ROI-based analysis of diffusion indices in healthy subjects and subjects with deficit or non-deficit syndrome schizophrenia

We analyzed DTI data involving 22 healthy subjects (HC), 15 patients with deficit syndrome schizophrenia (DSZ), and 25 patients with non-deficit syndrome schizophrenia (NDSZ). We used a 1.5-T MRI scanner to collect diffusion-weighted images and T1 images, which were employed to correct distortions and deformations within the diffusion-weighted images. For 156 regions of interest (ROI), we calculated the average fractional anisotropy (FA), mean diffusion (MD), and radial diffusion (RD). Each ROI underwent a group-wise comparison using permutation F-test, followed by post hoc pairwise comparisons with Bonferroni correction. In general, we observed lower FA in both schizophrenia groups compared to HC (i.e., HC>(DSZ=NDSZ)), while MD and RD showed the opposite pattern. Notably, specific ROIs with reduced FA in schizophrenia patients included bilateral nucleus accumbens, left fusiform area, brain stem, anterior corpus callosum, left rostral and caudal anterior cingulate, right posterior cingulate, left thalamus, left hippocampus, left inferior temporal cortex, right superior temporal cortex, left pars triangularis and right lingual gyrus. Significantly, the right cuneus exhibited lower FA in the DSZ group compared to other groups ((HC=NDSZ)>DSZ), without affecting MD and RD. These results indicate that compromised neural integrity in the cuneus may contribute to the pathophysiological distinctions between DSZ and NDSZ.

De-othering “schizophrenia”

Do psychiatry and clinical psychology have an “other”? This article critically addresses the clinical-scientific fascination with diagnostic challenges and other psychiatric mysteries, focusing on the example of “schizophrenia,” often seen as the most severe and enigmatic of all mental disorders. Over a century of clinical and scientific discourse on schizophrenia has painted a portrait of something indecipherable at the very foundation of psychiatric inquiry. Despite entrenched beliefs, mounting evidence from both qualitative-phenomenological and quantitative research suggests that the experience of psychosis can be meaningfully understood. Further, there is a wealth of data indicating that persons with lived experience of psychosis can lead self-actualized lives, and new studies have revealed that psychotic experiences are common in non-clinical populations. Yet traditional views of psychosis persist in the face of this mounting evidence. I suggest that the key to de-othering schizophrenia may lie in an emerging body of research on “social defeat,” marginalization, and alienation. More specifically, the experiences and behaviors commonly designated as psychosis arise in social and interpersonal contexts that are distinctly alienating, including the psychiatric encounter. It follows that schizophrenia may not be the elusive empirical object of debates about unintelligibility or “ununderstandability,” but rather a social configuration that is manifest within the deadlock of this debate itself.

A historical account of schizophrenia proneness categories from DSM-I to DSM-5 (1952-2013)

The history of diagnostic classifications in psychiatry has been recognized as a privileged means of access to the vicissitudes inherent to the configuration of a scientific and professional field, also bringing significant contributions to conceptual history. We have taken as primary sources the five editions of the DSM (1952-2013) to examine the construction of diagnostic categories related to schizophrenia proneness, indicating the scientific and social contexts related to the development of DSM and psychiatry itself. Along this process we highlight the conditions of possibility for the emergence of the Attenuated Psychosis Syndrome, a highly controversial diagnostic proposal, in the elaboration of DSM-5. This proposal ended up being rejected not only on scientific grounds, but also because of feared unintended consequences.