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Schizophrenia

  • Wendy N. Tenhula
  • Jason Peer
Chapter

Abstract

Schizophrenia is a complex, heterogeneous disorder that is often confusing and frightening not only for the individual who experiences it, but also for family members, health providers, and others that he or she encounters in day-to-day life. Diagnosis of schizophrenia poses many challenges but an accurate diagnosis is critical to the provision of appropriate information and treatment recommendations to individuals and their family members. Unlike most disorders in medicine, the symptoms of schizophrenia cannot be linked to a specific pathophysiological mechanism, and must be assessed solely on the basis of observations, verbal reports, and inferences. Thus, self-report is central to making a diagnosis. However, for various reasons, individuals with schizophrenia may either be reluctant or have considerable difficulty describing their experiences. This may be due to the direct effects of symptoms but can also be compounded by poor insight and cognitive impairment. Additionally, high rates of substance use, mood symptoms, and traumatic experiences in this population can complicate self-reporting and the differentiation of schizophrenia symptoms from these other factors. In this chapter, we will describe these challenges in more detail and offer strategies to address them in the context of clinical and diagnostic interviews.

Keywords

Mood Disorder Negative Symptom Psychotic Symptom Diagnostic Interview Positive Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Aleman, A., Kahn, R. S., & Selten, J. P. (2003). Sex differences in the risk of schizophrenia: Evidence from meta-analysis. Archives of General Psychiatry, 60, 565–571.CrossRefPubMedGoogle Scholar
  2. Amador, X., Strauss, D., Yale, S., & Gorman, J. M. (1991). Awareness of illness in schizophrenia. Schizophrenia Bulletin, 17, 113–132.PubMedGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.Google Scholar
  4. Andreasen, N. C. (1982). Negative symptoms in schizophrenia: Definition and reliability. Archives of General Psychiatry, 39, 784–788.PubMedGoogle Scholar
  5. Andreasen, N. C. (1983). The scale for the assessment of negative symptoms (SANS). Iowa City: University of Iowa.Google Scholar
  6. Andreasen, N. C. (1984). The scale for the assessment of positive symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
  7. Bellack, A. S., Morrison, R. L., Wixted, J. T., & Mueser, K. T. (1990). An analysis of social competence in schizophrenia. British Journal of Psychiatry, 156, 809–818.CrossRefPubMedGoogle Scholar
  8. Bennett, M. E., & Barnett, B. (2003). Dual diagnosis. In M. Hersen & S. M. Turner (Eds.), Adult psychopathology and diagnosis (4th ed., pp. 36–71). Hoboken, NJ: Wiley.Google Scholar
  9. Blanchard, J. J., Brown, S. A., Horan, W. P., & Sherwood, A. (2000). Substance use disorders in schizophrenia: Review, integration and a proposed model. Clinical Psychology Review, 20, 207–234.CrossRefPubMedGoogle Scholar
  10. Bleuler, M. (1972). The schizophrenic disorders. New Haven, CT: Yale University Press.Google Scholar
  11. Cannon, T. D., Jones, P. B., & Murray, R. M. (2002). Obstetrical complications and schizophrenia: Historical and meta-analytic review. American Journal of Psychiatry, 159, 1080–1092.CrossRefPubMedGoogle Scholar
  12. Cannon, T. D., Kaprio, J., Lonnqvist, J., Huttunen, M., & Koskenvuo, M. (1998). The genetic epidemiology of schizophrenia in a Finnish twin cohort: A population-based modeling study. Archives of General Psychiatry, 55, 67–74.CrossRefPubMedGoogle Scholar
  13. Carpenter, W. T., & Strauss, J. S. (1991). The prediction of outcome in schizophrenia: IV. Eleven year follow-up of the Washington IPSS cohort. Journal of Nervous and Mental Disease, 179, 517–525.CrossRefPubMedGoogle Scholar
  14. Ciompi, L. (1980). Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophrenia Bulletin, 6, 606–618.PubMedGoogle Scholar
  15. Cook, J. A., & Razzano, L. (2000). Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice. Schizophrenia Bulletin, 26, 87–103.PubMedGoogle Scholar
  16. David, A. S. (1990). Insight and psychosis. British Journal of Psychiatry, 156, 798–808.CrossRefPubMedGoogle Scholar
