No abstract

Notwithstanding that (excluding the dementias) they form the core of serious psychiatric illness the 'functional psychoses' lack a satisfactory label. The adjective 'functional' implies that, by contrast with the 'organic' dementias, there are no identifable changes in the brain. Seventeen years of neuroradiological research, backed up by post-mortem studies, have established beyond reasonable doubt that in schizophrenia at least such changes (a modest mean increase in ventricular size, a possible reduction in brain size and loss of asymmetry) are present but their meaning and the relationship to symptomatology is obscure.This modest gain in understanding has done little to illuminate nosology. The failure of the research community to establish whether schizophrenic, affective, schizo-affective and delusional psychoses (the subject matter of this volume) are distinct or overlapping disease entities (and if, in part, the latter -what overlaps with what?) represents the major unresolved crisis in psychiatric research. As this book makes abundantly clear there are an embarrassingly large number of ways of defining schizophrenia (or affective or schizo-affective psychoses) and, although this book does not document the evidence, they define quite different populations of patients. The Diagnostic Q Statistical Manual (DSM 111-R) criteria for example are considerably more restrictive than the criteria of Bleuler. There has been a welcome trend, well illustrated in this volume, towards the application of operational criteria. This helps us to agree on what (for a given purpose) we are going to call schizophrenia. but it docs not tell us whether what we are calling schizophrenia has any meaning in terms of predicting outcome or response to treatment. There is also the problem of labelling whatever illnesses have been excluded from the definition.The authors have provided a useful compendium of the different diagnostic systems that are now in use together with a brief commentary on the origins and application of each. What they have not done is to provide a critique of the validity (or otherwise) of the different systems, or to address the problem of whether there really are separable disease entities. Their own solution (the 'polydiagnostic approach') is to use an array of different criteria. This sounds cumbersome and evades the categorical question. A quite different approach (which I favour) is to accept that the categories are arbitrary, and to deal with continua which are defined by the frequency of occurrence of different psychopathological features (e.g. Schneiderian first rank symptoms, affective flattening, elation). One can then ask questions such as how age of onset and sex relate to form of psychosis, and what are the predictors of early relapse and response to neuroleptic medication without being too concerned about whether this is a case of true schizophrenia (according to x's criteria) or schizo-affective disorder. But for an account of which criteria are actually being used to reach diagnoses and what they...

Although a poorer quality of life and a higher level of mental distress are demonstrated, the similarity to the general population in the domain social relationships shows that this does not affect all domains. These findings show the need for easily accessible health services for the deaf which offer sensitive communication with them.

Clinical research centers in Aarhus, Berlin, Hamilton and Vienna collected mortality data for 827 manic-depressive and schizoaffective patients given lithium treatment for more than 6 months. The average duration of the treatment was 81 months and the total time on lithium 5600 patient-years. For each patient, the mortality risk was calculated by entering the appropriate national life tables for the general population. The number of observed deaths was 44; the number of expected deaths was 49.7. The standardized mortality ratio, 0.89, did not differ significantly from 1.0. The mortality of manic-depressive patients is 2-3 times that of the general population. Our data show that the mortality of manic-depressive and schizoaffective patients given long-term lithium treatment does not differ significantly from that of the general population.