Rene Kahn commentary during SRF Live Webinar: "Is Schizophrenia Dead Yet?
1. A few misconceptions
• SCZ does NOT overlap with bipolar illness
• Schizophrenia CANNOT be understood by understanding
psychosis
• That psychosis is prevalent in the population is IRRELEVANT
• Denying poor prognosis in schizophrenia may be good politics,
it is POOR SCIENCE
2. Overlap schizophrenia and bipolar illness
hardly exists, inconvenient as it may be
Genetic overlap is (much) smaller than difference
Many more risk genes found for SCZ than for BPD
Many specific risk genes are different
Rare variants common in SCZ, (almost) absent in BPD
Lithium (and ECT) ineffective in schizophrenia
Lithium monotreatment and ECT monotreatment ineffective in scz
Risk factors are different
Low IQ is risk for SCZ; high IQ risk for BPD
Brain development different
ICV smaller in SCZ, larger in BPD
3. Schizophrenia cannot be reduced to psychosis
The core in SCZ is cognitive dysfuntion
Prognosis is determined by cognition, not psychosis
Neither Kraepelin or Bleuler considered psychosis the core
The three A’s of Bleuler don’t contain a P
Cognitve decline precedes onset of psychosis in SCZ (by a decade!)
Population-based studied
Birth cohorts
Twin studies
High-risk studies
(Cognitive decline follows onset of BPD)
4. Prognosis in schizophrenia: wishful thinking
doesn’t help; good science does
Life expectancy is lower by 20 years
Suicide is 10-15%
80-90% is not employed
Most funcion under the premorbid level
Most are rehospitalized (more than once)
Most men never marry
Fecundity is decreased
5. Denying schizophrenia is…....
…...poor science
It is based on a narrow view (psychosis)
It detracts from the core (cognition)
It ignores the evidence (genetic, epidemiological, brain studies)
…...poor politics
It will hurt the credibility of psychiatry
It overpromises and will underdeliver
…...poor clinical care
It deceives patients and their families by promising a good
prognosis where there may be none
