This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Reassessment of the Specificity of 'Schizophrenic' Symptoms in the Light of Current Research

Harrison G. Pope, Jr, MD; Joseph F. Lipinski, Jr, MD

Arch Gen Psychiatry. 1978;35(7):811-828.

Abstract
• Present clinical and research methods of differential diagnosis of schizophrenia and affective psychoses rely very heavily on presenting symptoms and signs, especially in acute psychosis. We have reviewed studies bearing on this issue, including studies of the phenomenology of psychotic illness, outcome, family history, response to treatment with lithium carbonate, and cross-national and historical diagnostic comparisons. We conclude that most so-called schizophrenic symptoms, taken alone and in cross section, have remarkably little, if any, demonstrated validity in determining diagnosis, prognosis, or treatment response in psychosis. In the United States, particularly, overreliance on such symptoms alone results in overdiagnosis of schizophrenia and underdiagnosis of affective illnesses, particularly mania. This compromises both clinical treatment and research.

Author Affiliations
From the Laboratories for Psychiatric Research, Mailman Research Center, McLean Hospital, Belmont, Mass, and the Department of Psychiatry, Harvard Medical School, Boston.

Footnotes
Accepted for publication Nov 1, 1977.

Reprint requests to Mailman Research Center, McLean Hospital, 115 Mill St, Belmont, MA 02178 (Dr Lipinski).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Mania: A Short History of Bipolar Disorder
GHAEMI
Am. J. Psychiatry 2009;166:498-499.
FULL TEXT  

Hypothesis: Grandiosity and Guilt Cause Paranoia; Paranoid Schizophrenia is a Psychotic Mood Disorder; a Review
Lake
Schizophr Bull 2008;34:1151-1162.
ABSTRACT | FULL TEXT  

Current Psychopathological Issues in Psychosis: Towards a Phenome-wide Scanning Approach
Cuesta and Peralta
Schizophr Bull 2008;34:587-590.
FULL TEXT  

Disorders of Thought Are Severe Mood Disorders: the Selective Attention Defect in Mania Challenges the Kraepelinian Dichotomy A Review
Raymond Lake
Schizophr Bull 2008;34:109-117.
ABSTRACT | FULL TEXT  

Differentiation in the Preonset Phases of Schizophrenia and Mood Disorders: Evidence in Support of a Bipolar Mania Prodrome
Correll et al.
Schizophr Bull 2007;0:sbm028v1-1.
ABSTRACT | FULL TEXT  

Long-Term Course of Schizophrenic Illness: Bleuler's Study Reconsidered
Modestin et al.
Am. J. Psychiatry 2003;160:2202-2208.
ABSTRACT | FULL TEXT  

The Effect on Diagnostic Rates of Assigning Patients to Ethnically Focused Inpatient Psychiatric Units
Mathews et al.
Psychiatr. Serv. 2002;53:823-829.
ABSTRACT | FULL TEXT  

Hierarchy and Heritability: The Role of Diagnosis and Modeling in Psychiatric Genetics
Kendler
Am. J. Psychiatry 2002;159:515-518.
FULL TEXT  

The Case of Sam: Multidisciplinary Perspectives: Psychiatric Medication: What Medications Should Be Prescribed?
Zarate
Psychiatr. Serv. 2001;52:1325-1328.
FULL TEXT  

A Separate Disease Within the Syndrome of Schizophrenia
Kirkpatrick et al.
Arch Gen Psychiatry 2001;58:165-171.
ABSTRACT | FULL TEXT  

Dimensional Approach to Delusions: Comparison Across Types and Diagnoses
Appelbaum et al.
Am. J. Psychiatry 1999;156:1938-1943.
ABSTRACT | FULL TEXT  

Evaluation of Bipolar Disorder in Inpatients With Prelingual Deafness
Shapira et al.
Am. J. Psychiatry 1999;156:1267-1269.
ABSTRACT | FULL TEXT  

Boundaries of Major Depression: An Evaluation of DSM-IV Criteria
Kendler and Gardner
Am. J. Psychiatry 1998;155:172-177.
ABSTRACT | FULL TEXT  

Understanding Manic-depressive Illness
Goodwin and Ghaemi
Arch Gen Psychiatry 1998;55:23-25.
FULL TEXT  

