LAUSR

This issue of the European Archives of Psychiatry and Clinical Neuroscience contains several contributions to the field of schizophrenia research, nearly all of which report on clinical research, predominantly neurobiological studies. This leads to the question of our current understanding of the diagnosis and conceptualization of the construct “schizophrenic psychoses.” Do the current diagnostic systems give a satisfactory answer? The prefinal version of the ICD-11 was recently published and will now be discussed by psychiatrists all over the world. Like DSM-5, ICD-11—which more or less follows the DSM-5 system in many respects—continues to use a categorical classification system, enriched with elements of a dimensional approach; it also contains some elements that underline the syndromal overlap between different categories. Each individual disorder continues to be categorized on the basis of its psychopathological profile and duration of symptoms. As part of the overall development of ICD-11 across all disease areas, each category is characterized by a “content form” that covers descriptive areas, such as category name, relationship to ICD-10, definition, diagnostic guidelines, functional properties, coded qualifiers (specifiers), assessment issues, and others. Regarding schizophrenic psychoses, which are described in the chapter “Schizophrenia spectrum and other primary psychotic disorders,” ICD-11 takes a similar direction as DSM-5. For example, the principal diagnostic criteria are the same and the subtypes of schizophrenic psychoses have been replaced by a dimensional approach based on assessments of symptoms, the so-called coded qualifiers. Although the importance of first-rank symptoms is de-emphasized, a diagnosis of schizophrenia requires the presence of at least two out of eight symptoms, including at least one core symptom. Core symptoms include delusions, thought insertion/ thought withdrawal, hallucinations, and thought disorders. Symptoms should have been clearly present for at least 1 month. Coded qualifiers include the presence of positive, negative, depressive, manic, and psychomotor symptoms. However, considering the problems of the psychometric assessment of negative symptoms, for example, and knowing—on the basis of the results of psychometric research in this field—that the concept of negative symptoms is much more complex than was believed for a long time, how can a simple global rating be sufficiently valid? The paper by Schmidt et al. in this issue reports on a 12-month trial of assertive community treatment and underlines the need for a differentiated psychometric assessment of negative symptoms that offers the possibility to evaluate subdimensions of the total score [7]. Given the fact that negative symptoms are of such principal relevance in the context of schizophrenia, because they are closely associated with social functioning and prognosis and require special treatment approaches, we should not avoid making the necessary effort to assess them in the proper psychometric way in everyday clinical practice. ICD-11 also provides a trans-sectional diagnostic criterion for schizoaffective disorders and reorganizes acute and transient psychotic and delusional disorders. Interestingly, psychotic symptoms occurring in mood disorders are classified in the chapter on mood disorders. Non-primary (i.e., “secondary”) psychotic disorders, such as psychotic disorders in general medical conditions and psychotic disorders due to substance use or withdrawal, are placed in the respective sections of the chapter “Mental and Behavioural Disorders.” Although those involved in developing ICD-11 hoped to harmonize the two diagnostic systems, several differences remain in the general conceptualization and in many details, not only in the schizophrenia-related chapter but also in the other chapters. ICD-11 comes closer to DSM-5 than ICD-10 did to DSM-IV, but the two diagnostic systems still differ in * Hans-Jürgen Möller [email protected]