In Europe, there had been an untested assumption that the concept
of nuclear schizophrenia, based on Schneiderian First Rank
Symptoms, identified the exact same poor-prognosis disorder described
by Kraepelin. Although family study data suggested that
a broader concept of the illness had greater validity in capturing
the genetic component of schizophrenia, the nuclear schizophrenia
concept reduced heterogeneity- and the narrower construct
was associated with greater reliability.
Eventually, the United States accepted the need for international,
uniform illness definitions. This acceptance was hastened
as differential pharmacotherapy became available and diagnosis
made a substantial impact on clinical approach. And in part because
attempts to establish efficacious psychotherapy based on a
psychodynamic understanding of schizophrenia had not been successful.
Thus, the disparity between U.S. and international standards
for diagnosing schizophrenia was emphatically addressed in
the 1970s. DSM-III was produced and embraced the European
concept of nuclear schizophrenia. Negative symptoms including
avolition were not diagnostic criteria, disorganization of thought
was not required, and reality distortion symptoms became prominent.
Schizophrenia could now be diagnosed with a single First
Rank Symptom as the only symptom criterion
In Europe, there had been an untested assumption that the conceptof nuclear schizophrenia, based on Schneiderian First RankSymptoms, identified the exact same poor-prognosis disorder describedby Kraepelin. Although family study data suggested thata broader concept of the illness had greater validity in capturingthe genetic component of schizophrenia, the nuclear schizophreniaconcept reduced heterogeneity- and the narrower constructwas associated with greater reliability.Eventually, the United States accepted the need for international,uniform illness definitions. This acceptance was hastenedas differential pharmacotherapy became available and diagnosismade a substantial impact on clinical approach. And in part becauseattempts to establish efficacious psychotherapy based on apsychodynamic understanding of schizophrenia had not been successful.Thus, the disparity between U.S. and international standardsfor diagnosing schizophrenia was emphatically addressed inthe 1970s. DSM-III was produced and embraced the Europeanconcept of nuclear schizophrenia. Negative symptoms includingavolition were not diagnostic criteria, disorganization of thoughtwas not required, and reality distortion symptoms became prominent.Schizophrenia could now be diagnosed with a single FirstRank Symptom as the only symptom criterion
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