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"Transition" to Schizophrenia or Fluctuations within the Same Disorder?
Julie Nordgaard1,2, Rasmus Handest1, Mads Gram Henriksen1,3
1Mental Health Center Amager, Copenhagen, Denmark.
Psychopathology
|August 15, 2021
Summary
Prodromal research on psychosis is complex. This study found that individuals diagnosed with schizotypal disorder who later developed schizophrenia showed dimensional fluctuations rather than a distinct transition or conversion. Psychotic experiences and self-disorders were present at baseline.
Area of Science:
- Psychiatry
- Clinical Psychology
- Neuroscience
Background:
- Prodromal research aims to identify and treat individuals at risk of psychosis to prevent or delay onset.
- Understanding the shift from conditions like schizotypal disorder to schizophrenia is unclear, with current terms like 'conversion' or 'transition' being debated.
- This study investigates the psychopathological changes in patients transitioning from schizotypal disorder to schizophrenia.
Purpose of the Study:
- To examine the psychopathological manifestations and functional level of patients diagnosed with schizotypal disorder who later developed schizophrenia.
- To explore the nature of diagnostic shifts from schizotypal disorder to schizophrenia, challenging the notions of linear progression or sudden conversion.
- To provide a nuanced understanding of the developmental trajectory from prodromal states to full-blown psychotic disorders.
Main Methods:
- A cohort of 40 patients initially diagnosed with schizotypal disorder was followed for 5 years.
- Ten patients who were re-diagnosed with schizophrenia at follow-up were selected for detailed psychopathological and functional analysis.
- Comparison of baseline and follow-up data, including self-disorders, perceptual disorders, and formal thought disorders, was conducted.
Main Results:
- A slight decrease in the level of functioning was observed in 9 out of 10 patients who progressed to schizophrenia.
- Eight patients reported prior micro-psychotic or psychotic experiences before the 5-year follow-up.
- All patients exhibited self-disorders at baseline, with several showing perceptual disorders and nine having formal thought disorders.
Conclusions:
- The study suggests that the progression from schizotypal disorder to schizophrenia may involve dimensional fluctuations within the same condition, rather than a distinct 'conversion' or 'transition'.
- No striking psychopathological or functional changes were identified that would signify a clear shift between the two diagnoses.
- Findings indicate a need to reconsider diagnostic categories and the conceptualization of psychosis development.
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