조현병 진단기준에 대한 정신병리학적 고찰

Abstract

Background: Considering the conterarguement of the optimistic attitude of psychoanalysis and environmental change, the current diagnostic criteria for schizophrenia (i.e., Diagnostic and Statistical Manual of Mental Disorders, 5th edition-text revised [DSM-5-TR], International Classification of Diseases, 11th revision [ICD-11]) are defined under the substantial influences of symptom-based operationalism. The current diagnostic criteria for schizophrenia are occasionally considered as the incorporated characteristic mixtures of the chronicity, positive symptoms, and negative symptoms of Emil Kraepelin, Kurt Schneider, and Eugen Bleuler, respectively. Current Concepts: Concerning the diagnostic criteria for schizophrenia, the two remarkable changes from DSM-IV or DSM-IV-TR to DSM-5 or DSM-5-TR are as follows. First, related to diagnosing schizophrenia, the weighting of Kurt Schneider’s first-rank symptoms has been omitted. Second, the defining subtypes (i.e., paranoid, disorganized, undifferentiated, catatonic, and residual) have also been omitted. In addition, catatonia has been newly considered a semi-independent diagnostic entity in DSM-5 or DSM-5-TR. Therefore, from a psychopathological aspect, the operationally defined diagnostic criteria for schizophrenia display several limitations: First, the oblivion of the concept of formal thought disorder, considered as the fundamental symptom of schizophrenia by the greatest psychopathologists, has been deepened. Second, the current diagnostic criteria for schizophrenia have been partly inconsistent with the disease essentialism model. Discussion and Conclusion: Schizophrenia cases are interconnected with ‘family resemblance’ but not shared by common underlying neurobiological correlates. Herein, in clinical psychiatric practice, with an emphatic approach, phenomenological psychopathology would still be required to evaluate the subjective experiences of an individual with schizophrenia.