BMJ  2007;334:221-222 (3 February), doi:10.1136/bmj.39108.396852.1F

Letters

Semantics

Schizophrenia can and should be renamed

Lieberman and First make the case against renaming schizophrenia on the grounds that changing the term would not change the stigma attached to the underlying condition.¹ Yet renaming is a key strategy used by marketing and public relations industries to improve image, alongside attitude change and education.

But what should it be replaced with? One of the conclusions emerging from the "Deconstructing psychosis" conference, part of the DSM-V Prelude project was for replacing the current categories with a general psychosis syndrome.² However, this would increase still further the heterogeneity that currently bedevils biological and psychosocial research, clinical practice, and resource management, when differentiation is really needed.

Trauma has recently been recognised as relevant to a significant group of patients with this diagnosis.³ Since the 1950s, a new group has also been included to broaden the diagnosis further: those in whom there is an association with hallucinogenic drugs.⁴ Renaming and differentiation of these two groups ("traumatic" and "drug precipitated" psychosis) is clinically possible from those patients who develop systematised delusions and those who seem to be particularly vulnerable to stress ("sensitivity psychosis"). In a study of the use of these terms with medical students (n=241), we found that they were associated with reduced perception of dangerousness and much increased expectation of recovery than "schizophrenia." Most importantly, patients and carers themselves, when asked, find the term unacceptable.⁵

¹ University of Southampton, Royal South Hants Hospital, Southampton SO14 0YG, ² Hampshire Partnership Trust, Southampton SO40 2RZ, ³ Hampshire Partnership NHS Trust, Tadley RG26 3HX

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Competing interests: None declared.

References

1. Lieberman JA, First MB. Renaming schizophrenia. BMJ 2007;334:108. (20 January.)[Free Full Text]
2. First MB. Deconstructing psychosis. http://dsm5.org/conference5.cfm.
3. Read J, Agar K, Argyle N, Aderhold V. Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychol Psychother: Theory, Research and Practice 2003;76:22.
4. Hall W. Is cannabis use psychotogenic? Lancet 2006;367:193- 5.[CrossRef][ISI][Medline]
5. Kingdon D, Gibson A, Turkington D, Rathod S, Morrison A. Acceptable terminology and subgroups in schizophrenia: an exploratory study. Soc Psychiatry Psychiatric Epidemiol (in press).

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