Positive and Negative Symptoms in Psychosis: Description, Research, and Future Directions

By Philip D. Harvey; Elaine E. Walker | Go to book overview

Afterword

John M. Neale, Ph.D.

In the nineteenth century, books were written about a number of behavioral disorders, among them hebephrenia, catatonia, and paranoid dementia. These disorders were often elegantly described, and viewed as discrete diagnostic categories. Kraepelin, of course, changed this with his conception of dementia praecox. The previously mentioned disorders were now viewed as subtypes of a single entity, defined more on the basis of course than on symptoms. That is, members of a single class, dementia praecox, were thought to share a common course (early onset and progressive deterioration) even though their specific symptoms might vary widely.

Given Kraepelin's formulation of the concept of dementia praecox, it is clear that patients in the class will be heterogeneous with respect to symptoms. Bleuler's concept of schizophrenia also allowed for wide phenotypic variation, as the core of the disorder became an inferred concept, "breaking of associative threads". The original subtypes provide clear recognition of this point. But researchers were never enamoured with the classic subtypes as a way of optimally apportioning symptomatic variance. Subtype diagnoses were notoriously unreliable as indexed by interrater agreement, and also changed in the same patient across admissions or episodes. Therefore, by the 1960's psychological researchers were more likely to subdivide patients into good vs. poor premorbid, process vs. reactive, and acute vs. chronic. Generally these subdivisions "worked" in the sense that between group differences merged upon analysis of a variety of dependent variables. However, it is clear that enthusiasm for these subtypes has waned as the 1980's approached.

The distinction between positive and negative symptoms has quickly become the predominant approach to dealing with the obvious symptomatic heterogeneity of schizophrenia. It has become a "hot" topic in the field and spawned the conference that yielded this volume. The papers presented at the conference are a representative cross-section of the kinds of research that have been elicited by the positive/negative distinction. Thus, there are a number of papers examining the correlates of the dimension-- cognitive processes, electrodermal responding, prognosis, genetics, and neuropathy. And, there are a number of papers addressing

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