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1.
Front Psychiatry. 2019 Jan 30;9:757. doi: 10.3389/fpsyt.2018.00757. eCollection 2018.

The Group of Treatment Resistant Schizophrenias. Heterogeneity in Treatment Resistant Schizophrenia (TRS).

Author information

1
Lundbeck North America, Deerfield, IL, United States.

Abstract

Schizophrenia is composed of a heterogeneous group of patient segments. Our current notion of the heterogeneity in schizophrenia is based on patients presenting with diverse disease symptom phenotypes, risk factors, structural and functional neuropathology, and a mixed range of expressed response to treatment. It is important for clinicians to recognize the various clinical presentations of resistance to treatment in schizophrenia and to understand how heterogeneity across treatment resistant patient segments may potentially inform new strategies for the development of effective treatments for Treatment Resistant Schizophrenia (TRS). The heterogeneity of schizophrenia may be reduced by parsing patient segments based on whether patients demonstrate an adequate or inadequate response to treatment. In our current concept of TRS, TRS is defined as non-response to at least two adequate trials of antipsychotic medication and is estimated to affect about 30% of all patients with schizophrenia. In this narrative review, the author discusses that the demonstration of inadequate response to antipsychotic drugs (APDs) may infer that some TRS patients may be suffering from a non-dopamine pathophysiology since D2 receptor antagonist-based treatment is ineffective. Preliminary neurobiological findings may further support the pathophysiologic distinction of TRS from that of general schizophrenia. Investigation of the basis for heterogeneity in TRS through the systematic investigation of relevant "clusters" of similarly at risk individuals may hopefully bring us closer to realize a precision medicine approach for developing effective therapies for TRS patient segments.

KEYWORDS:

antipsychotic drug; clozapine; dopamine; first-episode schizophrenia (FES); magnetic resonance spectroscopy (MRS); positron emission tomography–PET; schizophrenia; treatment resistant

Publication type

Publication type

2.
Nervenarzt. 2013 Mar;84(3):381-5. doi: 10.1007/s00115-012-3520-y.

[A case of Bleuler's disease? 100 years of dementia praecox or group of schizophrenias].

[Article in German]

Author information

1
LVR Klinik Köln, Fachkrankenhaus für Psychiatrie und Psychotherapie, Akademisches Lehrkrankenhaus der Universität zu Köln, Adamsstr. 12, 51063 Köln, Deutschland. jelena.miric@lvr.de

Abstract

Approximately 100 years ago Eugen Bleuler published the most significant contribution to psychiatry by conceptualizing the term schizophrenia as a diagnostic entity. In modern diagnostic manuals Bleuler's concept is only reflected in subordinated criteria, i.e. the negative symptoms. On the occasion of the anniversary of Bleuler's essential publication, the present work aims to exemplify the differences in diagnostic concepts and it will be illustrated that Bleuler's intention to establish his so-called basic symptom as a guideline for diagnostics has to be considered as failed from a present day viewpoint.

PMID:
22528064
DOI:
10.1007/s00115-012-3520-y
[Indexed for MEDLINE]
Icon for Springer
3.
Schizophr Bull. 2011 Nov;37(6):1101-3. doi: 10.1093/schbul/sbr130.

Eugen Bleuler: centennial anniversary of his 1911 publication of Dementia Praecox or the group of schizophrenias.

Author information

1
Department of Psychiatry, Yale University, New Haven, CT, USA. thomas.mcglashan@yale.edu

Abstract

In 1911, a book was published in Europe by Eugen Bleuler describing in detail asylum patients under his care who met clinical criteria for the psychotic disorder named Dementia Praecox by Emil Kraepelin. Bleuler's voluminous publication, now a classic to world psychiatry, validated Kraepelin's observations and extended them in ways that remain familiar to us a full century later in how we describe, diagnose, treat, and understand psychosis.

PMID:
22013082
PMCID:
PMC3196955
DOI:
10.1093/schbul/sbr130
[Indexed for MEDLINE]
Free PMC Article
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4.
Schizophr Bull. 2011 May;37(3):471-9. doi: 10.1093/schbul/sbr016.

Eugen Bleuler's Dementia praecox or the group of schizophrenias (1911): a centenary appreciation and reconsideration.

Author information

1
Department of Psychology, Aarhus University, Aarhus C, Denmark; 2Private Practice, Berlin, Germany. andrew@psy.au.dk

Abstract

On the 100th anniversary of the publication of Eugen Bleuler's Dementia Praecox or the Group of Schizophrenias, his teachings on schizophrenia from that seminal book are reviewed and reassessed, and implications for the current revision of the category of schizophrenia, with its emphasis on psychotic symptoms, drawn. Bleuler's methods are contrasted with Kraepelin's, and 4 myths about his concept of schizophrenia addressed. We demonstrate that (1) Bleuler's concept of schizophrenia has close ties to historical and contemporary concepts of dissociation and as such the public interpretation of schizophrenia as split personality has some historical basis; (2) Bleuler's concept of loosening of associations does not refer narrowly to a disorder of thought but broadly to a core organically based psychological deficit which underlies the other symptoms of schizophrenia; (3) the "4 A's," for association, affect, ambivalence, and autism, do not adequately summarize Bleuler's teachings on schizophrenia and marginalize the central role of splitting in his conception; and (4) Bleuler's ideas were more powerfully influenced by Pierre Janet, particularly with regard to his diagnostic category Psychasthenia, than by Sigmund Freud. We conclude that Bleuler's ideas on schizophrenia warrant reexamination in the light of current criticism of the emphasis on psychotic symptoms in the schizophrenia diagnosis and argue for the recognition of the dissociative roots of this most important psychiatric category.

