Skip to main content

Advertisement

Log in

Diagnosing schizophrenia circa 2005: How and why?

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Since the introduction of the third edition of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition in 1980, schizophrenia has been widely diagnosed with good to excellent levels of reliability. This is no small feat, as prior to the 1970s the reliability of this diagnosis over time and place was very poor. Although there have been some changes in the diagnostic algorithm for schizophrenia with subsequent revisions of the Diagnostic and Statistical Manual of Mental Disorders, there has been little change in the overall classification scheme. However, there has also been relatively little movement toward enhancing the validity of this diagnosis. Although there is broad consensus that what we now call schizophrenia is probably very heterogeneous with respect to underlying etiology and pathophysiology, attempts to identify more valid subtypes or dimensions have not progressed to the point that they are likely to be incorporated into diagnostic systems any time soon. The limited progress in defining more valid disease categories has increasingly important clinical implications as the field moves more and more to treatment by preset algorithms that are typically driven by diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Kraepelin E, Barclay RM, Robertson GM: Dementia Praecox and Paraphrenia. Edinburgh: E&S Livingstone; 1919.

    Google Scholar 

  2. Bleuler E: Dementia Praecox or the Group of Schizophrenias (1911). Translated by Zinkin J. New York: International Universities Press; 1950.

    Google Scholar 

  3. Schneider K: Clinical Psychopathology, edn 3. New York: Grune, Stratton; 1959.

    Google Scholar 

  4. Cooper J, Sartorius N: Cultural and temporal variations in schizophrenia: a speculation on the importance of industrialization. Br J Psychiatry 1977, 130:50–55.

    PubMed  CAS  Google Scholar 

  5. Kuriansky JB, Deming WE, Gurland BJ: On trends in the diagnosis of schizophrenia. Am J Psychiatry 1974, 131:402–408.

    PubMed  CAS  Google Scholar 

  6. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3. Washington, DC: American Psychiatric Association; 1980.

    Google Scholar 

  7. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3, Revised. Washington, DC: American Psychiatric Association; 1987.

    Google Scholar 

  8. Kendler KS, Lieberman JA, Walsh D: The structured interview for schizotypy (SIS): a preliminary report. Schizophr Bull 1989, 15:559–571.

    PubMed  CAS  Google Scholar 

  9. Modestin J, Huber A, Satirli E, et al.: Long-term course of schizophrenic illness: Bleuler’s study reconsidered. Am J Psychiatry 2003, 160:2202–2208. A very interesting retrospective review on Bleuler’s original study showing prognostic differences between schizophrenia and schizoaffective disorder.

    Article  PubMed  Google Scholar 

  10. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 2000.

    Book  Google Scholar 

  11. Jager M, Bottlender R, Strauss A, Moller HJ: Classification of functional psychoses and its implication for prognosis: comparison between ICD-10 and DSM-IV. Psychopathology 2004, 37:110–117.

    Article  PubMed  Google Scholar 

  12. Fujii DE, Ahmed I: Is psychosis a neurobiological syndrome? Can J Psychiatry 2004, 49:713–718. A good review of secondary psychosis due to neurobiologic problems and how this compares with the psychosis manifested in schizophrenia.

    PubMed  Google Scholar 

  13. Antonova E, Sharma T, Morris R, Kumari V: The relationship between brain structure and neurocognition in schizophrenia: a selective review. Schizophr Res 2004, 70:117–145.

    Article  PubMed  Google Scholar 

  14. Boks MP, Russo S, Knegtering R, van den Bosch RJ: The specificity of neurological signs in schizophrenia: a review. Schizophr Res 2000, 43:109–116.

    Article  PubMed  CAS  Google Scholar 

  15. Davidson LL, Heinrichs RW: Quantification of frontal and temporal lobe brain-imaging findings in schizophrenia: a meta-analysis. Psychiatry Res 2003, 122:69–87.

    Article  PubMed  Google Scholar 

  16. Elkis H, Friedman L, Wise A, Meltzer HY: Meta-analyses of studies of ventricular enlargement and cortical sulcal prominence in mood disorders. Comparisons with controls or patients with schizophrenia. Arch Gen Psychiatry 1995, 52:735–746.

