Neuroleptics and Diagnostic Heterogeneity in Relation to Drug Evaluation

Abstract

The opinion that schizophrenia is a heterogenous disease goes back to E. Bleuler who in his monograph Dementia Praecox oder Gruppe der Schizofrenien (Bleuler 1911) proposed the term schizophrenia in his psychopathological descriptions of patients with dementia praecox. In his textbook Lehrbuch der Psychiatrie he writes: “Wenn wir auch eine naturliche innere Einteilung noch nicht machen konnen, so erscheint uns die Schizophrenie doch nicht als eine Krankheit im engeren Sinne, sondern als eine Krankheitsgruppe, etwa analog der Gruppe der Organischen, die in Paralyse, senile Formen usw. Zerfällt. Man sollte deswegen eigentlich von Schizophrenien in der Mehrzahl sprechen” (Since we cannot divide schizophrenia on objective grounds, schizophrenia seems not to be one disease, but rather a group of disorders, more like the organic psychoses - paralysis, dementia. One should conceive of schizophrenia in plural.) (Bleuler 1916) However, in previous research most investigators have conceived schizophrenia as a uniform disease with Kraepelin’s subtypes, i. e., catatonic, paranoid, and hebephrenic schizophrenia. Over the years several different diagnostic systems have been developed and used in schizophrenia research. This means that different criteria for selection of patients in research have been used, suggesting that quite different patient categories have been studied. Thus Brockington et al. (1978), using 10 diagnostic systems in the study of 119 psychotic patients, found that the number of patients with a diagnosis of schizophrenia ranged between 4% and 45%.