Linguistic and (micro)cultural differences in the global debate about re-naming 'schizophrenia': A mixed-methods survey from Switzerland.

BACKGROUND AND HYPOTHESIS: This survey explores Swiss mental health professionals', users', and relatives' opinions on re-naming schizophrenia exploiting Switzerland's specific multilingualism to examine possible effects of linguistic and microcultural differences on the issue. STUDY DESIGN: Opinions on 'schizophrenia' were collected using a self-rated online questionnaire incl. Freetext answers available in the three main Swiss languages, German, French and Italian. It was distributed to the main professional and self-help organizations in Switzerland between June and October 2021. STUDY RESULTS: Overall, 449 persons completed the questionnaire, 263 in German, 172 in French and 14 in Italian. Of the total sample, 339 identified as mental health professionals, 81 as relatives and 29 as users. Considering the whole sample, almost half favored a name-change with a significant difference between stakeholder- and between language groups. Also, the name 'schizophrenia' was evaluated more critically than the diagnostic concept. Qualitative analysis of freetext answers showed a highly heterogenous argumentation, but no difference between language groups. CONCLUSIONS: Our results suggest the attitude towards re-naming might itself be subject to (micro)cultural difference, and they highlight the nature of 'schizophrenia' as not only a scientific, but also a linguistic and cultural object. Such local factors ought to be taken into consideration in the global debate.

A naturalistic cohort study of first-episode schizophrenia spectrum disorder: A description of the early phase of illness in the PSYSCAN cohort.

BACKGROUND: We examined the course of illness over a 12-month period in a large, international multi-center cohort of people with a first-episode schizophrenia spectrum disorder (FES) in a naturalistic, prospective study (PSYSCAN). METHOD: Patients with a first episode of schizophrenia, schizoaffective disorder (depressive type) or schizophreniform disorder were recruited at 16 institutions in Europe, Israel and Australia. Participants (N = 304) received clinical treatment as usual throughout the study. RESULTS: The mean age of the cohort was 24.3 years (SD = 5.6), and 67 % were male. At baseline, participants presented with a range of intensities of psychotic symptoms, 80 % were taking antipsychotic medication, 68 % were receiving psychological treatment, with 46.5 % in symptomatic remission. The mean duration of untreated psychosis was 6.2 months (SD = 17.0). After one year, 67 % were in symptomatic remission and 61 % were in functional remission, but 31 % had been readmitted to hospital at some time after baseline. In the cohort as a whole, depressive symptoms remained stable over the follow-up period. In patients with a current depressive episode at baseline, depressive symptoms slightly improved. Alcohol, tobacco and cannabis were the most commonly used substances, with daily users of cannabis ranging between 9 and 11 % throughout the follow-up period. CONCLUSIONS: This study provides valuable insight into the early course of a broad range of clinical and functional aspects of illness in FES patients in routine clinical practice.

Linguistic features of suicidal thoughts and behaviors: A systematic review.

Language is a potential source of predictors for suicidal thoughts and behaviors (STBs), as changes in speech characteristics, communication habits, and word choice may be indicative of increased suicide risk. We reviewed the current literature on STBs that investigated linguistic features of spoken and written language. Specifically, we performed a search in linguistic, medical, engineering, and general databases for studies that investigated linguistic features as potential predictors of STBs published in peer-reviewed journals until the end of November 2021.We included 75 studies that investigated 279,032 individuals with STBs (age = 29.53 ± 10.29, 35% females). Of those, 34 (45%) focused on lexicon, 20 (27%) on prosody, 15 (20%) on lexicon and first-person singular, four (5%) on (morpho)syntax, and two (3%) were unspecified. Suicidal thoughts were predicted by more intensifiers and superlatives, while suicidal behaviors were predicted by greater usage of pronouns, changes in the amount of verb usage, more prepend and multifunctional words, more nouns and prepositions, and fewer modifiers and numerals. A diverse field of research currently investigates linguistic predictors of STBs, and more focus is needed on their specificity for either suicidal thoughts or behaviors.

[Incredible language! A qualitative investigation of conversations about delusions]. / Wahnsinns Sprache! Eine qualitative Untersuchung zur kommunikativen Darstellung von Wahn im Gespräch.

BACKGROUND: Communicating about delusions is generally considered a challenging task. MATERIAL AND METHODS: Assuming that there are nevertheless a variety of communicative resources competently employed to meet this challenge, the authors present a conversation analytic study of two narrative interviews in which people talk about their experience of delusions. RESULTS: It is shown that through pauses, breaks, reformulations, negotiations of the so-called common ground and the use of metaphoric speech, they succeed in conveying many aspects of the experience of delusions that cannot simply be described in terms of content. CONCLUSIONS: These examples of communicative strategies can be a resource for others and encourage mental health professionals and users alike to engage in conversations on delusions.

