Schizophrenia as a diagnostic entity has been criticised as lacking in scientific validity or reliability,<ref name="Bentall1992">Bentall RP (1992) ''Reconstructing Schizophrenia''. London: Routledge. ISBN 0415075246</ref><ref name="Boyle2002">Boyle M (2002) ''Schizophrenia: A Scientific Delusion?''. London: Routledge. ISBN 0415227186</ref> part of a larger [[Biopsychiatry controversy|criticism]] of the validity of psychiatric diagnoses in general. One alternative suggests that the issues with the diagnosis would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill. This approach appears consistent with research on [[schizotypy]] and of a relatively high prevalence of psychotic experiences<ref name="fn_5">Verdoux H, van Os J (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. ''Schizophrenia Research'', 54(1–2), 59–65. PMID 11853979</ref><ref name="fn_65">LC, van Os J. (2001). The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8),1125–41. PMID 11702510</ref> and often non-distressing delusional beliefs<ref name="fn_67">Peters ER, Day S, McKenna J, Orbach G(2005). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). ''Schizophrenia Bulletin'', 30, 1005–22. PMID 15954204</ref> amongst the general public.<ref name="Johns_vanOs_2001">Johns LC, van Os J (2001) The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8), 1125–41. PMID 11702510.</ref>
Another criticism is that the definitions used for criteria lack consistency;<ref name="David1999">David AS (1999) On the impossibility of defining delusions. ''Philosophy, Psychiatry and Psychology'', 6 (1), 17–20</ref> this is particularly relevant to the evaluation of [[delusion#Diagnostic issues and controversies|delusion]]s and [[thought disorder#Diagnostic issues and controversies|thought disorder]]. More recently, it has been argued that psychotic symptoms are not a good basis for making a diagnosis of schizophrenia as "psychosis is the 'fever' of mental illness — a serious but nonspecific indicator".<ref name="fn_6">Tsuang MT, Stone WS, Faraone SV (2000). Toward reformulating the diagnosis of schizophrenia. ''American Journal of Psychiatry'', 157(7), 1041–1050. PMID 10873908</ref>
Perhaps because of these factors, studies examining the [[diagnosis]] of schizophrenia have typically shown relatively low or inconsistent levels of diagnostic reliability. Most famously, David Rosenhan's 1972 study, published as ''[[Rosenhan experiment|On being sane in insane places]]'', demonstrated that the diagnosis of schizophrenia was (at least at the time) often subjective and unreliable.<ref>Rosenhan D (1973). On being sane in insane places. ''Science'', 179, 250-8. PMID 4683124[http://www.stanford.edu/~kocabas/onbeingsane.pdf Full text as PDF]</ref> More recent studies have found agreement between any two psychiatrists when diagnosing schizophrenia tends to reach about 65% at best.<ref name="fn_7">McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R (1995). Spurious precision: procedural validity of diagnostic assessment in psychotic disorders. ''American Journal of Psychiatry'', 152 (2), 220–3. PMID 7840355</ref> This, and the results of earlier studies of diagnostic reliability (which typically reported even lower levels of agreement) have led some critics to argue that the diagnosis of schizophrenia should be abandoned.<ref name="fn_8">Read J (2004) Does 'schizophrenia' exist? Reliability and validity. In Read J, Mosher LR, Bentall RP (eds) ''Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia''. ISBN 1-58391-906-6</ref>
In 2004 in Japan, the Japanese term for schizophrenia was changed from ''Seishin-Bunretsu-Byo'' (mind-split-disease) to ''Tōgō-shitchō-shō'' ([[integration disorder]]).<ref name="Sato">Sato M (2004). Renaming schizophrenia: a Japanese perspective. ''World Psychiatry'', 5(1), 53–5. PMID 16757998</ref> In 2006, campaigners in the UK, under the banner of Campaign for Abolition of the Schizophrenia Label, argued for a similar rejection of the diagnosis of schizophrenia and a different approach to the treatment and understanding of the symptoms currently associated with it.<ref name="schizophrenia_invalid">[http://news.bbc.co.uk/2/hi/health/6033013.stm Schizophrenia term use 'invalid'.] BBC News Online, ([[9 October]] [[2006]]). Retrieved on [[2007-05-16]]. </ref>
Alternatively, other proponents have put forward using the presence of specific [[neurocognitive deficit]]s to make a diagnosis. These take the form of a reduction or impairment in basic psychological functions such as [[memory]], [[attention]], [[executive function]] and [[problem solving]]. It is these sorts of difficulties, rather than the psychotic symptoms (which can in many cases be controlled by [[antipsychotic]] medication), which seem to be the cause of most [[disability]] in schizophrenia. However, this argument is relatively new and it is unlikely that the method of diagnosing schizophrenia will change radically in the near future.<ref name="GreenSchizophreniaBook">Green MF (2001) ''Schizophrenia Revealed: From Neurons to Social Interactions''. New York: W.W. Norton. ISBN 0393703347</ref>
The diagnosis of schizophrenia has been used for political rather than therapeutic purposes; in the Soviet Union an additional sub-classification of [[sluggishly progressing schizophrenia]] was created. Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), this diagnosis was used for the purpose of silencing political dissidents or forcing them to recant their ideas by the use of forcible confinement and treatment.<ref name="Wilkinson1986">Wilkinson G (1986) Political dissent and "sluggish" schizophrenia in the Soviet Union. ''Br Med J (Clin Res Ed)'', 293(6548), 641-2. PMID 3092963</ref> In 2000 there were similar concerns regarding detention and 'treatment' of practitioners of the Falun Gong movement by the Chinese government. This led the [[American Psychiatric Association|American Psychiatric Association's]] ''Committee on the Abuse of Psychiatry and Psychiatrists'' to pass a resolution to urge the [[World Psychiatric Association]] to investigate the situation in China.<ref name="Lyons2001">Lyons D (2001). Soviet-style psychiatry is alive and well in the People's Republic. ''British Journal of Psychiatry'', 178, 380–381. PMID 11282823</ref>
Molecule of chlorpromazine, which revolutionized treatment of schizophrenia in the 1950s.
