Long-Term Monomorphism of Negative and Positive Schizophrenic Episodes

Abstract

As Berrios (1985, 1991) pointed out, “positive” and “negative” symptoms of mental disorders were already described in the 19th century, especially by Reynolds (1858) and Jackson (1889). Their relevance in schizophrenia research increased, however, after the descriptions of Bleuler’s “Grundsymptome” (“fundamental Symptoms”) and Kurt Schneider’s “first rank symptoms”. In the 1960s and 1970s, however, the interest of clinicians and researchers focused on positive symptoms, especially on schizophrenic first rank symptoms (Koehler 1979, Marneros 1984a, b, Mellor 1970, 1991, Taylor 1972). As Andreasen (1990 a) pointed out, the emphasis on positive symptoms, and especially Schneiderian symptoms, derived from several concerns: The first was that Bleulerian symptoms were difficult to define and to rate reliably. They are often continuous with normality, while positive symptoms are clearly abnormal. In addition, stressing florid psychotic symptoms, particularly Schneiderian symptoms, was a useful way to achieve a narrow concept of schizophrenia, since it appeared that schizophrenia was often diagnosed on the basis of mild Bleulerian negative symptoms (Andreasen 1990). The Schneiderian first rank symptoms, the core of positive symptoms, proved to be reliable, easy to be detected and independent of cultural and social factors (Marneros 1984a, b, Mellor 1970, Taylor 1972). That was one of the most important factors leading to the incorporation of first rank symptoms in many diagnostic instruments like Research Diagnostic Criteria (RDC, Spitzer et al. 1978), DSM-III and DSM-III-R (APA 1980, 1987), Present State Examination (PSE, Wing et al. 1974, 1982) etc.