    PubMed  CAS  Google Scholar 

  17. Dean K, Bramon E, Murray RM: The causes of schizophrenia: neurodevelopment and other risk factors. J Psychiatr Pract 2003, 9:442–454. A good review of the neurodevelopmental theories as the etiologic basis for schizophrenia.

    Article  PubMed  Google Scholar 

  18. Meehl PE: Schizotaxia, schizotypy, schizophrenia. Am Psychol 1962, 17:827–838.

    Article  Google Scholar 

  19. Tsuang MT, Stone WS, Faraone SV: Toward reformulating the diagnosis of schizophrenia. Am J Psychiatry 2000, 157:1041–1050. A good review of how psychosis has historically been the major symptoms used to describe the diagnosis of schizophrenia.

    Article  PubMed  CAS  Google Scholar 

  20. Trimble MR: Can schizophrenia be localized? J Neuropsychiatry Clin Neurosci 1991, 3:89–94.

    PubMed  CAS  Google Scholar 

  21. Salokangas RK, Cannon T, Van Erp T, et al.: Structural magnetic resonance imaging in patients with first-episode schizophrenia, psychotic and severe non-psychotic depression and healthy controls. Results of the schizophrenia and affective psychoses (SAP) project. Br J Psychiatry 2002, 43(Suppl):s58-s65.

    Article  CAS  Google Scholar 

  22. Miller BL, Lesser IM, Boone K, et al.: Brain white-matter lesions and psychosis. Br J Psychiatry 1989, 155:73–78.

    PubMed  CAS  Google Scholar 

  23. Starkstein SE, Bryer JB, Berthier ML, et al.: Depression after stroke: the importance of cerebral hemisphere asymmetries. J Neuropsychiatry Clin Neurosci 1991, 3:276–285.

    PubMed  CAS  Google Scholar 

  24. Lisanby SH, Kohler C, Swanson CL, Gur RE: Psychosis secondary to brain tumor. Semin Clin Neuropsychiatry 1998, 3:12–22.

    PubMed  Google Scholar 

  25. Fujii D, Ahmed I: Characteristics of psychotic disorder due to traumatic brain injury: an analysis of case studies in the literature. J Neuropsychiatry Clin Neurosci 2002, 14:130–140.

    PubMed  Google Scholar 

  26. Kanner AM: Recognition of the various expressions of anxiety, psychosis, and aggression in epilepsy. Epilepsia 2004, 45(Suppl 2):22–27.

    Article  PubMed  Google Scholar 

  27. Lopez OL, Smith G, Becker JT, et al.: The psychotic phenomenon in probable Alzheimer’s disease: a positron emission tomography study. J Neuropsychiatry Clin Neurosci 2001, 13:50–55.

    PubMed  CAS  Google Scholar 

  28. Stebbins GT, Goetz CG, Carrillo MC, et al.: Altered cortical visual processing in PD with hallucinations: an fMRI study. Neurology 2004, 63:1409–1416.

    PubMed  CAS  Google Scholar 

  29. Schatzberg AF, Posener JA, DeBattista C, et al.: Neuropsychological deficits in psychotic versus nonpsychotic major depression and no mental illness. Am J Psychiatry 2000, 157:1095–1100.

    Article  PubMed  CAS  Google Scholar 

  30. Edelstyn NM, Oyebode F: A review of the phenomenology and cognitive neuropsychological origins of the Capgras syndrome. Int J Geriatr Psychiatry 1999, 14:48–59.

    Article  PubMed  CAS  Google Scholar 

  31. Young AW, Robertson IH, Hellawell DJ, et al.: Cotard delusion after brain injury. Psychol Med 1992, 22:799–804.

    Article  PubMed  CAS  Google Scholar 

  32. Fujii DE, Ahmed I, Takeshita J: Neuropsychologic implications in erotomania: two case studies. Neuropsychiatry Neuropsychol Behav Neurol 1999, 12:110–116.

    PubMed  CAS  Google Scholar 

  33. Sekine Y, Minabe Y, Ouchi Y, et al.: Association of dopamine transporter loss in the orbitofrontal and dorsolateral prefrontal cortices with methamphetamine-related psychiatric symptoms. Am J Psychiatry 2003, 160:1699–1701.

