- Email: [email protected]
DIMENSIONAL CLASSIFICATION OF SCHIZOPHRENIA
Abstracts / Schizophrenia Research 102/1–3, Supplement 2 (2008) 1–279 and that they often, but not always, affect more than one member of the family. The preparations for the next revision of the classification of mental disorders in the ICD 11 and of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM5) have started and, not surprisingly, several options for the classification of schizophrenia have been proposed. One of them is to remove the subcategories of schizophrenia and to replace them by dimensions of abnormality, of cognition, for example. Another option is to leave the classification unchanged because the evidence to justify a significant change is insufficient. It has also been proposed to re-consider the earlier proposal to place all psychotic conditions into a single major category of “psychosis” possibly with the inclusion of various syndromes that are thought to be part of the schizophrenic spectrum of disorders. Other options are also being discussed. The presentation will review some of the proposals and review the advantages and disadvantages of accepting them.
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is not known whether cognitive disturbances, generally seen to be the most relevant vulnerability indicator of schizophrenia, increase or remain on the pre-psychosis level.Beside psychopathological and social outcome, neuro pathological outcome may also be relevant. Structural MRI findings, including the Munich MRI database with 400 patients and controls, indicate changes of brain structure over the course of the disease. Further replication and an evaluation of the specificity for schizophrenia versus affective disorders are required. Evidence suggests that brain alterations are more marked and progressive in schizophrenia than in affective disorders. Additional analyses show that they are associated with global outcome, among other things. References [1] Möller Hj, Bottlender R, Groß A, Hoff P, Wittmann J, Wegner U, Strauss A (2002) The Kraepelinian dichotomy: preliminary results of a 15-year follow-up study on functional psychoses: focus on negative symptoms. Schizophr Res 56: 87-94.
DIMENSIONAL CLASSIFICATION OF SCHIZOPHRENIA
Jim van Os Maastricht University, Maastricht, The Netherlands [email protected] The current DSM-IV classification of psychosis stems directly from the systematic clinical observations of Kraepelin (Kraepelin, translated by RM Barkley, 1971), Bleuler (Bleuler translated by Zinkin, 1950) and Schneider (Schneider, 1959) who worked in the large asylums of Western Europe during the late 19th and early 20th century. These institutions provided care for people with severe and debilitating conditions. There are at least two potentially important limitations to a classification system derived from such a selective case sample. First, your clinical experience would be of severe cases in need of treatment, you would understandably conceptualize psychosis as a discrete disease entity, as a categorical construct, distinct from normality. This, however, may not reflect the true distribution of psychosis at the population level. Second, the observed pattern of psychopathological co-occurrence may actually reflect symptoms, which are risk factors for hospital admission becoming conditionally dependent in the institutional setting, a phenomena known as Berkson’s fallacy (bias). A community study has shown that positive and negative symptoms are both ly associated with need for care (Maric et al., 2004). Such additive effects could inflate the positive/negative co-occurrence in hospital settings, indicating that the current conceptualization of schizophrenia as a unitary entity with high co-occurrence of positive and negative psychopath ological domains may in part be the result of Berkson’s bias.
COURSE OF SCHIZOPHRENIA: A CRITERION FOR CLASSIFICATION?
Hans-Juergen Moeller Department of Psychiatry, University of Munich, Munich, Germany [email protected] Grouping symptoms of schizophrenia into dimensions may be clinically more relevant than the current categorisation. It is unclear whether a categorical or dimensional classification of non-organic psychosis has a higher prognostic value, and whether course can help to validate this classification.The Munich 15-year follow-up study1 of first-hospitalised patients with schizophrenic, schizoaffective or affective psychosis found a less favourable course and outcome of schizophrenia, and at least a subgroup of schizophrenic patients with a generally poor outcome. Negative symptoms were present in all groups but more frequent and prominent in schizophrenia at all assessments, especially after 15 years. The deficit syndrome concept of negative symptoms appears to differentiate much better than positive or negative symptoms between schizophrenic and affective/schizoaffective patients, and thus be more specific for schizophrenia. Negative symptoms increase during the long-term course of schizophrenia, but it
DEFICIT SCHIZOPHRENIA: A VALID CATEGORICAL SUBTYPE OF SCHIZOPHRENIA?
