Review cognitive Finally, following the onset of illness, common factors are Ambivalent; likely to underlie the deterioration in brain structure in schizophrenia and cognitive and social function, which can occur in both psychotic mood illnesses [SZ and BP]. A conceptual case can be made for a relationship between schizophrenia and bipolar disorder.
Unfortunately, once a overlap diagnostic concept such as schizophrenia has come into general use, it tends to become reified. That is, people too easily assume that it is an entity of some kind that can be evoked to explain the patients symptoms and whose validity need not be questioned. The term schizophrenia pays homage to disorder our professional predecessors.
Of course many organizations and individuals are invested in the name schizophrenia, e. Schizophrenia and epidemiology, [article title]; Schizophrenic and bipolar disorders are psychotic mood family, and similar in several epidemiologic respects, including age at disorder similar molecular onset, lifetime risk, course of illness, worldwide genetics distribution, risk for suicide, gender influence, and genetic susceptibility. When Continuum; and Sands psychotic differentiating from schizophrenia and schizoaffective schizophrenia and 1. It is proposed that this continuum rests on a genetic base.
Clinical One possible reason for this lack of progress [in discovering Schizophrenia invalid Psychol the etiology of schizophrenia] is that schizophrenia is not a valid object of scientific enquiry. Data from published research [mainly carried out by distinguished psychia- trists] are reviewed casting doubt on: i the reliability, ii the construct validity, iii the predictive validity, and iv the aetiological specificity of the schizophrenia diagnosis.
In the area of psychotic phenomena such as overlap delusions, hallucinations and passivity phenomena, the overlap is almost complete. There are no known pathogno- response monic symptoms for schizophrenia, nor even any cluster of symptoms, to be valid in diagnosing schizophrenia. The non-specificity of schizophrenic symptoms brings 1. Review symptoms, many patients whose conditions are diagnosed as Paranoid schizophrenia psychotic paranoid schizophrenia actually suffer from an affective same as psychotic Overview.
Review symptoms, family studies do not validate good prognosis schizo- Schizophrenia and Introduction. Doran et al. He wrote that chronic mania insanity similar was not at all a rare occurrence. He believed that once chronic mania took hold, there was no return to normal and that with advancing age, the condition worsened. Upon reviewing the ancient literature through the twentieth century, Goodwin and Jamison , make clear that psychosis and chronicity are consistent with a bipolar disorder diagnosis. Many physicians from different coun- tries through the centuries recorded observations that such bipolar patients could be psychotic and sustain a downhill, cognitively impaired course leading to dementia.
Dementia implies an absence of continued cycling, chronic cognitive decline, and permanent dysfunctionality, a course and prognosis that, in the mid-to-late s, Morel and then Kraepelin, Bleuler, and others reassigned to a new disease. In the mid-nineteenth century, despite knowledge at that time and earlier that classic bipolar patients could become psychotic and develop a chronically impaired course, dementia praecox or schizophrenia was named to account for young psychotic patients who incurred severe intellectual deterioration. Because such patients were relatively young and suffered cognitive decline superficially akin to dementia of old age, the disease was first called dementia praecox Morel The key to improvement is effective treatment, and the key to correct treatment is an accurate diagnosis.
Such patients, their families, and their caretakers suffer significant disadvantages from the misdiagnosis of schizophrenia. Psychotic mood-disordered patients misdiagnosed with schizophrenia receive substandard care regarding their medications, thus allowing their mood conditions to worsen. Other adverse effects are substantial and are detailed in Chap. These include stigma, hopelessness, and an increased risk for suicide due to a lack of recognition and treat- ment for depression. There is liability for medical malpractice for the mental health professionals who make the majority of the diagnoses of schizophrenia.
The impact to the taxpayers of the cost of schizophrenia specifically is significant. According to Wu et al. An understanding of basic terms such as insanity, psychosis, dementia, dementia praecox, schizophrenia, manic-depressive insanity, bipolar disorder, and the Kraepelinian dichotomy is important before their discussions. Chapter 3 details the history of the diagnoses of psychotic patients from BCE until The idea that one disease caused psychosis was common until between and when two diseases, dementia praecox and manic-depressive insan- ity, were cited to explain the functional psychoses.
