The DSM-IV version of schizophrenia may be harmful to patients' health

The DSM-III, III-R and DSM-IV diagnostic systems required deterioration (functional loss) and duration (6 months) in the diagnosis of schizophrenia. These criteria made schizophrenia exceptional to an otherwise phenomenologically-based nosology, but their inclusion represented an effort to disentangle the diagnosis of schizophrenia from considerable historical baggage. Newer findings about the efforts of early detection and intervention in schizophrenia, however, are now calling into question the validity, utility and even the safety of these decisions. This communication will review the original reasons for including deterioration and duration as criteria. It will then argue that these reasons are now obsolete and potentially anti-therapeutic, and that a revised set of cross-sectional phenomenologic criteria for schizophrenia need to be utilized as soon as possible.