Three dimensions of characteristic symptoms

The preponderance of evidence(1. d3,2.0) from factor analysis of schizophrenic symptoms indicates that the characteristic symptoms of schizophrenia segregate into three syndromes, as shown in TableZ These syndromes do not reflect separate illnesses, but different dimensions of illness, in the sense that a patient might exhibit more than one of the syndromes. In an individual case, the three syndromes vary independently in severity over time, while the symptoms from within each syndrome tend to vary in parallel. (20)

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Table 2 Three syndromes of symptoms characteristic of schizophrenia

The three syndromes embrace only the characteristic symptoms that are given weight in making a diagnosis of schizophrenia. In addition, there are two affective syndromes, depression and psychomotor excitation, that are prevalent in schizophrenia, (12) despite being more characteristic of mood disorders. These affective syndromes are usually transient.

An accumulating body of evidence(12> from brain imaging studies indicates that the three characteristic syndromes are associated with three distinguishable patterns of cerebral malfunction involving the areas of association cortex and related subcortical nuclei, which serve higher mental functions. Overall, the evidence indicates that the heterogeneity of symptom profiles in schizophrenia does not reflect the existence of several discrete illnesses, but rather, the existence of several dimensions of psychopathology, each arising from disorder of a specific neuronal system that serves an aspect of higher mental function. In an individual case, several of these neural systems might be involved.

Although many details of the relationships between the diverse clinical features of schizophrenia remain uncertain, a growing understanding of the neural pathways involved is beginning to provide the foundation for understanding the protean manifestations of this disorder.

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