Renaming Schizophrenia

The name “Schizophrenia” is the subject of a new Forum in the journal Psychological Medicine. An article written by Bill George and Aadt Klijn, Foreign Affairs co-coordinators for Anoiksis (the Dutch association of and for people with a psychotic vulnerability), has been reflected on by various commentators.

Anoiksis has introduced a new name for the disease schizophrenia: psychosis susceptibility syndrome (PSS) with the aim that together with the old name, its attached prejudices, misleading significance and stigma can be thrown overboard.

Schizophrenia is a term loaded with negative connotations, since it still conveys an image of people with schizophrenia as all being unreliable, dangerous ‘lunatics’. The term consequently lends itself to stigma and self-stigma. Society stamps persons with schizophrenia with a negative hallmark; people diagnosed with schizophrenia then take the negative blueprint to themselves and this gives rise to a negative self-image. Not only does the term call up prejudices, it maintains misunderstandings, because schizophrenia means split personality and is therefore a misnomer. A split personality is in fact quite another disorder and has nothing to do with what we currently call schizophrenia.

Recently the World Health Organisation has been approached with a request to recognise the new name – currently the name PSS is not recognised either nationally or internationally.

Anoiksis has chosen the name Psychosis Susceptibility Syndrome (PSS) – the reasoning is as follows:

• Psychosis: because of the unreality of hallucinations and delusions.
• Susceptibility: because patients are not necessarily continually psychotic (but it is latent).
• Syndrome: because this word includes the negative and cognitive symptoms also associated with the disease. Negative symptoms include lack of feelings and energy while cognitive symptoms may be problems with concentration and memory or a reduced capacity for problem-solving for example.

Full commentaries have been provided by several people, who generally agree with the idea of changing the name, but argue that the biggest change will come from changing the public perception of schizophrenia.

Dr Brabban and colleagues comment, “There is no doubt that for many, the diagnosis of schizophrenia can be as debilitating as the associated symptoms. The word ‘schizophrenia’ appears to do more harm than good, more frequently communicating prejudice and misinformation than fact and hope. It is indisputable that the stigma surrounding the term schizophrenia can in itself lead to misery for many with the diagnosis. Therefore, any label that removes some of these disadvantages would be a welcome change.”

Professor Bentall states, “Schizophrenia has been a contested label for many years not only because it is associated with stigma, but also because it fails to achieve any of the purposes for which it was originally designed. Rebranding schizophrenia solves none of these problems. By replacing one ill-fitting label with another, we do nothing to advance psychiatric research or to develop better treatment plans for our patients.

“It is not hard to locate some of these causes [of stigma]. Without a doubt, one is the media’s treatment of schizophrenia, which consistently over-emphasizes the risk of dangerous behaviour by patients, conveying the impression that people with psychosis are responsible for an epidemic of interpersonal violence. The reality is, of course, quite different. Whereas there is an increased risk of violence associated with psychosis, most of this is attributable to co-morbid substance abuse and most psychiatric patients pose absolutely no risk to their neighbours.

“The problem has become not whether to replace schizophrenia, but what to replace it with. Simple re-labelling will do nothing to address the many scientific and clinical limitations of the categorical approach to diagnosis. Nor is it likely to address the problem of stigma, which arises out of background assumptions about the nature of severe mental illness. To persuade the general public to be more accepting of people with mental illness, we must persuade them that psychosis arises, in part, understandably from adverse life experiences (while of course acknowledging that genetic factors must play some role), that it does not necessarily lead to violence, and that recovery is possible.”

“Forum”, can be viewed free of charge for a limited time and comprises 5 articles. 

View the original competition poster here.

View the winning name poster (English language) here.

Sexual minorities vulnerable to psychosis?

Lesbians, gays and bisexuals (LGB’s) report more psychiatric symptoms which may be associated with psychosis, possibly this is due to experiences of discrimination and social exclusion. This finding is reported by researchers of Rivierduinen, Maastricht University, the Netherlands Institute of Mental Health and Addiction and the Parnassia Group.

