An ever widening gap is appearing between clinical practice and the treatment prescribed in DSM-5, the standard work on schizophrenia, psychiatrist Jan Dirk Blom will assert in his inaugural lecture on 11 November. Psychiatric disturbances are all too often diagnosed as schizophrenia. 'Personalized medicine' may offer the solution.
Since 1 January Blom had occupied the chair in Clinical Psychopathology at the Faculty of Social and Behavioural Sciences, instituted by the Parnassia Group. Clinical psychopathology is the science that describes and classifies psychiatric syndromes that are the foundation for treatment.
Gap between theory and practice
In his lecture Blom will address the way in which serious psychiatric syndromes are described in DSM-5, the standard work or 'map', and the gap that is becoming increasingly apparent between this map and what it refers to: the symptoms that patients experience in practice. This is particularly applicable to schizophrenia.
The advantage of the DSM system is that clinicians and researchers are able to speak a uniform language and can diagnose a disturbance on the basis of uniform criteria. In clinical practice, however, the description of schizophrenia is so broad that there is a risk that numerous patients are wrongly being diagnosed with schizophrenia. As a result these patients are being treated with antipsychotic drugs while an alternative treatment would be more effective.
In his lecture Blom will mention a number of examples of disturbances that in practice are often mistaken for schizophrenia, and he will explain how empirical scientific research can contribute to improving care for people with diverse psychotic disturbances.
The ideal that he is aiming for is 'personalized medicine': treatment tailored precisely to the individual. And a method of diagnosis and treatment that recognizes the individual with his or her unique combination of symptoms, characteristics, coping mechanisms and talents. To realise this ideal, a number of steps have to be taken before this ideal can be realized. Blom, as a professor and clinician, wants to contribute to this aim.
Don't make light of it
The symptoms that we define as 'schizophrenia' are among the most serious that can befall a person. In the international literature schizophrenia is no longer regarded as a single illness, but as a group of separate conditions, some of which have yet to be defined. A public debate has grown up on this issue, and there are a number of people who support the statement that 'schizophrenia' doesn't actually exist.'
On the wrong track
Blom believes this is a confusing position that does little justice to the subtle scientific discussion on which it is based; it can put not only patients and their family members on the wrong track, but also clinicians and researchers. Blom therefore calls for the scientific debate on this group of synmptoms to be conducted in a way that will do justice both to the complexity of the issue and its seriousness.
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