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Article
Publication date: 25 January 2010

Costa Vakalopoulos

Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar…

Abstract

Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar disorder from schizophrenia with affective features has led to a third category of patients often loosely labeled as schizoaffective. Research in schizophrenia has attempted to render the presence or absence of negative symptoms and their relation to etiology and prognosis more explicit. A dichotomous population is a recurring theme in experimental paradigms. Thus, schizophrenia is defined as process or reactive, deficit or non-deficit and by the presence or absence of affective symptoms. Laboratory tests confirm the clinical impression showing conflicting responses to dexamethasone suppression and clearly defined differences in autonomic responsiveness, but their patho-physiological significance eludes mainstream theory. Added to this is the difficulty in agreeing to what exactly constitutes useful clinical features differentiating, for example, negative symptoms of a true deficit syndrome from features of depression. Two recent papers proposed that the general and specific cognitive features of schizophrenia and major depression result from a monoamine-cholinergic imbalance, the former due to a relative muscarinic receptor hypofunction and the latter, in contrast, to a muscarinic hypersensitivity exacerbated by monoamine depletion. Further development of these ideas will provide pharmacological principles for what is currently an incomplete and largely, descriptive nosology of psychosis. It will propose a dimensional view of affective and negative symptoms based on relative muscarinic integrity and is supported by several exciting intracellular signaling and gene expression studies. Bipolar disorder manifests both muscarinic and dopaminergic hypersensitivity. The greater the imbalance between these two receptor signaling systems, the more the clinical picture will resemble schizophrenia with bizarre, incongruent delusions and increasingly disorganized thought. The capacity for affective expression, by definition a non-deficit syndrome, will remain contingent on the degree of preservation of muscarinic signaling, which itself may be unstable and vary between trait and state examinations. At the extreme end of muscarinic impairment, a deficit schizophrenia subpopulation is proposed with a primary and fixed muscarinic receptor hypofunction.

The genomic profile of bipolar disorder and schizophrenia overlap and both have a common dopaminergic intracellular signaling which is hypersensitive to various stressors. It is proposed that the concomitant muscarinic receptor upregulation differentiates the syndromes, being marked in bipolar disorder and rather less so in schizophrenia. From a behavioral point of view non-deficit syndromes and bipolar disorder appear most proximate and could be reclassified as a spectrum of affective psychosis or schizoaffective disorders. Because of a profound malfunction of the muscarinic receptor, the deficit subgroup cannot express a comparable stress response. None -theless, a convergent principle of psychotic features across psychiatric disorders is a relative monoaminergic-muscarinic imbalance in signal transduction.

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Mental Illness, vol. 2 no. 1
Type: Research Article
ISSN: 2036-7465

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Article
Publication date: 13 July 2012

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International Journal of Health Care Quality Assurance, vol. 25 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 15 March 2013

Alex Dregan, Tea Lallukka and David Armstrong

Typologies of sleep problems have usually relied on identifying underlying causes or symptom clusters. The purpose of this paper is to explore the value of using the…

Abstract

Purpose

Typologies of sleep problems have usually relied on identifying underlying causes or symptom clusters. The purpose of this paper is to explore the value of using the patient's own reasons for sleep disturbance.

Design/methodology/approach

Using secondary data analysis of a nationally representative psychiatric survey the patterning of the various reasons respondents provided for self‐reported sleep problems were examined. Over two thirds (69.3 per cent) of respondents could identify a specific reason for their sleep problem with worry (37.9 per cent) and illness (20.1 per cent) representing the most commonly reported reasons. And while women reported more sleep problems for almost every reason compared with men, the patterning of reasons by age showed marked variability. Sleep problem symptoms such as difficulty getting to sleep or waking early also showed variability by different reasons, as did the association with major correlates such as worry, depression, anxiety and poor health.

Findings

While prevalence surveys of “insomnia” or “poor sleep” often assume the identification of an underlying homogeneous construct, there may be grounds for recognising the existence of different sleep problem types, particularly in the context of the patient's perceived reason for the problem.

Originality/value

A typology based on reasons presents a different snapshot of the landscape of insomnia. Using patient's reasons to underpin a sleep nosology is an alternative way of sub‐dividing patients' symptoms which has some face validity given the “subjective” associations between reasons and symptoms.