Comment in

PMID:
21505113
PMCID:
PMC3080676
DOI:
10.1093/schbul/sbr016
[Indexed for MEDLINE]
Free PMC Article
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6.
Vertex. 2008 May-Jun;19(79):114-22.

[Schizophrenia with obsessive-compulsive symptoms or the group of schizo-obsessive schizophrenias: clinical characteristics and prognosis].

[Article in Spanish]

Author information

1
Departamento de Salud Mental (UBA). Corte Suprema de Justicia de la Nación. etoro@fibertel.com.ar

Abstract

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this paper, the rate of occurrence of OCS and OCD in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms, depressive symptoms, cognitive function and age are reviewed. The author proposes to use the term "group of schizo-obsessive disorders" and proposes an integrate classification system.

PMID:
18997904
[Indexed for MEDLINE]
7.
J Psychiatry Neurosci. 1994 Jul;19(4):270-7.

A contribution to the differential diagnosis of the "group of schizophrenias": structural abnormality of chromosome 4.

Author information

1
Department of Psychiatry, McGill University, Montreal, Quebec.

Abstract

A structural abnormality of chromosome 4 [inv 4 (p15.2; q21.3)] is reported in a male presenting with DSM-III-R schizophrenia, undifferentiated type (295.94) and in his mother, who displayed symptoms associated with schizotypal personality disorder (DSM-III-R 301.22). The proband had a performance IQ of 91, poor motor coordination, stature in the lowest quartile and an impaired sense of time. There were no diagnostic physical or neurological abnormalities. Mild ventricular enlargement and prominent sulci were found on computed tomography. Both he and his chromosomally normal father had strabismus which required surgical correction. This case joins the long list of chromosomal abnormalities previously reported to confer an increased risk of mental illness and emphasizes the importance of a sophisticated differential diagnosis in evaluating patients who present with symptoms of schizophrenia. The implications for recent initiatives which attempt to localize genes conferring susceptibility to schizophrenia and other major mental illnesses are discussed.

PMID:
7918348
PMCID:
PMC1188607
[Indexed for MEDLINE]
Free PMC Article
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8.
Fortschr Neurol Psychiatr. 1992 Aug;60(8):289-95.

[Psychiatry and psychoanalysis--Eugen Bleuler's "dementia praecox or group of schizophrenias" (1911)].

[Article in German]

Author information

1
Klinik für Kinder- u. Jugendpsychiatrie der Rheinischen Landes- und Hochschulklinik Essen.

Abstract

Unlike many psychiatrists around 1900, Eugen Bleuler had a friendly, even partly affirmative attitude towards psychoanalysis. In his famous book "Dementia Praecox or Group of Schizophrenias" (1911) he emphasized the influence of psychoanalysis on his theory about schizophrenia. In this article we describe Bleuler's fundamental thoughts on psychology and psychotherapy in order to look for a special disposition to accept psychoanalysis. Psychoanalysis seemed to him to be one of the most promising attempts to develop a systematic psychotherapy founded on a scientific psychology. In particular, Freud's hypothesis about the wish-fulfilling character of dreams influenced Bleuler's understanding of delusion and other symptoms of schizophrenia.

PMID:
1511944
DOI:
10.1055/s-2007-999148
[Indexed for MEDLINE]
Icon for Georg Thieme Verlag Stuttgart, New York
12.
Aust N Z J Psychiatry. 1978 Dec;12(4):221-31.

Loose associations: straight and crooked thinking and the group of schizophrenias.

Abstract

In this paper I hope to provide the basis for a discussion on logic, logical thinking and creativity in medicine, particularly in psychiatry. By way of illustration we will examine schizophrenia with particular reference to biochemistry, but the discussion will focus on semantic issues and philosophical concepts. These issues are of fundamental importance in the development of psychiatry both as art and craft. Thus the paper deals both with the study of madness and madness itself. The title of the address illustrates some forms of communication which occur in the schizophrenias. It includes references to other ideas, to formal thought disorder and illogical thinking, private puns, vague links, and pointers to other sources and authors, namely, Bleuler (1950), Ernest Jones (1959) and Thouless (1974). These are all contained in a loose framework, wherein reference is made to a key anomaly always found in, but by no means unique to schizophrenia.

PMID:
33652
DOI:
10.3109/00048677809159085
[Indexed for MEDLINE]
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