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Schizophrenia spectrum concepts and diagnosis
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SCHIZOPHRENIA SPECTRUM CONCEPTS AND DIAGNOSIS Thomas H. McGlashan, M.D.* Chestnut Lodge, 500 West Montgomery Avenue, Rockville, MD
20850
The concept of the schizophre-niaspectrum (SS) began with Sandor Rado and Paul Meehl who postulated that schizophrenia (S) begins with an inherited disposition or genotype (schizotaxia). The interaction of this with the environment produces the S phenotype, an individual with certain personality traits called the schizotype. Under sufficient and/or specific stress, the schizotype can develop S proper. The clinical visage of the schizotype has remained elusive, and representative specimens have been "sighted" in several nosologic waters such as latent S, simple S, psuedoneurotic S, borderline personality disorder (BPD), and schizoid PD. The genetic visage of the schizotype has always been clearer. The Danish adoption studies identified relatives with a "touch" of S and formulated the original clinical definition of the spectrum concept. The characteristics of these relatives were incorporated into DSM-III's bold division of the borderline conditions into BPD and schizotypal personality disorder (SPD). SPD may have been the only diagnostic group in DSM-III that started with validating criteria (genetic linkage) to select identifying signs and symptoms. The SPD/BPD division has been validated often, and the question now is might further divisions (subtypes) of SPD ferret out more homogeneous phenotypes for etiologic studies? This presentation will address the following topics: 1) the origin of the SS concept, 2) its development into its current status as SPD, 3) issues around the contemporary definition of SPD, 4) the evidence validating its position as a SS disorder, 5) proposed nosologic changes for SPD and other possible spectrum disorders in DSM-IV, and 6) directions for future research. The presentation till review relevant literature, especially the flurry of investigation from this last decade. It will also highlight data from the Chestnut Lodge follow-up study which have contributed to some of these issues, such as studies in validation (the long-term course and outcome of SPD compared to S, BPD, and affective disorder; SPD gender differences; SPD criteria as predictors of future S decompensation) and studies in nosology (the characteristics or core symptoms of DSM-III SPD, the diagnostic efficiency of combined SPD criteria; depression and transient psychosis as discriminators between SPD and BPD).
SCHIZOPHRENIA SPECTRUM CONCEPTS AND DIAGNOSIS Thomas H. McGlashan, M.D.* Chestnut Lodge, 500 West Montgomery Avenue, Rockville, MD
20850
The concept of the schizophre-niaspectrum (SS) began with Sandor Rado and Paul Meehl who postulated that schizophrenia (S) begins with an inherited disposition or genotype (schizotaxia). The interaction of this with the environment produces the S phenotype, an individual with certain personality traits called the schizotype. Under sufficient and/or specific stress, the schizotype can develop S proper. The clinical visage of the schizotype has remained elusive, and representative specimens have been "sighted" in several nosologic waters such as latent S, simple S, psuedoneurotic S, borderline personality disorder (BPD), and schizoid PD. The genetic visage of the schizotype has always been clearer. The Danish adoption studies identified relatives with a "touch" of S and formulated the original clinical definition of the spectrum concept. The characteristics of these relatives were incorporated into DSM-III's bold division of the borderline conditions into BPD and schizotypal personality disorder (SPD). SPD may have been the only diagnostic group in DSM-III that started with validating criteria (genetic linkage) to select identifying signs and symptoms. The SPD/BPD division has been validated often, and the question now is might further divisions (subtypes) of SPD ferret out more homogeneous phenotypes for etiologic studies? This presentation will address the following topics: 1) the origin of the SS concept, 2) its development into its current status as SPD, 3) issues around the contemporary definition of SPD, 4) the evidence validating its position as a SS disorder, 5) proposed nosologic changes for SPD and other possible spectrum disorders in DSM-IV, and 6) directions for future research. The presentation till review relevant literature, especially the flurry of investigation from this last decade. It will also highlight data from the Chestnut Lodge follow-up study which have contributed to some of these issues, such as studies in validation (the long-term course and outcome of SPD compared to S, BPD, and affective disorder; SPD gender differences; SPD criteria as predictors of future S decompensation) and studies in nosology (the characteristics or core symptoms of DSM-III SPD, the diagnostic efficiency of combined SPD criteria; depression and transient psychosis as discriminators between SPD and BPD).