Schizophrenia Is a Misdiagnosis: Implications for the Dsm-5 and the ICD-11 by C. Raymond Lake

Author:C. Raymond Lake
Language: eng
Format: mobi
Publisher: Springer
Published: 2012-03-22T22:00:00+00:00

212

11 Changing Concepts in the 1990s, 2000s, and 2010s…

100

SZ

MOOD

SAD

NOS

90

80

70

60

50

40

30

20

% DIAGNOSES OF PSYCHOTIC PTS 10

0 Pre 1850's 1910's-1920's 1930's-1940's 1950's-1970's 1980's-1990's 2000's-2010's 2020's-2030's

Fig. 11.2 Estimated diagnoses of functionally psychotic patients over 2000 years

Abbreviations: SZ schizophrenia, SAD schizoaffective disorder, BP bipolar disorder, MOOD

psychotic mood disorder, NOS psychosis not otherwise specifi ed (for the purpose of this graph, NOS includes unrecognized organic causes)

Before the 1850s, manic-depressive insanity was the only disease still today considered to be

functional that was diagnosed in psychotic patients cycling from depressions to manias and back.

There were other diseases considered functional such as “general paresis of the insane” but which

organic causes have been determined. There was no dementia praecox or schizophrenia until the

latter half of the nineteenth century.

By the 1910s and 1920s, the infl uences of Kraepelin and Bleuler caused the rapid increase in the

diagnosis of schizophrenia over manic-depressive insanity in psychotic patients so that their ratio

was approximately 50/50.

By the 1930s and 1940s, schizophrenia may have been diagnosed in 75% of functionally psy-

chotic patients versus 25% for manic-depressive insanity.

By the 1950s through the 1970s, the frequency of the diagnosis of schizophrenia had increased

even further to approximately 85% compared to 10% for manic-depressive insanity. Schizoaffective

disorder had begun its impressive increase.

In the 1980s and 1990s, schizoaffective disorder became very popular, possibly topping both

schizophrenia and bipolar disorder in the diagnosis of psychotic patients. Psychosis Not Otherwise

Specifi ed may have comprised a small percentage of psychotic patients’ diagnoses.

By the 2000s and 2010s, psychotic bipolar disorders are even more recognized and schizophre-

nia along with schizoaffective disorder diagnoses decreased toward zero. A continuation of this

trend suggests a ratio similar to the pre-1850s with psychotic mood disorders accounting for the

vast majority of functionally psychotic patients.

By 2020, schizophrenia and schizoaffective disorder may have been eliminated, and about 94%

of functionally psychotic patients will be diagnosed with a psychotic mood disorder. About 6%

may be diagnosed with a psychotic disorder NOS while organic causes and mood symptoms are

sought.

11.3 Overlap and Similarities from Basic Science…

213

have been studied for hundreds of thousands of common DNA variance (single-

nucleotide polymorphisms) spread across the genome (Craddock and Owen 2005,

2010a, b ) . These studies demonstrate common DNA variance that increases the

risk of diagnoses of both schizophrenia and bipolar disorders. Examples of specifi c

risk loci include ZNF804A and CACNA1C. Thus Craddock and colleagues con-

cluded that,

… there is evidence for overlap in the identity of genes showing gene-wide association

signals in genome-wide association studies of schizophrenia and bipolar disorder. Perhaps

more compellingly, there is strong evidence that the aggregate polygenic contribution of

many alleles of small effect to susceptibility for schizophrenia also infl uences susceptibility

to bipolar disorders.

(Moskvina et al. 2009 ; The International Schizophrenia Consortium 2009 )

At least one rare but specifi c genetic translocation between chromosomes 1 and

11 from a large Scottish family study is reported to increase the risk of psychiatric

disorders including schizophrenia, bipolar disorder, major depressive disorder, and

alcohol abuse (Blackwood et al. 2001 ) .

Although there remain several susceptibility loci reported to be unique to either

schizophrenia or bipolar disorder, increasing focus on psychotic bipolar disorder

has revealed increasing similarities and overlap.

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