Schizophrenia Suspecta

We investigated what makes a Schneider-oriented psychiatrist diagnose "suspected schizophrenia" yet nevertheless stop short of a definitive diagnosis of schizophrenia. We compared the case records of 1208 patients hospitalised for schizophrenia for the first time in their life and all patients with discharge diagnosis "suspected schizophrenia" (n = 358). We found that the main factors for making the diagnosis of "suspected schizophrenia" are, as when using Bleuler's concept, intrasymptomatological ones, i.e. type, structure and constellation of symptoms. Hereby the non-committal character of the "expression symptoms in the wider sense" (Schneider), i.e. disorders of thought, of affect and behaviour, is of particular importance. Psychotic productive symptoms in the form of delusions or hallucinations alone are not always sufficient to confirm the diagnosis of schizophrenia. Even first rank symptoms cannot establish the diagnosis schizophrenia if certain factors reducing their pathognomonic value are present.