Recent developments in the assessment and conceptualization of schizophrenia

The pioneering efforts of Kraepelin and Bleuler spawned two distinct approaches to schizophrenia. In America, Bleuler's influence and the efforts of a number of other theorists produced a broad and vague schizophrenia construct. This broad schizophrenia construct, as exemplified by DSM-II, was widely criticized as being unreliable and invalid. Two recent developments have addressed these criticisms. First, American diagnostic criteria (e.g., the Research Diagnostic Criteria and DSM-III) have become much more explicit and detailed. Second, structured diagnostic interviews have been developed (e.g., the Present State Exam and the Schedule for Affective Disorders and Schizophrenia) that allow the reliable recording of data for diagnostic decisions. As to validity, the schizophrenia construct is embedded in a network of lawful relationships, e.g., favorable response to phenothiazines and higher risk for the disorder in first degree relatives. It is also apparent, however, that nonsymptomatic data are of importance to anyone wishing to assess schizophrenia. Social and occupational skills, for example, predict posthospitalization adjustment; characteristics of the environments to which schizophrenics are discharged predict relapse. Thus, some of the concepts and methods of behavioral assessment provide an important supplement to traditional diagnostic procedures.