'Schizophrenia' does not exist, argues expert

February 2, 2016, British Medical Journal
Functional magnetic resonance imaging (fMRI) and other brain imaging technologies allow for the study of differences in brain activity in people diagnosed with schizophrenia. The image shows two levels of the brain, with areas that were more active in healthy controls than in schizophrenia patients shown in orange, during an fMRI study of working memory. Credit: Kim J, Matthews NL, Park S./PLoS One.

The term "schizophrenia," with its connotation of hopeless chronic brain disease, should be dropped and replaced with something like "psychosis spectrum syndrome," argues a professor of psychiatry in The BMJ today.

Professor Jim van Os at Maastricht University Medical Centre says several others have called for updated psychiatric classifications, particularly regarding the term "schizophrenia." Japan and South Korea have already abandoned this term.

The official list of mental disorders that doctors use to diagnose patients is found in ICD-10 (International Classification of Diseases, 10th revision) and DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition).

But Professor van Os argues that the classification is complicated, particularly for psychotic illness.

Currently, psychotic illness is classified among many categories, including schizophrenia, schizoaffective disorder, delusional disorder, depression or with psychotic features, and others, he explains.

But categories such as these "do not represent diagnoses of discrete diseases, because these remain unknown; rather, they describe how symptoms can cluster, to allow grouping of patients."

This allows clinicians to say, for example, "You have symptoms of psychosis and mania, and we classify that as schizoaffective disorder." If your psychotic symptoms disappear we may reclassify it as bipolar disorder. If, on the other hand, your mania symptoms disappear and your psychosis becomes chronic, we may re-diagnose it as schizophrenia.

"That is how our classification system works. We don't know enough to diagnose real diseases, so we use a system of symptom based classification."

If everybody agreed to use the terminology in ICD-10 and DSM-5 in this fashion, there would be no problem, he says. However, this is not what is generally communicated, particularly regarding the most important category of psychotic illness: schizophrenia.

For example, the American Psychiatric Association, which publishes the DSM, on its website describes schizophrenia as "a chronic brain disorder," and academic journals describe it as a "debilitating neurological disorder," a "devastating, highly heritable brain disorder," or a "brain disorder with predominantly genetic risk factors."

This language is highly suggestive of a distinct, genetic , writes van Os. Yet strangely, no such language is used for other categories of psychotic illness, even though they constitute 70% of .

Scientific evidence indicates that the different psychotic categories can be viewed as part of the same spectrum syndrome, he adds. However, people with this psychosis spectrum syndrome display extreme diversity (heterogeneity), both between and within people, in psychopathology, treatment response, and outcome.

He believes that the best way to inform the public and provide patients with diagnoses, is to forget about "devastating" schizophrenia as the only category that matters "and start doing justice to the broad and heterogeneous psychosis spectrum syndrome that really exists."

And he argues that ICD-11 should remove the term "schizophrenia."

Explore further: Is left-handedness higher among those suffering from psychosis?

More information: "Schizophrenia" does not exist,The BMJ, www.bmj.com/cgi/doi/10.1136/bmj.i375

Related Stories

Is left-handedness higher among those suffering from psychosis?

October 30, 2013
Researchers have long studied the connections between hand dominance and different aspects of the human brain. A new study out today in SAGE Open finds that among those with mental illnesses, left-handers are more likely ...

Researchers identify key biological markers for psychotic disorders

December 8, 2015
A team of researchers led by faculty at the University of Georgia has identified a number of biological markers that make it possible to classify mental disorders with greater precision. Their findings, published today in ...

Study establishes biomarkers to help diagnose, treat psychosis

December 8, 2015
In a groundbreaking study led by UT Southwestern Medical Center, a comprehensive set of empirical biomarkers has been established to aid in diagnosis and treatment of psychosis.

Possible mechanism for specific symptoms in bipolar disorder discovered

December 15, 2015
Researchers at Karolinska Institutet, and the Sahlgrenska Academy at Gothenburg University in Sweden have identified a gene variant linked to psychotic symptoms and cognitive impairment in people with bipolar disorder. The ...

Reduction in volume in hippocampus region of brain seen in psychotic disorders

May 14, 2014
Reduction in brain volume in the hippocampus (a region related to memory) was seen in patients with the psychotic disorders schizophrenia (SZ), schizoaffective disorder (SZA) and psychotic bipolar disorder (BPP).

Can smoking drive you mad? Study suggests it might

July 10, 2015
People who suffer from psychosis are about three times more likely to be smokers, but scientists have long scratched their heads over which one leads to the other.

Recommended for you

Researcher unlocking relationship between early math ability, fingers

March 23, 2018
Ask toddlers how old they are, and they are likely to hold up the corresponding number of fingers and say, "this many."

Analyzing past failures may boost future performance by reducing stress

March 23, 2018
Insights from past failures can help boost performance on a new task—and a new study is the first to explain why. US researchers report that writing critically about past setbacks leads to lower levels of the "stress" hormone, ...

How reciprocity can magnify inequality

March 22, 2018
People tend to reciprocate others' actions in ways that increase disparities in wealth, according to findings published in Psychological Science, a journal of the Association for Psychological Science.

Building tolerance to anxiety is key to OCD symptom relief

March 22, 2018
Excessive hand washing, out of a fear of contamination or germs, is one of the most common and best-known examples of obsessive-compulsive disorder, or OCD. Though OCD can't be "cured," symptoms can be significantly reduced ...

Stopping exercise can increase symptoms of depression

March 22, 2018
Stopping exercise can result in increased depressive symptoms, according to new mental health research from the University of Adelaide.

Antioxidants and amino acids could play role in the treatment of psychosis

March 22, 2018
A scientific paper has revealed that some nutrients found in food may help reduce the symptoms of psychotic illness, when used in the early stages of treatment.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

not rated yet Feb 03, 2016
Sounds about right--psychiatric diagnoses have always been descriptive metaphors not biomedical diseases despite the efforts of many scientists/doctors for many decades (if not centuries) to "prove" the latter (they always seem to be getting closer but never quite make it, it's like chasing a rainbow).

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.