The Influence of Stigma on Preventive Efforts in Psychotic Disorders

Stigma has been with us since the beginning of civilization. Erving Goffman characterized it as ''spoiled identity'', an evocative term which captures its impact on the individual, yet fails to convey its social origins. The latter derive from ignorance and fear, as well as the disempowerment which accompanies any devalued status. Non-medical forms of stigma deriving from power imbalances and shame have been seen in slavery, women, racial groupings characterized as ''inferior'', and in Vietnam...

Prodromal Symptoms And Onset

It has long been known that schizophrenia does not start with first admission and not even with the first psychotic symptoms. Early manifestations of the disorder have usually been called prodromal signs and symptoms. During the last decade, the question of when and with what symptoms schizophrenia starts and what type of course it follows until the beginning of the first psychotic episode has led to a considerable number of investigations relative to the signs and symptoms that precede the...

The Schizophrenic Syndrome A Warning and a Conjecture

This commentary is limited to two topics first, how best to avoid some drawbacks of ''diagnostic criteria'', and second, a conjecture that some of 1 Meadow Cottage, 25 Ireton Grove, Attenborough, Nottingham NG9 6BJ, UK the effects of the schizophrenic syndrome can be usefully interpreted at the conceptual level of a reduction of some of the ordinary social rituals of everyday life. ICD-10 and DSM-IV share two problems in the way that they present the necessary names and criteria by which the...

Icd10

In the ICD-10, the diagnosis of schizophrenia depends upon the presence of characteristic symptoms, a minimum duration of those symptoms, and a differentiation from affective, other psychotic, organic or substance-induced disorders. The ICD-10 diagnostic criteria for research of schizophrenia are shown in Table 1.1. Table 1.1 ICD-10 research diagnostic criteria for schizophrenia G1. Either at least one of the syndromes, symptoms, and signs listed under (1) below, or at least two of the symptoms...

Characteristic Symptoms Of Schizophrenia

The characteristic features of schizophrenia are hallucinations and delusions, disorders of thought and speech, disorders of behaviour, disturbance of emotions and affect, cognitive deficits and avolition. Hallucinations and delusions are frequently observed at some time during the course of schizophrenia. According to Cutting 13 , visual hallucinations occur in 15 , auditory in 50 and tactile in 5 of all subjects, and delusions in more than 90 . Particular diagnostic importance has been...

Irremediable Flaws in the Schizophrenia Spectrum Concept

The spectrum concept of schizophrenia is historically a modification of the categorical concept of schizophrenia, adding cases that are considered to be milder forms or variable expressions of susceptibility to the core entity. It was developed in the Danish adoption studies of schizophrenia and gave rise to our current concept of schizotypal personality disorder. Consequently the crucial test is whether the putative spectrum disorder is found in excess in the relatives of schizophrenics...

Explicit Diagnostic Criteria For Schizophrenia

In the early 1970s, a group of researchers at the Washington University School of Medicine in St Louis, led by Robins and Guze 96 , introduced a method that attempted to enhance the reliability as well as the validity of psychiatric diagnosis 97 . For a limited number of diagnostic categories, the authors proposed research definitions that were based on clinical description, laboratory studies, exclusion of other diagnoses, follow-up studies and family studies. In addition, each category was...

Treatment Options

The treatment of schizophrenia rests on three columns pharmacotherapy, psychotherapy and sociotherapy. The pharmacotherapy of acute schizophrenia is based on the use of neuroleptics, being effective mainly against positive symptoms 217 . Therefore, one would predict that patients with schizophrenia spectrum disorders will benefit from similar approaches. However, most people with schizotypal PD do not seek psychiatric treatment. Those who do seek treatment often suffer from associated symptoms,...

Door Toran Of 10 Rupps

Gunderson J.G., Mosher L.R. (1975) The cost of schizophrenia. Am. J. Psychiatry, 132 901-906. Davies L.M., Drummond M.F. (1994) Economics and schizophrenia the real cost. Br. J. Psychiatry, 165 (Suppl. 25) 18-21. Andrews G., Hall W., Goldstein G., Lapsey H., Bartels R., Silove D. (1985) The economic costs of schizophrenia. Arch. Gen. Psychiatry, 42 537-543. Warner R., de Girolamo G. (1995) Epidemiology of Mental Disorders and Psychosocial Problems. World Health Organisation, Geneva. Knapp...

Assessment Instruments For The Diagnosis Of Schizophrenia

Traditional psychological tests continue to be routinely applied in psychiatric settings to assess patients with a potential diagnosis of schizophrenia. The most widely used include questionnaires such as the Minnesota Multi-phasic Personality Inventory and projective tests such as the Rorschach test and the Thematic Apperception Test (TAT). The value of traditional tests in diagnosing schizophrenia in the absence of clinical findings has been questioned 108 . A considerable number of...

Acknowledgement

The authors' studies are supported by the Stanley Foundation. REFERENCES 1. Waddington J.L., Lanc A., Scully P.J., Larkin C., O'Callaghan E. (1998) Neurode-velopmental and neuroprogressive features in schizophrenia antithetical or complementary over a lifetime trajectory of disease Psychiatr. Clin. N. Am., 21 123-149. 2. Harvey I., McGuffin P., Williams M., Toone B.K. (1990) The ventricle-brain ratio (VBR) in functional psychoses an admixture analysis. Psychiatry Res. (Neuroimag-ing), 35 61-69....