The discovery of the infectious cause of general paresis of the insane supported the acceptance of schizophrenia as a bona fide disease. Since no psychiatric disorder has a recognizable pathophysiology, Chap. Extensive direct quotations of their descriptions of some of their patients from their most respected books are reproduced, allowing an understanding of how they reached their ideas and beliefs.
A review of their original publications shows that signs and symptoms that today are considered indicative of a psychotic mood disorder were often thought diagnostic of schizophrenia by these early authors. The contribution of Kasanin was bold for its rejection of established Bleulerian tradition. Often the theories and ideas that these highly influential Psychiatrists became famous for are in conflict with some of what they wrote at other times Table 1. For example, world psychiatry and especially academic psychiatry promoted the Kraepelinian dichotomy, but ignored the publication of Kraepelins later reversal of his opinion that schizophrenia and manic-depressive insanity were so different Table 1.
Chapter 5 focuses on the writings of Emil Kraepelin and his contri- butions to modern psychiatry. Kraepelin was a prolific writer, and the volumes of his work that consisted of multiple editions were published over decades from the late nineteenth century well into the twentieth century. Mid career, Kraepelin believed dementia praecox or schizophrenia was distinct from manic-depressive insanity or bipolar disorder based on course and prognosis.
His Kraepelinian dichotomy became a cornerstone of psychiatry. The validity of schizophrenia as a bona fide disease has been sustained by the acceptance of the Kraepelinian dichotomy. Ignored until relatively recently was Kraepelins later reversal in , from his initial opinion to his belief that there was considerable overlap between schizophrenia and bipolar disorder Table 1. Chapter 6 reviews the contributions and influence of Eugene Bleuler Bleulers famous textbook titled Dementia Praecox or the Group of Schizophrenias may have had more influence upon academic psychiatry, especially in the USA, than any other single work with the exception of the DSMs which have been heavily influenced by Bleulers ideas.
Extensive quotations from his case descriptions are given. Many academic departments of psychiatry through the s required the study of his textbook. Bleuler Dementia Praecox 1 SZ defined by hallucinations Manic and depressive moods may occur in all psychoses: Academic psychiatry by means or the Group of and delusions, 2 psychosis flight of ideas, inhibition and hallucinations and of the DSM has erroneously Schizophrenias nor chronicity necessary for delusions, are partial phenomena of the most varied considered functional SZ, 3 four SZ subtypes: diseases.
Their presence is often helpful in making the hallucinations, delusions, catatonia, disorganized, diagnosis of a psychosis, but not in diagnosing the paranoia, disorganization, paranoid, and added simple presence of schizophrenia. As far as the true schizo- and catatonia as disease later dropped , and 4 no phrenic symptoms have been described up to the present specific and diagnostic for restituto ad integrum.
Kasanin AJP Schizoaffective disorder. Published a paper titled, The Acute Schizoaffective Psychoses. Broke with Bleulers dogma and Concluded that psychotic patients with symptoms of mood enabled the exploration of disturbances, a brief psychotic course with full remission and similarities and overlap productivity did not have SZ. Unwilling to diagnose them between patients diagnosed with psychotic mood disorders, he used schizoaffective with SZ and psychotic mood psychoses AJP 13, pp.
Schneider Clin Psychopathol The first-rank symptoms FRS Schneider divided the functional psychoses into cyclothymia Schneider was mistaken as his are pathognomonic of SZ, and schizophrenia, suggesting that there could be no FRS are not disease specific irrespective of course. Schneiders second-rank but readily explained by symptoms include perplexity, depressed and elated psychotic mood disorders moods, experiences of flattened feeling and so on.
If only that he apparently did not symptoms of this order are present, diagnosis will have to recognize. His second-rank depend wholly on the coherence of the total clinical symptoms of SZ appear to picture. Symptoms of first-rank importance do not include mood-disordered 1. Not explicitly clear in Bleulers definition of schizophrenia is the fact that his diagnosis of schizophrenia was not limited to psychotic patients or to those who had a deteriorating course.
Rather, his diagnostic criteria were so broad as to encompass subjects with eccentric, idiosyncratic, or odd behavior who did not develop psychotic or cognitive deterioration. Undoubtedly, as a result of this overbroad conceptualization, there were patients who were misdiagnosed and treated for schizophrenia whose eccentricities may have fallen within a range of normal limits as suggested by Szasz, Bentall, van Os, and others Szasz ; Bentall et al. Remnants of his fundamental symptoms have been retained in the negative symptoms still considered by many as diagnostic of schizophrenia APA, DSM Catatonia, disorganization, and paranoid hallucinations and delusions became and continue as the essential subtypes as well as the core diagnostic symptoms of schizophrenia.
