ADVERTISEMENT
The Validity of Schizophrenia as a Diagnostic Entity
Question:
"Is schizophrenia really a valid diagnostic entity?"
This is a great question and gets to the heart of the “spectrum concept” of psychiatric illness that we have presented recently at The Treating the Whole Patient: The Mind-Body Connection in Psychiatric Disorders conference in Newport Beach, Calif. Many now view schizophrenia along a continuum with schizoaffective disorder and bipolar spectrum illnesses. Certainly, patients who exhibit psychotic symptoms and are misdiagnosed with schizophrenia suffer major disadvantages in terms of treatment with antipsychotics as first- line agents instead of mood stabilizers. Indeed, families and caregivers are adversely affected as well. Not to be understated is the cost of diagnosing schizophrenia, which was estimated to be $62.7 billion in the United States alone in 2002. Thus, many authors and much research now support the idea that schizophrenia and bipolar affective disorder are more alike than they are different.
The Kraepelinian dichotomy from the 19th century, which separated schizophrenia diagnostically from bipolar affective disorder, is now way obsolete. There are many now who view psychotic illnesses as one disease along a spectrum that encompasses psychotic bipolar (formerly thought of as schizophrenia), bipolar disorder with moderate psychotic signs and symptoms (formerly schizoaffective disorder), and classic bipolar affective disorder (non- psychotic type with prominent mood symptoms).
As clinicians we know that most patients diagnosed with schizophrenia have prominent mood signs and symptoms—especially depressed mood, and it is extremely rare to see “schizophrenic” patients with no mood symptomatology. In the very small percent of patients who exhibit psychotic symptoms with no mood disturbance, my opinion would be that psychotic disorder NOS may better serve the long-term prognosis than a diagnosis of schizophrenia. The idea being that eventually most of these patients will develop mood symptoms, and if they undergo treatment with antipsychotics too early, the mood symptoms will be mashed and/or exacerbated by the pharmacologic regimen. This can be considered heretical by some; myself and many others believe that there is essentially no such pure diagnostic entity as “schizophrenia.”
I invite your comments and discussion on this controversial topic and will continue to explore this concept in our Community Forum. We will discuss this topic at our Treating the Whole Patient presentations at the 2010 Psych Congress in Orlando on Nov. 18-21.
