A CASE AGAINST SUBTYPING IN SCHIZOPHRENIA

In this paper we consider the generally accepted view that schizophren ia is 'heterogeneous'. We point out that the view derives from prima f acie evidence from clinical presentation, studies of course, and facto r analysis. However, upon closer examination internal contradictions a re apparent, e.g., subtypes change, different groupings of symptoms co occur in the same individual. Another type of paradigm, depending on c areful study of case controls (e.g., monozygotic twins discordant for schizophrenia) and distributions, indicates that abnormalities in neur ocognition, regional cerebral blood flow, and regional neuroanatomy ma y be present in nearly every patient, irrespective of absolute level o r diagnostic subtype. These results suggest that a simple model in whi ch patients vary along a severity dimension might parsimoniously expla in much of the variance. Thus, while it is possible and even probable that schizophrenia may have many etiologies, phenocopies may represent the expression of a unitary pathogenesis of greater or lesser impact.