[Theory of schizophrenia and community psychiatry--conclusions from current models for management]

Starting with Ciompis model of "affect logic" I want to show that affective, cognitive and behavioral patterns, once emerged in psychosis, subsequently tend to repetition and chronification on account of psychological, social but also neuronal plasticity. In the discussion about reasons of the chronification process, negative symptoms become more and more relevant. Beside the primary negative symptoms, patients develop coping strategies to avoid a new relapse. These secondary negative symptoms, however, should not only be understood as an adaptation effort of internal "disturbing factors", but also of external ones, caused by the surroundings. Therefore, the patient's behavior should not be seen detached from his context. To see negative symptoms also as coping strategy has major therapeutical implications for community psychiatry, because of the involved option that negative symptoms can be replaced by more curative and less disabling behaviour, i.e. they are accessible to therapeutical efforts. That means for community psychiatry, however, to develop itself out of its deficit oriented treatment paradigm and to increase its therapeutical ambitions.