Diagnosis of Schizophrenia Arguments for a Narrowing of the Concept

The explicit criteria for schizophrenia provided by the DSM-IV and the ICD-10 certainly allow us to establish the diagnosis more reliably, but they have apparently not increased its prognostic and aetiopathogenetic validity. This failure can be attributed to the fact especially stressed by Maj 1 with regard to DSM-IV that both consensus classifications lack an underlying paradigm. They combine elements of the diagnostic proposals of Kraepelin, Bleuler, and Schneider, but without taking into...

Clustering Of Symptoms

The characteristic symptoms of schizophrenia that have been described above may be classified in many different ways. Prominent among the attempts that have been proposed up to now are Bleuler's classifications in fundamental and accessory symptoms and in primary versus secondary symptoms, as well as Schneider's division in first- and second-rank symptoms. In recent years, the attention of researchers and clinicians alike has focused on the distinction between positive and negative symptoms....

Comments on the Diagnosis of the Schizophrenic Syndrome

The introduction of a non-aetiological criteria-based diagnostic classification in ICD-10 and DSM-III IV has represented a major advantage in psychiatric research and clinical psychiatry. This applies particularly to the schizophrenic syndrome, which previously was diagnosed in widely different ways in various countries even within the frame of ICD-8 and ICD-9 1 . The diagnostic approach based upon operationally defined criteria ensures a high reliability of the schizophrenic syndrome in...

References

World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. World Heath Organization, Geneva. 2. World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. World Health Organization, Geneva. 3. American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association, Washington,...

Biological Indicators

During the last two decades, a considerable number of biological indices have been investigated with the aim to find measurable indicators of, and confirmatory tests for, the disorder. According to Szymanski et al 123 , the most promising biological indicators are pursuit eye movement dysfunctions, abnormalities in electrodermal activity, abnormalities in event-related brain voltage potentials, deficits in attention and information processing, and abnormal findings from brain imaging...

Primarycareled Health Service

Professor Knapp et al's review elegantly highlights many of the conflicts and dilemmas faced by those who attempt to plan or to provide services for people with schizophrenia and other severe mental illnesses. Economic evaluations seek to provide answers, and indeed in some cases have contributed valuable evidence to support or refute claims for particular approaches to care provision. However, much work remains to be done. In the UK, the division of care provision between primary and secondary...

Stigma and Schizophrenia The Greek Experience

It has long been realized that mental illness and especially schizophrenia is associated with a significant amount of stigma all over the world, but this stigma has many variations across cultures. In Greece there are many folk beliefs, stereotyped ideas and scornful expressions about schizophrenia generated by strong religious and cultural values. These notions are mostly empirically noticeable in some aspects of interpersonal relationships in everyday life, the mass media and the civil laws...

Reducing the Stigma Associated with Schizophrenia

Media hyperbole and biased reporting tend to perpetuate negative attitudes toward schizophrenia. Entertainment and news media in Britain, America and elsewhere often portray the mentally ill as dangerous and evil, at best figures of fun. Modern communication technology, however, also offers the possibility of reducing stigma. Since the unsuccessful anti-stigma campaigns of the postwar period, public education methods and techniques for health promotion have improved dramatically. ''Social...

Individual Psychoeducation For Schizophrenia

Psychoeducation refers to the provision of information about psychosis and skills of self-management. It has generally been targeted either at neuroleptic medication compliance and or improving understanding and insight into psychotic illness itself. A randomized controlled trial by Eckman et al 122 randomly assigned 41 DSM-III-R patients to a modularized psychoeducation programme or to supportive psychotherapy. Two modules were taught including symptom self-management (identification of early...

Subtypes Of Schizophrenia

The classical subtypes of schizophrenia relate back to Kraepelin and Bleuler. They are defined by the predominant symptomatology at the time of evaluation. The first three classical subtypes of schizophrenia (dementia paranoides, hebephrenia and catatonia) were described as separate illnesses until Krae-pelin brought them together under the name dementia praecox. Together with schizophrenia simplex or simple schizophrenia, which was introduced by Bleuler, Kraepelin's paranoid, hebephrenic and...

Historical Background

The conceptual history of schizophrenia dates back to the end of the nineteenth century, and to the description of dementia praecox by Emil Kraepelin. Other major influences on the current concept of schizophrenia are those of Bleuler, Schneider, Jaspers and Hughlings Jackson. In the fifth edition of his textbook 6 , Emil Kraepelin established a classification of mental disorders which was based upon the medical model. His goal was to delineate disease entities having a common aetiology,...

Info

Operational criteria were developed as a provisional and pragmatic tool, but are increasingly reified and gradually elevated to a status of unquestionable truth. A brief critical survey of the diagnostic criteria of schizophrenia ICD-10, DSM-IV is therefore due. It may be helpful to realize that these criteria represent a convention of unknown validity as compared to potential rival definitions. The first-rank symptoms FRS are assigned a strong prominence, due to their presumed simplicity and...

Studies on Schizophrenic Symptomatology in Peru

Once more, Prof. Pull reveals, in his thorough review, that psychiatrists of past decades exhaustively described the clinical manifestations of schizophrenia. They had to develop semiologic abilities to describe their clinical observations, and time has proven that they were privileged to develop those skills. Unfortunately, today, the stress of psychiatric training on semiology has considerably diminished in medical schools and postgraduate courses and, as a...

Disability and Stigma Prevention The Russian Experience

Cancro and Meyerson's review deals with one of the main problems of modern psychiatry. I would like to focus on the social and economic aspects of this problem. In our professional practice, we are used to hearing that the problem of treatment of schizophrenia and of disability due to this illness are an exclusive domain of psychiatry and psychiatrists. In connection with this, demonstrating that schizophrenia is not only a clinical, but also a serious social problem, becomes an important task...