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.

Cardiovascular Disease responsible for shorter life expectancy in people with mental illness

Blog Post by David Gardner, Professor of Psychiatry, Dalhousie University

People living with a major mental illness have a quite notable shorter life expectancy, and the primary reason for this is surprising to some. The risk of death due to suicide is about 15-30 times greater in people with schizophrenia, bipolar disorder, and depression compared to the general population. However, suicide, a rare event, is not the leading driver of excess death or shortened life expectancy. It is cardiovascular disease.

Dementia Awareness Week: Conversations with an Alzheimer’s Patient, and other books from Cambridge Medicine

Blog Post by Nisha Doshi, Editorial, Cambridge University Press

4^th-10^th July 2010 is Dementia Awareness Week in the UK, and this year the Alzheimer’s Society have been asking us to think about people we know living with dementia, and how their lives can be made more enjoyable.

From an in-depth study of communication with an elderly female Alzheimer’s patient over four-and-half-years, to a unique collection of dementia case studies from around the world, Cambridge Medicine’s mental health list offers a wide range of resources to help clinicians and family members caring for dementia patients across the globe.

The Practical Management of Bipolar Disorder

Blog Post by Allan H. Young, University of British Columbia, Vancouver and I. Nicol Ferrier, University of Newcastle-upon-Tyne, UK

Bipolar disorder is now acknowledged to be the heartland of psychiatry and core to our clinical concepts of mood disorders. It is an illness which causes a very great amount of human suffering. In recent years we have seen some real advances in our understanding of the causes of bipolar disorder with important findings published about the role of genetics, neuropsychology, stress hormones and a large number of trials published about treatment.

Make sense of neuropsychology in psychiatry

Book Review by Vaughan Bell, Departamento de Psiquiatría, Hospital San Vicente de Paúl, Medellín, Colombia

One of the lesser noted revisions in the draft DSM-V is a change in the definition of a mental disorder from “a manifestation of a behavioral, psychological, or biological dysfunction” to one “that reflects an underlying psychobiological dysfunction”, highlighting the fact that we have increasingly come to regard neuropsychology as the best compromise in the vexatious mind-body problem and sometimes the reluctant redeemer of a medical speciality best known for its irreconcilable differences between objective and subjective worldviews.

Young people and substance misuse

Blog Post by Professor Hamid Ghodse, Dept of Addictive Behaviour & Psychological Medicine, St George’s Hospital Medical School, University of London

The young people of today live in a world that it is complex, providing them both with tremendous opportunities as well as challenges, with many benefits as well as many risks.  The influence of their peers and their surroundings upon them and their behaviour, their life style and their health is greater than ever before. Peer influences are no longer solely emanating from school or the neighbourhood but can come from thousands of miles away. Indeed, adolescents’ ideals and role models may be in another continent, and their problems may start from under the same roof or from a long distance away. 

Encouraging our medical students to consider psychiatry

Blog Post by Michael Casher, MD, Director, Psychiatry Adult Inpatient Program, Clinical Assistant Professor, Department of Psychiatry, University of Michigan Medical School

Psychiatry is an exciting field with so many specialties within it that will fit virtually any student’s needs.  This at least is what I and most of my colleagues think.  But how do we communicate this to the talented medical students that pass through their mandatory psychiatric clerkships?  After all, they are bombarded with identical pitches from all the other specialties within the entire medical field, some of which may appear more “glamorous” than psychiatry. 

NEW REVIEW — YEUNG / Self-Management of Depression: A Manual for Mental Health

NEW REVIEW — YEUNG / Self-Management of Depression: A Manual for Mental Health
and Primary Care ProfessionalsYeung, Albert, MD, ScD; Feldman, Greg, PhD; Fava, Maurizio, MD
ISBN: 978-0-521-71008-4, 206 pages, soft cover.

[DOODY'S NOTES]

[REVIEWER'S EXPERT OPINION]
Vincent F Carr, DO, MSA, FACC, FACP(Uniformed Services University of the Health Sciences)

 

**Description**
This book outlines ways that mental health and primary care providers can help
patients be actively involved in their medical care and manage their symptoms.

Managing Violent Patients

Managing Violent Patients - see it on YouTube

A training video for psychiatrists on how to best manage potentially violent patients. It was made by psychiatry residents at the University of Iowa in the spring of 2008.

View Part 1

View Part 2

One of the bright spots in any educator’s career is seeing his students’s own creative and influential productions. Literally, that’s what I am proud to introduce—a professional, very clever, and educational video production dramatizing the principles of what I’ve taught psychiatry residents regarding the management of violent patients. Readers will be able to see the principles in my chapter in the forthcoming book, Introduction to Psychosomatic Medicine.