Simple schizophrenia: past, present, and future

In the recently published revision of the Diagnostic and Statistical Manual of Mental Disorders, third edition - a reference book for the classification and diagnosis of psychiatric disorders - the term 'simple schizophrenia' has been omitted as a diagnostic category and it has been replaced by the term 'schizotypal personality'. Although usage of the earlier term has generally been discontinued in the United States, it remains in ICD-9 (International Classification of Diseases, ninth edition), a text which is used internationally. The authors believe the deletion is premature and simple schizophrenia should be reinstated as a diagnostic category in the forthcoming DSM-IV, as the nature of this disorder is not adequately described elsewhere. This condition was originally documented in the late nineteenth century by psychiatrists who classified it as a simple primary dementia syndrome. Subsequent investigators, Otto Diem and Eugen Bleuler, further described the condition and Kraepelin characterized simple schizophrenia, which he initially termed 'dementia praecox', as a specific disease. The scope and definition of this disorder have frequently changed over that last several decades. As a result the term 'schizophrenia' has become quite broad and the term 'simple schizophrenia' has been thought to be somewhat vague. However, further research is recommended before this classification be eliminated. The authors have enclosed an appendix entitled 'Proposed Criteria for Simple Schizophrenia (Simple Deteriorated State)' to assist in clarifying and defining simple schizophrenia. Included in the appendix are the description and duration of symptoms, criteria for the elimination of other possibilities such as organic causes, and the consideration of patient's history.