    Article  PubMed  Google Scholar 

  34. Walder DJ, Walker EF, Lewine RJ: Cognitive functioning, cortisol release, and symptom severity in patients with schizophrenia. Biol Psychiatry 2000, 48:1121–1132.

    Article  PubMed  CAS  Google Scholar 

  35. Strauss JS, Carpenter WT Jr, Bartko JJ: The diagnosis and understanding of schizophrenia. Part III. Speculations on the processes that underlie schizophrenic symptoms and signs. Schizophr Bull 1974, 11:61–69.

    PubMed  Google Scholar 

  36. Crow TJ: The continuum of psychosis and its genetic origins. The sixty-fifth Maudsley lecture. Br J Psychiatry 1990, 156:788–797.

    PubMed  CAS  Google Scholar 

  37. Liddle PF: The symptoms of chronic schizophrenia. A re-examination of the positive-negative dichotomy. Br J Psychiatry 1987, 151:145–151.

    Article  PubMed  CAS  Google Scholar 

  38. Andreasen NC, Arndt S, Alliger R, et al.: Symptoms of schizophrenia. Methods, meanings, and mechanisms. Arch Gen Psychiatry 1995, 52:341–351.

    PubMed  CAS  Google Scholar 

  39. Carpenter WT Jr, Heinrichs DW, Wagman AM: Deficit and nondeficit forms of schizophrenia: the concept. Am J Psychiatry 1988, 145:578–583.

    PubMed  Google Scholar 

  40. Amador XF, Kirkpatrick B, Buchanan RW, et al.: Stability of the diagnosis of deficit syndrome in schizophrenia. Am J Psychiatry 1999, 156:637–639.

    PubMed  CAS  Google Scholar 

  41. Tek C, Kirkpatrick B, Buchanan RW: A 5-year follow-up study of deficit and nondeficit schizophrenia. Schizophr Res 2001, 49:253–260. A good review of the evidence supporting the deficit and nondeficit models of schizophrenia.

    Article  PubMed  CAS  Google Scholar 

  42. Messias E, Kirkpatrick B, Bromet E, et al.: Summer birth and deficit schizophrenia: a pooled analysis from 6 countries. Arch Gen Psychiatry 2004, 61:985–989.

    Article  PubMed  Google Scholar 

  43. Heckers S, Goff D, Schacter DL, et al.: Functional imaging of memory retrieval in deficit vs nondeficit schizophrenia. Arch Gen Psychiatry 1999, 56:1117–1123.

    Article  PubMed  CAS  Google Scholar 

  44. Davidson LL, Heinrichs RW: Quantification of frontal and temporal lobe brain-imaging findings in schizophrenia: a meta-analysis. Psychiatry Res 2003, 122:69–87.

    Article  PubMed  Google Scholar 

  45. Heinrichs RW: Meta-analysis and the science of schizophrenia: variant evidence or evidence of variants? Neurosci Biobehav Rev 2004, 28:379–394. A very thought-provoking quantification of the neuroscience literature that predicts four unique subtypes of schizophrenia based on biologic rather than clinical symptoms.

    Article  PubMed  Google Scholar 

  46. Heinrichs RW: In Search of Madness: Schizophrenia and Neuroscience. Oxford: Oxford University Press; 2001:347.

    Google Scholar 

  47. Gilbert DA, Altshuler KZ, Rago WV, et al.: Texas Medication Algorithm Project: definitions, rationale, and methods to develop medication algorithms. J Clin Psychiatry 1998, 59:345–351.

    PubMed  CAS  Google Scholar 

  48. Mellman TA, Miller AL, Weissman EM, et al.: Evidence-based pharmacologic treatment for people with severe mental illness: a focus on guidelines and algorithms. Psychiatr Serv 2001, 52:619–625. A good review of developing practice guidelines and medication algorithms for patients with severe mental illness.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

McCormick, L.M., Flaum, M. Diagnosing schizophrenia circa 2005: How and why?. Curr Psychiatry Rep 7, 311–315 (2005). https://doi.org/10.1007/s11920-005-0086-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-005-0086-4

Keywords

Navigation