Schizophrenia: Implications of the Treatment Approach in Predicting Outcome

Abstract

Of the major health problems of the twentieth century, none combines the disability, the frequency, and the early onset of schizophrenia. If one were to add the number of person years of wasted human potential, no other health problem would even come close to the impact of schizophrenia. The term itself, schizophrenia, calls forth an image of the sometimes bizarre, isolated, empty shells of human beings we all have known. Somewhere in this nightmare collage, perhaps, is a unifying concept that brings, meaning to this powerful and highly emotional charged term. For many disorders the diagnosis provides this unifying concept, bringing together conceptual understanding, etiologic discrimination, and treatment implication. Unfortunately, the diagnosis of schizophrenia falls short of this. Much of the problem comes from our having no means of validating the diagnosis of schizophrenia as we do for such entities as diabetes or anemia. Because of this absence of validating criteria, a profound effort has been made to establish the reliability of the diagnosis by selecting symptoms that can be rated reliably. And yet, even the very best reliability has failed to bring validity to the diagnosis. To date, no single, multiple, or cluster of biologic, psychophysiologic, psychologic, or social variables can be found in all schizophrenic patients or only in schizophrenics. The basic heterogeneity of the disorder seems inescapable.