  17. Dickerson, F. (1997). Assessing clinical outcomes: The community functioning of persons with serious mental illness. Psychiatric Services, 48, 897–902.PubMedGoogle Scholar
  18. Dickinson, D., Ramsey, M. E., & Gold, J. M. (2007). Overlooking the obvious: A meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry, 64, 532–542.CrossRefPubMedGoogle Scholar
  19. Dixon, L. (1999). Dual diagnosis of substance abuse in schizophrenia: Prevalence and impact on outcomes. Schizophrenia Research, 35, S93-S100.CrossRefPubMedGoogle Scholar
  20. First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (2002). Users guide for the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (research version). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  21. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  22. Geddes, J. R., & Lawrie, S. M. (1995). Obstetric complications and schizophrenia: A meta-analysis. British Journal of Psychiatry, 167, 786–793.CrossRefPubMedGoogle Scholar
  23. Hampton, M. D. (2007). The role of treatment setting and high acuity in the overdiagnosis of schizophrenia in African Americans. Archives of Psychiatric Nursing, 21(6), 327–335.CrossRefGoogle Scholar
  24. Harding, C. M. (1988). Course types in schizophrenia: An analysis of European and American studies. Schizophrenia Bulletin, 14, 633–642.PubMedGoogle Scholar
  25. Heinrichs, D. W., Cohen, B. P., & Carpenter, W. T. (1985). Early insight and the management of schizophrenic decompensation. Journal of Nervous and Mental Disease, 173, 133–138.CrossRefPubMedGoogle Scholar
  26. Heinrichs, R. W., & Zakzanis, K. K. (1998). Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12, 426–445.CrossRefPubMedGoogle Scholar
  27. Hill, S. K., Schuepbach, D., Herbener, E. S., Keshavan, M. S., & Sweeney, J. A. (2004). Pretreatment and longitudinal studies of neuropsychological deficits in antipsychotic-naïve patients with schizophrenia. Schizophrenia Research, 68, 49–63.CrossRefPubMedGoogle Scholar
  28. Johnson, J., Herwath, E., & Weissman, M. M. (1991). The validity of major depression with psychotic features based on a community study. Archives of General Psychiatry, 48, 1075–1081.PubMedGoogle Scholar
  29. Jones, P., Rodgers, B., Murray, R., & Marmot, M. (1994). Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet, 344, 1398–1402.Google Scholar
  30. Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.PubMedGoogle Scholar
  31. Kay, S. R., & Sevy, S. (1990). Pyramidical model of schizophrenia. Schizophrenia Bulletin, 12, 261–276.Google Scholar
  32. Keshavan, M. S., Diwadkar, V. A., Montrose, D. M., Rajarethinam, R., & Sweeney, J. A. (2005). Premorbid indicators and risk for schizophrenia: A selective review and update. Schizophrenia Research, 79, 45–57.CrossRefPubMedGoogle Scholar
  33. Kraeplin, E. (1904). Lectures on clinical psychiatry. New York, NY: William Wood & Co.CrossRefGoogle Scholar
  34. Lawson, W. B. (2008). Schizophrenia in African Americans. In K. Mueser & D. Jeste (Eds.), Clinical handbook of schizophrenia. New York: Guilford (pp. 616–673).Google Scholar
  35. Li, D., & He, L. (2007). Association study between the dystrobrevin binding protein I gene (DTNBP1) and schizophrenia: A meta-analysis. Schizophrenia Research, 96, 112–118.CrossRefPubMedGoogle Scholar
  36. Liddle, P. F. (1987). The symptoms of chronic schizophrenia: A re-examination of the positive-negative dichotomy. British Journal of Psychiatry, 151, 145–151.CrossRefPubMedGoogle Scholar
  37. Lukoff, D., Liberman, R. P., & Nuechterlein, K. (1986). Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin, 12, 578–593.PubMedGoogle Scholar
  38. Lysaker, P., Bell, M., Milstein, R., Bryson, G., & Beam-Goulet, J. (1994). Insight and psychosocial treatment compliance in schizophrenia. Psychiatry, 57, 307–315.PubMedGoogle Scholar
  39. Marwaha, S., & Johnson, M. (2004). Schizophrenia and employment: A review. Social Psychiatry and Psychiatric Epidemiology, 39, 337–349.CrossRefPubMedGoogle Scholar
  40. McEvoy, J., Apperson, J., Appelbaum, P., Ortlip, P., Brecosky, J., Hammil, K., et al. (1989). Insight in schizophrenia. Its relationship to acute psychopathology. Journal of Nervous and Mental Disease, 177, 43–47.CrossRefPubMedGoogle Scholar