The risk of psychotic symptoms is two to three times greater among homosexual participants in the study than among heterosexual participants. The researchers found this result using data from the Netherlands Mental Health and Incidence Studies (NEMESIS-1 and NEMESIS-2), two large-scale epidemiological studies which aim to investigate how often mental health problems occur in the general population.

The findings illustrate that the mental health of LGB’s still lags behind that of heterosexual compatriots even in a relatively gay friendly country like the Netherlands. Where previous research in this area often dealt with depression and substance abuse, the present study shows that delusions and hallucinations are also more common among LGB’s. This could mean that they are more likely to develop other serious mental disorders, associated with impairment of reality.

“Homosexual study participants who report that they have been discriminated against based on their sexual orientation have more often experienced a period during which they had psychotic perceptions or thoughts than homosexual participants who do not experience discrimination,” says Mr Gevonden, leading author of the paper. “We assume that the experience of social exclusion because you are part of a minority produces chronic stress. Through that stress, possibly in combination with a genetic predisposition, some people develop symptoms. Those can be depressive thoughts, or excessive drinking, or as in this case psychotic symptoms.”

This study focused on psychotic symptoms and not psychotic disorders. Psychotic symptoms may include hallucinations, such as hearing voices, or delusions, such as the idea that one is constantly being followed. Even if they are not serious and no help is sought, psychotic symptoms have predictive value for the onset of a psychotic disorder such as schizophrenia. Such disorders often result in the need for long-term care and are demanding to both the patient and his environment.

Mr Gevonden concluded, “More knowledge about the development of these disorders is needed in the search for new opportunities for preventive action and effective treatment strategies.”

Read the full paper” Sexual minority status and psychotic symptoms: findings from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS)”available free here for a limited time.

via Sexual minorities vulnerable to psychosis? « Medicine « Cambridge Journals Blog.

Neurocognitive rehabilitation of Down syndrome

Blog post by Jean-Adolphe Rondal, Ph.D., jeanarondal@skynet.be, Emeritus Professor of Psycholinguistics at the University of Liège, Belgium, Juan Perera, Ph.D., asnimo@telefonica.net, Director of the Center Principe de Asturias, University of the Balearic Islands, Mallorca, Spain,  and Donna SPIKER, Ph.D., donna.spiker@sri.com  Program Manager of the Early Childhood Program, SRI International, Menlo Park, California, USA.

Down syndrome is one of the most commonly occurring developmental disorders, with considerable bodies of research within many different disciplines. Despite calls for strong interdisciplinary and transdisciplinary approaches to both research and treatment of developmental disorders, including Down syndrome, bringing together knowledge across disciplines in a systematic and comprehensive way is still rare. 

The utility of non-psychiatric phenotype in diagnosing secondary psychosis, and of psychopathology in diagnosing primary psychosis

Blog post by Rudolf N. Cardinal, clinical research associate, Department of Psychiatry, University of Cambridge, and honorary specialist registrar, Cambridgeshire and Peterborough NHS Foundation Trust, and Edward T. Bullmore, professor of psychiatry, University of Cambridge.

Psychosis originally meant any kind of disordered mental state [1], and subsequently a severe mental disorder involving loss of contact with reality [2, 3]. Nowadays it may be defined (1) narrowly as the presence of delusions and/or hallucinations without insight, or (2) more broadly to include delusions and/or hallucinations with insight into their hallucinatory nature, or (3) more broadly still to include disordered thought or speech, or (4) yet more broadly to include severe behavioural abnormalities including behavioural disorganization, gross excitement and overactivity, or psychomotor retardation and catatonia [4, 5]. Different classificatory systems vary slightly in their definition [4, 5].

