Docherty et als Model

Another stage model designed with the aim of enabling early recognition was published by Docherty et al. in 1978 and has been entered especially in the Anglo-American canon of knowledge [22]. The introduction to this work reads like a statement from current research efforts to improve our understanding of the early course of schizophrenia:

There are many reasons for wanting to know more about the period of onset of schizophrenic psychosis. The dearest benefit is in the area of preventive psychiatry. The establishment of regular premonitory signs might permit a reliable early recognition of impending psychosis and also the staging of the degree of psychological and biological decompensation. That is an assessment of how close a patient is to a psychotic episode. Further this knowledge raises the possibility of developing a clearer rationale for stage-appropriate treatment.

We think that the available data strongly suggest that schizophrenic psychosis is one stage in a process of psychological and biological breakdown that has a specific structure and a characteristic unfolding. . . . The structure consists of the sequential appearance of hierarchical or distinguishable and recognizable psychological states.

Reflected in these sentences are a few theoretical premises. Docherty et al.'s model of the onset of schizophrenic psychosis consists of four - or six -stages. Stages 5 and 6, psychotic resolution and remission, are regarded as phases of remitting psychosis and increasing mental stability. The ''empirical basis'' of the model were three case histories and a survey of the extremely heterogeneous pertinent literature, including Conrad's stage model.

Stage 1, which Docherty et al. called overextension, is characterized by experiences of passivity, overstimulation, irritability, persistent anxiety and first signs of cognitive impairment (distractability). This stage tends to show a lengthy, insidious course. Predominant at stage 2, called restricted consciousness, are such symptoms as apathy, social withdrawal, hopelessness and somatization, but also deterioration of personal appearance and - here the authors follow Sullivan - obsessional and phobic symptoms. The third stage, disinhibition, brings forth symptoms that give the impression of patients losing their inhibitory abilities: hypomania, elevation of mood and occasional ideas of reference. This stage, still part of the prepsychotic prodromal period, is followed by a fourth called psychotic disorganization, characterized by disorganization of cognition and perception, hallucinations, ideas of reference, disorders of self and sometimes by catatonic symptoms. In the stages that follow, i.e. psychotic resolution and remission, as stability of the mental state increases, affective and psychotic symptoms remit completely or in part.

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