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Authors: Perminder S. Sachdev
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alternative
of deciding upon the significance of an identifiable Having listed so many problems with “organic,” I must cerebral disorder in the causation of a psychiatric syn-argue, like Spitzer and colleagues [8], that it is now drome is not helped by this change. That will have to “time to retire the term . . . ” But what must take its await an increase in our knowledge of brain function – place? Two terms that have been considered seriously normal and abnormal. Second, the proposed strategy are “symptomatic” and “secondary,” the latter havis likely to prove very unreliable, as one would expect a ing won out in DSM-IV. Primary psychiatric disor-low agreement between psychiatrists regarding the rel-
18
ders are, thereby, the disorders that were previously ative significance of neurobiology in individual cases.
Chapter 2 – The concept of organicity and its application to schizophrenia
Classifiers are unlikely, therefore, to adopt the sugges-molecular mechanisms remain inadequate to explain tion. An alternative is to regard all psychotic disorders higher-level phenomena in their entirety; and iii) our as being neurobiological, and indicate on a separate dialogue occurs in a language born in a dualist age, and axis what contributions – on a continuum again – this is difficult to transform. This may seem to be the interpersonal, social, and cultural factors may have position of a pessimist, but the hope that I see is in made in a particular case. This position is complemen-the debate that has already been generated. The initial tary to the above, and the associated difficulties are moves, as in DSM-IV, are in the right direction, but we similar.
have further to travel. For this book, the prefix “sec-I feel that we are condemned to an unsatisfactory ondary” to schizophrenia will have to suffice because position, and the reasons are not difficult to under-it acknowledges the contribution of the “organic” fac-stand: i) positron emission tomography notwithstand-tor while at the same time accepting that the syndrome ing, our understanding of brain function and that of may be no different from the idiopathic schizophrenic the etiology of psychiatric disorders is still very rudi-disorder. It challenges us to rethink schizophrenia mentary; ii) even as neuroscience is progressing, the while providing clues to its pathophysiology. My hope realization is prevalent that we have to continue con-is that these clues will lead to insights that will provide ceptualizing brain function at multiple levels because a deeper understanding of this enigmatic disorder.
19
Introduction – Section 1
References
4.
Starkstein S. E., Mayberg H. S.
language in psychiatry: Results
(1993). Depression in Parkinson
from the field trials accompanying
1.
Searle J. R. (1992). The
disease. In Depression in
the clinical guidelines of mental
Rediscovery of the Mind.
Neurologic Disease, Starkstein
and behavioural disorders in
Cambridge, Mass: The MIT Press.
S. E., Robinson R. G. (Eds.).
ICD-10. Arch Gen Psychiatry,
2.
Slavney P. R., McHugh P. R.
Baltimore: The Johns Hopkins
1993. 50 :115–24.
(1987). Psychiatric Polarities:
University Press, pp. 97–
Methodology and Practice.
116.
7.
Birley J. L .T. DSM-III: from left
Baltimore: The Johns Hopkins
to right or right to left? Br J
University Press.
5.
Slater E., Beard A. W., Glither E.
Psychiatry, 1990. 157 :116– The schizophrenia-like psychosis
8.
3.
World Health Organization
of epilepsy. Br J Psychiatry, 1963.
(1992). The ICD-10 Classification
109 :95–150.
8.
Spitzer R. L., First M. B., Williams
of Mental and Behavioural
J. B. W., et al. Now is the time to Disorders: Clinical Descriptions
6.
Sartorius N., Kaelber C. T.,
retire the term “organic mental
and Diagnostic Guidelines.
Cooper J. E., et al. Progress
disorders.” Am J Psychiatry, 1992.
Geneva: WHO.
toward achieving a common
149 :240–4.
20
Section
of deciding upon the significance of an identifiable Having listed so many problems with “organic,” I must cerebral disorder in the causation of a psychiatric syn-argue, like Spitzer and colleagues [8], that it is now drome is not helped by this change. That will have to “time to retire the term . . . ” But what must take its await an increase in our knowledge of brain function – place? Two terms that have been considered seriously normal and abnormal. Second, the proposed strategy are “symptomatic” and “secondary,” the latter havis likely to prove very unreliable, as one would expect a ing won out in DSM-IV. Primary psychiatric disor-low agreement between psychiatrists regarding the rel-
18
ders are, thereby, the disorders that were previously ative significance of neurobiology in individual cases.
Chapter 2 – The concept of organicity and its application to schizophrenia
Classifiers are unlikely, therefore, to adopt the sugges-molecular mechanisms remain inadequate to explain tion. An alternative is to regard all psychotic disorders higher-level phenomena in their entirety; and iii) our as being neurobiological, and indicate on a separate dialogue occurs in a language born in a dualist age, and axis what contributions – on a continuum again – this is difficult to transform. This may seem to be the interpersonal, social, and cultural factors may have position of a pessimist, but the hope that I see is in made in a particular case. This position is complemen-the debate that has already been generated. The initial tary to the above, and the associated difficulties are moves, as in DSM-IV, are in the right direction, but we similar.
have further to travel. For this book, the prefix “sec-I feel that we are condemned to an unsatisfactory ondary” to schizophrenia will have to suffice because position, and the reasons are not difficult to under-it acknowledges the contribution of the “organic” fac-stand: i) positron emission tomography notwithstand-tor while at the same time accepting that the syndrome ing, our understanding of brain function and that of may be no different from the idiopathic schizophrenic the etiology of psychiatric disorders is still very rudi-disorder. It challenges us to rethink schizophrenia mentary; ii) even as neuroscience is progressing, the while providing clues to its pathophysiology. My hope realization is prevalent that we have to continue con-is that these clues will lead to insights that will provide ceptualizing brain function at multiple levels because a deeper understanding of this enigmatic disorder.
19
Introduction – Section 1
References
4.
Starkstein S. E., Mayberg H. S.
language in psychiatry: Results
(1993). Depression in Parkinson
from the field trials accompanying
1.
Searle J. R. (1992). The
disease. In Depression in
the clinical guidelines of mental
Rediscovery of the Mind.
Neurologic Disease, Starkstein
and behavioural disorders in
Cambridge, Mass: The MIT Press.
S. E., Robinson R. G. (Eds.).
ICD-10. Arch Gen Psychiatry,
2.
Slavney P. R., McHugh P. R.
Baltimore: The Johns Hopkins
1993. 50 :115–24.
(1987). Psychiatric Polarities:
University Press, pp. 97–
Methodology and Practice.
116.
7.
Birley J. L .T. DSM-III: from left
Baltimore: The Johns Hopkins
to right or right to left? Br J
University Press.
5.
Slater E., Beard A. W., Glither E.
Psychiatry, 1990. 157 :116– The schizophrenia-like psychosis
8.
3.
World Health Organization
of epilepsy. Br J Psychiatry, 1963.
(1992). The ICD-10 Classification
109 :95–150.
8.
Spitzer R. L., First M. B., Williams
of Mental and Behavioural
J. B. W., et al. Now is the time to Disorders: Clinical Descriptions
6.
Sartorius N., Kaelber C. T.,
retire the term “organic mental
and Diagnostic Guidelines.
Cooper J. E., et al. Progress
disorders.” Am J Psychiatry, 1992.
Geneva: WHO.
toward achieving a common
149 :240–4.
20
Section
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