A framework for integration of dimensional and diagnostic approaches to the diagnosis of schizophrenia

Abstract

Schizophrenia, as currently operationalized, is a serious public health concern everywhere in the globe. Occurring at a rate of approximately 4.6 per 1000 population at any point of observation and between 3.0 and 6.0 per 1000 over the lifetime, the condition is responsible for 7% of disability adjusted live years caused by mental and substance use disorders. The impact of the disorder on affected persons and communities across the world is thus considerable. In Africa, where schizophrenia is seen as the prototypical “mental disorder” by the lay public, it constitutes a major cause of human rights abuses as well as experienced stigma and discrimination. The delineation of the disorder, including its construct validity and cultural applicability, is of interest not only to researchers but also to mental health practitioners and policy makers. Studies conducted on the continent have demonstrated that the construct of schizophrenia, as described in the global classificatory systems, is recognizable and applicable in the African settings. But such studies have been largely designed from an etic perspective leaving open the question of whether the diagnostic construct has sufficient cultural and social fit as well as salience to African populations. This commentary seeks to highlight ways in which existing gap in knowledge can be addressed in providing an African perspective on the future status of schizophrenia as a diagnostic construct and as a descriptive label of a clinical state.