A Mental Healthcare Model for Mass Trauma Survivors

Blog post by Metin Basoglu, Professor of Psychiatry, & Ebru Salcioglu, Associate Professor of Psychology and Research Associate, Trauma Studies, Department of Psychological Medicine, Institute of Psychiatry, King’s College London & Istanbul Center for Behavior Research and Therapy (ICBRT / DABATEM), Turkey

Mass trauma events, such as wars, armed conflicts, acts of terror, political violence, torture, and natural disasters affect millions of people around the world. Currently there is no mental healthcare model that is capable of addressing the needs of masses of trauma-exposed people, particularly the dispossessed populations of developing countries that often bear the brunt of mass trauma events. Effective dealing with this problem requires interventions that are (1) theoretically sound, (2) proven to be effective, (3) brief, (4) easy to train therapists in their delivery, (5) practicable in different cultures, and (6) suitable for dissemination through media other than professional therapists, such as lay people, self-help tools, and mass media. Current treatments commonly used with trauma survivors do not meet more than two or three of these requirements. The last requirement is particularly important, as even the most effective treatment is of limited use if it cannot be widely disseminated to millions of people in need of help.

Delirium as a Cause of Violent Behavior

Blog Post by James J. Amos MD, University of Iowa, USA

Another reason why it would important to prevent delirium is the risk for violence patients can have for themselves and others. Patients who would not otherwise be violent can sometimes become violent when exposed to medications with which they’re unfamiliar. One combination of drugs that most people tolerate well but which can provoke intoxication delirium in others is Versed and Fantanyl. Versed is a sedative-hypnotic in the benzodiazepine class (Valium is in the same class) and Fentanyl is an opioid pain killer. Demerol is another opioid pain-killer that is a well-recognized cause of delirium.

These medications are often used on outpatient minor surgical procedures to produce sedation and analgesia. Occasionally, the relaxed and pain-free states they produce can cause an altered mental state that make people appear as though they’ve been on an all-night bender on alcohol.

Core Competencies and the Psychosomatic Medicine “Supraspecialty”

Blog Post by James J. Amos MD, University of Iowa, USA 

At the annual Academy of Psychosomatic Medicine (APM) meeting this year held on Marco Island, Florida, I heard Dr. Theodore Stern call Psychosomatic Medicine (PM) a “supraspecialty”. Usually it’s described as a subspecialty.  I couldn’t find the word in Webster’s although “supra” comes from the Latin for “above, beyond, earlier”. One of the definitions is “transcending”.  I tried to Google “supraspecialty” and came up empty. So I guess it’s a neologism. The context was a workshop on how to enhance resident and medical student education on Psychosomatic Medicine services. Dr.  Stern coined the term while talking about the scope of practice of PM. As he went through the long list, it gradually dawned on me why “supraspecialty” as a title probably fits our profession, mainly because it makes us, as psychiatrists, accountable for aspects of general and specialty medical and surgical care above and beyond that of Psychiatry alone.

Conversion Disorder

Blog Post by James J. Amos MD, University of Iowa, USA 

I was fascinated by the blog “The Mind in Modern Medicine” by E.S. Krishnamoorthy, et al, posted 10/21/2010. As a Psychosomatic Medicine (PM) specialist, I’m often consulted by neurologists for help managing hysteria, nowadays called conversion disorder. Although it’s been in the somatoform disorder category for many years, the opinion of many of my colleagues is that it’s more of a dissociative state.

The Stolen Book

Blog Post by James J. Amos MD, University of Iowa, USA  

What I wanted to do as I took over the psychiatry consultation service this month was to highlight the usefulness of our newly published book Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry.  I planned to refer to the first chapter on consultation process in order to highlight the importance of clarifying the consultation question. When I asked the residents whether they’d yet seen the copy that I’d donated to the Staff Consult Office a couple of months ago, they said indeed they had, found it useful, and held it up for me to see.

23rd ECNP Congress -The European College of Neuropsychopharmacology

Mental disorders, such as depression, anxiety disorders, addiction and schizophrenia are the core challenge of most health care systems around the world. In the EU alone, each year 27% of the total adult population – this corresponds to 83 Million citizens – suffer from mental disorders. Depression alone affects almost 20 million ranking in the EU as the most disabling disorder of all diseases. Unless appropriately treated, mental disorders are typically associated with a wide range of complications and sequelae for the subjects affected, their partners and families as well as society as a whole, and they can be lethal. Suicide – a frequent complication of depression and other mental disorders – is a major cause of premature death in Europe with over 160.000 completed suicides every year; rates of attempted suicides are at least 10 times higher.