The Diagnosis of Schizophrenia: A Review of Recent Developments

Abstract

Empirical research on the diagnosis of schizophrenia during the late 1970s is reviewed. This period covers work carried out just before the introduction of DSM-III. Two trends are apparent. First, the concept of schizophrenia is narrowing as a result of a decreased emphasis on "classic" schizophrenic symptoms, an increased reliance on affective symptoms as more diagnostically useful, a shift toward classifying schizoaffective disorder as more similar to affective diagnoses, and an increase in the use of explicitly defined operational criteria derived with an emphasis on reliability. Second, the concept of schizophrenia as a unitary disease is diminishing. Heterogeneity is becoming a focus of study, and biological variables may define subtypes. As definition and reliability have been the nosological problems of the 1970s, subtyping and comparative validity among diagnostic systems may be the problems for the 1980s.

Is paranoid schizophrenia really camouflaged depression?

“…The schizophrenia category encompasses a group of individuals extremely heterogeneous with respect to symptomatology and a variety of other characteristics. The heterogeneity of patients within the schizophrenia category is so great that many workers now propose that schizophrenia is not a single disorder but rather a collection of disorders (Haier, 1980; Strauss & Carpenter, 1981). The increasingly frequent use of the phrase “the schizophrenias” reflects this position.…”

“…The classic schizophrenia subtypes—catatonic, paranoid, undifferentiated, and hebephrenic or disorganized—have persisted with only minor variations from the time of Kraepelin through the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987). The shortcomings of these subclassifications have been discussed widely (e.g., Carpenter & Stephens, 1979; Haier, 1980). In fact, the derivation of more useful schizophrenia subtypes has been designated as a major task for the 1980s (Haier, 1980).…”

ERPs and Psychopathology

“…Over the last two decades, diagnostic reliability has improved consistently (Zubin, 1967;Spitzer and Fleiss, 1974;Zubin et al, 1975;Haier, 1980). During the decade of the 60s, kappa values were in the vicinity of 0.30 to 0.40, which is an indication of only moderate reliability.…”

ICD 9 & DSM III CLASSIFICATION FOR THE CLINICIAN

“…Judgement on the two systems must rest on proof rather than disputation. Pessimists will note that the antecedents of the DSM III, the Research Diagnostic Criteria series or the rather similar Catego approach have failed, in more than a decade, to produce a consensus even on a single disorder such as schizophrenia (see Haier, 1980). Nevertheless, insofar as child psychiatry can make any claim to being a scientific activity, it must begin to establish a classification system and then use the tools of science to test its validity.…”