Psychiatrists' perspectives on schizophrenia from around the world

 

There were conflicts in the history of how foreign psychiatry came to be. The definition of schizophrenia was too broadened as a result of the conceptions of E. Kraepelin, E. Bleuler, C. Schneider, and others. Some psychiatrists have proposed that schizophrenia is neither an illness no a collection of disorders, but rather a collection of characteristics present in a variety of pathologies. Schizophrenia diagnoses were at least twice as prevalent in the middle of the twentieth century as they were at the start.

 

Those who studied schizophrenia at the time became more convinced that extensive and systematic investigations of each of its types were required. K. Jaspers, an existentialist psychiatrist, saw schizophrenia as a "pure mental process" requiring only the way of "understanding psychology" to grasp. After WWII, the field of schizophrenia clinics had a period of stasis as existentialist psychiatrists and psychoanalysts dominated psychopathology. We are specifically discussing actual schizophrenia and false schizophrenia (Rumke H.). At the same time, the major criterion of division was the result or prognosis of the disease's progress.

 

Existentialist psychiatrists' conceptions of schizophrenia (C. Jaspers, M. Boss)

  • Schizophrenia is a process, a "mental totality" that can be understood in terms of a specific psychology
  • Schizophrenia has no clear boundaries
  • At the initial stage of development, schizophrenia takes the cosmic form of religious or metaphysical revelation
  • A schizophrenic patient is characterized by creativity
  • For a schizophrenic patient, what is inaccessible to other people is open

The twentieth-century existentialist psychiatrists were noteworthy for their mystical approach to schizophrenia. M. Boss, an existentialism in psychiatry ideologist, claimed that a schizophrenic person is capable of finding some dimension of being that most people do not have access to. In the 1960s, the charismatic existentialist R. Laing's "anti-psychiatry" was especially popular in Europe and the United States. Laing also felt that the patient with schizophrenia may be left alone to "discover his own self."

 The family of the schizophrenic patient reveals manifestations of alienation and strangeness in a particularly striking form. The popularity of "anti-psychiatry" waned markedly in the 1970s, when attempts to justify it theoretically were inevitably crushed by the reality of practice. In the late 1960s, many psychiatrists began to draw attention to the negative consequences of labelling patients as schizophrenic.

 

England

In England, as in other continental European countries, psychiatrists in the diagnosis of schizophrenia relied on the K. Schneider criteria. The dichotomous hypothesis of the English psychologist T. Crow, according to which there are two variants of symptoms of this mental disorder, was popular in the clinical concept of schizophrenia. Two types of schizophrenia can be distinguished: the first type is found in 30%, the second type in 70% of patients.

 

In 1987, P. Liddle developed a factorial analysis of the symptomatology of 40 cases of chronic schizophrenia.

Schizophrenia syndromes based on factor analysis of chronic schizophrenia symptomatology (Liddle P., 1987)

1. Psychomotor poverty syndrome:

  • poverty of speech;
  • reduction of spontaneous movements;
  • a frozen expression on his face;
  • a limited number of expressive gestures;
  • absence of changes in the affective sphere in response to various stimuli;
  • weak voice modulation.

2. Disorganization syndrome

  • inadequate affect;
  • poverty of speech content;
  • tangential responses ("tangency");
  • slipping ("coming off the rails");
  • "stilted speech."
  • absent-mindedness.

3. Reality Distortion Syndrome

  • "voices" talking to the patient;
  • persecutory delirium;
  • attitude nonsense;
  • somatic delirium.

While the first two syndromes represented both negative and positive symptoms, the latter syndrome could hardly be unequivocally assigned to one of the two major groups of schizophrenia symptoms. Attempts by other authors to identify more factors determining the structure of schizophrenia symptomatology usually resulted in the remaining symptomatology being attributed either to depression or to mania (Bell M., et al., 1994).

Germany

Germany, like other twentieth-century countries, had its own ideas about how schizophrenia developed. O. Bumke expressed questions about early dementia being a different disease at the turn of the twentieth century. He claimed in his book Dissolving Schizophrenia that schizophrenia was a symptom complex or group of symptom complexes with an external etiology. East Germany's psychomorphological school was influenced by Viennese psychiatrists S.

 

T. Meinert and Wernicke In his book "Division of Existing Psychoses," K. Leonard, a K. Kleist disciple, categorized all schizophrenia into two types of mental diseases.

Classification of Schizophrenia (K. Leonard)

  • "Systematized group": catatonia, hebephrenia, paraphrenia
  • "Unsystematized group": affective paraphrenia, schizophasia, periodic catatonia

C. Leongard's viewpoint was similar in that it emphasized the importance of syndromes rather than individual diseases. H. Prinzhorn (1922), a physician at the Heidelberg Clinic, proposed that the term "schizophrenia" was changing from a pathological to a psychological one.