Depressive Symptoms in the Early Course of Schizophrenia: Relationship to Familial Psychiatric Illness
Subotnik et al.
Am. J. Psychiatry 1997;154:1551-1556.
ABSTRACT | FULL TEXT  

In Vivo D2 Dopamine Receptor Density in Psychotic and Nonpsychotic Patients With Bipolar Disorder
Pearlson et al.
Arch Gen Psychiatry 1995;52:471-477.
ABSTRACT  

Symptoms of Schizophrenia: Methods, Meanings, and Mechanisms
Andreasen et al.
Arch Gen Psychiatry 1995;52:341-351.
ABSTRACT  

Schizophrenia
Carpenter and Buchanan
NEJM 1994;330:681-690.
FULL TEXT  

The Deficit Syndrome in Schizophrenia: Psychoanalytic and Neurobiological Perspectives
Willick
J Am Psychoanal Assoc 1993;41:1135-1157.
ABSTRACT  

Ideology, Camouflage or Contingency? Racism in British Psychiatry
Littlewood
Transcultural Psychiatry 1993;30:243-290.
ABSTRACT  

The management of treatment-resistant affective disorder: clinical perspectives
Malizia and Bridges
J Psychopharmacol 1992;6:145-155.
 

Mood-Incongruent Psychotic Affective Illness: A Historical and Empirical Review
Kendler
Arch Gen Psychiatry 1991;48:362-369.
ABSTRACT  

Toward a Biochemical Classification of Depressive Disorders: X. Urinary Catecholamines, Their Metabolites, and D-Type Scores in Subgroups of Depressive Disorders
Schatzberg et al.
Arch Gen Psychiatry 1989;46:260-268.
ABSTRACT  

Plasma 3-Methoxy-4-Hydroxyphenylglycol Changes Associated With Clinical State and Schizophrenic Subtype
Ko et al.
Arch Gen Psychiatry 1988;45:842-846.
ABSTRACT  

Adjunctive Imipramine in the Treatment of Postpsychotic Depression: A Controlled Trial
Siris et al.
Arch Gen Psychiatry 1987;44:533-539.
ABSTRACT  

Schizoaffective Psychosis: I. Comparative Long-term Outcome
Williams and McGlashan
Arch Gen Psychiatry 1987;44:130-137.
ABSTRACT  

Comparative Studies of Thought Disorders: II. Schizoaffective Disorder
Shenton et al.
Arch Gen Psychiatry 1987;44:21-30.
ABSTRACT  

Affective Illness in the Families of Schizophrenic Patients: What Does It Mean Diagnostically?
Hayward
Arch Gen Psychiatry 1986;43:714-714.
ABSTRACT  

Quantitative Cytoarchitectural Studies of the Cerebral Cortex of Schizophrenics
Benes et al.
Arch Gen Psychiatry 1986;43:31-35.
ABSTRACT  

Diagnosis and Prognosis in Schizophrenia
Cloninger et al.
Arch Gen Psychiatry 1985;42:15-25.
ABSTRACT  

Exclusion Criteria of DSM-III: A Study of Co-occurrence of Hierarchy-Free Syndromes
Boyd et al.
Arch Gen Psychiatry 1984;41:983-989.
ABSTRACT  

Outcome in Schizoaffective, Psychotic, and Nonpsychotic Depression: Course During a Six- to 24-Month Follow-up
Coryell et al.
Arch Gen Psychiatry 1984;41:787-791.
ABSTRACT  

Pursuit Eye Movement Dysfunctions in Schizophrenia: Family Evidence for Specificity
Holzman et al.
Arch Gen Psychiatry 1984;41:136-139.
ABSTRACT  

Lithium: A Treatment for Learning and Behavioral Problems
Heckelman
Intervention in School and Clinic 1983;19:133-138.
 

Differences Among Clinicians in the Decision to Admit
Apsler and Bassuk
Arch Gen Psychiatry 1983;40:1133-1137.
ABSTRACT  

Schizophrenia Subdivided by the Family History of Affective Disorder: A Comparison of Symptomatology and Course of Illness
Kendler and Hays
Arch Gen Psychiatry 1983;40:951-955.
ABSTRACT  

Electrodermal Activity in Euthymic Unipolar and Bipolar Affective Disorders: A Possible Marker for Depression
Iacono et al.
Arch Gen Psychiatry 1983;40:557-565.
ABSTRACT  

Inpatient Community Meeting as an Aid To Psychiatric Diagnosis
Schaffer et al.
Int J Soc Psychiatry 1983;29:199-204.
 

