Overdiagnosis of schizophrenia as a cognitive distortion of the process of knowledge of clinical reality

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

The article is devoted to the analysis of the causes of overdiagnosis and misdiagnosis of schizophrenia from the standpoint of cognitive distortions in the process of cognition of clinical reality. Using the diagnosis of “sluggish schizophrenia” as an example, it is concluded that overdiagnosis is based on the false consensus effect, which in psychiatry reflects the diagnostician’s solidarity with the position of the scientific school to which he belongs, and with the inability to resist the pressure of authorities. A clinical example of an erroneous diagnosis is given. In conclusion, it is stated that the overdiagnosis of schizophrenia and the unjustified prescription of antipsychotic therapy to patients leads to the discrediting of psychiatry and the stigmatization of the mentally ill. This trend should be reconsidered and the diagnosis of schizophrenia should be made solely on the basis of obvious, and not indirect, clinical phenomena.

About the authors

Vladimir D. Mendelevich

Kazan State Medical University

Author for correspondence.
Email: mendelevich_vl@mail.ru
ORCID iD: 0000-0002-8476-6083
SPIN-code: 2302-2590
Scopus Author ID: 6602765981
ResearcherId: HKW-6320-2023
https://kazangmu.ru/psychiatry/sotrudniki-kafedry

M.D., D. Sci. (Med.), Prof., Head of the Depart., Depart. of Psychiatry and Medical Psychology

