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• W206587567 abstract "Can J Psychiatry. 2009;54(3): 137-139. The diagnostic entity of schizophrenia creates a loose boundary around a heterogeneous collection of interrelated and relatively distinct phenotypes. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-V planning process is currently under way and it has once again ignited the debate about the boundaries of this diagnosis. One question concerns whether psychotic symptoms can occur in healthy people. A recent quantitative review of all reported incidence and prevalence studies of population rates of subclinical psychotic experiences revealed a median prevalence rate of around 5% and a median incidence rate of around 3%.1 Many people who hear voices can cope with them and even view them as a positive part of their lives. I remember one of my own patients who had been hallucinating for 25 years. The month after I prescribed clozapine, he began to complain about the absence of auditory hallucinations. He was feeling lonely, bored, and sad. I decided to decrease the dosage of clozapine so he could hear his voices momentarily during the day. This clinical situation was new to me because it encouraged me, for the first time, to let the voices resurface gradually to increase my patient's quality of life, instead of trying to eradicate them. This prompted me to review literature and make connections with groups of people who consider that hearing voices is not automatically something negative but may actually be positive. In a more personal and provocative book entitled Is It Normal to be Psychotic?,2 I described subjective experiences and discussions with colleagues concerning these dimensional aspects of psychosis. For instance, in the case of psychoticlike symptoms during an exposure to cannabis in a nonpatient, what makes a person experience psychotic symptoms? One hypothesis is that individual differences may reflect a genetic psychotic vulnerability (for example, for carriers of the valine allele of the COMT Val 158Met polymorphism i3,4) so that cannabis use may have no adverse influence on people with 2 copies of the methionine allele. Given that psychosis results from the interaction of many genes, it could be a continuous phenotype with mild forms present in the general population. Currently, 114 combinations of symptoms can lead to establishing the DSM-PV definition of schizophrenia, and different populations of patients are defined by different diagnostic systems (that is, DSM-III-R, DSM-IV, International Classification of Diseases, 10th edition, and Research Diagnostic Criteria). This raises questions about the validity of the current definition. Some clinicians lean toward a categorical approach, whereas others consider psychosis a dimensional phenomenon. In the 2 following In Review articles,5,6 the authors illustrate the debate between the dimensional and categorical approaches. In the first article,5 Dr Genevieve Letourneau and I review the literature about what could be considered as psychotic phenomena in the healthy or nonclinical population. Having attended some European meetings and symposia organized by the International Network for Training, Education and Research into Hearing Voices, I observed that this phenomenon can be considered either as a purely pathological or as a completely normal phenomenon. On another occasion, during a meeting with several members of our team (nurses and doctors), I mentioned that I was writing an article on auditory hallucinations in healthy people. Surprisingly, 8 out of 10 members of the team admitted (in certain cases, with details) that they had heard voices at some point during their life. It did not prevent them from being health professionals, working in psychiatry, and, for the majority, taking charge of psychotic people suffering from auditory hallucinations. This discussion reflected epidemiologic findings showing that nonclinical subjects can experience temporary or durable psychotic phenomena. …" @default.
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• W206587567 date "2009-03-01" @default.
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• W206587567 title "Psychosis: A Category or a Dimension?" @default.
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• W206587567 doi "https://doi.org/10.1177/070674370905400301" @default.
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