 

USA

In certain aspects, America's approach to the creation of schizophrenia conceptions differed from that of European psychiatric schools. Psychoanalysis and a neurophysiological understanding of schizophrenia were blended by American psychiatrists of the time. "Schizophrenia is a pathological process in which a changed attitude toward living systems is expressed," writes Schilder (1939). During World War II, physicians who emigrated to America from Europe had a significant impact on psychiatry in the United States. For many emigrant doctors, the medical features of schizophrenia were secondary to psychological and social variables. Beginning in the 1950s, the concept of "pseudoneurotic schizophrenia" became increasingly popular in the United States. Many American doctors believe that it is difficult to define the line in the case of schizophrenia.

Comparative DSM-111 and DSM-1V diagnostic criteria for schizophrenia

Diagnostic criteria DSM - 111 DSM - 1V
The duration of the existence of the characteristic features (criterion A) Characteristic signs should persist for at least one week (if not successfully controlled) Characteristic signs should be observed for a long enough time for one month
Characteristic signs of psychosis in the active phase (criterion A) 1. delirium (bizarre delirium, which includes such manifestations that, according to cultural norms accepted in the patient's society, are unacceptable, for example, his thoughts are transmitted by radio, his behavior is controlled by a dead person). 2. Expressed hallucinations (for a whole day or several days, or several times a week for several weeks, with each outburst of hallucinations not to be of short duration); usually by a voice whose contents are not related to depression or, on the contrary, to elevated mood, or by a voice commenting on the patient's actions or thoughts, or by two voices contradicting each other). 3. incomprehensible or significantly altered associations. 4. Symptoms of catatonia. 5. A thickening or pronounced inadequacy of affect. Delusions (usually bizarre), illusions. 2. Hallucinations (especially significant are voices that constantly comment on what the patient is doing, or the patient hears two or more voices talking to each other. 3. Disorganized speech (i.e., frequent interruptions or incoherence). 4. Severely disorganized behavior or symptoms of catatonia. 5. Negative symptoms, i.e. subdued emotions, illogic, lack of will.
Disorders of social and labor function During the disease, the subject's success in all areas such as work, social relationships, and ability to take care of oneself is significantly reduced compared to the person's success before the disease or, if the disease begins in childhood or adolescence, the subject cannot reach a certain level of social development; Disruption of social and work function for a considerable period of time after the onset of impairments in one or more important areas, such as work, interpersonal relationships, and sense of self-preservation, which become far below the level attained before the changes began.
Affective disorders A condition in which a severe depressive syndrome or a severe manic syndrome has been observed during the active phase of the illness, but the duration of these episodes with mood disorders is relatively short compared to the overall duration of the active or residual phase of the illness. Significant episodes of depression or mania should not occur simultaneously with symptoms of psychosis.
Persistence of disease symptoms and the presence of phases Persistence of symptoms for at least six months. This time period must include an active phase (lasting at least one week, or less if symptoms are well tolerated) during which symptoms of schizophrenia characteristic of psychosis are observed, with or without prodromal or residual phases. Persistent signs of impairment are present for at least six months. This six-month period may include at least one month of characteristic symptoms (or less if treatment is successful).
Prodromal phase The prodromal phase includes distinct signs of a decrease in successful activity that is not associated with a mood disorder or intake of psychotropic drugs. At least two of the symptoms listed below are noted: 1) Significant isolation or autism; 2) Significant impairment of the function of breadwinner, student, homeowner; (3) Significant oddities in behavior (e.g., picking up trash, talking to oneself in the presence of other people, hoarding food); 4) expressed violations of personal hygiene and self-care rules; 5) flattened or inadequate affect; 6) distracting, intricate or elaborate speech, or poverty of speech or its content; (7) Strange beliefs or mystical thoughts that influence behavior or do not conform to cultural norms (e.g., superstition, belief in clairvoyance, telepathy, "sixth sense," that "others can experience my feelings," relationship ideas); 8) unusual perceptual sensations (e.g., periodic recurring illusions, a feeling of exposure or the presence of a person who is actually absent); 9) pronounced violations of initiative, interest or energy.  
Exclusion of organic factor and other diseases, including those associated with taking medications It cannot be established that the disorder arose and developed as a result of an organic factor. If there is a history of autism disorder, an additional diagnosis of schizophrenia is made only when there is severe delirium or hallucinations. The disorder is not due to the direct effects of medications (drugs or abuse of medications or side effects of medications) or a known disorder in the brain area (brain tumor).  

 

The advocate of the "positive" and "negative" schizophrenia theories N. Andreasen (1982) spoke of the necessity to look for a "integral explanation of the clinical polymorphism" of schizophrenia. E. Bleuler's "schisis" criteria are all examples of the modern trend of schizophrenia doctrine.

 

Switzerland

Like other European nations, Switzerland has evolved its own opinions on the subject of schizophrenia. The importance of personality in the etiology and clinical manifestations of this mental condition was overstated by Swiss Psychiatrist J. Wyrsch in the middle of the 20th century. At the time they were published, the pathophysiological evidence for schizophrenia sparked controversy, but typically subsequent research disproved the findings of earlier investigations.

Norway

In his research on the prognosis of schizophrenia, the Norwegian psychiatrist G. Langfeld also attempted to separate patients with actual "dementia praecox" or "nuclear schizophrenia" from those experiencing psychoses that are schizophrenic in nature. The ideas of K. Jaspers had a special impact on Scandinavian psychiatrists.

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