Mario Maj, Silvana Galderisi Institute of Psychiatry, University of Naples, Naples, Italy [email protected] If clinical heterogeneity of schizophrenia reflects different etiopathogenetic mechanisms, the identification of valid categorical subtypes would represent the most appropriate strategy to advance scientific knowledge and develop more specific treatments. The diagnosis of deficit schizophrenia has a good interrater agreemen t and longitudinal stability. Patients with deficit schizophrenia differ from those with non-deficit schizophrenia on variables related to the syndrome construct (i.e. more negative symptoms), but also for a lower prevalence of suspiciousness, dysphoria, hostility, suicidal ideation and substance abuse. When compared with non-deficit patients, those with deficit schizophrenia are characterized by more severe neurological impairment and poorer psychosocial functioning, response to treatment and long-term prognosis, but less neuroanatomic abnormalities. Double dissociation findings for the two schizophrenia subtypes were reported for the season of birth and event-related potentials abnormalities. So far, research on deficit schizophrenia failed to prove that it represents the severe end of a unitary disease continuum, and did not disprove the claim that it may be a valid categorical subtype within the syndrome of schizophrenia. References [1] Galderisi S et al: Patterns of structural MRI abnormalities in deficit and nondeficit schizophrenia; Schizophr Bull. 2007; in press [2] Mucci A et al: Double dissociation of N1 and P3 abnormalities in deficit and nondeficit schizophrenia; Schizophr Res. 2007; 92: 252-61
ORAL COMMUNICATIONS 7
June 24th, 2008
Is COMT Relevant? META-ANALYSIS OF THE GENETIC ASSOCIATION BETWEEN THE COMT VAL158/108MET POLYMORPHISM AND SIX COGNITIVE PHENOTYPES
Jennifer Barnett 1 , Linda Scoriels 2 , Marcus Munafò 3 of Cambridge/Massachusetts General Hospital, Boston, Mass, USA; 2 University of Cambridge, UK; 3 University of Bristol, UK [email protected] 1 University
Introduction: Cognitive endophenotypes may help dissect the genetic basis of psychiatric disorders. The catechol O-methyltransferase
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is not known whether cognitive disturbances, generally seen to be the most relevant vulnerability indicator of schizophrenia, increase or remain on the pre-psychosis level.Beside psychopathological and social outcome, neuro pathological outcome may also be relevant. Structural MRI findings, including the Munich MRI database with 400 patients and controls, indicate changes of brain structure over the course of the disease. Further replication and an evaluation of the specificity for schizophrenia versus affective disorders are required. Evidence suggests that brain alterations are more marked and progressive in schizophrenia than in affective disorders. Additional analyses show that they are associated with global outcome, among other things. References [1] Möller Hj, Bottlender R, Groß A, Hoff P, Wittmann J, Wegner U, Strauss A (2002) The Kraepelinian dichotomy: preliminary results of a 15-year follow-up study on functional psychoses: focus on negative symptoms. Schizophr Res 56: 87-94.