Russian Federation, Kazan

References

  1. Bressan RA, Grohs GEM, Matos G, Shergill S. Hope or hype in the treatment of schizophrenia — what’s the role of the physician? Br J Psychiatry. 2018;212(1):1–3. doi: 10.1192/bjp.2017.13.
  2. Oexle N, Waldmann T, Staiger T et al. Mental illness stigma and suicidality: the role of public and individual stigma. Epidemiology and Psychiatric Sciences. 2018;27:169–175. doi: 10.1017/S2045796016000949.
  3. Neznanov NG, Martynihin IA, Mosolov SN. Diagnostika shizofrenii v Rossii: rezul’taty onlajn-oprosa vrachej-psihiatrov Chast’ 1. Ispol’zovanie MKB-10. Sovremennaya terapiya psihicheskih rasstrojstv. 2019;1:2–19. (In Russ.) doi: 10.21265/PSYPH.2019.24.24.001.
  4. Lake CR. Schizophrenia is a misdiagnosis: Implications for the DSM-5 and the ICD-11. 2013. https://link.springer.com/book/10.1007/978-1-4614-1870-2 (access date: 19.11.2022). doi: 10.1007/978-1-4614-1870-2.
  5. Selten JP, Hoek HW. Does misdiagnosis explain the schizophrenia epidemic among immigrants from developing countries to Western Europe? Social Psychiatry and Psychiatric Epidemiology. The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services. 2008;43(12):937–939. doi: 10.1007/s00127-008-0390-5.
  6. Ayano G, Demelash S, Yohannes Z et al. Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia. Annals of General Psychiatry. 2021;20:10. doi: 10.1186/s12991-021-00333-7.
  7. Coulter Ch, Baker KK, Margolis RL. Specialized consultation for suspected recent-onset schizophrenia: Diagnostic clarity and the distorting impact of anxiety and reported auditory hallucinations. Journal of Psychiatric Practice. 2019;25(2):76–81. doi: 10.1097/PRA.0000000000000363.
  8. Ogbebor A. The impact of implicit bias on the overdiagnosis of schizophrenia. Electronic Theses, Projects, and Dissertations. 2022. р. 1524. https://scholarworks.lib.csusb.edu/etd/1524 (access date: 19.11.2022).
  9. Petrova NN, Dorofejkova MV. Psihiatriya kak klinicheskaya nejronauka: Nastoyashchee i budushchee. Nevrologicheskij vestnik. 2020;4:12–19. (In. Russ.) doi: 10.17816/nb52656.
  10. Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. Journal of Trauma & Dissociation. 2022;5:1–15. doi: 10.1080/15299732.2022.2120154.
  11. Muchnik PYu, Snedkov EV. Tipichnye vrachebnye oshibki v differencial’noj diagnostike endogennyh psihozov. Obozrenie psihiatrii i medicinskoj psihologii. 2013;2:32–36. (In. Russ.)
  12. D’yachenko AV, Buhanovskaya OA, Soldatkin VA, Perekhov AYa. Kto obrashchaetsya k psihiatru s zaprosom na izmenenie pola: rezul’taty 30-letnego issledovaniya. Psihiatriya. 2020;18(3):32–41. (In. Russ.) doi: 10.30629/2618-6667-2020-18-3-32-41.
  13. Smulevich AB. K psihopatologicheskoj harakteristike vyalotekushchej shizofrenii. Zhurnal nevrologii i psihiatrii im. SS Korsakova. 2009;109(11):4–15. (In. Russ.)
  14. Smulevich AB. Sluggish schizophrenia in the modern classification of mental illness. Schizophr Bull. 1989;15(4):533–539. doi: 10.1093/schbul/15.4.533.
  15. Sen’ko EV. Osobennosti klinicheskoj kartiny pozdno diagnostiruemoj vyalotekushchej shizofrenii v zavisimosti ot vozrasta nachala zabolevaniya. Sibirskij medicinskij zhurnal. 2009;7:125–127. (In. Russ.)
  16. Fink GF. Vyalotekushchaya nevrozopodobnaya shizofreniya (kliniko-sistemnoanaliticheskoe issledovanie). Avtoreferat diss. … kand. med. nauk. Smolensk; 2001. 26 р. (In. Russ.)
  17. Stas’ S.Yu. Obsessii kontrastnogo soderzhaniya pri vyalotekushchej shizofrenii (klinika, tipologiya, terapiya). Avtoreferat diss. … kand. med. nauk. M.; 2008. 24 р. (In. Russ.)
  18. Garrabe ZH. Istoriya shizofrenii. SPb.: SPbNIPI im. VM Bekhtereva; 2000. 303 р. (In. Russ.)
  19. Zajicek B. Soviet psychiatry and the origins of the sluggish schizophrenia concept, 1912–1936. History of the Human Sciences. 2018;31(2):88–105. doi: 10.1177/0952695117746057.
  20. Mendelevich V. Towards diagnostic and therapeutic relativism in psychiatry and addiction medicine. Heroin Addiction & Related Clinical Problems. 2019;21(5):9–14.
  21. Bobrova LA. Kognitivnye iskazheniya (obzor). Otechestvennaya i zarubezhnaya literatura. Seriya 3. Filosofiya. 2021;2:69–79. (In. Russ.) doi: 10.31249/rphil/2021.02.04.
  22. Kanneman D. Dumaj medlenno… reshaj bystro. M.: AST; 2016. 653 р. (In. Russ.)
  23. Mendelevich VD. Terminologicheskie osnovy fenomenologicheskoj diagnostiki v psihiatrii. M.: Gorodec; 2016. 128 р. (In. Russ.)
  24. Kornetov NA. MKB-10 bez adaptacii — kraeugol’nyj kamen’ reformy otechestvennoj psihiatrii. Visnik Associacii Psihiatriv Ukraini. 1998;3:39–54. (In. Russ.)
  25. Morgenstern J. Cognitive theory in medicine: A brief overview. First10EM. September 14, 2015. https://doi.org/10.51684/FIRS.736 (access date: 19.01.2022).
  26. Grube M. Towards an empirically based validation of intuitive diagnostic: Rümke’s ‘Praecox Feeling’ across the schizophrenia spectrum: preliminary results. Psychopathology. 2006;39(5):209–217. doi: 10.1159/000093921.
  27. Moskalewicz M, Gozé T. Clinical judgment of schizophrenia: Praecox feeling and the bizarreness of contact-open controversies. In: The Clinician in the Psychiatric Diagnostic Process. Springer; 2022. с. 135–149.
  28. Moskalewicz M, Kordel P, Brejwo A et al. Psychiatrists report praecox feeling and find it reliable. A cross-cultural comparison. Front Psychiatry. 2021;12:642322. doi: 10.3389/fpsyt.2021.642322.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Figure 1. Evaluation of the “feeling of schizophrenia” as a reliable diagnostic method [28]

Download (121KB)
Indexing metadata

Copyright (c) 2023 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies