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Similar to Jim van Os presentation during SRF live webinar "Is Schizophrenia Dead Yet?" (17)
Jim van Os presentation during SRF live webinar "Is Schizophrenia Dead Yet?"
- 1. IIs Schizophrenia Dead Yet? Jim van Os & Sinan Guloksuz, Utrecht University Medical Centre, Utrecht, The Netherlands
- 2. The Psychosis Spectrum Syndrome
- 3. Debate is about Clinical Diagnosis, not About: Research – researchers can choose their own sample inclusion criteria, eg DSM schizophrenia, ICD schizophrenia, or ‘Deficit syndrome’ Subclinical psychotic experiences – part of phenotype but not of ‘diagnosable’ clinical syndrome Semantics: ‘psychosis’ here refers to the multidimensional syndrome, not merely positive symptoms
- 4. “Who gets to define value in health systems? The notion that it should be the people who use their services, rather than those who provide them, is gaining momentum.” (Richards, 2017). Who gets to define value?
- 5. Medicine and Health Care Moving into the 3rd Era JAMA, 2016 Era 1: Professional dominance Era 2: Accountability and market theory Era 3: The moral era
- 6. Two Discourses – 1 Dominant BMC Psychiatry, 2015 “Two discourses exist in mental health research and practice. The first focuses on the limitations associated with disability arising from mental disorder. The second focuses on the possibilities for living well with mental health problems”
- 7. Health is absence of disease and complete wellbeing WHO 1947 Health is the ability to adapt and selfmanage, given physical, mental & social challenges Huber, 2011 Two Definitions of ‘Health’
- 8. Two Discourses and two Types of Care SICK CARE HEALTH CARE
- 9. We revealed a dysfunctional system that does not deliver the quality of treatment needed for recovery. Is this tolerable in the 21st century? (Evaluation Sick Care Model)
- 10. Values According to Users: CHIME-D ……..point to the need for a greater emphasis on assessment of strengths and support for self-narrative development, promoting the role of mental health systems in developing inclusive communities enabling access to peer support as well as providing retreats, and clinical interaction styles which promote empowerment and self-management. CONNECTEDNESS; HOPE AND OPTIMISM; IDENTITY; MEANING IN LIFE; EMPOWERMENT Leamey et al, 2011; Stuart et al, 2016 Difficulties
- 11. Narrative development & Hope? “Schizophrenia is a devastating, highly heritable brain disorder” Science, 2009
- 12. Genetic Brain Test for “Disorder”? Diagnosis Mental Disorder Diagnostic Brain Test Kapur, Philips & Insel, Mol Psychiatry 2012
- 13. Useful for Patient? Weak relationship between diagnosis and symptoms Weak relationship between diagnosis and needs Weak relationship between diagnosis and prognosis
- 14. Academic Abstractions Sell Poorly Because they Disempower Are being caused by: Hearing voices (plus some secondary delusional ideation) Schizophrenia Allen Frances, 2012
- 15. DSM5: Introducing Human Variation Perspective ❖ Autism spectrum ❖ Addiction spectrum Multi-dimensional
- 16. Disorder Prevalence Schizophrenia 1.00% Schizoaffective 0.32% Schizophreniform 0.07% Delusional disorder 0.18% Brief psychotic disorder 0.05% Psychotic disorder NOS 0.45% Affective (Bip + Dep) 0.62% Substance use 0.43 Gen. Med. Condition 0.22% Perala et al, 2007 3.5%
- 17. Schizoaffective Schizophreniform Delusional disorder Psychotic depression Psychotic bipolar disorder Brief psychotic disorder Substance-induced psy. dis. Psy. disorder medical cond. Psychotic disorder NOS Hidden Syndrome: Prognostication Bias Schizophrenia PSYCHOSIS MORBIDITY 70% 30% PUBLICATIONS 95% 5%
- 18. “Belief-based” Psychiatric Dichotomy Woo-kyoung Ahn, 2009 Extremely serious Biological “Physical” treatment Mild Psychosocial “Psychological” treatment
- 19. What is Science? The important thing in science is not so much to obtain new facts as to discover new ways of thinking about them. (William Lawrence Bragg)
- 20. Hallucinations & delusions Cognitive alterations Affective dysregulationSform SA Sz BP Psychosis Spectrum Syndrome 3.5% Van Os & Reininghaus, World Psychiatry, 2016
- 21. Adverserial Collaboration: Personal Dimensional Diagnosis Within Categorical Psychosis Spectrum Syndrome 3.5%
- 22. Fin
- 23. Guérir parfois, Soulager toujours “Better false hope than false hopelessness” Daniel Fisher
- 24. Not Knowing is also a form of Knowledge Users Reminding Us: Wouter Kusters, 2015
- 25. Resistance to Change: “Organisational Readiness” Lancet, 2013, Plos One, 2014