Reinventing schizophrenia: Updating the construct ‐ Primary schizophrenia 2021 - The road ahead ‐

Abstract

About hundred years after E. Bleuler (1911) published his monograph 'Dementia Praecox or Group of Schizophrenias' and after intense expert discussions over the decades the concept of schizophrenia kept its position also in the newly revised classification systems DSM-5 and ICD-11. Despite scientific developments between splitting or lumping in the meantime and the critique of continuing with the classical diagnostic categories and ignoring the dimensional nature of overlapping mental disorders both in phenotype and biotype, a true paradigm shift has not been attained. Accordingly, 'schizophrenia spectrum' (DSM-5) or 'primary' schizophrenia (ICD-11) and/or other (primary) psychotic disorders are still around. Hence, the modified schizophrenia construct in 2021 is still alive and viable and may probably improve contemporary clinical practice globally. The revised schizophrenia category from the perspectives of global applicability, utility, reliability and clinical validity has salvaged the construct for clinical practice. A pilot model of a deconstructed schizophrenia version would need to be evaluated on top of and in comparison with the current classification version. Validating a new if not supplanting construct would need adequate scientific strategies and methodologies depending also on the kind of innovation. Further improving treatment and care - either for 'schizophrenia' or for a deconstructed 'disease' version of the 'disorder' - would be of foremost importance.