He supported the Kraepelinian dichotomy and minimized the role of mood disorders. The influence of Jacob Kasanin is discussed in Chap. Just as Kraepelins reversal was largely ignored, so was Kasanins publication in that recognized that Bleuler was wrong in his belief that psychosis dictated the diagnosis of schizophrenia. Kasanin did not diagnose these patients with schizophrenia or with a psychotic mood disorder. Today, his patients likely would have received the diagnosis of a psychotic mood disorder. Rather, he compromised with the creation of a new diag- nosis, acute schizoaffective psychosis, that became schizoaffective disorder.
This diagnosis linked schizophrenia and bipolar disorder, initiating a merger that would take some 80 years to close. Although this author believes the diagnosis of schizoaf- fective disorder has been a disservice to patients, Kasanins break with Bleuler enabled doubt about the validity of schizophrenia as different from psychotic mood disorders. For this brave step, Kasanin deserves considerable credit. The reasons that these two diagnoses, schizophrenia and schizoaffective disorder, are detrimen- tal to patients is discussed in Chaps.
Schneider reinforced the beliefs of Bleuler that psy- choses, especially auditory hallucinations, were pathognomonic of schizophrenia. It is troubling that some of his first-rank symptoms, when present, still mandate a diagnosis of schizophrenia according to our current DSM, despite having been described in psychotic mood-disordered patients. His second-rank symptoms of schizophrenia are revealing of his broad concept of schizophrenia. Belief in the Kraepelinian dichotomy was bolstered by Schneider by default since he, as Bleuler, minimized the role of mood disorders and emphasized schizophrenia as a separate disease.
Several critical occurrences in the s and s that solidified the belief that schizophrenia was defined by psychosis and chronicity and indeed was a valid dis- ease are highlighted in Chap. The first DSM was published in and codified schizophrenia as a valid disease. Chlorpromazine Thorazine and ECT were discovered effective in psychotic patients who were diagnosed with schizo- phrenia.
The devastation attributed to the disease called schizophrenia stimulated publicity and major efforts by pharmaceutical, private, and federal government funding sources and psychopharmacologists to understand and cure it. The use of lithium in bipolar disorder was inhibited due to its reputation as dangerous. Physicians tended to diagnose the disorder for which there was treatment, that is, schizophrenia. The consistency of the diagnostic descriptions and criteria of schizo- phrenia and major mood disorders are traced through seven DSM editions.
The decades of the s and s are marked by a growing doubt by some psychiatrists about the disease specificity of the DSM diagnostic criteria of schizo- phrenia.
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Chapter 10 reviews this literature, primarily from the UK and the USA, that reflected recognition of the clinical overlap between the diseases called schizophre- nia and severe bipolar disorders Table Comparative clinical data questioned the concept that psychosis and chronicity were unique to schizophrenia because these same symptoms and chronicity were documented in psychotic bipolar and unipolar disorders.
The idea that chronic, psychotic mood disorders do occur was still a minority view, and the authors of such publications must have struggled for acceptance Tables 1. For example, psychotic bipolar patients were reported to suffer bizarre, mood-incongruent hallucinations and paranoid delusions, gross disorganization, catatonia, the negative symptoms during depression , cog- nitive impairment, and chronic, deteriorating, treatment-resistant courses Kendell and Gourlay a, b; Lipkin et al. Such bipolar patients can become persistently dysfunctional, complicating accurate diagnosis because psychotic symptoms can obscure mood symptoms that may not be aggressively pursued in psychotic presentations Carlson and Goodwin ; Post Based on the lessons of Bleuler and Schneider, mood symptoms were either ignored or dismissed in the presence of psychotic symptoms and psychotic patients usually continued to receive the diagnosis of schizophrenia through the s, s, and well into the s.
In this authors judgment, these data are not at all representative of diagnostic ratios among mental health professionals in general. As indicated in Fig. The importance of the comparative literature from the s, s, and s Chap. Such data come from neurochemical, neuroimaging, neuropsychological insight, sen- sory gating, cognitive impairment , neurodevelopmental, psychopharmacological, epidemiological, and genetic disciplines Tables Molecular genetic studies show several susceptibility loci common to both disorders. These data caused further skepticism about differences between the two.
