Schizophrenia: changing the name and broadening the concept is problematic

Schizophrenia and most other psychotic disorders are heterogeneous clinical syndromes. For treatment to be individualised, underlying factors need to be explored. Van Os’s suggestion of combining different types of psychotic disorder into the single category of “psychosis susceptibility syndrome” is problematic.1 The proposed broad category would increase the number of cases three to four fold. This would result in between-patient variability and within-category heterogeneity that challenges the application of existing knowledge. Besides, the current diagnostic categories are meaningful. For example, lithium can be beneficial in “bipolar disorder” and “schizo-affective disorder,” whereas long term antipsychotic drugs are not indicated in patients with “brief psychotic disorders.” Combining these various disorders into one group would increase heterogeneity and confound interpretation of science at the level of clinical application. In any case, clinicians should treat each patient individually, according to the pathology—DSM classification is only a starting point.

Changing the name of all these disorders may (or may not) improve public understanding. Such a name change should be done with extreme care, preferably by WHO convening relevant experts and stakeholders and making a single decision with international implications. However, it is unclear whether a name change would decrease stigma or make communication about the diagnostic category more informative. In Japan, the translation of schizophrenia resulted in a very negative term and it was hoped that a name change would result in a more benign public perception. A recent report showed that this name change has not improved public perception as represented in the media.2