Research Diagnostic Criteria and DSM-III: An Annotated Comparison
Williams and Spitzer
Arch Gen Psychiatry 1982;39:1283-1289.
ABSTRACT  

Psychotic Symptoms in Prepubertal Major Depressive Disorder
Chambers et al.
Arch Gen Psychiatry 1982;39:921-927.
ABSTRACT  

Behavioral Precursors of Schizophrenia Spectrum: A Prospective Study
Parnas et al.
Arch Gen Psychiatry 1982;39:658-664.
ABSTRACT  

Bipolar Illness in Adolescents With Major Depression: Clinical, Genetic, and Psychopharmacologic Predictors in a Three-to Four-Year Prospective Follow-up Investigation
Strober and Carlson
Arch Gen Psychiatry 1982;39:549-555.
ABSTRACT  

An Information Processing Model for Schizophrenia
Callaway and Naghdi
Arch Gen Psychiatry 1982;39:339-347.
ABSTRACT  

Using the Protirelin Test to Distinguish Mania From Schizophrenia
Extein et al.
Arch Gen Psychiatry 1982;39:77-81.
ABSTRACT  

Serotonin Uptake in Blood Platelets of Psychiatric Patients
Meltzer et al.
Arch Gen Psychiatry 1981;38:1322-1326.
ABSTRACT  

The Road to Nosologic Nirvana-Reply
Spitzer
Arch Gen Psychiatry 1981;38:1299-1300.
ABSTRACT  

Span of Apprehension Deficits During the Postpsychotic Stages of Schizophrenia: A Replication and Extension
Asarnow and MacCrimmon
Arch Gen Psychiatry 1981;38:1006-1011.
ABSTRACT  

Borderline Personality Disorder: Construct Validity of the Concept
Kroll et al.
Arch Gen Psychiatry 1981;38:1021-1026.
ABSTRACT  

Paranoid Psychosis (Delusional Disorder) and Schizophrenia: A Family History Study
Kendler and Hays
Arch Gen Psychiatry 1981;38:547-551.
ABSTRACT  

Diagnostic Discrepancy in Personal Accounts of Patients With 'Schizophrenia'
North and Cadoret
Arch Gen Psychiatry 1981;38:133-137.
ABSTRACT  

Toward the Validation of RDC Schizoaffective Disorder
Rosenthal et al.
Arch Gen Psychiatry 1980;37:804-810.
ABSTRACT  

Schizophrenia-Primary Affective Disorder Discrimination: I. Development of a Data-Based Diagnostic Index
Fowler et al.
Arch Gen Psychiatry 1980;37:811-814.
ABSTRACT  

Long-term Outcome of Major Psychoses: II. Schizoaffective Disorder Compared With Schizophrenia, Affective Disorders, and a Surgical Control Group
Tsuang and Dempsey
Arch Gen Psychiatry 1979;36:1302-1304.
ABSTRACT  

Differential EEG Patterns in Affective Disorder and Schizophrenia
Abrams and Taylor
Arch Gen Psychiatry 1979;36:1355-1358.
ABSTRACT  

Schizophrenia in Identical Twins
Nagy
JAMA 1979;242:712-712.
ABSTRACT  

Lateral Cerebral Ventricular Enlargement in Chronic Schizophrenia
Weinberger et al.
Arch Gen Psychiatry 1979;36:735-739.
ABSTRACT  

'Schizoaffective Disorder' Dead or Alive?
Tsuang
Arch Gen Psychiatry 1979;36:633-634.
ABSTRACT  

Psychiatry
Freedman
JAMA 1979;241:1373-1375.
ABSTRACT  

Activities of Types A and B MAO and Catechol-O-methyltransferase in Blood Cells and Skin Fibroblasts of Normal and Chronic Schizophrenic Subjects
Groshong et al.
Arch Gen Psychiatry 1978;35:1198-1205.
ABSTRACT  

Research Designs for the Study of Gene-Environment Interactions in Psychiatric Disorders: Report of a Foundations Fund for Research in Psychiatry Panel
Kidd and Matthysee
Arch Gen Psychiatry 1978;35:925-932.
ABSTRACT