The diagnosis of schizophrenia

Until the early 1970s, the diagnosis of schizophrenia was one of the most contentious and fraught issues in the whole of psychiatry. Since then a massive international effort has been put in motion out of which explicit diagnostic criteria emerged. Some achieved widespread and even multinational agreement, allowing the painstaking process of calculating diagnostic specificity, sensitivity, reliability, and (perhaps) validity to begin. Although criticism of the diagnosis of schizophrenia continues, mostly from outside psychiatry, the vast majority of psychiatrists look upon the major sets of diagnostic criteria with weary acceptance, seeing them as flawed but useful and possibly 'as good as it gets' given our current state of knowledge/ignorance.

Throughout the 1970s and early 1980s there was an overabundance of criteria including the St Louis criteria (1) and the Research Diagnostic Criteria,(2) followed by the Present State Examination (PSE-CATEGO), the ICD-9, and finally the DSM-III. Perhaps because of the 'cookbook' explicitness of the DSM-III or the pervasive influence of American psychiatric practice, dubbed by some 'neo-colonial', the DSM, now in its fourth revision, is perhaps the mostly widely used, or at least quoted. The ICD-10 is also used throughout the world, but seldom in North America.

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