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 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Schizophrenia is a common disorder, affecting approximately 1 out of every 100 people, with a typical onset during adolescence and early adulthood. The personal and societal costs of schizophrenia are extremely high. Prevention of schizophrenia, would offer substantial benefits to patients, their family members, and the community at large. The prodromal phase of schizophrenia has been recognized since the 19th century. At-risk individuals for psychosis and schizophrenia are the subjects who can provide information for intervention prior to development of frank psychosis. This approach is currently being investigated. The question remains, however, whether it can be a diagnostic category by itself. The proposal for including the risk syndrome is one of the recommendations by the working group on schizophrenia and psychotic disorders for the forthcoming DSM-V. There are differing views in academia regarding this proposal. Prior to becoming fully psychotic, a consistent literature demonstrates that patients generally had suffered from accelerating attenuated symptoms and distress. It is important that the prodromal phase be accurately recognized in order to accomplish the goal of prevention. We can then purposefully engage in early intervention aiming toward prevention. A recent strong resurgent interest in this area stems largely from two developments: First, the identification of the neurobiological deficit processes associated with the severity and chronicity of schizophrenia, and second, the development of reliable criteria for diagnosis. Although the general at-risk construct appears to offer great potential to advance both the treatment and research dealing with psychotic illnesses, it seems premature to many researchers to include the syndrome as an established entity in the text of the new DSM-V. It would be far more appropriate to include this proposed syndrome in the appendix and evaluate the many contemporary issues in future studies. The main issues involved in this discussion are the clinical validity of the syndrome, concern about stigma and unnecessary treatment, and need for responding to patients' distress in addition to the ethical dilemma. In this review we examine the issue of inclusion of the risk syndrome as a diagnosis.
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PMID:"Attenuated psychotic symptoms syndrome" as a risk syndrome of psychosis, diagnosis in DSM-V: The debate. 2143 Oct 11

According to classic and contemporary social theory, the community is crucial to how individuals respond to the onset of health problems. Cultural response to symptoms provides the foundation for lay diagnosis; offers a gauge for marking individual and societal health literacy; and reflects the cultural embeddedness of modern medical knowledge. Using data collected between 2004 and 2007 from the Stigma in Global Context - Mental Health Study (SGC-MHS) on the recognition of schizophrenia from vignettes describing individuals meeting DSM-IV criteria, we examine the nature and correlates of lay diagnosis. Focusing on Western societies in the SGC-MHS, we ask three questions regarding problem recognition in Bulgaria (N = 255), Cyprus (N = 253), Germany (N = 382), Hungary (N = 352), Iceland (N = 291), Spain (N = 327), Great Britain (N = 289), and the United States (N = 449): (1) What is the cross-national variation in recognition of schizophrenia as a mental illness? (2) Is lay diagnosis associated with individuals' socio-demographic characteristics and/or their evaluation of underlying causes? (3) Are lay diagnoses likely to shape the nature and direction of the illness career? We find lay diagnosis of "mental illness" to be high across these Western nations with some, though modest, difference across countries. Variation for the more specific diagnosis of "schizophrenia" is greater, though fairly consistent in country ordering. Lay diagnoses are shaped most consistently by attributions, inconsistently by socio-demographics, and generally associated with respondents' treatment recommendations and expected outcomes. In light of assumptions about public beliefs and knowledge that often underlie research, community efforts, clinical programs, and health policy, these findings suggest that a greater understanding of the complexities of lay diagnosis is warranted.
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PMID:Constructing illness: how the public in eight Western nations respond to a clinical description of "schizophrenia". 2180 85

Many scientists, healthcare providers, policymakers and patients are awaiting in anticipation the application of biomedical technologies such as functional neuroimaging for the prediction, diagnosis and treatment of mental disorders. The potential efficacy of such applications is controversial, and functional neuroimaging is not yet routinely used in psychiatric clinics. However, commercial ventures and enthusiastic reporting indicate a pressing need to engage with the social and ethical issues raised by clinical translation. There has been little investigation of how individuals living with mental illness view functional neuroimaging, or of the potential psychological impacts of its clinical use. We conducted 12 semi-structured interviews with adults diagnosed with major depression or bipolar disorder, probing their experiences with mental health care and their perspectives on the prospect of receiving neuroimaging for prediction, diagnosis and planning treatment. The participants discussed the potential role of neuroimages in (i) mitigating stigma; (ii) supporting morally loaded explanations of mental illness due to an imbalance of brain chemistry; (iii) legitimising psychiatric symptoms, which may have previously been de-legitimised since they lacked objective representation, through objective representations of disorder; and (iv) reifying DSM-IV-TR disorder categories and links to identity. We discuss these anticipated outcomes in the context of participant lived experience and attitudes to biologisation of mental illness, and argue for bringing these voices into upstream ethics discussion.
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PMID:Neurobiological narratives: experiences of mood disorder through the lens of neuroimaging. 2255 90

