Indexed on: 05 Nov '05Published on: 05 Nov '05Published in: Fortschritte der Neurologie-Psychiatrie
This essay starts with a brief remark about the -- necessary -- de-tours of the historical pathway to the concept of schizophrenia. The first part on nosographic approaches then describes the results of cross-sectional and longitudinal psychopathological symptom-assembling, subgrouping by factorial analyses, and the cross-cultural stability of the emerging disease concept: The human idiopathic syndrome of structural mental decline in its clinical variegation. The second part about de-nosological approaches provides an account of the clinical concepts of basic symptoms, spectrum disorders, neuropsychological deficits and their genetic family loading. Genetics of neuropsychological deficits demonstrate in detail that risk and protective factors to schizophrenia are genetically closely enmeshed. Higher familial loading of some neuropsychological deficits compared to the actual disease itself points at the dilemma that functional psychopathology deepens causal understanding and yet looses specificity for the disease syndrome. The concluding part of this essay emphasizes some sequelae of de-nosological approaches: Better tools for earlier recognition treatment and prevention; ego-distal concepts of basic dysfunctions rather than the previous ego-proximal concepts, hence better self-esteem, insight, and de-stigmatization for patients.