The concept of a cure as such remains controversial, as there is no consensus on the definition, although some criteria for the remission of symptoms have recently been suggested.[1] The effectiveness of schizophrenia treatment is often assessed using standardized methods, one of the most common being the positive and negative syndrome scale (PANSS).[2]
Management of symptoms and improving function is thought to be more achievable than a cure. Treatment was revolutionized in the mid 1950s with the development and introduction of chlorpromazine.[3] A recovery model is increasingly adopted, emphasizing hope, empowerment and social inclusion.[4]
Hospitalization may occur with severe episodes of schizophrenia. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although can still occur.[5] Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment[6] and patient-led support groups.
In many non-Western societies, schizophrenia may only be treated with more informal, community-led methods. The outcome for people diagnosed with schizophrenia in non-Western countries may actually be better than for people in the West.[7] The reasons for this effect are not clear, although cross-cultural studies are being conducted.
References
↑van Os J, Burns T, Cavallaro R, et al (2006). Standardized remission criteria in schizophrenia. Acta Psychiatrica Scandinavica, 113(2), 91–5. PMID 16423159
↑Kay SR, Fiszbein A, Opler LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–76. PMID 3616518
↑Turner T. (2007). "Unlocking psychosis". Brit J Med. 334 (suppl): s7.
↑Bellack AS. (2006) Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull. Jul;32(3):432-42. PMID 16461575
↑Becker T, Kilian R. (2006) Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care? Acta Psychiatrica Scandinavica Supplement, 429, 9–16. PMID 16445476
↑McGurk, SR, Mueser KT, Feldman K, Wolfe R, Pascaris A (2007). Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. Am J Psychiatry. Mar;164(3):437–41. PMID 17329468
↑Kulhara P (1994). Outcome of schizophrenia: some transcultural observations with particular reference to developing countries. European Archives of Psychiatry and Clinical Neuroscience, 244(5), 227–35. PMID 7893767
Further reading
Bentall, R. (2003) Madness explained: Psychosis and Human Nature. London: Penguin Books Ltd. ISBN 0-7139-9249-2
Fallon, James H. et al. (2003) The Neuroanatomy of Schizophrenia: Circuitry and Neurotransmitter Systems. Clinical Neuroscience Research 3:77–107. Available at Elsevier article locater.
Green, M.F. (2001) Schizophrenia Revealed: From Neurons to Social Interactions. New York: W.W. Norton. ISBN 0-393-70334-7
Keen, T. M. (1999) Schizophrenia: orthodoxy and heresies. A review of alternative possibilities. Journal of Psychiatric and Mental Health Nursing, 1999, 6, 415–424. PMID 10818864
Lidz, Theodore, Stephen Fleck & Alice Cornelison, Schizophrenia and the Family. International Universities Press, 1965. ISBN 978-0823660018
Noll, Richard (2007) The Encyclopedia of Schizophrenia and Other Psychotic Disorders, Third Edition ISBN 0-8160-6405-9
Read, J., Mosher, L.R., Bentall, R. (2004) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. ISBN 1-58391-906-6. A critical approach to biological and genetic theories, and a review of social influences on schizophrenia.
Shaner, A., Miller, G. F., & Mintz, J. (2004). Schizophrenia as one extreme of a sexually selected fitness indicator. Schizophrenia Research, 70(1), 101–109. PMID 15246469Full text (PDF), Retrieved on 2007-05-17.
Szasz, T. (1976) Schizophrenia: The Sacred Symbol of Psychiatry. New York: Basic Books. ISBN 0-465-07222-4
Tausk, V. : "Sexuality, War, and Schizophrenia: Collected Psychoanalytic Papers", Publisher: Transaction Publishers 1991, ISBN 0-88738-365-3 (On the Origin of the 'Influencing Machine' in Schizophrenia.)
Wiencke, Markus (2006) Schizophrenie als Ergebnis von Wechselwirkungen: Georg Simmels Individualitätskonzept in der Klinischen Psychologie. In David Kim (ed.), Georg Simmel in Translation: Interdisciplinary Border-Crossings in Culture and Modernity (pp. 123–155). Cambridge Scholars Press, Cambridge, ISBN 1-84718-060-5
