a life characterized by as much autonomy as possible after the end of the school.

Patients', carers' and clinicians' attitudes towards alternative terms to describe the at-risk for psychosis state

OBJECTIVE

Language used in psychiatry is important because it provides an understandable and accurate way of describing clinical and theoretical concepts. The use of labels in psychiatry has often been associated with stigma and reduced engagement with clinical services. This studys aims were to generate new terms for the 'at-risk mental state' (ARMS) concept and to investigate what young people, their caregivers and clinicians thought about them as well as terms commonly used in early intervention clinics. Another aim was to understand participants preference related to the best timing to introduce the at-risk concept and the extent and context of the information presented.

METHODS

New terms illustrating the at-risk concept have been generated by a youth reference group with lived experience of mental illness: 'pre-diagnosis stage' (PDS), potential of developing a mental illness (PDMI) and disposition for developing a mental illness (DDMI). A specifically designed questionnaire was administered to 46 patients with ARMS, 24 caregivers and 52 clinicians to obtain their feedback on newly proposed terms and on the terms already used in clinical practice and research.

RESULTS

The preferred terms were PDS, PDMI and ARMS. The least favoured terms were Ultra High Risk and Attenuated Psychosis Syndrome, which were thought to be associated with the most stigma. Most participants agreed that disclosure about diagnosis should be delivered early by the key clinician.

CONCLUSIONS

Patients generated terms such as PDS, PDMI, alongside ARMS should be considered to be used in clinical practice. They present with low stigma and are illustrative of young peoples difficulties.