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Methods for SubtypingMethods for Subtyping

• Traditional subtypes based Traditional subtypes based on clinical presentationon clinical presentation

• Phenomenotype vs. biotypePhenomenotype vs. biotype

• Positive vs. mixed vs. Positive vs. mixed vs. negativenegative

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Traditional SubtypesTraditional Subtypes

• ParanoidParanoid

• DisorganizedDisorganized

• CatatonicCatatonic

• UndifferentiatedUndifferentiated

• ResidualResidual

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Traditional SubtypesTraditional Subtypes

• Divide patients based on Divide patients based on their prominent presenting their prominent presenting symptomssymptoms

• Useful for predictionUseful for predictionPrognosisPrognosis

Social and occupational functionSocial and occupational function

Response to treatmentResponse to treatment

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PhenomenotypePhenomenotype

• Types of symptomsTypes of symptoms• Severity of symptomsSeverity of symptoms• Longitudinal courseLongitudinal course• Mode of onsetMode of onset• Cognitive functionCognitive function• Psychosocial adaptationPsychosocial adaptation• Response to treatmentResponse to treatment

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BiotypeBiotype

• Genetic loading and linkageGenetic loading and linkage• Birth and pregnancy Birth and pregnancy

complicationscomplications• Viral risk factorsViral risk factors• Neurophysiological measuresNeurophysiological measures• Neuropsychological measuresNeuropsychological measures• Neuroimaging measuresNeuroimaging measures• Neurochemical measuresNeurochemical measures

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Positive vs. NegativePositive vs. Negative

PositivePositive NegativeNegative

Poor premorbidPoor premorbid

Acute onsetAcute onset

Psychotic symptomsPsychotic symptoms

Intact cognitionIntact cognition

Poor treatment responsePoor treatment response

Neurochemical mechanismNeurochemical mechanism

ReversibleReversible

Good premorbidGood premorbid

Insidious onsetInsidious onset

Negative symptomsNegative symptoms

Impaired cognitionImpaired cognition

Good treatment responseGood treatment response

Structural mechanismStructural mechanism

IrreversibleIrreversible

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DSM-IV Criteria for DSM-IV Criteria for Schizophrenia: The BasicsSchizophrenia: The Basics• Characteristic symptoms for one Characteristic symptoms for one

monthmonth

• Social/Occupational DysfunctionSocial/Occupational Dysfunction

• Overall Duration > 6 monthsOverall Duration > 6 months

• Not attributable to mood disorderNot attributable to mood disorder

• Not attributable to substance use Not attributable to substance use or general medical conditionor general medical condition

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Criterion A: Characteristic Criterion A: Characteristic SymptomsSymptoms

• At least two of the following, each present for At least two of the following, each present for a significant portion of time during a one a significant portion of time during a one month period (or less if successfully treated):month period (or less if successfully treated):• (1) delusions(1) delusions• (2) hallucinations(2) hallucinations• (3) disorganized speech (e.g., frequent (3) disorganized speech (e.g., frequent

derailment or incoherence)derailment or incoherence)• (4) grossly disorganized or catatonic behavior(4) grossly disorganized or catatonic behavior• (5) negative symptoms, I.e., affective (5) negative symptoms, I.e., affective

flattening, alogia, or avolitionflattening, alogia, or avolition

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Criterion A: Criterion A: Parenthetical NoteParenthetical Note

• [Note: Only one “A” symptom is [Note: Only one “A” symptom is required if delusions are bizarre required if delusions are bizarre or hallucinations consist of a or hallucinations consist of a voice keeping up a running voice keeping up a running commentary on the person’s commentary on the person’s behavior or thoughts, or two or behavior or thoughts, or two or more voices conversing with more voices conversing with each other.]each other.]

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Criterion B: Social/Occupational Criterion B: Social/Occupational DysfunctionDysfunction

• For a significant portion of the time For a significant portion of the time since the onset of the disturbance, one since the onset of the disturbance, one or more major areas of functioning such or more major areas of functioning such as work, interpersonal relations or self-as work, interpersonal relations or self-care is markedly below the level care is markedly below the level achieved prior to the onsetachieved prior to the onset

• OR when the onset is in childhood or OR when the onset is in childhood or adolescence, failure to achieve expected adolescence, failure to achieve expected level of interpersonal, academic, or level of interpersonal, academic, or occupational achievementoccupational achievement

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Criterion C: Overall Criterion C: Overall DurationDuration

• Continuous signs of the disturbance persist for at Continuous signs of the disturbance persist for at least six monthsleast six months

• This six-month period must include at least one This six-month period must include at least one month of symptoms that meet criterion A (i.e., active month of symptoms that meet criterion A (i.e., active phase symptoms), and may include periods of phase symptoms), and may include periods of prodromal or residual symptomsprodromal or residual symptoms

• During these prodromal or residual period, the signs During these prodromal or residual period, the signs of the disturbance may be manifested by only of the disturbance may be manifested by only negative symptoms or two or more symptoms listed negative symptoms or two or more symptoms listed in criterion A present in an attenuated form (e.g. in criterion A present in an attenuated form (e.g. odd beliefs, unusual perceptual experiences)odd beliefs, unusual perceptual experiences)

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Criterion D: Schizoaffective Criterion D: Schizoaffective and Mood Disorder Exclusionand Mood Disorder Exclusion• Schizoaffective Disorder and Mood Schizoaffective Disorder and Mood

Disorder with Psychotic Features have Disorder with Psychotic Features have been ruled out because of either:been ruled out because of either:(1)(1) No major depressive or manic episodes have No major depressive or manic episodes have

occurred concurrently with the active phase occurred concurrently with the active phase symptoms; or symptoms; or

(2)(2) If mood episodes have occurred during active If mood episodes have occurred during active phase symptoms, their total duration has been phase symptoms, their total duration has been brief relative to the duration of the active brief relative to the duration of the active and residual periodsand residual periods