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In many non-Western societies, schizophrenia may only be treated with more informal, community-led methods. The outcome for people diagnosed with schizophrenia in non-Western countries may actually be better than for people in the West.<ref name="fn_41">Kulhara P (1994). Outcome of schizophrenia: some transcultural observations with particular reference to developing countries. ''European Archives of Psychiatry and Clinical Neuroscience'', 244(5), 227&ndash;35. PMID 7893767</ref>  The reasons for this effect are not clear, although cross-cultural studies are being conducted.
In many non-Western societies, schizophrenia may only be treated with more informal, community-led methods. The outcome for people diagnosed with schizophrenia in non-Western countries may actually be better than for people in the West.<ref name="fn_41">Kulhara P (1994). Outcome of schizophrenia: some transcultural observations with particular reference to developing countries. ''European Archives of Psychiatry and Clinical Neuroscience'', 244(5), 227&ndash;35. PMID 7893767</ref>  The reasons for this effect are not clear, although cross-cultural studies are being conducted.
== Popular views and misconceptions ==
Views held by the public about mental disorders, including schizophrenia, may not coincide with available evidence or with the views held by some mental health professionals.
=== Treatment ===
Some psychiatrists believe patients can be discouraged by friends or family members from taking prescribed medication because of the latters' non-biological views of mental disorders.<ref Name="PsychNews00">American Psychiatric Association. Americans Still Cling to Myths About Mental Illness, Survey Finds. ''Psychiatric News.'' December 7, 2001 Volume 36 Number 23 [http://pn.psychiatryonline.org/cgi/content/full/36/23/14-a Full text]</ref> There is scientific difference of opinion about the use of medication in schizophrenia.<ref>Gould, JE. (2006) Ethical Considerations in Medication-Free Research with Schizophrenia Patients: An Expert Interview with William T. Carpenter, Jr., M.D. ''Medscape Psychiatry & Mental Health'' 2006:11(2) [http://www.medscape.com/viewarticle/546243 Full text available]</ref> Consumers' views on treatment and recovery may differ from those of mental health professionals.<ref name="Bellack06"/>
=== Violence ===
The relationship between violent acts and schizophrenia is a contentious topic. One survey found that 61% of Americans judged individuals with schizophrenia as likely to commit an act of interpersonal violence, while only 17% thought such an act likely to be committed by a person described as "troubled".<ref>Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S (1999). The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. ''[[American Journal of Public Health]].'' Sep;89(9):1339–45. PMID 10474550</ref>
Research on violence indicates that the percentage of people with schizophrenia who commit violent acts is several times higher than the percentage of people without any disorder, but lower than is found for disorders such as alcoholism, and the difference is reduced or not found in same-neighbourhood comparisons when related factors are taken into account, notably sociodemographic variables and substance misuse.<ref name="Walsh02">Walsh E, Buchanan A, Fahy T (2002). Violence and schizophrenia: examining the evidence. ''British Journal of Psychiatry.'' 2002 Jun;180:490–5. PMID 12042226</ref><ref name="Stuart 03">Stuart, H (2003). Violence and mental illness: an overview. ''World Psychiatry.'' June; 2(2): 121–124. PMID 16946914 [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525086 Full text,] Retrieved on [[2007-05-17]].</ref><ref>Steadman HJ, Mulvey EP, Monahan J, ''et al'' (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. ''Archives of General Psychiatry.'' May;55(5):393–401. PMID 9596041</ref><ref>Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, ''et al'' (2006). A national study of violent behavior in persons with schizophrenia. ''Archives of General Psychiatry.'' May;63(5):490–9. PMID 16651506</ref><ref>Swanson JW, Holzer CE, Ganju VK, Jono RT. (1990) Violence and Psychiatric Disorder in the Community: Evidence From the Epidemiologic Catchment Area Surveys ''Hosp Community Psychiatry'' 41:761-770, July 1990 PMID 2142118</ref> Studies have indicated that 5 to 10% of those charged with murder in Western countries have a schizophrenia spectrum disorder.<ref name="Mullen 06">Mullen PE (2006). Schizophrenia and violence: from correlations to preventive strategies. ''Advances in Psychiatric Treatment'' 12: 239–248. [http://apt.rcpsych.org/cgi/content/abstract/12/4/239 Full text available,] Retrieved on [[2007-05-17]].</ref><ref name="fn_52">Simpson AI, McKenna B, Moskowitz A, Skipworth J, Barry-Walsh J (2004). Homicide and mental illness in New Zealand, 1970–2000. ''British Journal of Psychiatry'', 185, 394–8. PMID 15516547</ref><ref name="fn_53">Fazel S, Grann M (2004). Psychiatric morbidity among homicide offenders: a Swedish population study. ''American Journal of Psychiatry'', 161(11), 2129–31. PMID 15514419</ref>
The occurrence of [[psychosis]] in schizophrenia has sometimes been linked to a higher risk of violent acts. Findings on the specific role of delusions or hallucinations have been inconsistent, but have focused on delusional jealousy, perception of threat and command hallucinations. It has been proposed that a certain type of individual with schizophrenia may be most likely to offend, characterized by a history of educational difficulties, low IQ, conduct disorder, early-onset substance misuse and offending prior to diagnosis.<ref name= "Mullen 06"/>
A consistent finding is that individuals with a diagnosis of schizophrenia are often the victims of violent crime—at least 14 times more often than they are perpetrators.<ref>Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. ''Psychiatric Services.'' Oct;52(10):1358–66. PMID 11585953</ref><ref name="fn_55">Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni J (2005). Victimization of patients with schizophrenia and related disorders. ''Australia and New Zealand Journal of Psychiatry'', 39(3), 169-74. (1), 187–9. PMID 15701066</ref> Another consistent finding is a link to substance misuse, particularly alcohol,<ref name="fn_51">Walsh E, Gilvarry C, Samele C, ''et al'' (2004). Predicting violence in schizophrenia: a prospective study. ''Schizophrenia Research'', 67(2–3), 247-52. PMID 14984884</ref> among the minority who commit violent acts. Violence by or against individuals with schizophrenia typically occurs in the context of complex social interactions within a family setting,<ref> Solomon PL, Cavanaugh MM, Gelles RJ (2005). Family Violence among Adults with Severe Mental Illness. ''Trauma, Violence, & Abuse'', Vol. 6, No. 1, 40–54. PMID 15574672[http://tva.sagepub.com/cgi/content/abstract/6/1/40 Full text available.]</ref> and is also an issue in clinical services<ref>Chou KR, Lu RB, Chang M (2001). Assaultive behavior by psychiatric in-patients and its related factors. ''Journal of Nursing Research.'' Dec;9(5):139–51. PMID 11779087</ref> and in the wider community.<ref>Logdberg B, Nilsson LL, Levander MT, Levander S (2004). Schizophrenia, neighbourhood, and crime. ''Acta Psychiatrica Scandinavica,'' 110(2) Page 92. PMID 15233709 [http://www.blackwell-synergy.com/links/doi/10.1111/j.1600-0047.2004.00322.x/abs/ Full text available,] Retrieved on [[2007-05-16]]</ref>


