Core of Schizophrenia: Estrangement, Dementia or Neurocognitive Disorder?

Abstract

Background: The recent literature frequently represents schizophrenia as a deteriorating neurocognitive process similar to organic degenerative dementia. Methods: This study addresses the following questions: (1) Did the classic authors equate degenerative dementia with schizophrenia? (2) Is there empirical evidence pointing to a close similarity between schizophrenia and organic dementia? (3) Does empirical evidence support the view that intellectual impairment and/or more specific neuropsychological dysfunctions are core features of schizophrenia? The classic authors agreed that the intellectual dysfunctions were most likely a consequence rather than a primary, causal factor in the manifestation of schizophrenia despite their consensus on the assumption of its neurobiological origins. Rather, they considered impairments of intelligence and neurocognition as an expression of pseudodementia, i.e. a dementia-like clinical picture caused by a weakening of motivation. Results: The empirical data from the draft, high-risk birth cohort and clinical samples show a low IQ and a variety of neurocognitive dysfunctions in schizophrenia. These findings are far from universal since substantial proportions of patients do not show deficits. In addition, the empirical morphological and neuropathological evidence does not support any close analogy of schizophrenia with neurodegenerative dementia. Moreover, neurocognitive dysfunctions cannot be considered a core feature of schizophrenia if core is understood as ‘essential’, i.e. constitutive of a diagnosis, or as ‘generative’, i.e. symptom producing. In the phenomenological psychopathological tradition, schizophrenia is seen as a progressive condition marked by autism, which is a profound alteration in the structures (frameworks) of subjectivity (consciousness), manifest in self-relation (self-disorders) and in the relation to the world (lack of natural evidence) and to others (eccentricity, solipsism and isolation). Conclusion: It is suggested that the neurodevelopmental model should integrate interactions between emerging psychological structures and genetic and environmental factors.

A Disappearing Heritage: The Clinical Core of Schizophrenia

“…More importantly, the negative symptoms are conceived of as quantitative deficits, fall-outs of normal functions (too little), which are signaled by the deprivative alpha: a-logia, a-volition, an-ergia, etc. This deficit view, however, has a limited resemblance to the clinical core of schizophrenia 15. Blankenburg25 evoked here an insightful and useful dictum: “the Minus (the deficit) in schizophrenia is caused by the Aliter (the different [strange]), whereas the reverse is true for the organic dementia.” Psychiatrists, trained today, have difficulty in indentifying and describing clinically significant formal thought disorder, disordered discourse, and varieties of disintegrated expressivity.…”

“…The fundamental features—also emphasized by Kraepelin and others—were many: autism, formal thought disorder, ambivalence, affective-emotional, and affect-expressive changes, changes in the structure of the person, disorders of volition, acting and behavior, and the socalled “schizophrenic dementia” (which Bleuler did not conceived on the analogy with organic dementia 14,15). …”

Exploring a lay Gestalt of schizophrenia? A Danish background population’s explanations on why and how first-episode schizophrenia patients’ narratives were intuitively sensed as contextually inappropriate

“…Both are common in spoken language, but violate written language norms (all narratives were transcribed verbatim and printed as such to the evaluators). Consequently, spokenness characteristics may "naturally" have elicited contextual inappropriateness evaluations 1 . On the other hand, spoken-ness characteristics are particularly interpretation rich as MaClay and Osgood (1959) suggest in one of the first influential works on pauses and hesitation signals (such as "uhm"): "naturally-appearing pauses and other hesitation phenomena influence the listener's connotative judgments of the speaker, e.g.…”

“…remains largely unanswered. This "whatness", the diagnostically defining and symptom-producing vulnerability trait or "core" of schizophrenia, is in recent continental-phenomenological psychiatry regarded as based not on cognitive deficits but on cognition used at the expense of pragmatics (1)(2)(3)(4). "Pragmatics" is primarily understood in the sense of what is contextually or socially appropriate.…”

A Structure-Function Mechanism for Schizophrenia

“…It is viewed that what defines a mental illness is its effect on the conscious representational experience (Anscombe, 1987; Graham and Stephens, 2007). Moreover, schizophrenia is thought to involve a profound alteration in the structures (frameworks) of subjectivity (consciousness), and to manifest in self-relation and in the relation to the world (Urfer-Parnas et al, 2010). Furthermore, it is thought that schizophrenic patients lack control over mental processes so that when emotions and intuitions are not brought into focus, the individual loses his or her sense of self (Krabbendam and van Os, 2005).…”