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A principal source of difficulty in this endeavor is the complex nature of the disorder itself, En date du jour assens the inherent weakness of the diagnostic concept of schizophrenia, in that it remains based upon assumptions about an underlying but still unknown disease process. Most of the attributes defining schizophrenia are primarily inferential and depend on self-reported subjective experience. The underlying structural and functional pathology is insufficiently understood, and there is no objective diagnostic test or validated biological marker that could provide a secure anchor for either clinical decision-making or biological and epidemiological research.
Recurrent controversies in schizophrenia research concern its delimitation from other psychoses, bipolar affective disorder, and neurodevelopmental disorders; the validity of the schizophrenia spectrum concept and the existence of subclinical forms, such as schizotypal disorder; the utility of its categorical classification as compared with descriptive symptom dimensions or subtypes based on quantitative cognitive traits, 2 and the discordances between the ICD and DSM-IV criteria for its diagnosis.
The aim of the present paper is to highlight aspects of the origin, evolution, En date du jour assens current state of the diagnostic concept of schizophrenia - ending with a speculation about its future prospects. By the middle of the 19th century, European psychiatrists began describing disorders of unknown causes, typically affecting the young, and often progressing to chronic deterioration. The ultimate validation of the disease entity, Kraepelin believed, would come from neuropathology, physiology, and biological chemistry of the brain, whereas the specific contribution of clinical research consisted in identifying replicable patterns of Thick asian porn videos between symptoms, course, and outcome.
They impart a characteristic tone to the illness quite irrespective of the mechanism which has brought them into play. It was the presence of the basic symptoms that, according to Bleuler, gave schizophrenia its distinctive diagnostic profile. Post-Kraepelinian and post-Bleulerian subtypes and dichotomies During the ensuing decades, a number of European and American clinicians proposed further subnosological distinctions within the widening phenotype of schizophrenia, including schizoaffective disorder, 13 schizophreniform psychoses, 14 process-nonprocess, 15 and paranoid-nonparanoid schizophrenia.
Familiality and modest to substantial heritability has been reported for the FRS, 22 but a recent study 23 found that these symptoms did not predict severe deterioration and cognitive deficit in schizophrenia patients. Leonhard defined sharply delineated disease entities, described by a detailed psychopathology emphasizing objective signs eg, psychomotor behaviorcourse and outcome, and family history. Notably, Leonhard's classification neither expands, nor constricts, the outer boundaries of schizophrenia, but carves up the schizophrenia spectrum in a different way.
Table II Karl Leonhard's classification of the non-affective endogenous psychoses. Group of systematic schizophrenias Insidious onset, auditory and somatic hallucinations, delusions, early blunting of affect, continuous unremitting course, personality deterioration Paraphrenias Auditory hallucinosis, audible thoughts, thought broadcast, passivity experiences, delusional misidentifications, falsifications of memory Hebephrenias Extreme autistic withdrawal, flat affect, impoverished or disorganized speech and behaviour Catatonias Excessive parakinesias, mannerisms, verbigeration, posturing, stereotypies, mutism, auditory hallucinations II. Group of unsystematic atypical schizophrenias Rapid onset, relatively preserved affect, remitting course, mild personality deterioration Affect-laden paraphrenia Paranoid delusions with affective loading Cataphasia schizophasia Incoherent, pressured speech but well-organised behaviour Periodic catatonia Episodic hyper- or hypokinesia, mixed excitatory and hallucinatory symptoms III.
Group of cycloid psychoses Sudden onset, pervasive delusional mood, multimodal hallucinations, labile affect, polarity of manifestations, typically complete recovery from episode Anxiety-happiness psychosis Extreme shifts of affect, polarity intense fear - ecstatic elation Motility psychosis Impulsive hypermotility - psychomotor inhibition Confusion psychosis Incoherent pressure of speech - mutism Open in a separate window The notion of a schizophrenia spectrum The concept of a continuum or spectrum of schizophrenia-related phenotypes originates in the observation that several ostensibly different disorders tend to cluster among biological relatives of individuals with clinical schizophrenia.
In all its variations, the spectrum concept remains critically dependent on the validity of the SPD concept. Accumulating evidence from family and twin data indicates that SPD is multidimensional and may be genetically heterogeneous.
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