Hierarchical arrangement of psychiatric symptoms in the context of schizophrenia

Abstract

Foulds' model proposing a four-class hierarchical structure of mental illness represents an interesting dimension of psychiatric research and discussion and probably has a significant potential on diagnosis, taxonomy, therapeutics and theory. Psychiatric symptoms were investigated in a group of 244 schizophrenic patients with the purpose of analyzing Foulds and Bedford's notion that psychiatric symptoms are arranged hierarchically. To achieve this the R (recent) version of the Delusions, Symptoms, States, Inventory (DSSI) was administered in the form of a constructed interview to these patients. The hierarchical arrangement of psychiatric symptoms was verified since a great majority of the cases (80.8%) produced symptom patterns conforming to the hierarchy model. However, patients with duration of illness longer than 10 years reported conforming patterns in a lower percentage (77%), whereas 84.6% of those with a duration of illness less than 2 years reported conforming patterns. The non-conforming patterns were those in which integrated delusions were absent in the presence of delusions of disintegration, neurotic symptoms were absent in the presence of integrated delusions, and dysthymic states were absent in the presence of neurotic symptoms.

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

“…This was in keeping with the notion that the hierarchical model is applicable only to acute patients [13,26]. Hence, no other study has included a large number of outpatients with chronic schizophrenia, not to mention non-patients – apart from that by the original authors of the DSSI [10]. The results of our study however suggested that the DSSI can be applied as effectively to both subclinical stabilized chronic illness group and non-patients as a screening measure for presence of active symptoms.…”

“…Accordingly, a self-report measure developed to assess the degree of adverse change in personal functioning and severity of clinical disorder in a hierarchical arrangement has been proposed previously by Foulds and Bedford [9]. The central notion is that starting with those without significant level of illness, or not personally ill (NPI), patients could be categorized according to a four-class hierarchical model of the severity of mental illness as follows: dysthymic states (DS) consisting of manifestations of states of anxiety, depression, and/or elation; neurotic symptoms (NS) involving conversion, dissociation, phobia, compulsion, and rumination; integrated delusion (ID) with delusions of persecution, grandeur, and/or contrition; and delusions of disintegration (DD) representing a single syndromal group corresponding to schizophrenia with considerable extent of personal disintegration as an agent of his/her own feelings, thoughts and actions [10,11]. The central hypothesis of this model is inclusive, non-reflexive relationship among the classes, which simply posits that the membership in the higher class also entails membership in the lower ones and that the converse does not hold.…”

The Association Between Adult Attachment Style and Delusional-Like Experiences in a Community Sample of Women

“…To assess anxiety, we examined responses to seven anxiety-related items included within the Delusions-Symptoms-State Inventory (DSSI) anxiety scale. This scale has also been widely used in clinical (Angelopoulos and Economou, 2001;Bedford and Presly, 1978) and community samples (Rodgers et al, 2000). For the purposes of this study, the presence of significant anxiety was defined as endorsing at least four anxiety items.…”