Schizophrenia: Basic, release, reactive and defect processes

Abstract

AbstractRecent development in the classification of schizophrenic psychopathology and research on the mechanism of action of neuroleptic drugs are reviewed in the light of a proposal by Chapman and McGhie in 1963 that schizophrenic morbidity might be significantly reduced by an appropriate cognitive management. It is concluded that current findings in cognitive psychology and neuropsychology support the Chapman and McGhie proposal, but that a clinical application of their proposal requires a recognition of the multidimensionality of positive and negative schizophrenic syndromes. These syndromes, it is suggested, are constituted by underlying basic, release, reactive and defect processes. Basic and release processes, it is postulated, stem from frontal lobe dysfunction. Reactive processes are composed of cognitive distortions of basic and release experiences and should be open to a cognitive management. Defect processes are constituted by coexisting minimal brain dysfunction. This proposal is at odds with the dopamine hypothesis of schizophrenia but is consistent with a dopamine hypothesis of neuroleptic action. The implications of the proposal for both the neuroleptic and non‐neuroleptic pharmacotherapy of schizophrenia are outlined. In particular the development of intermittent pharmacotherapy is noted and the likely significance of emerging cognitive managements for clinical problems for the future assessment of clinical trails of pharmacological agents in schizophrenia.