Evaluating the Process-reactive Dimension

Abstract

Harrow et al. (1986) report the limitations of the process-reactive dimension as a long-term outcome predictor for young, early phase DSM-III schizophrenics. Two additional studies are now described contrasting the good success of the process-reactive approach as a short-term predictor with DSM-II schizophrenia to its poor success in the same mode with DSM-III schizophrenics. The point is made that the change in diagnostic methods has reduced the heterogeneity of the current population of schizophrenics. The process-reactive conception is suggested as more valuable for a schizophrenia spectrum than for schizophrenia as now defined. Also, a reexamination of current schizophrenic heterogeneity is called for to determine the utility of a process-reactive dimension.

Is There an Association Between Duration of Untreated Psychosis and 24-Month Clinical Outcome in a First-Admission Series?

“…Haas et al), which confers a better outcome than schizophrenia or schizoaffective disorder. Thus, our findings support suggestions (4,5) that the inclusion of a 6-month duration of illness criterion for DSM-III-R and, subsequently, DSM-IV diagnoses would eliminate much if not all of the predictive effect seen in earlier studies of onset of psychosis. Although three studies (12, 21; unpublished 1994 paper by G.L.…”

“…That study, which used ICD-9 and the computer algorithm CATEGO to define the diagnostic categories, found onset type to be one of the two most important predictors of 2-year outcome (the other was settingi.e., developed versus developing country). However, in the mid-1980s, retrospective studies found that the 6-month duration of illness criterion required for the DSM-III diagnosis of schizophrenia reduced the number of patients considered to have an acute onset, making it more difficult to predict outcome in young patients with recent-onset schizophrenia (4,5).…”

Process-reactive Dimension and Outcome for Narrow Concepts of Schizophrenia

“…A key issue is the extent of heterogeneity in schizophrenia as defined by DSM-II and DSM-III . Herron (1987) and others have observed that DSM-III schizophrenia appears to be composed of process schizophrenics to a greater extent than was DSM-II schizophrenia. Indeed, recent research suggests that DSM-III schizophrenics are more likely to be a more homogeneous, “poor prognosis” group as defined by the classical prognostic indicators of Vaillant and Stephens (Westermeyer and Harrow 1984).…”

“…If these subtypes or dimensions are meaningful, then one might find that they separate schizophrenics according to their prognosis, course or outcome, or some other major factors (e.g., biological subtypes, family-genetic background, and parental home environment). Herron (1987) focuses on the process-reactive dimension, one of the major ways of subtyping schizophenia. This key dimension has been the subject of extensive research (Kantor and Herron 1966; Garmezy 1970; Higgins 1971), and has been invoked in theories about the origin of schizophrenia (Rodnick and Garmezy, 1957).…”

“…Herron (1987) focuses on the different results that can emerge when DSM-III (American Psychiatric Association 1980) schizophrenics as opposed to DSM-II (American Psychiatric Association 1968) schizophrenics are studied. In agreement with Herron, we note that the initial positive findings on the process-reactive dimension emerged in studies of patients diagnosed using a broad concept of schizophrenia (e.g., DSM-II ).…”