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Journal of Public Mental Health, vol. 12 no. 1
Type: Research Article
ISSN: 1746-5729

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Article
Publication date: 4 January 2016

Marco O. Bertelli

– The purpose of this paper is to provide a summary of main outcomes of the 10th EAMHID International Congress and a critical overview of some key contributions.

Abstract

Purpose

The purpose of this paper is to provide a summary of main outcomes of the 10th EAMHID International Congress and a critical overview of some key contributions.

Design/methodology/approach

A discussion on the impact of the neurodevelopmental perspective on mental health care achievements and failures in the field of intellectual disability (ID) and autism spectrum disorders (ASD).

Findings

The considerable progress in the field of mental health care for people with ID that has been made in the last 30 years and that is reflected through the 350 papers presented in this Congress represents the continuation of the work of great pioneers, such as Frank Menolascino, Felix Platter or William I. Gardner, who have been honoured by the EAMHID in the naming of the congress rooms, and the dedication of the poster award. The neurodevelopmental perspective was confirmed to be the current most valued conceptual framework to explain relations across systems and to support multi-level, transnosographic, life-long, interdisciplinary approaches in the production of aetiological insight and good-quality intervention for mental health problems; on the other hand it might determine a premature abandonment of the traditional nosology and the appearance of very broad spectrum conditions covering the full range of psychopathology. Also psychopharmacology was extensively considered, with the explicit aim to raise the attention of researchers and clinicians on this neglected topic. Unfortunately, adults with ID/ASD are still deprived of the right to receive treatments that are based on strong evidence, as it is for the general population.

Originality/value

This editorial outlines the second part of a special issue that offers a comprehensive and varied collection of papers from the contributions to the 10th International Congress of the EAMHID.

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Advances in Mental Health and Intellectual Disabilities, vol. 10 no. 1
Type: Research Article
ISSN: 2044-1282

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Book part
Publication date: 9 October 2012

Julie Netherland

So much has been written about addiction, one can reasonably ask why we need another volume on the subject now. The pieces gathered here take up a number of current trends…

Abstract

So much has been written about addiction, one can reasonably ask why we need another volume on the subject now. The pieces gathered here take up a number of current trends that make this exactly the right time to take a fresh look at addiction. These include: debates over the nosology of addiction as part of the revision to the Diagnostic and Statistical Manual of Mental Disorders (DSM); the expansion of addiction's meaning and spheres of control beyond alcohol and illicit substances; the rise of neuroscience; the increasing ‘pharmaceuticalization’ of everyday life and new pharmaceutical treatments for addiction; growing awareness about the intersection of the drug war and the mass incarceration of people of color; and new theoretical frameworks for understanding the role of addiction as a fundamental technique of social control. These trends are reshaping addiction in both new and not-so-new ways that warrant the interrogation this volume provides.

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Critical Perspectives on Addiction
Type: Book
ISBN: 978-1-78052-930-1

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Book part
Publication date: 3 August 2011

Annemarie Jutel

Purpose – This chapter presents a case for reframing medical sociology to focus on diagnosis as a pivotal category of analysis via an extended literature review of the…

Abstract

Purpose – This chapter presents a case for reframing medical sociology to focus on diagnosis as a pivotal category of analysis via an extended literature review of the diagnosis as a tool of medicine.

Methodology/approach – Conceptual overview.

Practical implications – By reviewing the range of social functions served by diagnosis, and the similarly wide assortment of social forces that shape diagnostic categories, this chapter pushes social scientists and theorists to consider diagnosis as a cornerstone to the understanding of health, illness, and disease.

Originality/value of paper – Building on Brown's earlier call for a sociology of diagnosis, this chapter sets forth potential parameters for this field. It defines how the study of diagnosis is dissipated across myriad areas of scholarship, including medicalization, disease theory, ethics, classification theory, and history of medicine. Extirpating diagnosis and revealing it for specific discussion provides an opportunity to study topics such as illness experiences, health social movements, and disease recognition from a different and rich perspective.

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Sociology of Diagnosis
Type: Book
ISBN: 978-0-85724-575-5

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Book part
Publication date: 3 August 2011

PJ McGann

Purpose – To explore the ideological effects and social control potential of diagnostic biopsychiatry and encourage the sociology of diagnosis to retain key insights of…

Abstract

Purpose – To explore the ideological effects and social control potential of diagnostic biopsychiatry and encourage the sociology of diagnosis to retain key insights of early medicalization scholarship.

