Foulds’ hierarchical model of psychiatric illness in a Dutch cohort: a re-evaluation

Abstract

SynopsisIn order to evaluate Foulds' hierarchical model of psychiatric illness, a study was carried out using data from a 3-year follow-up of patients suffering from functional non-affective psychoses. Of the 177 Present State Examinations carried out 86% yielded symptom patterns compatible with the model. It was shown that failures to fit the hierarchy can be explained either by measurement error or by the masking of major symptoms by the simultaneous presence of minor ones. A one-dimensional scale to measure the severity of psychiatric illness was constructed. Patients' scores were compared with ratings on the Index of Definition and the diagnosis of current mental state. The results of these comparisons were considered to be supportive validatory evidence. Some of the implications of the model and the data are discussed.

Prodromal Symptoms and Early Detection of Schizophrenia

“…Because of that, it is no surprise that de Jong et al [31], studying a sample of first-episode cases of schizophrenia assessed by the Present State Examination (PSE) in Groningen, and Biehl et al [32], who studied a first-episode sample of 70 patients with schizophrenia from Mannheim, found a sufficient goodness of fit for the sequence of Foulds' stages in about 85% of their samples. This result means that Foulds' stage model is applicable to the early course of schizophrenia without any substantial benefit in terms of the information it provides, but probably also to many other illnesses with progressive types of courses culminating in psychosis.…”

Examination of categorical approach to symptom assessment: cross-validation of foulds’ Delusions-Symptoms-States Inventory with Korean non-patient and patient groups

“…However, a notion of continuum from normality to psychotic illness has been articulated for over a century [3], though it has not been rigorously pursued except by a group of British researchers [1]. The severity of illness can be conceived and is embedded in the hierarchical path along which psychiatric diagnose is usually made - in the ascending order of anxiety and other neuroses, depressive neurosis, manic and paranoid psychoses, schizophrenia, and then organic psychosis [4]. Perceivably, such conceptualization of illness is more likely consider the shifting nature of the illness rather than diagnosis, which may have some important implications for treatment and prevention.…”

Hierarchical arrangement of psychiatric symptoms in the context of schizophrenia

“…In three studies [6,17,18] the Present State Examination (PSE) was used as a measuring instrument. Surtees and Kendell [18] observed that a high percentage of schizophrenic and manic patients did not fulfil the requirements of the model, because although they had the symptoms which could establish them in the classes of integrated delusions or delusions of disintegration they did not exhibit the neurotic symptoms that they were required lower in the hierarchy.…”

“…Sturt [17] reported very similar results to those derived from the studies in which the instrument used was the DSSI, but she suggested that the preconceived Foulds and Bedford model should be replaced by a model based on disorder prevalence. De Jong et al [6] suggested that failures to fit the hierarchy can be explained either by measurement error or by masking of minor symptoms by the simultaneous presence of major ones. In the majority of the studies [1,5,6,9,11,12,16,17] the participants comprised groups which received mixed diagnoses.…”

“…De Jong et al [6] suggested that failures to fit the hierarchy can be explained either by measurement error or by masking of minor symptoms by the simultaneous presence of major ones. In the majority of the studies [1,5,6,9,11,12,16,17] the participants comprised groups which received mixed diagnoses. In two studies [2,3] the participants comprised groups receiving diagnoses of affective illness.…”