Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited

firemonkey · May 28, 2019, 7:35pm

ncbi.nlm.nih.gov

Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited.

AA Loch, Frontiers in psychiatry, 2019

Current diagnostic criteria delineate schizophrenia as a discrete entity essentially defined by positive symptoms. However, the role of positive symptoms in psychiatry is being questioned. There is compelling evidence that psychotic manifestations are expressed in the population in a continuum of varying degrees of severity, ranging from normality to full-blown psychosis. In most cases, these phenomena do not persist, but they constitute risk factors for psychiatric disorders in general. Psychotic symptoms are also present in most non-psychotic psychiatric diagnoses, being a marker of severity. Research revealed that hallucinations and delusions appear to have distinct, independent biological underpinnings-in the general population, in psychotic, and in non-psychotic disorders as well. On the other hand, negative symptoms were seen to be far more restricted to schizophrenia, have other underlying pathophysiology than positive symptoms, predict outcome and treatment response in schizophrenia, and start before the first psychotic outbreak. The current work discusses the concept of schizophrenia, suggesting that a greater emphasis should be put on cases where psychotic symptoms emerge in a premorbid subtly increasing negative/cognitive symptoms background. In those cases, psychosis would have a different course and outcome while psychosis occurring in the absence of such background deterioration would be more benign-probably having no, or a milder, underlying degenerative process. This reformulation should better drive psychopathological classification, face positive symptoms as epiphenomenon of the schizophrenia process, and dishevel stigma from schizophrenia and from delusions and hallucinations.

SkinnyMe · May 28, 2019, 7:55pm

Very interesting. Cognitive and negative symptoms are more indicative signs than positive symptoms in sz/sza then.

firemonkey · May 28, 2019, 7:57pm

@SkinnyMe That’s what they say , but are negative symptoms really that exclusive to schizophrenia?

anon9798425 · May 28, 2019, 7:58pm

Severe bipolar can be pretty similar. But then there is also genetic overlap especially between bipolar 1 and sz. Cognitive impairments are even more pathognomic than negative symptoms, unless some new research cited in this paper says otherwise.

SkinnyMe · May 28, 2019, 8:05pm

Yes, not having any motivation and not wanting to do anything, when your mood is good, really is exclusive to sz/sza.

firemonkey · May 28, 2019, 8:10pm

https://psycnet.apa.org/record/2008-12201-001 re negative symptoms and remitted bipolar

ncbi.nlm.nih.gov

Negative symptoms in bipolar disorder and schizophrenia: A psychometric evaluation of the brief negative symptom scale across diagnostic categories.

GP Strauss, M Vertinski, SJ Vogel, EN Ringdahl and DN Allen, Schizophrenia research, Feb 2016

Past studies have demonstrated that the Brief Negative Symptom Scale (BNSS) has excellent psychometric properties in patients with schizophrenia. In the current study, we extended this literature by examining psychometric properties of the BNSS in outpatients diagnosed with bipolar disorder (n=46), outpatients with schizophrenia (n=50), and healthy controls (n=27). Participants completed neuropsychological testing and a clinical interview designed to assess negative, positive, disorganized, mood, and general psychiatric symptoms. Results indicated differences among the 3 groups in the severity of all BNSS items, with SZ and BD scoring higher than CN; however, SZ and BD only differed on blunted affect and alogia items, not anhedonia, avolition, or asociality. BD patients with a history of psychosis did not differ from those without a history of psychosis on negative symptom severity. The BNSS had excellent internal consistency in SZ, BD, and CN groups. Good convergent and discriminant validity was apparent in SZ and BD groups, as indicated by relationships between the BNSS and other clinical rating scales. These findings support the validity of the BNSS in broadly defined serious mental illness populations.

anon9798425 · May 28, 2019, 8:14pm

Very interesting! Thanks for adding this to the discussion!

SkinnyMe · May 28, 2019, 8:14pm

@firemonkey, the people with BD didn’t have blunted affect or alogia but they did have withdrawal and anhedonia which are more signs of depression which people with BD are more likely to have, which would account for their so called “negative symptoms”.

firemonkey · May 28, 2019, 8:33pm

I think we need to be very careful in teasing out ‘negative symptoms’ from ‘depressive symptoms’ . Anhedonia is seen as a negative symptom of schizophrenia so why can it not be seen as a negative symptom of bipolar?

anon9798425 · May 28, 2019, 9:23pm

Most people with BD have often very long euthymic periods that are possible to separate from their affective episodes. If they have continuous cycling, then yes, it would be difficult to separate, but that’s not the norm, and negative symptoms are much more stable than affective symptoms.

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Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited

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