The concept of schizophrenia only covers the 30% poor outcome fraction of a much broader multidimensional psychotic syndrome, yet paradoxically has become the dominant prism through which everything ‘psychotic’ is observed, even affective states with mild psychosis labelled ‘ultra-high risk’ (for schizophrenia). The inability of psychiatry to frame psychosis as multidimensional syndromal variation of largely unpredictable course and outcome – within and between individuals – hampers research and recovery-oriented practice. ‘Psychosis’ remains firmly associated with ‘schizophrenia’, as evidenced by a vigorous stream of high-impact but non-replicable attempts to ‘reverse-engineer’ the hypothesized biological disease entity, using case–control paradigms that cannot distinguish between risk for illness onset and risk for poor outcome. In this paper, the main issues surrounding the concept of schizophrenia are described. We tentatively conclude that with the advent of broad spectrum phenotypes covering autism and addiction in DSM5, the prospect for introducing a psychosis spectrum disorder – and modernizing psychiatry – appears to be within reach.
My mind fluctuates as to whether psychosis applies to me. Whether that indicates inconsistent insight I wouldn’t like to say.
I am on risperdal consta. There are 2 reasons for someone being on this (1)psychosis (2) autistic symptoms.
Whilst I definitely have autistic symptoms they are not recognised so I guess I am on consta because they see a tendency towards psychotic symptoms/thinking.
If psychosis does apply I would say like you it is at the mild end of the spectrum.
The more grey area there is in the diagnosis the harder it is to treat. My dr told me he’s not comfortable with a sza diagnosis even though I have it because, according to him, it’s not well defined. We need clear definitions and associated treatments not something that blurs the lines. I’d rather say I have sz and bp both of which can be treated independently (with caution) than some vague non coherent spectrum
I just hope that there remains a super strong, laser focus
on treating schizophrenia.
I think that already psychosis is an over emphasized facet of schizophrenia, there are problems are with cognitive and negative symptoms of schizophrenia, this as well should be emphasized and not just psychosis.
I feel like this is great news. Researchers have been searching the genome for a decade or more for the causes of “schizophrenia” and the reality is it has led to them coming up short again and again. This change to a spectrum approach could be seen as a realization that the problem is of a different nature genetically, with many different presentations and underlying causes contributing to psychosis. Hopefully the disease feature of psychosis is better understood in the future, as compared to other forms of brain dysfunction it is particularly disabling.