The schizophrenias, the neuroses and the covered wagon; a critical review

Abstract

Objective: In order to compare their validity, this review applies scientifi c standards for sustaining the neuroses, the schizophrenias and bipolar disorders as separate "bona-fi de" psychiatric diseases. The standards for disease validation demand specifi c and unique symptoms. Method: We review a wide variety of clinical and basic science comparisons between schizophrenia and psychotic bipolar in a select English-language literature. Results: Like covered wagons, the neuroses once served us well but became obsolete and were discarded or reorganized based on what was known about commonalities of symptoms, causation and pharmacological responsivity. Bipolar patients meet unique and specifi c diagnostic criteria and demonstrate consistent results across a variety of scientifi c disciplines. Neither the neuroses nor the schizophrenias have such unique or disease specifi c diagnostic criteria. Psychotic mood disorders account for the DSM diagnostic criteria for schizophrenia. A recent, selected but diverse basic science literature demonstrates surprising similarities between schizophrenia and psychotic bipolar which should not exist if these disorders are distinct. Conclusions: Like the neuroses, there is stigma, confusion and misunderstanding about the condition called schizophrenia, resulting in substantial negative impact on bipolar patients misdiagnosed as having schizophrenia. The psychoses, including the schizophrenias, likely are explained by a single disease, psychotic bipolar disorder, that has demonstrated a wide spectrum of severity of symptoms and chronicity of course, not traditionally recognized. Keywords: schizophrenia, mania, depression, bipolar mood disorder, neurosis, psychosis, Kraepelinian dichotomy A history of the neuroses and the schizophreniasIn contrast to some medical specialties where diagnostic criteria are based on objective and often quantifi able pathophysiology, the diagnostic criteria of psychiatric disorders depend largely on subjective interviews, observations and opinions. Between the mid 19th and mid 20th centuries, the absence of objective fi ndings stimulated individual mental health professionals to create their own idiosyncratic, redundant and often confusing names and diagnostic criteria for various psychiatric syndromes and subtypes. During this time mental illness was divided into two groups, the neuroses and the psychoses, the latter being further subdivided into the schizophrenias and manic-depressive insanity with schizophrenia the dominant disease of the two. The neuroses, with few exceptions, were less disabling than the schizophrenias. Patients called neurotic were likely to function adequately in most aspects of job, family life, and society with only a circumscribed area of dysfunction that could lead to temporary incapacitation. In contrast, patients diagnosed with schizophrenia were more globally dysfunctional and for longer periods of time, often spending months to years in psychiatric hospitals. While the neuroses were treated with psychoanalysis or other "ta...

Schizophrenia Is a Misdiagnosis

“…Recognizing that the diagnosis of neurosis was confusing, misunderstood, socially stigmatizing and lacking a scientifi c basis, the DSM-III eliminated the term "neurosis" from the offi cial nomenclature and either dropped or reorganized and renamed its subtypes. (Lake and Hurwitz 2007a ) Schizophrenia was listed as the "schizophrenic disorders" and the number of subtypes dropped to fi ve. The most signifi cant change was the elimination of Bleuler's subtype of "simple schizophrenia" that almost, but not quite, restricted schizophrenia to a psychotic process.…”

Tackling the Kraepelinian Dichotomy: A Neuroimaging Review

“…While Kraepelin believed Schizophrenia to be associated with a gradual and progressive cognitive and functional decline, he believed manic-depression to be more representative of a course of intermittent decline in functioning interwoven with periods of return to baseline and full recovery of illness. Kraepelin found, through his studies of families, that indeed what he termed Dementia Praecox (Bleuler later renamed this as Schizophrenia) and Manic Depression (later differentiated into various mood disorders including Bipolar illness and Depression)(2, 3) appeared to be inherited traits based on the similarities in course and outcome among generations within families.…”

Hypothesis: Grandiosity and Guilt Cause Paranoia; Paranoid Schizophrenia is a Psychotic Mood Disorder; a Review

“…If psychotic mood disorders explain many paranoid presentations, as suspected over 30 years ago, 13 questions arise about the distinction between schizophrenia and psychotic mood disorders. 7,8,13,[15][16][17][18][19] Selected reviews of symptoms, course, prognosis, family heritability, and epidemiology conclude that there are no diseasespecific characteristics of schizophrenia and that the DSM diagnostic criteria for schizophrenia are common to psychotic bipolar disorder patients. 7,8,[15][16][17][18][19][20] Further indications of closure toward one disease derive from recent basic science data, especially molecular genetic and neurocognitive studies, that show considerable overlap and similarities between schizophrenia and psychotic bipolar disorder.…”

“…7,8,13,[15][16][17][18][19] Selected reviews of symptoms, course, prognosis, family heritability, and epidemiology conclude that there are no diseasespecific characteristics of schizophrenia and that the DSM diagnostic criteria for schizophrenia are common to psychotic bipolar disorder patients. 7,8,[15][16][17][18][19][20] Further indications of closure toward one disease derive from recent basic science data, especially molecular genetic and neurocognitive studies, that show considerable overlap and similarities between schizophrenia and psychotic bipolar disorder. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] One author states that '' .…”

“…7,8,[15][16][17][18][19][20] Further indications of closure toward one disease derive from recent basic science data, especially molecular genetic and neurocognitive studies, that show considerable overlap and similarities between schizophrenia and psychotic bipolar disorder. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] One author states that '' . of the (11) chromosome loci found for the transmission of schizophrenia and bipolar disorder, eight have been found to overlap ....'' 28 Crow 30,31 advances an explanation for the 3 or more loci that do not overlap between schizophrenia and bipolar that is compatible with a single disease to explain all 3 of the functional psychoses: ''Epigenetic variation associated with chromosomal rearrangements that occurred in the hominid lineage and that relates to the evolution of language could account for predisposition to schizophrenia and schizoaffective disorder and bipolar disorder and failure to detect such variation by standard linkage approaches.''…”