Psychiatric Emergencies in the Community: Characteristics and Outcome in Switzerland.

Psychiatric emergencies occur frequently in the community setting, e.g. the patient's home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient's home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of all consultations, 38.4% resulted in involuntary admissions, mainly in patients with psychosis, suicidality, aggression, refusal of necessary treatment and previous involuntary admissions. Situation-related factors and the involvement of relatives were no significant predictors of the outcome. Psychiatric emergencies occur in different places and in patients with a variety of psychiatric symptoms. Although half of the emergency situations were resolved in the community, the rate of involuntary admissions was still high. For additional reduction, the further development of quickly available alternatives to psychiatric inpatient treatment is required. These should be specifically geared towards acute situations in patients with the described risk factors. Additionally, the role of relatives during psychiatric emergencies should be further studied.

The Ins and Outs of 'Schizophrenia': Considering Diagnostic Terms as Ordinary Linguistic Expressions.

Diagnostic terms in psychiatry like 'schizophrenia' and 'bipolar disorder' are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of 'schizophrenia.' Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their actual usage and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders.

Orbitofrontal-Striatal Structural Alterations Linked to Negative Symptoms at Different Stages of the Schizophrenia Spectrum.

Negative symptoms such as anhedonia and apathy are among the most debilitating manifestations of schizophrenia (SZ). Imaging studies have linked these symptoms to morphometric abnormalities in 2 brain regions implicated in reward and motivation: the orbitofrontal cortex (OFC) and striatum. Higher negative symptoms are generally associated with reduced OFC thickness, while higher apathy specifically maps to reduced striatal volume. However, it remains unclear whether these tissue losses are a consequence of chronic illness and its treatment or an underlying phenotypic trait. Here, we use multicentre magnetic resonance imaging data to investigate orbitofrontal-striatal abnormalities across the SZ spectrum from healthy populations with high schizotypy to unmedicated and medicated first-episode psychosis (FEP), and patients with chronic SZ. Putamen, caudate, accumbens volume, and OFC thickness were estimated from T1-weighted images acquired in all 3 diagnostic groups and controls from 4 sites (n = 337). Results were first established in 1 discovery dataset and replicated in 3 independent samples. There was a negative correlation between apathy and putamen/accumbens volume only in healthy individuals with schizotypy; however, medicated patients exhibited larger putamen volume, which appears to be a consequence of antipsychotic medications. The negative association between reduced OFC thickness and total negative symptoms also appeared to vary along the SZ spectrum, being significant only in FEP patients. In schizotypy, there was increased OFC thickness relative to controls. Our findings suggest that negative symptoms are associated with a temporal continuum of orbitofrontal-striatal abnormalities that may predate the occurrence of SZ. Thicker OFC in schizotypy may represent either compensatory or pathological mechanisms prior to the disease onset.

Diagnosis as dialogue: historical and current perspectives
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Ever since psychiatry emerged as a clinical discipline and field of scientific inquiry in the late 18th century, debates about diagnosis have been at its very heart. Considered by many a requirement for clinical communication as well as for systematic study, others have critiqued psychiatric diagnosis for being modeled on a medical conception of disease that is ill-suited to the specific nature of mental disorders. Based on a review of seminal positions in the conceptual history of psychiatry and an examination of their epistemological underpinnings, we propose to consider diagnosis as dialogue. Such understanding, we argue, can serve as a meta-framework that provides a conceptual and practical umbrella to encourage open-minded conversation across the diverse conceptual and experiential frameworks that are characteristic of psychiatry. In this perspective psychopathology will also reinforce the interpersonal realm as a necessary element of any clinical encounter, be it diagnostic in purpose or otherwise. Current challenges to traditional diagnostic systems like Research Domain Criteria (RDoC) and Hierarchical Taxonomy of Psychopathology (HiTOP) are discussed in light of these considerations.
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Desde finales del siglo XVIII, en que la psiquiatría surgió como disciplina clínica y campo de investigación científica, los debates acerca del diagnóstico han estado en su centro. Muchos lo han considerado como un requisito para la comunicación clínica, así como para el estudio sistemático, y otros han criticado el diagnóstico psiquiátrico por basarse en una concepción médica de la enfermedad, lo que no sería una buena adaptación a la naturaleza específica de los trastornos mentales. De acuerdo con una revisión de los planteamientos seminales en la historia conceptual de la psiquiatría y un examen de sus bases epistemológicas, se propone considerar el diagnóstico como un diálogo. Se argumenta que tal comprensión puede servir como un meta-marco que proporcione un paraguas conceptual y práctico para fomentar una conversación abierta a través de los diversos marcos conceptuales y experimentales que son característicos de la psiquiatría. De acuerdo con esta perspectiva, la psicopatología también reforzará el ámbito interpersonal como elemento necesario para cualquier encuentro clínico, ya sea de tipo diagnóstico u otro. A la luz de estas consideraciones, se discuten los desafíos actuales para los sistemas diagnósticos tradicionales como los Criterios de Dominio de Investigación (CDI) y la Taxonomía Jerárquica de la Psicopatología (TJP).