Acknowledging blurred zones of rarity between bipolar disorder, schizoaf- fective disorder, and schizophrenia, Professor Tim Crow and others have proposed the continuum theory stating that the propensity for psychosis is heritable, irre- spective of diagnosis. The continuum theory is consistent with the one-disease hypothesis since the full spectrum of severity and chronicity can be explained by psychotic bipolar disorders. Schizophrenia and bipolar disorder were thought to breed true for decades, indicating two different diseases. However, the recent data suggest that psychosis breeds true, irrespective of diagnosis, that is, that psychotic bipolar disorder and nonpsychotic classic bipolar disorder tend to breed true.
This understanding can resolve the conflict with the older family studies when the psychotic bipolar patients are assumed to have been misdiagnosed with schizophrenia. It is the psychosis that is heritable. In , data from a large Swedish heritability study now reveal that there is considerable overlap of the two diagnoses schizophrenia and bipolar disorder in the same families, suggesting one disease and some overlap of heritability of psychotic and nonpsychotic mood-disordered patients Lichtenstein et al.
Chapter 12 reveals how the current core subtypes of schizophrenia paranoid, catatonic, and disorganized as well as the negative symptoms alogia, avolition, flat affect are accounted for by psychotic mood disorders. The subtypes, the posi- tive and the negative symptoms of schizophrenia are synonymous with the DSM diagnostic criteria for schizophrenia. The absence of meaningful change of the sub- types, negative symptoms, and diagnostic criteria for schizophrenia for decades if not a century, despite the growing recognition of overlap with psychotic mood dis- orders, shows the lasting impact of Kraepelin, Bleuler, and Schneider.
Since , changes to the DSM diagnostic criteria for schizophrenia have been trivial. These subtypes of schizophrenia that have defined schizophrenia for a century there could be no schizophrenia without its subtypes may be eliminated from the DSM-5, due to be published in Presumably, this is because of some doubts as to their validity. Eliminating the subtypes does not solve the problem of overlap of diagnostic symptoms of schizophrenia with psychotic mood disorders because the positive symptoms of the diagnostic criteria of schizophrenia are synonymous to the subtypes.
The same diagnostic criteria will be retained to diagnose schizophrenia Tables 2. If the subtypes are to be dropped, what about the identical criterion A diagnostic criteria? Chapter 13 documents that psychotic mood disorders are disorders of thought as well as of mood, making schizophrenia redundant.
In Chap. Examples are legal and illegal drugs as well as many medical and surgical disorders. Some of these, such as a previous use of phencyclidine PCP and the concept of tardive psychosis, account for some cases of misdiagnoses of schizophrenia. The negative impact of a misdiagnosis of schizophrenia on patients, relatives, caretakers, and society in general is large Chap.
Many in the mental health field, physicians and scientists as well as the public and the media are certainly skeptical of any question as to the validity of schizophre- nia. Chapter 16 explores explanations for the continued acceptance of schizophre- nia. Schizophrenia remains the most widely known and feared mental health disease worldwide. This is documented by the hundreds of millions of dollars, if not more, devoted to research and drug development for schizophrenia by government and the pharmaceutical industries.
There are hundreds, if not thousands, of articles and books published, lectures, talks, seminars given, and con- ferences held that focus on schizophrenia. There are at least three international psy- chiatric journals with schizophrenia in the journal name. Schizophrenia is often the diagnosis presumed in the media in high-profile murder cases perpetrated under bizarre circumstances such as the John Hinckley and Andrea Yates cases, the West Virginia and Tucson shooters, and the case of Willie, as reported on Anderson Cooper degrees.
Schizophrenia is often the featured psychiatric condition of psychotic characters in movies and television. Chapter 17 suggests some strategies for patients and families when there is a diagnosis of schizophrenia. Chapter 18 offers ideas for shifting the concepts of the Kraepelinian dichotomy, schizophrenia, and schizoaffective disorder from diagnos- tic to historical relevance and focusing more time helping medical students learn to recognize depression and a risk for suicide.
