Abandoning the concept of ‘schizophrenia‘: Some implications of validity arguments for psychological research into psychotic phenomena

Bentall, Richard P.; Jackson, Howard F.; Pilgrim, David

doi:10.1111/j.2044-8260.1988.tb00795.x

Cited by 221 publications

(123 citation statements)

References 65 publications

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“…Given apparent flaws of schizophrenia, both complementary and alternative paradigms, bearing a resemblance to our speculations in the current article, have been debated for a long time (Strauss & Gift, 1977;Bentall et al 1988;Brockington, 1992;Boteva & Lieberman, 2003;Keshavan et al 2011). Despite a series of demands for reconceptualization, these scholarly communications (in particular, strategies for clinical implementation) have been stuck at the theoretical level.…”

Section: The Term 'Schizophrenia'mentioning

confidence: 83%

The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum

2017

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The concept of schizophrenia only covers the 30% poor outcome fraction of a much broader multidimensional psychotic syndrome, yet paradoxically has become the dominant prism through which everything ‘psychotic’ is observed, even affective states with mild psychosis labelled ‘ultra-high risk’ (for schizophrenia). The inability of psychiatry to frame psychosis as multidimensional syndromal variation of largely unpredictable course and outcome – within and between individuals – hampers research and recovery-oriented practice. ‘Psychosis’ remains firmly associated with ‘schizophrenia’, as evidenced by a vigorous stream of high-impact but non-replicable attempts to ‘reverse-engineer’ the hypothesized biological disease entity, using case–control paradigms that cannot distinguish between risk for illness onset and risk for poor outcome. In this paper, the main issues surrounding the concept of schizophrenia are described. We tentatively conclude that with the advent of broad spectrum phenotypes covering autism and addiction in DSM5, the prospect for introducing a psychosis spectrum disorder – and modernizing psychiatry – appears to be within reach.

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Section: The Term 'Schizophrenia'mentioning

confidence: 83%

The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum

2017

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“…However, where we were able to investigate the impact of diagnosis on intervention efficacy we found no significant differences. This is perhaps not surprising given the well-documented difficulties associated with making clear and distinct diagnoses based on symptoms associated with psychosis (Bentall, Jackson, & Pilgrim, 1988;Craddock & Owen, 2005;van Os, 2010); and many services combine psychosis and bipolar disorder when providing treatment provision (Citrome & Yeomans, 2005;Jolley et al, 2015; National Institute for Health and Clinical Excellence, 2009). As a result, we cautiously conclude that the self-help interventions reviewed here are likely to be equally appropriate for the experiences associated with both psychosis and bipolar disorder diagnoses, but accompany this conclusion with a call for more research focusing specifically on the value of self-help interventions for people with bipolar disorder.…”

Section: What Factors Influence the Effectiveness Of Self-help Intervmentioning

confidence: 99%

Self-help interventions for psychosis: A meta-analysis

Webb

Rowse

2015

Clinical Psychology Review

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Self-help has been shown to be an effective intervention for a wide range of mental health problems. However, there is less evidence on the efficacy of self-help for psychosis and, to date, there has been no systematic review. A search of bibliographic databases identified 24 relevant studies with a total sample size of N = 1816. Ten studies adopted a repeated measures design and 14 an independent group design (including RCTs and quasiexperimental studies). Self-help interventions had, on average, a small-to-medium-sized effect on overall symptoms (d + = 0.33, 95% CI: 0.17 to 0.48). Sub-analyses revealed that selfhelp interventions had a small-to-medium-sized effect on positive symptoms (d + = 0.42, 95% CI: 0.13 to 0.72), a small-to-medium-sized effect on negative symptoms (d + = 0.37, 95% CI: 0.07 to 0.66), and a small-sized effect on outcomes associated with the symptoms of psychosis such as quality of life (d + = 0.13, 95% CI: 0.02 to 0.24). Moderation analysis identified a number of factors that influenced treatment effects including the complexity of the intervention and amount of contact time. Self-help interventions for psychosis have a lot of potential and recommendations for further research are discussed. Word count: 190Key words: Self-help, psychosis, meta-analysis P r e P u b l i c a t i o n C o p y Self-help interventions for psychosis 3 Self-help interventions for psychosis: A meta-analysis "A massive, systematic, and yet largely silent revolution is occurring in mental health today and is gathering steam for tomorrow" (Norcross, 2000, p. 370) In the quote above, Norcross (2000) refers to the proliferation of self-help approaches for mental health conditions, an approach that has gathered momentum with practitioners, researchers, and policy makers placing an increasing emphasis on self-help for treating mental health problems (Lewis et al., 2003). Self-help interventions are defined as those that are "designed to be conducted predominantly independently of professional contact" (Bower, Richards, & Lovell, 2001, p. 839). Self-help interventions can be administered through a variety of mediums such as face-to-face or group meetings, through computers, mobile, and online platforms. Self-help typically involves working independently through a guide that describes the steps to be taken in order to apply a psychological treatment. A slight variation is guided self-help, which is distinguished "by the support that is given by a professional therapist or coach to the patient when working through the standardized treatment" (Cuijpers, Donker, van Straten, & Andersson, 2010, p. 1934. The support offered can range from assisting the person to work through the self-help program to emotional support and can be provided in a range of ways (e.g., face-to-face, telephone, or email). Most self-help interventions are based on standardized psychological treatments, with the most common interventions being those based on cognitive behavioral therapy (CBT: Cuijpers & Schuurmans, 2007). Self-help inter...

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“…The paradox of an ever increasing volume of research data, and the apparent stalemate of the search for causes of the disorder, has fuelled doubts about the validity of the schizophrenia construct, some leading to proposals to discard the category 7,8 or to replace it with a pre-Kraepelinian notion of a unitary 'psychosis'. 9 Given the protean nature of the symptoms of schizophrenia and the poor coherence of the clinical and biological findings, such doubts are not without reason.…”

Section: Introductionmentioning

confidence: 99%

Subtyping schizophrenia: implications for genetic research

2006

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Phenotypic variability and likely extensive genetic heterogeneity have been confounding the search for the causes of schizophrenia since the inception of the diagnostic category. The inconsistent results of genetic linkage and association studies using the diagnostic category as the sole schizophrenia phenotype suggest that the current broad concept of schizophrenia does not demarcate a homogeneous disease entity. Approaches involving subtyping and stratification by covariates to reduce heterogeneity have been successful in the genetic study of other complex disorders, but rarely applied in schizophrenia research. This article reviews past and present attempts at delineating schizophrenia subtypes based on clinical features, statistically derived measures, putative genetic indicators, and intermediate phenotypes, highlighting the potential utility of multidomain neurocognitive endophenotypes.

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Abandoning the concept of ‘schizophrenia‘: Some implications of validity arguments for psychological research into psychotic phenomena

Cited by 221 publications

References 65 publications

The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum

The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum

Self-help interventions for psychosis: A meta-analysis

Subtyping schizophrenia: implications for genetic research

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