Cognitive Research Unit, University Department of Psychiatry, Hvidovre Hospital, DK-2650 Hvidovre, Denmark (e-mail: jpa{at}cfs.ku.dk) and Danish National Research Foundation, University of Copenhagen, Denmark.
Correspondence: E-mail: jpa{at}cfs.ku.dk
Paper presented at the Third International Early
Psychosis Conference, Copenhagen, Denmark, September 2002.
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ABSTRACT |
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INTRODUCTION |
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Several psychopathological issues merit attention. First, schizophrenia remains a fuzzy scientific concept. For example, the so-called polydiagnostic studies (e.g. comparing DSMIII (American Psychiatric Association, 1980), research diagnostic criteria with other, equally reasonable definitions of schizophrenia) consistently demonstrate that the number of patients with schizophrenia diagnosed in a given sample varies by a factor of 23, 23, depending on the diagnostic criteria applied and the composition of the examined sample (Jansson et al, 2002). The official endorsing of the DSMIII concept of schizophrenia and its contemporary permutations (DSMIV (American Psychiatric Association, 1994) and ICD10 (World Health Organization, 1993)) was not so much motivated by its superior validity (as younger colleagues believe), but was founded by a pragmatic consensus. In a polydiagnostic scenario, a patient diagnosed as being pre-onset by one diagnostic system may be already considered as post-onset by another system. This notorious fuzziness of the schizophrenia concept makes dating the illness onset not only a psychometric problem, but a theoretical issue intimately associated with the conceptual validity of schizophrenia, that is, what we conceptualise or take schizophrenia to be in the very first place (see Kendler, 1990). Evidence is available suggesting that onset dating is practically impossible in nearly half of those with schizophrenia (Fenton & McGlashan, 1991).
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PSYCHOSIS PREVENTION |
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PRODROMAL PHASE INTERVENTION |
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In consequence, only intermittent or low-intensity (attenuated) psychotic features are the current candidate symptoms for predicting a future full-blown psychosis in first-contact clinical populations (e.g. Miller et al, 2002; McGorry et al, 2002), a predicament that is theoretically highly tautological.
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SUBJECTIVE PERSPECTIVE |
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Phenomenologically informed empirical studies, paying attention to anomalies of subjective experience in early schizophrenia and in schizotypal conditions, appear therefore as a promising research direction in the context of early detection. One group of such studies, initiated in Germany, is the basic symptoms research, which targets non-psychotic experiential anomalies of affectivity, cognitionperception and bodymotor experience. In a 10-year follow-up of a highly selected clinical sample (suspected of having the potential for schizophrenia), these symptoms predicted subsequent development of schizophrenia with remarkable accuracy (Klosterkötter et al, 2001). These results are obviously in need of replication in more representative clinical samples. Another, overlapping symptom dimension consists of anomalies of self-experience. These anomalies pre-date the onset of schizophrenia, occur in the schizotypal conditions and differentiate schizophrenia from the psychotic bipolar illness (Parnas et al, 1998, 2003; Møller & Husby, 2000; Parnas & Handest, 2003). Guided by phenomenological considerations, it has been recently proposed that alterations of self-awareness constitute the phenotypic core of schizophrenia-spectum disorders (Sass & Parnas, 2003). Self-anomalies comprise unstable first-person perspective with varieties of depersonalisation, disturbed sense of ownership and agency of experience and action, fluidity of the basic sense of identity, distortions of the stream of consciousness and experiences of disembodiment. Our group at Hvidovre Hospital is finalising an English version of a psychometric instrument targeting these phenomena. However, these symptoms are not suited to rapid, structured screening by non-clinicians, because reliable eliciting and evaluating of these phenotypes require psychopathological sophistication, interviewing skill and considerable training.
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CONCLUSION |
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