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SchizophreniaEvolution and Synthesis$
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Steven M. Silverstein, Bita Moghaddam, and Til Wykes

Print publication date: 2013

Print ISBN-13: 9780262019620

Published to MIT Press Scholarship Online: May 2014

DOI: 10.7551/mitpress/9780262019620.001.0001

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How the Diagnosis of Schizophrenia Impeded the Advance of Knowledge (and What to Do About It)

How the Diagnosis of Schizophrenia Impeded the Advance of Knowledge (and What to Do About It)

(p.49) 3 How the Diagnosis of Schizophrenia Impeded the Advance of Knowledge (and What to Do About It)

William T. Carpenter

The MIT Press

Schizophrenia is best viewed as a clinical syndrome, without compelling evidence of a homogeneous disease. Most investigations over the past century, however, have been designed without addressing heterogeneity, thus impeding knowledge acquisition. Recent paradigm shifts in the schizophrenia construct are intended to provide more valid and more robust approaches to discovery. These include: 1) Identifying patient subgroups to enrich study cohort homogeneity on causal pathway and pathophysiology; 2) Identifying key domains of psychopathology and using each domain as the pathology of interest; 3) Investigating molecules, genes, and pathways related to known neural circuits and behavioral constructs which, in turn, are related to psychopathology domains; and 4) Using stages of vulnerability development as study targets, to conceptualize causal pathways to early vulnerability that are not specific to schizophrenia, as well as later stages associated with pathological variables which have greater disorder-outcome specificity. The first paradigm shift can be informative for a form of schizophrenia that may not generalize to all forms of the disorder. The last three provide for more specific study targets but address pathologies that will cut across current disorder boundaries. The fourth paradigm, in particular, calls attention to preventive and resiliency factors as well as causal factors. Published in the Strungmann Forum Reports Series.

Keywords:   Schizophrenia, Heterogeneity, Psychopathology, Pathophysiology, Neuroscience, Vulnerability, Prevention, Resilience, Paradigm, Research Domain Criteria

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