The experience of individuals who happen to be transgender is one that reflects a complex constellation of powerful influences both within and outside of the health care system in the United States. Profound stigma, prejudice, misunderstanding, and hate for these individuals are just a few examples of the formidable challenges that potently shape their lives. The combination of exposed vulnerabilities in the expression of their true selves, and the often hostile environment where this transformation occurs creates the perfect storm for the onset of serious psychiatric illnesses. Oddly enough, the pathology is often not wrought in the experience of the genuine self but more so in what happens to that self in the context of a violent environment. This article explores these factors in the context of psychiatric diagnosis in the DSM-5.
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PMID:Issues of diagnosis and care for the transgender patient: is the DSM-5 on point? 2295 51

The proposed changes to the DSM-IV-TR are an attempt to advance a common language to be used by clinicians and researchers in psychiatry in the United States. Any improvement brought about by these changes may be jeopardized unless the ICD-10, which is used by non-psychiatric clinicians and researchers worldwide, and the DSM resolve the differences in the definitions and diagnostic criteria of most disorders. Unless there is congruence between the two manuals, debate is therefore likely to continue in the literature as to which provider is best suited to direct the care for the person with dementia: primary care providers, psychiatric providers, or neurologists. The changes to the DSM-IV-TR have the potential to promote preventive measures and early diagnosis, provided that the stigma associated with mental illnesses can be mitigated. A common language among psychiatric and primary care APRNs, other clinicians, and researchers will enhance effective communication and improve dementia care.
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PMID:Neurocognitive diagnostic challenges and the DSM-5: perspectives from the front lines of clinical practice. 2295 57

Schizophrenia is one of the most important diseases in psychiatry. The diagnostic criteria, first formulated more than 100 years ago, have since undergone multiple changes. While the disease was originally named "dementia praecox" by Emil Kraepelin, the term "schizophrenia" was coined by Eugen Bleuler soon afterwards. DSM-III changed diagnostic criteria dramatically in 1980, relying especially on Kurt Schneider's first rank criteria. These changes were also incorporated into ICD-10. Diagnosis of schizophrenia thus became much more reliable. Yet there remain many problems to be solved: the demarcation towards other psychotic disorders remains arbitrary; the diagnosis is based on multiple, quite different symptoms, enabling two patients being diagnosed with schizophrenia without sharing a single symptom, yet further important symptoms (e.g. cognitive impairments) are not even covered by present diagnostic criteria; until now it was not possible to formulate diagnostic criteria reflecting underlying biological processes or to find a reliable biological marker. These methodological uncertainties are in stark contrast to the persistence of the stigma which accompanies schizophrenia despite all efforts. For the forthcoming publication of DSM-5 and ICD-11 further revisions of diagnostic criteria of schizophrenia are to be expected.
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PMID:[The diagnosis "schizophrenia": past, present and future]. 2313 94

With the approaching release of the DSM V in 2013, there has been much debate about the proposal to remove the diagnostic label of Asperger's disorder from the new DSM. This study explored how health and education professionals perceive the conditions of autism and Asperger's disorder and their views on the proposed diagnostic changes. Analysis of the 547 participant responses confirmed an increase stigma is associated with the label of autism, with autism considered to be a more severe than the condition of Asperger's disorder. Approximately half of the participants reported being opposed to proposed diagnostic changes and of the remaining participants, 22% supported the proposed changes and 28% expressed uncertainty.
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PMID:Views on the diagnostic labels of autism and Asperger's disorder and the proposed changes in the DSM. 2314 30