==References==
==References==

Revision as of 00:08, 8 October 2012

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Schizophrenia
Eugen Bleuler (1857–1939) coined the term "Schizophrenia" in 1908
ICD-10 F20
ICD-9 295
OMIM 181500
DiseasesDB 11890
MedlinePlus 000928
MeSH F03.700.750

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Diagnostic issues and controversies

Schizophrenia as a diagnostic entity has been criticised as lacking in scientific validity or reliability,[1][2] part of a larger criticism of the validity of psychiatric diagnoses in general. One alternative suggests that the issues with the diagnosis would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill. This approach appears consistent with research on schizotypy and of a relatively high prevalence of psychotic experiences[3][4] and often non-distressing delusional beliefs[5] amongst the general public.[6]

Another criticism is that the definitions used for criteria lack consistency;[7] this is particularly relevant to the evaluation of delusions and thought disorder. More recently, it has been argued that psychotic symptoms are not a good basis for making a diagnosis of schizophrenia as "psychosis is the 'fever' of mental illness — a serious but nonspecific indicator".[8]

Perhaps because of these factors, studies examining the diagnosis of schizophrenia have typically shown relatively low or inconsistent levels of diagnostic reliability. Most famously, David Rosenhan's 1972 study, published as On being sane in insane places, demonstrated that the diagnosis of schizophrenia was (at least at the time) often subjective and unreliable.[9] More recent studies have found agreement between any two psychiatrists when diagnosing schizophrenia tends to reach about 65% at best.[10] This, and the results of earlier studies of diagnostic reliability (which typically reported even lower levels of agreement) have led some critics to argue that the diagnosis of schizophrenia should be abandoned.[11]