Le diagnostic en psychiatrie est au coeur de débats dans cette discipline devenue, à la fin du 18e siècle, à la fois clinique et domaine de recherche scientifique. Pour de nombreux médecins le diagnostic est aussi nécessaire à la communication qu'à la mise en œuvre d'études systématiques. D'autres en revanche ont critiqué cette conception médicale du diagnostic psychiatrique, inadaptée selon eux à la nature spécifique des troubles mentaux. Nous proposons d'envisager le diagnostic comme un dialogue, en examinant les positions fondamentales de l'histoire conceptuelle de la psychiatrie et leurs fondements épistémologiques. Selon nous, ce point de vue peut servir de méta-cadre pour un environnement conceptuel et pratique favorable à un échange ouvert au sein des divers contextes abstraits et expérientiels qui caractérisent la psychiatrie. Dans cette perspective, la psychopathologie renforcera également le domaine interpersonnel en tant qu'élément indispensable à toute rencontre clinique, que son but soit diagnostique ou non. Les méthodes de diagnostic traditionnelles, tels que les critères des domaines de recherche et la taxonomie hiérarchique de la psychopathologie, rencontrent aujourd'hui des difficultés examinées à la lumière de ces considérations.

Towards Precision Medicine in Psychosis: Benefits and Challenges of Multimodal Multicenter Studies-PSYSCAN: Translating Neuroimaging Findings From Research into Clinical Practice.

In the last 2 decades, several neuroimaging studies investigated brain abnormalities associated with the early stages of psychosis in the hope that these could aid the prediction of onset and clinical outcome. Despite advancements in the field, neuroimaging has yet to deliver. This is in part explained by the use of univariate analytical techniques, small samples and lack of statistical power, lack of external validation of potential biomarkers, and lack of integration of nonimaging measures (eg, genetic, clinical, cognitive data). PSYSCAN is an international, longitudinal, multicenter study on the early stages of psychosis which uses machine learning techniques to analyze imaging, clinical, cognitive, and biological data with the aim of facilitating the prediction of psychosis onset and outcome. In this article, we provide an overview of the PSYSCAN protocol and we discuss benefits and methodological challenges of large multicenter studies that employ neuroimaging measures.

Cross-Cultural Notions of Risk and Liberty: A Comparison of Involuntary Psychiatric Hospitalization and Outpatient Treatment in New York, United States and Zurich, Switzerland.

Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the person authorized to conduct and maintain an involuntary hospitalization has on the outcome.

Schizophrenia, Self, and Person: Eugen Bleuler and Arthur Kronfeld on a Conceptual Alliance.

The conceptual history of schizophrenia is marked by considerable dissent about its nosological status, and the question of whether it represents a distinct disease entity remains hotly debated. Another recurring feature in the conceptual history of schizophrenia is the reference to concepts of self and person. This paper brings in connection these two debates by interrogating the nosological function of "self" and "person" by means of a fictitious dialogue between Eugen Bleuler, the inventor of schizophrenia, and his contemporary Arthur Kronfeld. Introducing their respective accounts of schizophrenia with a special focus on how concepts of self and person figure therein, our analysis suggests that these concepts are primarily employed in an attempt to guarantee the nosological unity of schizophrenia: mediated by the concept of a core disturbance, alterations of the self or the person thus become the essential core of schizophrenia. Yet, rather than providing an easy solution to the nosological problem of the unity of schizophrenia, the concepts of self and person and their assumed disturbances are themselves fraught with debates about unity. We discuss these conceptual challenges in light of present-day nosological debates and the currently abounding research on the self.

What's 'difficult'? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms.