The primary driving force behind this work has been the motivation to provide the best psychiatric care for patients who suffer from psychotic episodes; a misdiagno- sis of schizophrenia is an extremely heavy burden. The strategy has been to docu- ment, collate, and interpret data suggesting similarities from a variety of scientific disciplines to justify approaching the elimination of the diagnosis of schizophrenia from the nomenclature, hopefully for the benefit of patients, their families, the phy- sicians who treat them, the mental health professions, and the public in general.
This author is now convinced that patients diagnosed with schizophrenia are misdi- agnosed and that the vast majority suffer from a psychotic mood disorder and the rest, with an absence of mood symptoms, from subtle, unrecognized, organic etiolo- gies. However, readers must judge for themselves whether there are two diseases, that is, the Kraepelinian dichotomy, a continuum or only a single disease.
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The author has not conducted research with comparative studies but has reviewed the research literature by others relevant to this subject. Advances in molecular genetic linkage and association studies, identifying con- tributions of allele variants to phenotypic outcome, will eventually link DNA sequence polymorphisms to specific diagnostic behaviors and resolve this question. Yet, the data currently available, especially overlap from comparative clinical, molecular genetic, and cognitive decline studies, warrant extending the hypothesis that there is no dichotomy and that schizophrenia is the same disease as a psychotic mood disorder.
If schizophrenia and psychotic mood disorders are in fact different, then one would not expect to find the similarities and overlap reviewed from a broad literature and presented in this book. A touch of schizophrenia psychosis is schizophrenia must evolve to A touch of a mood disturbance in psychotic patients is a psychotic mood disorder Figs.
The beginning of the end of the Kraepelinian dichotomy has already been predicted by Craddock and Owen No dichotomy, a continuum, and overlap suggest a single disorder. This would be a mood disorder, not schizophrenia, because bipolar disorder is scientifically grounded with very specific and unique diagnostic symptoms; schizophrenia has no such grounding because its diagnostic criteria are disease nonspecific and explained by psychotic mood disorders Chap.
In general, mood disorders and risk for suicide are not effectively treated because they are inadequately recognized; psychotic mania and depression are too often misdiagnosed as schizophrenia Lake c, d; Lake and Baumer Substantial time and money now invested in schizophrenia might be more productively redi- rected to research on the causes, recognition, treatment, and prevention of severe mood disorders and suicide as well as the development of new mood-stabilizing medications. Such a change can be fostered by increased academic focus on mood disorders. The validity of two basic psychiatric concepts is questioned in this discussion: 1 the equation of functional psychosis with a single disease, schizophrenia and 2 the persistent idea that schizophrenia and bipolar are different diseases Chap.
The concept put forward in this work, if accurate, will have a discipline-altering impact. Chapter 2 The Basic Data. Psychosis is prevalent in bipolar disorder. When differentiating from schizophrenia and schizoaffective disorder, presenting signs and symptoms are usually not helpful.
Dieperink and Sands the validity of the diagnostic distinction between schizophrenia and bipolar disorder is increasingly challenged. Maier et al. Definitions and explanations of the terms and diseases referred to in this book are derived from various sources including the American Psychiatric Associations APA current DSM and the American Psychiatric Glossary as well as Wikipedia and other sources.
Examples include the definitions of the functional or primary versus the organic or secondary psychoses, insanity, dementia, dementia praecox, schizophrenia, manic-depressive insanity, bipolar disorder, major depressive disor- der, and the Kraepelinian dichotomy.
According to Wikipedia ,. Although dementia is far more com- mon in the geriatric population, it may occur in any stage of adulthood. Dementia is a non-specific illness syndrome set of signs and symptoms in which affected areas of cogni- tion may be memory, attention, language, and problem solving. It is normally required to be present for at least 6 months to be diagnosed; In all types of general cognitive dysfunction, higher mental functions are affected first in the process.
Especially in the later stages of the condition, affected persons may be disoriented in time not knowing what day of the week, day of the month, or even what year it is , in place not knowing where they are , and in person not knowing who they are or others around them. Dementia, , is usually due to causes that are progressive and incurable. Wikipedia According to the APAs Psychiatric Glossary , dementia is A cognitive disorder characterized by deficits in memory, aphasia, apraxia, agnosia, and deficits in executive functioning.
The concept of dementia as it is known today evolved during the twentieth cen- tury. Prior to the early s, dementia was broadly defined as mental dysfunction- ality. The terms madness, dementia, insanity, and psychosis might have been used interchangeably before and even into the early years of the twentieth century. Dementia praecox or dementia of the young a precursor to what was later labeled as schizophrenia was initially confused with dementia of old age.
