New diagnostic vistas

There are many difficulties in establishing criteria for better drug compliance and improved quality assurance in the treatment of schizophrenic patients. The most serious problem (especially with first episodes) is that of diagnosis. Since no biological markers for schizophrenia have been found the clinician is referred to "symptom collecting"--including collecting social data. In spite of many attempts there is still no general agreement of the concept of schizophrenia. This deplorable fact is reflected in the everchanging subdivisions of the schizophrenias over the decades: from a division of acute and chronic dementia praecox via a classification of simple, hebephrenic, catatonic, paranoid forms, on to new classifications based on positive/negative manifestations, divisions of type I/type II forms etc. The many different rating scales are reflections of the same problem, as are the different diagnostic systems (e.g. DSM-III and ICD-10). The recent attempts to make a synthesis of these systems seem promising but raise new problems related to etiological and pathogenetic views of psychiatric disorders.