On the Nature of Schizophrenia: Changes in the Observer as Well as the Observed (1932-77)*

148

It is important to elaborate what we know about the symptomatic, syndromal, and functional course of schizophrenia in order to test models for this illness. The sample of schizophrenic patients from the Chestnut Lodge followup study was subtyped using classical (modified DSM-III-R) criteria and deficit/nondeficit (Schedule for the Deficit Syndrome) criteria. During the first 5 years of manifest illness, the subtype phenomenologies were moderately stable. Instability consisted of a drift toward disorganization (hebephrenia) and nonspecificity (undifferentiated) among the classical subtypes, and toward the deficit subtype within that categorization. Over the same time, positive symptoms were relatively stable, but negative symptoms became significantly worse. Such changes probably reflect "deterioration" because they were associated with poorer functional outcome an average of 15 years later. These data dovetail with other reports in the literature and suggest a hierarchy of symptomatic/syndromal progression in early manifest schizophrenia that may reflect active deterioration processes at work. We suggest that any theory of schizophrenic pathophysiology must account for these patterns of symptom course.

Section: Discussionmentioning

confidence: 99%

Subtype Progression and Pathophysiologic Deterioration in Early Schizophrenia

McGlashan

Fenton

1993

148

Section: Brain Plasticity: Are Deficit Processes Treatable?mentioning

confidence: 99%

“…Clinicians who have noted progressively milder schizophrenia throughout the 20th century include Ødegård (1967), Grinker (1973), and Romano (1977). Those who have suggested that catatonia and hebephrenia may be disappearing include Hogarty and Gross (1966), Morrison (1974), Romano (1977), and Mahendra (1981). Manfred Bleuler noted that catastrophic schizophrenia seemed to disappear between the time his father described schizophrenia at the turn of the century (E.…”

Section: Brain Plasticity: Are Deficit Processes Treatable?mentioning

confidence: 99%

Early Detection and Intervention With Schizophrenia: Rationale

McGlashan

Johannessen

1996

377

185

This article explores the rationale for early detection and intervention in schizophrenia. The most compelling reason is the disorder's severity and chronicity and our knowledge that, while many treatments for schizophrenia are effective, they are also limited and palliative. This state of affairs suggests that researchers pay closer attention to schizophrenia's premorbid and onset phases, when the vulnerability to psychosis becomes expressed and the neurobiological deficit processes driving symptom formation appear to be the most active. We review the evidence that brain plasticity can be retained or reversed despite deficit processes. This evidence includes the putative attenuation of the severity of schizophrenia throughout the 20th century, retrospective and prospective linkage of earlier neuroleptic treatment and better long-term outcome, and data from a program designed to intervene in the prodromal phase of disorder. While the evidence to date does not demonstrate that early intervention with known treatments can change the natural history of schizophrenia, it is suggestive enough (for both biological and psychosocial treatment) to support further investigation. Focusing on the early course of schizophrenia also offers the possibility of identifying potential patients long before onset using vulnerability markers and of making more feasible primary prevention efforts. Finally, studies of untreated psychosis in first-episode cases have revealed that patients are often actively psychotic for a very long time before they get help. Bringing treatment more rapidly to a person who has been psychotic is in itself enough to justify early detection efforts.

“…Patients diagnosed latent, pseudoneurotic, or borderline type are diagnosed in the absence of delusions, hallucinations, or formal thought disorder. We agree with Romano (1977) that to achieve reliability in grouping homogeneous populations for study, the diagnosis of schizophrenia must include evidence of at least one of the following: delusions, hallucinations, or formal thought disorder at some time during the illness of the patient. Gunderson, Carpenter, and Strauss (1975) have demonstrated that borderline patients are symptomatically clearly distinct from schizophrenics by conventional standards.…”

Section: Schizoaffective Schizophreniamentioning

confidence: 53%

An Attempted Integration of Information Relevant to Schizophrenic Subtypes

Carpenter

Stephens

1979

The usefulness and validity of traditional subtypes are questionable. The subtypes described in earlier years no longer emerge with the clarity previously described. The four classical subtypes cannot be reliably distinguished and have not been shown to have predictive validity. Subtypes classified along course or prognostic lines may be more clinically useful. Attempts to subdivide schizophrenia along biologic and genetic lines offer promise. Recent efforts to describe new subdivisions of schizophrenia are readily justified, but new descriptive subtypes are likely to prove useful only when validated by biological, genetic, treatment response, and outcome data.