The Term ‘Schizophrenia’ Should Be Abandoned

The term ‘schizophrenia’ is an “unhelpful description of symptoms” that should be replaced with “psychosis spectrum syndrome,” wrote Jim van Os, MD, PhD, in an editorial published in BMJ. Dr. van Os is Professor and Chair of the Department of Psychiatry and Psychology at Maastrict University, Netherlands.

In making his case, Dr. van Os explained that ICD-10 and DSM-5 both use several categories to describe psychosis. These classifications are descriptions of symptoms rather than of disease diagnoses, because the diseases themselves are still unknown. The descriptive approach allows clinicians to group clusters of patients with the same set of symptoms together.

“If everybody agreed to use the terminology in ICD-10 and DSM-5 in this fashion, there would be no problem,” stated Dr. van Os.

However, the American Psychiatric Association and academic journals use definitions of schizophrenia that differ from this descriptive approach. “This language is highly suggestive of a distinct, genetic brain disease. Strangely, no such language is used for other categories of psychotic illness (schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, and so on),” said Dr. van Os.

He points out that even though these other categories of psychosis comprise 70% of psychotic illness, they are not discussed in academic literature or in online materials from professional bodies. “They are certainly not referred to as brain disorders or similar,” he said. “It’s as if they don’t exist.”

According to the literature, the various categories of psychosis may be part of a spectrum syndrome, with schizophrenia representing less than a third—and the most severe—of the possible outcomes. Dr. van Os emphasized that people with psychosis spectrum disorder “display extreme heterogeneity, both between and within people, in psychopathology, treatment response, and outcome.”

Given this diversity of outcomes, he concluded that the mental health community should “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.”

—Lauren LeBano

Reference

1. van Os J. ‘Schizophrenia’ does not exist. BMJ. 2016 Feb 2;[Epub ahead of print].