PMID: 8322032Jan 1, 1993

Diagnosis and classification of schizophrenia

Schizophrenia Bulletin
N C Andreasen, W T Carpenter


Schizophrenia is a clinical syndrome of both extraordinary importance and extraordinary complexity. Its conceptual history contains many perspectives on the "essential" nature of the illness. For example, Kraepelin in 1919 emphasized primarily onset and course, although he also stressed the importance of some symptoms such as changes in affect and volition. Bleuler in 1911 took a more cross-sectional approach and attempted to identify fundamental characteristic symptoms, especially stressing fragmenting of thought processes. Schneider's (1959) approach was cross-sectional, stressing a group of "first-rank symptoms." DSM-III and its successors attempted to achieve a synthesis of these concepts. Nevertheless, heterogeneity in the clinical presentation of schizophrenia is certain, and heterogeneity in pathophysiology and etiology is likely. Although we can now define a particular construct of schizophrenia with reasonable agreement, the construct must be recognized as provisional and based on a need to achieve consensus about definitions rather than on an understanding of pathophysiology and etiology. The major challenge confronting the student of schizophrenia is to identify its mechanisms and causes in order to develop improved ...Continue Reading


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