Clinical models of schizophrenia: a critical approach to competing conceptions

Clinical and etiopathological heterogeneity in schizophrenia has been recognized long ago. The main hypothesis held in this report is that as long as we are not able to disentangle the heterogeneity question at the clinical level, it is not likely that heterogeneity at the etiological and pathophysiological levels may be solved. While the description of symptoms and signs of schizophrenia has remained mainly unchanged over the years, the way in which authors have articulated the varied phenomenological manifestations has been very unequal, thus rendering different views of schizophrenia across periods and countries. We still lack a global and comprehensive model to understand clinical heterogeneity in schizophrenia. In absence of compelling evidence for supporting either a categorical or a dimensional view, it is necessary to integrate and empirically compare competing approaches. The use of a polydiagnostic approach on the one hand, and a multidimensional approach on the other (the polydiagnostic-multidimensional paradigm), seems to be a promising strategy to better understand the heterogeneity of schizophrenia.