Deconstructing Schizophrenia forDSM-V: Challenges for Clinical and Research Agendas

Considerable effort is focused on a revised definition of for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) anticipated in 2012. Among the core debates are how to define a disorder without an established pathophysiology, whether diagnosis is improved by implementing continuous symptomatic dimensions, and to what extent neurocognitive deficits should be integrated into for DSM-V. Although lacking in validity, the diagnosis schizophrenia remains a useful term for clinical communication, with current antipsychotic therapies encouraging diagnostic lumping rather than splitting. Much evidence supports a move to a dimensional model for psychosis, but doing so raises the potential for overdiagnosis. Validity problems exist not only with schizophrenia, but also with its defining symptoms such as delusions and hallucinations. Integrating dimensional symptom clusters into DSM-V schizophrenia, exemplified by models based on neurocognitive defic...