Psychosis is the modern term for insanity. According to the American Psychiatric Glossary, eighth edition , psychosis is defined by, A severe mental disorder characterized by gross impairment in reality testing, typically manifested by delusions, hallucinations, disorganized speech, or disorganized or catatonic behavior. Note that this definition of a primary or functional psychosis is identical to the DSM core diagnostic symptoms of schizophrenia Chap.
Their ideas are described in detail in Chaps. A state of psychosis is often characterized by aggressive behavior, inappropriate mood, diminished impulse control, and delusions and hallucinations. Aggressive behavior and diminished impulse control are characteristics of psy- chotic mania and inconsistent with avolition attributed to schizophrenia and major depression.
The psychotic behaviors of several murderers over the past decades have been consistent with manic episodes but have been called schizophrenia Chap.
Diagnostic and Statistical Manual of Mental Disorders - Wikipedia
Table 2. The disorder must be suf- ficiently severe as to grossly interfere with the individuals capacity to meet the ordinary demands of life. The psychoses can be artificially divided into two major subtypes: 1 primary or functional and 2 secondary or organic Table 2. This work will focus primarily on the functional psychoses because it is this subtype that includes schizophrenia and psychotic mood disorders. However, to date, no clinically reliable pathophysiology has been discovered for any psychiatric disorder despite massive efforts. The possibly misdiagnoses include bipolar disorder, major depression, schizoaffective disorder, and schizo- phrenia Chap.
There are substantial negative con- sequences of such misdiagnoses Chap. The DSM is the most widely accepted authority on classifications and definitions of mental disorders. The most recent edition, the DSM-IV-Text Revision DSM- IV-TR , lists five diagnoses with potential for functional psychosis: 1 mood disorders, 2 schizophrenia, 3 schizoaffective disorder, 4 delusional disorders, and 5 psychotic disorders not otherwise specified Table 2. The latter two diagnoses have been included relatively recently in contrast to the first three disorders that date to the first century, the nineteenth century, and , respectively Chap.
The delusional disorders are a relatively rare group of disor- ders, characterized by a focused rather than generalized dysfunctionality APA, DSM These patients display various nonbizarre delusions of paranoia, such as having an imaginary illness, of being loved by another at a distance, of the replacement of a significant other, etc. The relevance of the delusional disorders to the present work is that they may account for a small percent of patients misdiag- nosed with schizophrenia, especially paranoid schizophrenia.
The erotomanic type of delusional disorder involves the delusion that another person, typically of a higher social and economic status, is in love with the individual. Such grandiosity also fulfills one of the criteria for mania and thus indicates a consideration of a diag- nosis of bipolar disorder. However, to qualify for a diagnosis of bipolar disorder, the other DSM diagnostic criteria must be present Tables 2.
This label is sometimes used in forensic psychiatry with the goal of avoiding a specific diagnosis; it is not recommended and should not be used as a permanent diagnosis but may be appropriate for a brief period while a more definitive diagnosis is sought.
Manic-depressive insanity was the early name for bipolar disorder, and the two are synonymous. That insanity was used for bipolar patients for centuries suggests that such patients are capable of exhibiting psychosis. The mood disorders, also previously called affective disorders, are common and have been subdivided into bipolar and unipolar Table 2.
When only hypomanic episodes occur and not full blown mania, bipolar-II is the diagnosis, while bipolar-I requires a full manic epi- sode. The depressions that can occur in both bipolar-I and bipolar-II disorders, as well as in recurrent unipolar or major depressive disorder, are indistinguishable with regard to severity, signs, symptoms, psychosis, and risk for suicide. Distinct period for at least 1 week or inpatient hospitalization necessary of abnormal and persistently elevated, expansive, or irritable mood B.
In the period, three symptoms four if mood is only irritable persist to a significant degree: 1. Distractibility 2. Insomnia with increased energy 3. Flight of ideas 5.
