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Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited

Current diagnostic criteria delineate schizophrenia as a discrete entity essentially defined by positive symptoms. However, the role of positive symptoms in psychiatry is being questioned. There is compelling evidence that psychotic manifestations are expressed in the population in a continuum of va...

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Autor principal: Loch, Alexandre Andrade
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526283/
https://www.ncbi.nlm.nih.gov/pubmed/31133901
http://dx.doi.org/10.3389/fpsyt.2019.00328
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author Loch, Alexandre Andrade
author_facet Loch, Alexandre Andrade
author_sort Loch, Alexandre Andrade
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description Current diagnostic criteria delineate schizophrenia as a discrete entity essentially defined by positive symptoms. However, the role of positive symptoms in psychiatry is being questioned. There is compelling evidence that psychotic manifestations are expressed in the population in a continuum of varying degrees of severity, ranging from normality to full-blown psychosis. In most cases, these phenomena do not persist, but they constitute risk factors for psychiatric disorders in general. Psychotic symptoms are also present in most non-psychotic psychiatric diagnoses, being a marker of severity. Research revealed that hallucinations and delusions appear to have distinct, independent biological underpinnings—in the general population, in psychotic, and in non-psychotic disorders as well. On the other hand, negative symptoms were seen to be far more restricted to schizophrenia, have other underlying pathophysiology than positive symptoms, predict outcome and treatment response in schizophrenia, and start before the first psychotic outbreak. The current work discusses the concept of schizophrenia, suggesting that a greater emphasis should be put on cases where psychotic symptoms emerge in a premorbid subtly increasing negative/cognitive symptoms background. In those cases, psychosis would have a different course and outcome while psychosis occurring in the absence of such background deterioration would be more benign—probably having no, or a milder, underlying degenerative process. This reformulation should better drive psychopathological classification, face positive symptoms as epiphenomenon of the schizophrenia process, and dishevel stigma from schizophrenia and from delusions and hallucinations.
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spelling pubmed-65262832019-05-27 Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited Loch, Alexandre Andrade Front Psychiatry Psychiatry Current diagnostic criteria delineate schizophrenia as a discrete entity essentially defined by positive symptoms. However, the role of positive symptoms in psychiatry is being questioned. There is compelling evidence that psychotic manifestations are expressed in the population in a continuum of varying degrees of severity, ranging from normality to full-blown psychosis. In most cases, these phenomena do not persist, but they constitute risk factors for psychiatric disorders in general. Psychotic symptoms are also present in most non-psychotic psychiatric diagnoses, being a marker of severity. Research revealed that hallucinations and delusions appear to have distinct, independent biological underpinnings—in the general population, in psychotic, and in non-psychotic disorders as well. On the other hand, negative symptoms were seen to be far more restricted to schizophrenia, have other underlying pathophysiology than positive symptoms, predict outcome and treatment response in schizophrenia, and start before the first psychotic outbreak. The current work discusses the concept of schizophrenia, suggesting that a greater emphasis should be put on cases where psychotic symptoms emerge in a premorbid subtly increasing negative/cognitive symptoms background. In those cases, psychosis would have a different course and outcome while psychosis occurring in the absence of such background deterioration would be more benign—probably having no, or a milder, underlying degenerative process. This reformulation should better drive psychopathological classification, face positive symptoms as epiphenomenon of the schizophrenia process, and dishevel stigma from schizophrenia and from delusions and hallucinations. Frontiers Media S.A. 2019-05-10 /pmc/articles/PMC6526283/ /pubmed/31133901 http://dx.doi.org/10.3389/fpsyt.2019.00328 Text en Copyright © 2019 Loch http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Loch, Alexandre Andrade
Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited
title Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited
title_full Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited
title_fullStr Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited
title_full_unstemmed Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited
title_short Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited
title_sort schizophrenia, not a psychotic disorder: bleuler revisited
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526283/
https://www.ncbi.nlm.nih.gov/pubmed/31133901
http://dx.doi.org/10.3389/fpsyt.2019.00328
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