Psychosis Prevention
نویسنده
چکیده
This article focuses on the limitations of contemporary psychopathology which appear to diminish the feasibility of early detection and prevention of the schizophrenia-spectrum disorders. Basically, there are three options for early intervention: (a) intervening early in the course of psychosis, to reduce its duration and potential sequelae; (b) intervening in the ‘prodromal’ phase, to prevent or defer the onset of psychosis and/or attenuate its course; and (c) primary prevention, through reducing the prevalence of potential risk factors (e.g. obstetric complications). This paper discusses the first two issues only and abstains from epidemiological considerations on the flexibility of detection programmes and from a critical appraisal of the rationale behind such programmes. Several psychopathological issues merit attention. First, schizophrenia remains a ‘fuzzy’ scientific concept. For example, the so-called polydiagnostic studies (e.g. comparing DSM–III (American Psychiatric Association, 1980), research diagnostic criteria with other, equally reasonable definitions of schizophrenia) consistently demonstrate that the number of patients with schizophrenia diagnosed in a given sample varies by a factor of 2–3, depending on the diagnostic criteria applied and the composition of the examined sample (Jansson et al, 2002). The official endorsing of the DSM–III concept of schizophrenia and its contemporary permutations (DSM–IV (American Psychiatric Association, 1994) and ICD–10 (World Health Organization, 1993)) was not so much motivated by its superior validity (as younger colleagues believe), but was founded by a pragmatic consensus. In a polydiagnostic scenario, a patient diagnosed as being ‘pre-onset’ by one diagnostic system may be already considered as ‘postonset’ by another system. This notorious ‘fuzziness’ of the schizophrenia concept makes dating the illness onset not only a psychometric problem, but a theoretical issue intimately associated with the conceptual validity of schizophrenia, that is, what we conceptualise or take schizophrenia to be in the very first place (see Kendler, 1990). Evidence is available suggesting that onset dating is practically impossible in nearly half of those with schizophrenia (Fenton & McGlashan, 1991).
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تاریخ انتشار 2005