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KMID : 1177220080110020071
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Korean Journal of Schizophrenia Research
2008 Volume.11 No. 2 p.71 ~ p.77
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General Psychotic Syndrome
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Jim Van Os
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Abstract
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A diagnosis in psychiatry ideally should have 3 elements. First, Natural phenotype must have some links with the diagnostic construct of disease. Subclinical psychotic experience shows a degree of epidemiological, psychopathological, longitudinal, familial, aetiological and some syndromal continuity with diagnostic constructs such as schizophrenia. however, at the level of the general population, positive and negative experiences of psychosis are more loosely associated with each other than at the level of clinical disorder due to the phenomenon of morbidity concentration or Berkson’s bias. Second, diagnostic construct should have a fair validity to make a decision in clinical practice. But there is no consistent evidence for specificity in terms of symptoms, aetiology, treatment and prognosis between diagnostic categories such as schizophrenia and many other psychiatric disorders. Third, diagnostic construct can make an usefulness in terms of outcome, treatment response and aetiology. Although criticisms about the diagnostic construct of schizophrenia may be deflected with the argument that it is merely a syndrome that has the same status as did dropsy in nineteenth century medicine the problem nevertheless is that the way mental health professionals use and communicate about the term results in medical reification and behavioural pseudo-validation. Given the fact that maximum utility in terms of conveying clinical information may be obtained by combining the categorical with a dimensional representation of sychopathology, DSM-V and ICD-11 may be best served by creating separate categorical and dimensional axes of the psychopathology of psychotic disorders. Many people with impaired glucose regulation also have several other continuous cardiovascular risk factors - they have a tendency to occur together. This disorder is referred to as the ‘metabolic syndrome’. Analogous to the metabolic syndrome, many people with positive psychotic experiences also display evidence of alterations in other dimensions of psychopathology such as mania, disorganization and information processing deficits. This may be referred to as the “General Psychotic Syndrome”, reflecting the broad syndromal nature of what is now called schizophrenia.
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KEYWORD
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General psychotic syndrome, Schizophrenia, Categorical representations, Dimensional representations
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