William O. Faustman and Shelley Fleming Ficek
Veterans Affairs Palo Alto Health Care System
and Stanford University School of Medicine
Schizophrenia has been recognized for over 100 years as a form of severe mental illness, typically, although not always, showing an onset in late adolescence or early adulthood. Extensive biological research searching for a unique diagnostic marker has failed to yield a means of diagnosing the illness from a medical test. Accordingly, clinicians remain wholly dependent on the observation of clinical symptom clusters to diagnose the disorder. Since schizophrenia may represent a complex syndrome with diverse etiological bases and disorder outcomes, the identification of specific symptom clusters is vital in the understanding of the nature of the disorder.
The goal of this chapter is to provide an overview of symptom presentation and assessment in schizophrenia. It begins with a historical review chronicling the evolution of diagnostic criteria from the early descriptions of Kraepelin to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Detailed descriptions of currently recognized symptom clusters (e.g., positive, negative, and disorganized symptoms) are presented. Given the increasing emphasis on the documentation of outcomes in clinical practice, the review