Development and structure of the DCR Budapest-Nashville

The DCR Budapest-Nashville was developed by adopting a differentiated concept of the 'full disease entity'. The so-called small disease entity is a preliminary stage in the search for more complicated disease entities. In its present form, the DCR is a diagnostic method for identifying small disease entities in the spectrum of reactive (i.e. psychogenic) and functional (i.e. endogenous) psychoses. The nosological concept of the DCR can be characterized by thirteen paradigms: (1) a nonkraepelinian clinical classificatory system given by Leonhard; (2) the index-psychosis paradigm as opposed to the end-state paradigm; (3) conceptual differentiation of the disease entities as opposed both to the full disease entity paradigm and to the only-one-psychosis (or no disease entity) paradigm, respectively; (4) an aristotelian distinction between content (meaning) and form as opposed to the paradigm of ideas; (5) three-aspect approach to the psychopathological phenomena instead of choosing only one or two of the aspects of experience, of the behavior and of the achievement as special paradigm; (6) gestalt paradigm specified in different ways, as completing the associationist paradigm; (7) structural paradigm, especially concerning the delusions; (8) method of understanding in contrast to the method of causal explanation in distinguishing reactive (i.e. psychogenic) psychoses from functional (i.e. endogenous) psychoses; (9) behavioral symptoms overrule experiential symptoms in the decision-tree process concerning schizophrenias; (10) erosive psychotic phenomena ('minus symptoms') overrule productive phenomena ('plus symptoms') in the decision-tree process concerning hebephrenias in the group of systematic schizophrenias; (11) three-dimensional (polarity, rhythmicity, deterioration) assessment of course of illness; (12) sociological paradigm in reformulation of types of 'defect'; (13) psychosis paradigm concerning the operationalization of applicability of DCR to patients. Some empirical investigations are mentioned concerning the validity of the DCR.