In 2004 in Japan, the Japanese term for schizophrenia was changed from Seishin-Bunretsu-Byo (mind-split-disease) to Tōgō-shitchō-shō (integration disorder).[12] In 2006, campaigners in the UK, under the banner of Campaign for Abolition of the Schizophrenia Label, argued for a similar rejection of the diagnosis of schizophrenia and a different approach to the treatment and understanding of the symptoms currently associated with it.[13]

Alternatively, other proponents have put forward using the presence of specific neurocognitive deficits to make a diagnosis. These take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving. It is these sorts of difficulties, rather than the psychotic symptoms (which can in many cases be controlled by antipsychotic medication), which seem to be the cause of most disability in schizophrenia. However, this argument is relatively new and it is unlikely that the method of diagnosing schizophrenia will change radically in the near future.[14]

The diagnosis of schizophrenia has been used for political rather than therapeutic purposes; in the Soviet Union an additional sub-classification of sluggishly progressing schizophrenia was created. Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), this diagnosis was used for the purpose of silencing political dissidents or forcing them to recant their ideas by the use of forcible confinement and treatment.[15] In 2000 there were similar concerns regarding detention and 'treatment' of practitioners of the Falun Gong movement by the Chinese government. This led the American Psychiatric Association's Committee on the Abuse of Psychiatry and Psychiatrists to pass a resolution to urge the World Psychiatric Association to investigate the situation in China.[16]

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Treatment and services

Main article: Treatment of schizophrenia
Molecule of chlorpromazine, which revolutionized treatment of schizophrenia in the 1950s.

The concept of a cure as such remains controversial, as there is no consensus on the definition, although some criteria for the remission of symptoms have recently been suggested.[17] The effectiveness of schizophrenia treatment is often assessed using standardized methods, one of the most common being the positive and negative syndrome scale (PANSS).[18] Management of symptoms and improving function is thought to be more achievable than a cure. Treatment was revolutionized in the mid 1950s with the development and introduction of chlorpromazine.[19] A recovery model is increasingly adopted, emphasizing hope, empowerment and social inclusion.[20]

Hospitalization may occur with severe episodes of schizophrenia. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although can still occur.[21] Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment[22] and patient-led support groups.

In many non-Western societies, schizophrenia may only be treated with more informal, community-led methods. The outcome for people diagnosed with schizophrenia in non-Western countries may actually be better than for people in the West.[23] The reasons for this effect are not clear, although cross-cultural studies are being conducted.

