Download
1 / 12
120 likes | 252 Vues
Schizophrenia is a polythetic construct with no single characteristic symptom but many manifestations affecting thinking, emotion, and relationships. This comprehensive overview explores the complexities surrounding the characteristic symptoms of schizophrenia, the boundaries of the concept, and the considerations for narrowing or broadening the understanding of the illness. Delve into the debates around the heterogeneity of schizophrenia, whether it represents a single disease entity or multiple entities, and the implications for diagnosis and treatment. Gain insights into the competing models, genetic and environmental factors, and the diverse domains of psychopathology in schizophrenia.
E N D
Schizophrenia as a “Polythetic Construct” • No single characteristic symptom • Many symptoms, all present in some, not present in all • Manifestations in thinking, emotion, interpersonal relationships • A multisystem disease
What are the Characteristic Symptoms of Schizophrenia? • Depends upon whom you ask • Depends upon theoretical construct • Depends upon what you mean by characteristic Common? Specific? Core?
Kraepelin: The Borders of Schizophrenia …it is certainly possible that its borders are drawn at present in many directions too narrow, in others perhaps too wide.
Boundaries of the Concept • Schizoaffective Disorder • Psychotic Mood Disorders • Nonpsychotic disorders Schizotypal Personality Simple Schizophrenia
“Good Prognosis Schizophrenia” • Prominent affective symptoms • Acute onset • Family history of affective disorder • Good premorbid function • Presence of insight
Narrowing of Concept: Rationale • Risk of tardive dyskinesia • Risk of erroneously treating mood disorders with neuroleptics • Risk of self-fulfilling prophesies of poor outcome • Risk of political abuse
Single or Multiple Illnesses • Whether dementia praecox in the extent here delimited represents one uniform disease, cannot be decided at present with certainty. -- Emil Kraepelin
Heterogeneity: Competing Models • Single disease entity: multiple sclerosis • Multiple disease entities: mental retardation • Multiple domains of psychopathology
Single Disease Entity • A single illness • A single cause that produces diverse manifestations • Possible mechanism: process producing multiple brain lesions
Multiple Disease Entities • “The group of schizophrenias” • Multiple causes Purely genetic forms, e.g. phenylketonuria Purely environmental forms, e.g. virally induced Multifactorial forms • Manifestations reflect site of injury and time of the maturational process
Multiple Domains • Multiple dimensions of psychopathology e.g., psychotic, disorganized, negative • Different mechanism for each dimension • Disease process A dimension A • Disease process B dimension B • Disease process C dimension C • Mixed clinical presentation due to multiple disease processes
