Issue 1/2023
Haralanova, E., Haralanov, S.
University Hospital for Neurology and Psychiatry “St. Naum”,
First Psychiatric Clinic, Sofia
After a brief historical analysis of the main concepts about the core of schizophrenia, we justify that the currently dominant approach in diagnostics and treatment of the disease integrates the classical approaches of Schneider and Kraepelin, focusing on relatively late (psychotic and post-psychotic) positive and negative symptoms, but ignoring the more fundamental approach of Bleuler, focused on earlier (prepsychotic) negative symptoms of the disease process in the brain. In the light of the latest discoveries in the field of psychiatric genetics and neurosciences, we argue for the need to radically reassess the previous approach and to change its focus. The new approach views schizophrenia as a disease process in the brain that includes a prepsychotic, psychotic, and postpsychotic phase. By analogy with other fields of medicine, diagnostics and treatment shift to the earliest phase of the disease, with a view to prevent later unwanted consequences. From such a point of view, the timely identification of prepsychotic negative symptoms would allow their treatment with anti-schizophrenic drugs (targeted at the brain mechanisms of the schizophrenic process itself), while the antipsychotics (targeted at the brain mechanisms of the schizophrenic psychosis) would retain their place in the treatment of psychotic episodes and in the prevention of future psychotic relapses. In conclusion, we highlight the advantages of the new approach and the prospects for its implementation in the everyday clinical practice.
Address for correspondence:
S. Haralanov
UMBALNP „St. Naum“ – IVth km First Psychiatric Clinic
1, Lyuben Rusev, Str.
1113, Sofia
Phone: 02 9702 251
e-mail: haralanovsvet@yahoo.com