E. Poli - Vol. 5, Settembre 1999 - n. 3
Testo Bibliografia Summary Riassunto Indice
La diagnosi di schizofrenia: problematiche
attuali
The diagnosis of schizophrenia: current
issues
The question of whether schizophrenia is a disease entity (Emil Kraepelin’s view) or an individual’s maladaptive reaction to specific environmental conditions (Alfred Meyer’s view), or a rational response to an irrational context (Lange’s antipsychiatric view) is debated against the background of the disorder’s clinical polymorphism and the existence of a schizophrenic spectrum is used to partially explain the latter. Negative symptoms appear to differentiate various subgroups of schizophrenia. Cognitive impairment seems to partially overlap with the one of mood disorders; however, a schizophrenic disorders-specific cognitive disorganisation component appears to be present, albeit it does not explain key aetiological questions. Concerning nosological nomenclature, it is important to understand whether schizophrenia is distinct from other psychoses or whether it overlaps with psychotic mood disorders; the existence of a schizoaffective disorder appears to constitute a link between the two concepts. Diagnostic reliability is not strengthened by the negative-positive dichotomic view of the disorder. Both aetiopathogenetic and clinical course-outcome issues do not contribute to the clarification of the problem, but the latter would argue against a progressive nature of the disease. Schizophrenia could well consist in a heterogeneous group of diseases, its damage permanent, but not progressive, not characterised by specific symptoms but distinguished from mood disorders, despite there are not sufficient data to reject the Einheitpsychose concept.