The present study examined variables related to the quality of the therapeutic alliance in out-patients with schizophrenia. We expected recovery orientation and insight to be positively, and self-stigma to be negatively associated with a good therapeutic alliance. We expected these associations to be independent from age, clinical symptoms (i.e. positive and negative symptoms, depression), and more general aspects of relationship building like avoidant attachment style and the duration of treatment by the current therapist. The study included 156 participants with DSM-IV diagnoses of schizophrenia or schizoaffective disorder in the maintenance phase of treatment. Therapeutic alliance, recovery orientation, self-stigma, insight, adult attachment style, and depression were assessed by self-report. Symptoms were rated by interviewers. Hierarchical multiple regressions revealed that more recovery orientation, less self-stigma, and more insight independently were associated with a better quality of the therapeutic alliance. Clinical symptoms, adult attachment style, age, and the duration of treatment by current therapist were unrelated to the quality of the therapeutic alliance. Low recovery orientation and increased self-stigma might undermine the therapeutic alliance in schizophrenia beyond the detrimental effect of poor insight. Therefore in clinical settings, besides enhancing insight, recovery orientation, and self-stigma should be addressed.
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PMID:Therapeutic alliance in schizophrenia: the role of recovery orientation, self-stigma, and insight. 2320 Mar 19

Previous analyses have suggested that the personal experience of schizophrenia might be different from its depiction in the DSM-IV-TR. In this study, 17 people with schizophrenia or schizoaffective disorder were interviewed about their experiences of the DSM-IV-TR diagnostic criteria for schizophrenia. Descriptive phenomenological analysis was used to analyze the ways in which the personal experiences of the people in this study were similar to or different from the depiction of schizophrenia in the DSM-IV-TR. The personal experience of schizophrenia was similar in some way to each of the five diagnostic criteria for schizophrenia. Participants' personal experiences also went beyond the DSM-IV-TR criteria. Specifically, participants described strong emotional reactions to their symptoms, including fear, sadness, embarrassment, and alienation. Also, participants described intense interest but severe disruptions in goal-directed behavior due to their hallucinations being engrossing, confusing, and distracting. Further, participants described not sharing their experiences in order to avoid social stigma. These findings suggest that the description of schizophrenia in DSM-5 may benefit from a change to DSM-IV-TR criteria to incorporate more of the personal experience of schizophrenia. Further research is needed to establish the representativeness, reliability, and validity of the qualitative findings described here.
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PMID:Considering DSM-5: the personal experience of schizophrenia in relation to the DSM-IV-TR criteria. 2324 14

Previous studies suggest that self-stigma is related to social isolation and discrimination. Although it is known that stigma has cultural and social impacts, only a few studies in Japan have explored self-stigma in people with schizophrenia. The present study was conducted to investigate self-stigma in people with schizophrenia and schizoaffective disorder in Japan under a typical clinical setting, and to examine the effect of psychoeducation on self-stigma. Fifty-six participants (44 men and 12 women) who met the DSM-IV criteria for schizophrenia and schizoaffective disorder were recruited. All participants completed several questionnaires including social distance scale. Collected data were classified into an experiential or non-experiential group according to hospital records. The experiential group received psychoeducation which focused on reducing self-stigma by correcting inaccurate ideas about schizophrenia, and the relation between schizophrenia and criminal activity or violence, by watching videotapes and analyzing data from a report published by the National Police Agency. After the intervention, participants completed the Japanese version of the Social Distance Scale (SDS-J), the Knowledge of Illness and Drugs Inventory (KIDI) questionnaire, the Drug Attitude Inventory 10 (DAI-10), and the Birchwood's Psychosis Insight Scale (BPIS). In addition Global Assessment of Functioning Scale (GAF) scores were calculated for each participant. Significant differences between the 2 groups were observed for the SDS-J, KIDI, and BPIS (P<0.01 for each). However, no significant differences were observed for the DAI-10, GAF, age, and duration of treatment. The results of a path analysis showed that increasing knowledge about schizophrenia and its treatment might play an important role in reducing the self-stigma associated with this disease. When performing psychoeducation for people with schizophrenia and schizoaffective disorder, we need to discuss the pervasive effects of stigma and discrimination.
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PMID:Psychoeducation may reduce self-stigma of people with schizophrenia and schizoaffective disorder. 2325 35


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