DIMENSIONAL CLASSIFICATION OF SCHIZOPHRENIA
Jim van Os Maastricht University, Maastricht, The Netherlands [email protected] The current DSM-IV classification of psychosis stems directly from the systematic clinical observations of Kraepelin (Kraepelin, translated by RM Barkley, 1971), Bleuler (Bleuler translated by Zinkin, 1950) and Schneider (Schneider, 1959) who worked in the large asylums of Western Europe during the late 19th and early 20th century. These institutions provided care for people with severe and debilitating conditions. There are at least two potentially important limitations to a classification system derived from such a selective case sample. First, your clinical experience would be of severe cases in need of treatment, you would understandably conceptualize psychosis as a discrete disease entity, as a categorical construct, distinct from normality. This, however, may not reflect the true distribution of psychosis at the population level. Second, the observed pattern of psychopathological co-occurrence may actually reflect symptoms, which are risk factors for hospital admission becoming conditionally dependent in the institutional setting, a phenomena known as Berkson’s fallacy (bias). A community study has shown that positive and negative symptoms are both ly associated with need for care (Maric et al., 2004). Such additive effects could inflate the positive/negative co-occurrence in hospital settings, indicating that the current conceptualization of schizophrenia as a unitary entity with high co-occurrence of positive and negative psychopath ological domains may in part be the result of Berkson’s bias.
COURSE OF SCHIZOPHRENIA: A CRITERION FOR CLASSIFICATION?
Hans-Juergen Moeller Department of Psychiatry, University of Munich, Munich, Germany [email protected] Grouping symptoms of schizophrenia into dimensions may be clinically more relevant than the current categorisation. It is unclear whether a categorical or dimensional classification of non-organic psychosis has a higher prognostic value, and whether course can help to validate this classification.The Munich 15-year follow-up study1 of first-hospitalised patients with schizophrenic, schizoaffective or affective psychosis found a less favourable course and outcome of schizophrenia, and at least a subgroup of schizophrenic patients with a generally poor outcome. Negative symptoms were present in all groups but more frequent and prominent in schizophrenia at all assessments, especially after 15 years. The deficit syndrome concept of negative symptoms appears to differentiate much better than positive or negative symptoms between schizophrenic and affective/schizoaffective patients, and thus be more specific for schizophrenia. Negative symptoms increase during the long-term course of schizophrenia, but it
DEFICIT SCHIZOPHRENIA: A VALID CATEGORICAL SUBTYPE OF SCHIZOPHRENIA?
Mario Maj, Silvana Galderisi Institute of Psychiatry, University of Naples, Naples, Italy [email protected] If clinical heterogeneity of schizophrenia reflects different etiopathogenetic mechanisms, the identification of valid categorical subtypes would represent the most appropriate strategy to advance scientific knowledge and develop more specific treatments. The diagnosis of deficit schizophrenia has a good interrater agreemen t and longitudinal stability. Patients with deficit schizophrenia differ from those with non-deficit schizophrenia on variables related to the syndrome construct (i.e. more negative symptoms), but also for a lower prevalence of suspiciousness, dysphoria, hostility, suicidal ideation and substance abuse. When compared with non-deficit patients, those with deficit schizophrenia are characterized by more severe neurological impairment and poorer psychosocial functioning, response to treatment and long-term prognosis, but less neuroanatomic abnormalities. Double dissociation findings for the two schizophrenia subtypes were reported for the season of birth and event-related potentials abnormalities. So far, research on deficit schizophrenia failed to prove that it represents the severe end of a unitary disease continuum, and did not disprove the claim that it may be a valid categorical subtype within the syndrome of schizophrenia. References [1] Galderisi S et al: Patterns of structural MRI abnormalities in deficit and nondeficit schizophrenia; Schizophr Bull. 2007; in press [2] Mucci A et al: Double dissociation of N1 and P3 abnormalities in deficit and nondeficit schizophrenia; Schizophr Res. 2007; 92: 252-61
ORAL COMMUNICATIONS 7
June 24th, 2008
Is COMT Relevant? META-ANALYSIS OF THE GENETIC ASSOCIATION BETWEEN THE COMT VAL158/108MET POLYMORPHISM AND SIX COGNITIVE PHENOTYPES
Jennifer Barnett 1 , Linda Scoriels 2 , Marcus Munafò 3 of Cambridge/Massachusetts General Hospital, Boston, Mass, USA; 2 University of Cambridge, UK; 3 University of Bristol, UK [email protected] 1 University
Introduction: Cognitive endophenotypes may help dissect the genetic basis of psychiatric disorders. The catechol O-methyltransferase