References

  1. ↑ Bentall RP (1992) Reconstructing Schizophrenia. London: Routledge. ISBN 0415075246
  2. ↑ Boyle M (2002) Schizophrenia: A Scientific Delusion?. London: Routledge. ISBN 0415227186
  3. ↑ Verdoux H, van Os J (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia Research, 54(1–2), 59–65. PMID 11853979
  4. ↑ LC, van Os J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21 (8),1125–41. PMID 11702510
  5. ↑ Peters ER, Day S, McKenna J, Orbach G(2005). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). Schizophrenia Bulletin, 30, 1005–22. PMID 15954204
  6. ↑ Johns LC, van Os J (2001) The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21 (8), 1125–41. PMID 11702510.
  7. ↑ David AS (1999) On the impossibility of defining delusions. Philosophy, Psychiatry and Psychology, 6 (1), 17–20
  8. ↑ Tsuang MT, Stone WS, Faraone SV (2000). Toward reformulating the diagnosis of schizophrenia. American Journal of Psychiatry, 157(7), 1041–1050. PMID 10873908
  9. ↑ Rosenhan D (1973). On being sane in insane places. Science, 179, 250-8. PMID 4683124Full text as PDF
  10. ↑ McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R (1995). Spurious precision: procedural validity of diagnostic assessment in psychotic disorders. American Journal of Psychiatry, 152 (2), 220–3. PMID 7840355
  11. ↑ Read J (2004) Does 'schizophrenia' exist? Reliability and validity. In Read J, Mosher LR, Bentall RP (eds) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. ISBN 1-58391-906-6
  12. ↑ Sato M (2004). Renaming schizophrenia: a Japanese perspective. World Psychiatry, 5(1), 53–5. PMID 16757998
  13. ↑ Schizophrenia term use 'invalid'. BBC News Online, (9 October 2006). Retrieved on 2007-05-16.
  14. ↑ Green MF (2001) Schizophrenia Revealed: From Neurons to Social Interactions. New York: W.W. Norton. ISBN 0393703347
  15. ↑ Wilkinson G (1986) Political dissent and "sluggish" schizophrenia in the Soviet Union. Br Med J (Clin Res Ed), 293(6548), 641-2. PMID 3092963
  16. ↑ Lyons D (2001). Soviet-style psychiatry is alive and well in the People's Republic. British Journal of Psychiatry, 178, 380–381. PMID 11282823
  17. ↑ van Os J, Burns T, Cavallaro R, et al (2006). Standardized remission criteria in schizophrenia. Acta Psychiatrica Scandinavica, 113(2), 91–5. PMID 16423159
  18. ↑ Kay SR, Fiszbein A, Opler LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–76. PMID 3616518
  19. ↑ Turner T. (2007). "Unlocking psychosis". Brit J Med. 334 (suppl): s7.
  20. ↑ Bellack AS. (2006) Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull. Jul;32(3):432-42. PMID 16461575
  21. ↑ Becker T, Kilian R. (2006) Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care? Acta Psychiatrica Scandinavica Supplement, 429, 9–16. PMID 16445476
  22. ↑ McGurk, SR, Mueser KT, Feldman K, Wolfe R, Pascaris A (2007). Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. Am J Psychiatry. Mar;164(3):437–41. PMID 17329468
  23. ↑ Kulhara P (1994). Outcome of schizophrenia: some transcultural observations with particular reference to developing countries. European Archives of Psychiatry and Clinical Neuroscience, 244(5), 227–35. PMID 7893767

Further reading

  • Bentall, R. (2003) Madness explained: Psychosis and Human Nature. London: Penguin Books Ltd. ISBN 0-7139-9249-2
  • Fallon, James H. et al. (2003) The Neuroanatomy of Schizophrenia: Circuitry and Neurotransmitter Systems. Clinical Neuroscience Research 3:77–107. Available at Elsevier article locater.
  • Green, M.F. (2001) Schizophrenia Revealed: From Neurons to Social Interactions. New York: W.W. Norton. ISBN 0-393-70334-7
  • Keen, T. M. (1999) Schizophrenia: orthodoxy and heresies. A review of alternative possibilities. Journal of Psychiatric and Mental Health Nursing, 1999, 6, 415–424. PMID 10818864
  • Lidz, Theodore, Stephen Fleck & Alice Cornelison, Schizophrenia and the Family. International Universities Press, 1965. ISBN 978-0823660018
  • Noll, Richard (2007) The Encyclopedia of Schizophrenia and Other Psychotic Disorders, Third Edition ISBN 0-8160-6405-9
  • Open The Doors - information on global programme to fight stigma and discrimination because of Schizophrenia. The World Psychiatric Association (WPA)
  • Read, J., Mosher, L.R., Bentall, R. (2004) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. ISBN 1-58391-906-6. A critical approach to biological and genetic theories, and a review of social influences on schizophrenia.
  • Scientific American Magazine (January 2004 Issue) Decoding Schizophrenia
  • Shaner, A., Miller, G. F., & Mintz, J. (2004). Schizophrenia as one extreme of a sexually selected fitness indicator. Schizophrenia Research, 70(1), 101–109. PMID 15246469Full text (PDF), Retrieved on 2007-05-17.
  • Szasz, T. (1976) Schizophrenia: The Sacred Symbol of Psychiatry. New York: Basic Books. ISBN 0-465-07222-4
  • Tausk, V. : "Sexuality, War, and Schizophrenia: Collected Psychoanalytic Papers", Publisher: Transaction Publishers 1991, ISBN 0-88738-365-3 (On the Origin of the 'Influencing Machine' in Schizophrenia.)
  • Wiencke, Markus (2006) Schizophrenie als Ergebnis von Wechselwirkungen: Georg Simmels Individualitätskonzept in der Klinischen Psychologie. In David Kim (ed.), Georg Simmel in Translation: Interdisciplinary Border-Crossings in Culture and Modernity (pp. 123–155). Cambridge Scholars Press, Cambridge, ISBN 1-84718-060-5


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