Methodology – As the sociology of diagnosis emerges from medicalization, it is imperative that the new sub-specialty retains the critical edge of the early scholarship. With this in mind the paper reviews key aspects of the medicalization thesis, emphasizing the links between medical definitions and social control processes (e.g. Conrad, 1992; Conrad & Schneider, 1992; Zola, 1972). Based on this review scholars are urged to be mindful of the “diagnostic imaginary” -- a way of thinking that conceals the presence of the social in diagnoses, and which closes off critical analysis of the existential-connectedness and political nature of diagnoses.

Findings – The paradigm shift from dynamic to diagnostic psychiatry in DSM-III opened the door to a new biomedical model that has enhanced American psychiatry's scientific aura and prestige. With the increased presence and ordinariness of diagnoses in everyday life, an illusory view of diagnoses as scientific entities free of cultural ties has emerged, intensifying the dangers of medical social control.

Social implications – By illustrating that diagnoses are cultural objects imbued with political meaning, the ideological effects and social control potential of diagnostic biopsychiatry may be mitigated.

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Article
Publication date: 14 October 2014

Kellian Clink

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Reference Reviews, vol. 28 no. 8
Type: Research Article
ISSN: 0950-4125

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Article
Publication date: 2 September 2014

W.J. Penson

The purpose of this paper is to critically discuss how the psy-sciences have been, and continue to be, typified by some critics, as colonizers and are credited with…

Abstract

Purpose

The purpose of this paper is to critically discuss how the psy-sciences have been, and continue to be, typified by some critics, as colonizers and are credited with Imperialistic motivations. However, rarely are these critiques developed beyond a pejorative characterisation.

Design/methodology/approach

This paper reviews the criticisms of psychiatry as colonial and outlines the tensions in taking different frames of reference in the mental health field, before going on to suggest theoretical and research perspectives arising from postcolonial theory that might advance these critical positions more coherently and the implications of doing so.

Findings

This study suggests an engagement with humanities-based methods and fields such as postcolonial scholarship.

Social implications

This argument is timely, especially given recent controversies over the publication of DSM5, the scaling up agenda for mental health in the Global South and increased attention to the agenda of Big Pharma.

Originality/value

Postcolonial intersections with psy-science remains a relatively undeveloped area in the critical literature.

Details

Mental Health Review Journal, vol. 19 no. 3
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 18 May 2021

Jona T. Garz

This paper has two purposes. One is to examine the ways mentally disabled children were disciplined and cared for in Berlin, Germany/Prussia, at the end of the 19th…

Abstract

Purpose

This paper has two purposes. One is to examine the ways mentally disabled children were disciplined and cared for in Berlin, Germany/Prussia, at the end of the 19th century, by considering the way the architecture of the asylum affected the practices within it. The second purpose is to examine the manner in which the practices at the Dalldorf Asylum, especially the administrative paperwork, fabricated and stabilized the medico-pedagogical category of “feeble-mindedness”.

Design/methodology/approach

This paper engages with reflections on asylum architecture and its connection to disciplining bodies as shown in Disability History and linking these insights to recent scholarship from the field of Science and Technology Studies on the fabrication of knowledge through observation. Drawing on microhistory as methodology it examines the fabrication of “feeble-mindedness” with and within the Dalldorf Asylum, focusing on architecture and design as well as administrative practices.

Findings

The analysis of the asylum's architecture reveals how certain ideas of hygiene and control derived from 19th century psychiatry, along with personal attentiveness and individualized learning were incorporated into the building, creating the notion of a “feeble-minded child” as being simultaneously dangerous and in danger. The paper further shows how the professionals involved were struggling with diagnosing these children, further showcasing that the space as well as the categorization of children, oscillating between psychiatry and pedagogy, has to be understood as contested.

Originality/value

This paper engages findings on the disciplining structures organizing everyday life within the asylum with concepts of fabricating knowledge as central to science studies. The Dalldorf Asylum, the earliest state-funded asylum for mentally disabled children in Germany and largely understudied, is used as the main research object. A microhistorical approach allows to make visible the intricate yet mundane practices involved in stabilizing the category of “feeble-mindedness”.

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