The development of a scale to measure concepts of schizophrenia: experience among Brazilian psychiatrists* Desenvolvimento de escala para medir conceitos de esquizofrenia: experiência entre psiquiatras brasileiros

Introduction Among psychiatric disorders schizophrenia is often said to be the condition with the most disputed definition.The Bleulerian and Schneiderian approaches have given rise to diagnostic formulations that have varied with time and place. Controversies over the concept of schizophrenia were examined within European/North American settings in the early 1970s but little has since been reported on the views of psychiatrists in developing countries. In Brazil both concepts are referred to in the literature. A scale was developed to measure adherence to Bleulerian and Schneiderian concepts among psychiatrists working in S. Paulo. Methodology A self-reported questionnaire comprising seventeen visual analogue-scale statements related to Bleulerian and Schneiderian definitions of Shizophrenia, plus sociodemographic and training characteristics, was distributed to a nonrandomised sample of 150 psychiatrists. The two sub-scales were assessed by psychometric methods for internal consistency, sub-scale structure and testretest reliability. Items selected according to internal consistency were examined by a two-factor model exploratory factor analysis. Intraclass correlation coefficients described the stability of the scale. Results Replies were received from 117 psychiatrists (mean age 36 (SD 7.9)), 74% of whom were made and 26% female. The Schneiderian scale showed better overall internal consistency than the Bleulerian scale. Intra-class correlation coefficients for test-retest comparisons were between 0.5 and 0.7 for Schneiderian items and 0.2 and 0.7 for Bleulerian items. There was no negative association between Bleulerian and Schneiderian scale scores, suggesting that respondents may hold both concepts. Place of training was significantly associated with the respondent’s opinion; disagreement with a Bleulerian standpoint predominated for those trained at the University of S. Paulo. * Work carried out at: Section of Epidemiology and General Practice, Institute of Psychiatry, London. Study funded by “Conselho Nacional de Desenvolvimento Científico e Tecnológico/CNPq” (Process no 203310-870). Derived from a PhD thesis “The diagnosis of schizophrenia in S. Paulo, Brazil: the influence of patients culture and clinicians' concepts”, submitted to and approved by the University of London in April 1996. Correspondence to: Darci N. Santos Rua Padre Feijó, 29 4o andar Canela 40110-170 Salvador, Ba Brasil. E-mail: [email protected] Submited on 16.6.1997. Approved on 27.1.1998. 202 Rev. Saúde Pública, 32 (3), 1998 A scale to measure concepts of schizophrenia Santos, D. N. et al. Conclusions The less satisfactory reliability for the Bleulerian sub-scale limits confidence in the whole scale but on the other hand this questionnaire contributes to the understanding of the controversy over Bleulerian and Schneiderian models for conceptualisation of schizophrenia, the former requiring more inference and therefore being prone to unreliability. Schizophrenia, diagnosis. Concept formation. Psychiatry, manpower.