  41. McGlashan, T. (1998). The profiles of clinical deterioration in schizophrenia. Journal of Psychiatric Research, 32, 133–141.CrossRefPubMedGoogle Scholar
  42. McGrath, J. J., & Welham, J. L. (1999). Season of birth and schizophrenia: A systematic review and meta-analysis of data from the southern hemisphere. Schizophrenia Research, 35, 237–242.CrossRefPubMedGoogle Scholar
  43. Mednick, S. A., Machon, R. A., Huttunen, M. O., & Bonnet, D. (1988). Adult schizophrenia following exposure to an influenza epidemic. Archives of General Psychiatry, 45, 189–192.PubMedGoogle Scholar
  44. Moore, T. H. M., Zammit, S., Lingford-Hughes, A., Barnes, T. R. E., Jones, P. B., Burke, M., et al. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet, 370, 319–328.CrossRefPubMedGoogle Scholar
  45. Mueser, K. T., Bellack, A. S., Douglas, M. S., & Morrison, R. L. (1991). Prevalence and stability of social skills deficits in schizophrenia. Schizophrenia Research, 5, 167–176.CrossRefPubMedGoogle Scholar
  46. Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, C., Vidaver, R., et al. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66, 493–499.CrossRefPubMedGoogle Scholar
  47. Mueser, K. T., Yarnold, P. R., Levinson, D. F., Singh, H., Bellack, A. S., Kee, K., et al. (1990). Prevalence of substance abuse in schizophrenia: Demographic and clinical correlates. Schizophrenia Bulletin, 16, 31–56.PubMedGoogle Scholar
  48. Norman, R. M. G., & Malla, A. K. (1993). Stressful life events and schizophrenia I: A review of the research. British Journal of Psychiatry, 162, 161–166.CrossRefPubMedGoogle Scholar
  49. Ohayon, M., & Schatzberg, A. F. (2002). Prevalence of depressive episodes with psychotic features in the general population. American Journal of Psychiatry, 159, 1855–1861.CrossRefPubMedGoogle Scholar
  50. Opler, L. A., Kay, S. R., Lindenmayer, J. P., & Fiszbein, A. (1992). Structured clinical interview for the positive and negative syndrome scale. New York: Multi-Health Systems.Google Scholar
  51. Overall, J. E., & Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological Reports, 10, 799–812.CrossRefGoogle Scholar
  52. Patterson, T. L., Goldman, S., McKibbin, C. L., Hughs, T., & Jeste, D. V. (2001). UCSD Performance-based skills assessment: Development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin, 27, 235–245.PubMedGoogle Scholar
  53. Perälä, J., Suvisaari, J., Saarni, S., Kuoppasalmi, K., Isometsä, E., Pirkola, S., et al. (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry, 64, 19–28.CrossRefPubMedGoogle Scholar
  54. Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., et al. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the epidemiological catchment area (ECA) study. Journal of the American Medical Association, 264, 2511–2518.CrossRefPubMedGoogle Scholar
  55. Rund, B. R. (1998). A review of longitudinal studies of cognitive functions in schizophrenia patients. Schizophrenia Bulletin, 24, 425–435.PubMedGoogle Scholar
  56. Salvatore, P., Baldessarini, R. J., Tohen, M., Khalsa, H. M., Sanchez-Toledo, J. P., Zarate, C. A., et al. (2009). McLean-Harvard International First-Episode Project: Two-year stability of DSM-IV diagnoses in 500 first-episode psychotic disorder patients. Journal of Clinical Psychiatry, 70(4), 458–466.CrossRefPubMedGoogle Scholar
  57. Tandon, R., Keshavan, M. S., & Nasrallah, H. A. (2008). Schizophrenia, “just the facts”: What we know in 2008 part I: Overview. Schizophrenia Research, 100, 4–19.CrossRefPubMedGoogle Scholar
  58. Ventura, J., Green, M., Shaner, A., & Lieberman, R. (1993). Training and quality assurance with the brief psychiatric rating scale: ‘the drift busters’. International Journal of Methods in Psychiatric Research, 3, 221–244.Google Scholar
  59. Wohl, M., & Gorwood, P. (2007). Paternal ages below or above 55 years old are associated with a different risk of schizophrenia in the offspring. European Psychiatry, 22, 22–26.CrossRefPubMedGoogle Scholar
  60. World Health Organization. (2001). Mental health report 2001. Mental health: New understanding, new hope. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.VISN 5 Mental Illness Research, Education and Clinical Center, Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreUSA

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