BACKGROUND: The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. DESIGN: Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term 'difficult'. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored. SETTING: Three NHS trust secondary care hospitals in North-East England. PARTICIPANTS: 17 senior clinicians from seven medical and two surgical specialities. RESULTS: Unsolicited use of the term 'difficult' was common. 'Difficult' was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used 'difficult' to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of 'difficult'. Participants also reported experiences that were rewarding and positive. CONCLUSIONS: This study shows that blanket statements such as 'difficult patients' mask the complexity of doctors' experiences in the context of MUS. Our nuanced analysis of the use of 'difficult' challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.

Eugen Bleuler's schizophrenia--a modern perspective.

The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essentialism, and stigma.

Con la introducción del término y concepto de esquizo-frenia su inventor, el psiquiatra suizo Eugen Bleuler, obtuvo fama mundial. Como Bleuler rechazó el principio fundamental de la nosología de Kraepelin, que se basaba en el pronóstico, su idea acerca de la unidad clínica de lo que Kraepelin había descrito como demencia precoz lo obligó a buscar otros rasgos característicos que permitieran una clasificación y descripción científicas. Esto lo llevó a considerar factores psicológicos y en menor medida factores sociales junto con suponer un proceso patológico neurobiológico subyacente como constitu-tivo de lo que él entonces denominó esquizofrenia, lo que hizo de él un precoz defensor de una comprensión bio-psico-social de la enfermedad mental. Este artículo entrega una visión crítica de los principios nosológicos clave de Bleuler al revisar su concepto de esquizofrenia junto con los antecedentes de todo su trabajo clínico y teórico, y relaciona su trabajo con los debates actuales acerca del naturalismo, el esencialismo y el estigma.

Grâce à l'introduction du terme et du concept de schizophrénie, son inventeur, le psychiatre suisse Eugen Bleuler, est mondialement connu. Comme Bleuler rejetait l'idée principale de la nosologie Kraepelinienne, à savoir le pronostic, sa foi en l'ensemble clinique de ce que Kraepelin a décrit comme démence précoce l'obligea à rechercher des traits caractéristiques alternatifs permettant une classification et une description scientifiques. Ceci le conduisit à prendre en compte les facteurs psychologiques et dans une moindre mesure, sociaux, à côté d'un processus pathologique neurobiologique sous-jacent supposé comme constitutif de ce qu'il a ensuite appelé schizophrénie, faisant donc de lui un des premiers défenseurs d'une compréhension bio-psycho-sociale de la maladie mentale. En examinant la conception de Bleuler sur la schizophrénie par rapport au fond de son travail global clinique et théorique, cet article présente un aperçu majeur des principes nosologiques clés de Bleuler et associe son travail aux débats actuels sur le naturalisme, l'essentialisme et la stigmatisation.

The birth of schizophrenia or a very modern Bleuler: a close reading of Eugen Bleuler's 'Die Prognose der Dementia praecox' and a re-consideration of his contribution to psychiatry.

After Eugen Bleuler introduced 'schizophrenia' in 1908, the term was hotly debated but eventually led to the abandonment of Kraepelin's previous term 'dementia praecox'. Bleuler's contribution has subsequently been interpreted in two main ways. One tradition holds that Bleuler merely renamed 'dementia praecox' while conceptually continuing the Kraepelinian tradition. The other, focusing on Bleuler's characterization of 'dementia praecox' in terms of specific psychological alterations, accredits him with a genuine re-conceptualization. Based on a close reading of 'Die Prognose der Dementia praecox', the paper in which Bleuler first mentioned 'schizophrenia', we suggest a further interpretation of Bleuler's contribution and argue that the main motive for his re-conceptualization is to be found in his rejection of Kraepelinian nosology.

Development and validation of a set of German stimulus- and target words for an attachment related semantic priming paradigm.

Experimental research in adult attachment theory is faced with the challenge to adequately activate the adult attachment system. In view of the multitude of methods employed for this purpose so far, this paper suggests to further make use of the methodological advantages of semantic priming. In order to enable the use of such a paradigm in a German speaking context, a set of German words belonging to the semantic categories 'interpersonal closeness', 'interpersonal distance' and 'neutral' were identified and their semantics were validated combining production- and rating method. 164 university students answered corresponding online-questionnaires. Ratings were analysed using analysis of variance (ANOVA) and cluster analysis from which three clearly distinct groups emerged. Beyond providing validated stimulus- and target words which can be used to activate the adult attachment system in a semantic priming paradigm, the results of this study point at important links between attachment and stress which call for further investigation in the future.