Schizophrenia at the crossroads: A blueprint for the 80s

Abstract

It is clear that the greatest advance in the 70s has been made in descriptive psychopathology and to prevent this success from becoming a failure in the 80s, we must encourage innovative imagination to overcome the drift toward rigid application of standardized procedures. As for the improved outlook in outcome of schizophrenia, the evidence from long-term follow-up studies in Europe indicates that a significant proportion of schizophrenics have only one episode from which they recover and that an even larger proportion show an episodic course of several episodes with final remission. Only a small proportion remain chronically ill continuously but they are the ones who accumulate in our facilities and give schizophrenia its undeserved reputation for chronicity. The evidence has also shown that there is considerable doubt whether much of the chronicity that overwhelms our daily practicioners and engenders pessimism is indigenous to schizophrenia. There is reason to believe that it may be an artifact engendered by iatrogenic, ecogenic, and nosocomial factors. As for vulnerability markers, there are several potential candidates that have been found in both probands and their unaffected first-degree relatives with frequencies greater than chance expectancy. 1. 1. Cross-over index in reaction time (Shakow) 2. 2. Smooth pursuit eye movement index (Holzman) 3. 3. Continuous performance task (Kornetzky, Mirsky et al) 4. 4. Span of apprehension (Asarnow) 5. 5. Dichotic listening with distraction (spring) 6. 6. Platelet MAO We still have to determine whether these markers are vulnerability markers, episode markers, or residual markers. While the specificity of each of these markers for schizophrenia is still to be established, the possibility exists that patterns across these markers may serve to identify subgroups of schizophrenia and thus reduce the apparent heterogeneity of global schizophrenia. The availability of such markers, and the proposed behavioral and chemical challenges for eliciting episode markers as well as the possibility of early warning signs of the imminence of an episode, indicate that the future bodes well for supplementing the current clinical diagnoses and treatment with objective indicators that may succeed in reducing the heterogeneity of our nosological categories and reduce the excessive use of neuroleptics and other treatment modalities. These, together with the development of more knowledge about the role of the psychosocial factors in the development of episodes or in their triggering, ought to provide more efficient methods for therapeutic and preventive intervention.