Schizophrenia Is a Misdiagnosis: Implications for the DSM-5 and the ICD-11
Increased activities: including phoning, spending, travel, investing, gambling, sex; excessive involvement in pleasurable activities with high potential for negative outcome 6. Speech: pressed to incoherenta 7. Thoughts: racing, loose, tangentiala C. Symptoms cause marked impairment in functioninga job, social, family or hospitalizationa warranted because of severity of symptoms D. Symptoms not due to substance or general medical condition Note: See Table 2. Severity: mild, moderate, severe without, severe with psychotic features,a partial, full remission C. Although psychotic mood disorders are called primary or functional, which means that no consistent pathophysiology has been identified, data from patients with bipolar disorder, such as that from genetic studies, show differences between patients diagnosed with bipolar disorder and a nonaffected population; the limitation is that the specific brain pathophysiology remains elusive.
Heritability and molecu- lar genetic evidence substantiating bipolar as a bona fide disease is discussed in Chaps. Another definition is found in Wikipedia : Bipolar Disorder and Manic-Depressive Disorder [or originally manic-depressive insanity], which is also referred to as Bipolar Affective Disorder or Manic Depression, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy level, cognition, and mood with or without one or more depressive episodes.
The elevated moods are clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experi- ence depressive episodes, or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. These episodes are usually separated by peri- ods of normal mood; but, in some individuals, depression and mania may rapidly alter- nate, which is known as rapid cycling. Extreme manic episodes can sometimes lead to such psychotic symptoms as delusions and hallucinations.
The disorder has been subdivided into Bipolar I, Bipolar II, cyclothymia, and other types, based on the nature and severity of mood episodes experienced; the range is often described as the bipolar spectrum. Bipolar-III is designated for patients with episodes of mania or hypomania that occur only after use of an antidepressant. Diagnosis is based on the persons self-reported experiences, as well as observed behavior. Episodes of abnormality are associ- ated with distress and disruption and an elevated risk of suicide, especially during depressive episodes. In some cases, it can be a devastating long-lasting disorder.
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In others, it has also been associated with creativity, goal striving, and positive achievements. There is significant evidence to suggest that many people with creative talents have also suffered from some form of Bipolar Disorder. People with Bipolar Disorder exhibiting psychotic symptoms can sometimes be misdiagnosed as having Schizophrenia, another serious mental illness. As a general reference, this Wikipedia description of the signs and symptoms of the bipolar disorders is accurate and reasonably comprehensive.
Emil Kraepelin in his textbook defined dementia praecox as a series of clinical states which have as their common characteristic a peculiar destruc- tion of the internal connections of the psychic personality with the most marked damage of the emotional life and of volition. Kraepelin wrote that a chronic, downhill course of intellectual or cognitive dete- rioration was the defining common feature to all of the subtypes and thus to dementia praecox overall.
The goal is to document and interpret these data to justify eliminating the diagnosis of schizophrenia from the nomenclature. The author reviews the changing diagnostic concepts of schizophrenia and bipolar disorder with a historical perspective to clarify how the current conflict over explanations for psychosis has arisen.
That two disorders, schizophrenia and bipolar, known as the Kraepelinian dichotomy, account for the functional psychoses has been a cornerstone of Psychiatry for over years, but is questioned because of substantial similarities and overlap between these two disorders. Literature in the field demonstrates that psychotic patients are frequently misdiagnosed as suffering from the disease called schizophrenia when they suffer from a psychotic mood disorder. Such patients, their families, and their caretakers suffer significant disadvantages from the misdiagnosis. Psychotic patients misdiagnosed with schizophrenia receive substandard care regarding their medications, thus allowing their bipolar conditions to worsen.
Other adverse effects are substantial and will be included. Liability for medical malpractice is of critical importance for the mental health professionals who make the majority of the diagnoses of schizophrenia. The author reviews the changing diagnostic concepts of schizophrenia and bipolar disorder with a historical perspective to clarify how the current conflict over explanations for psychosis has arisen.
That two disorders, schizophrenia and bipolar, known as the Kraepelinian dichotomy, account for the functional psychoses has been a cornerstone of Psychiatry for over years, but is questioned because of substantial similarities and overlap between these two disorders. Literature in the field demonstrates that psychotic patients are frequently misdiagnosed as suffering from the disease called schizophrenia when they suffer from a psychotic mood disorder.
Such patients, their families, and their caretakers suffer significant disadvantages from the misdiagnosis. Psychotic patients misdiagnosed with schizophrenia receive substandard care regarding their medications, thus allowing their bipolar conditions to worsen. Other adverse effects are substantial and will be included.