Schizophrenia spectrum and related neuropathology

Excerpt

Focussing on the new DSM-5 classification system, Möller et al. [1] present the second part of their two-piece invited review on changes with reference to the bipolar, schizophrenia spectrum, anxiety and other disorders plus possible consequences under consideration of previous psychiatric classifications. Some important alterations in criteria were made, e.g., in schizophrenia spectrum and related disorders with special consideration of Kurt Schneider’s first-rank symptoms. Moreover, the subtypes of schizophrenia have been removed because of insufficient course stability. However, cognitive impairment defined by neuropsychological tests has not been included in DSM-5. Changes in diagnostic criteria are discussed under aspects of rationality, evidence base, usefulness and possible consequences. The new classification system may help to improve differential diagnosis of psychiatric syndromes, but against original intentions, a more neurobiological approach has not been included, probably due to the lack of robust biomarkers for neuropsychiatric disorders. Since schizophrenia is regarded as spectrum disorder, identification of residual symptoms is needed since most patients considered to be remitted by consensus criteria of the remission in Schizophrenia Working Group present mild psychopathological symptoms. In a naturalistic study with 399 schizophrenia patients, Schennach et al. [2] investigated residual symptoms along suggested consensus criteria as defined by any symptom being present at remission and confirmed that indeed, 94 % of the patients suffered from at least one residual symptom, mostly blunted affect, conceptual disorganization and social withdrawal. Those symptoms were related to severity of side effects, functioning at discharge and risk of relapse. …