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Schizophrenia and other psychoses are the most severe and disconcerting of all mental disorders [1]. Psychoses have provoked greater concern in society than many other medical disorders because of their manifold presentations, varied courses and outcomes, and because of the lack of awareness about the disorder. While the debate continues in the general public about its role as a true disease, with important social movements against it, clinical knowledge about schizophrenia and other psychoses is growing owing to increasing interest in neurobiological research [2,3].
Psychotic disorders usually start in young adulthood and are directly involved in a reduction in life expectancy by approximately 10 years, mostly as a consequence of suicide and loss of physical health. Individuals with psychosis display delusions and hallucinations, thought disorders and negative symptoms (affective flattering, alogia and abulia). Full recovery is not usual, and enduring symptoms and deficient outcomes are the rule, not the exception. Affective symptoms are prominent in psychotic disorders, such as bipolar disorder, which usually involves dramatic alterations of mood with psychotic phenomena as a frequent accompaniment, and the diagnosis of schizophrenia frequently overlaps.
Recently, cognitive deficits have also been identified as core symptoms of the disorder. Specifically, individuals with the disorder exhibit disturbances in executive, memory and attentional functioning, and alterations in the processing of social information, including processing of emotions, social perception, mentalization and social knowledge [4].
Psychoses cover a wide range of disorders, including not only schizophrenia and bipolar disorder, but also less common psychotic disorders such as: schizophreniform, schizoaffective, brief psychotic, delusional and shared psychotic disorders; psychotic disorder not otherwise specified; substance-induced psychotic disorder; psychotic disorder due to a general medical condition; and atypical psychoses.
There are now highly developed rehabilitation procedures available in addition to effective drugs. Treatment in natural settings is mainly based on the prescription of drugs for a variety of psychopathological conditions that are not necessarily related to nosological categories [5]. Heterogeneity of the diagnostic constructs has hampered the advancement of potential drug specificities.
In this article, the so-called 'clinical problem' of schizophrenia, which is a special case of clinical heterogeneity, will be reviewed in terms of its historical roots, important current issues and future lines of progress.
Relevance of schizophrenia & other psychoses
A first approach to...