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Subclassification of Major Affective Disorders and the Risk of Rapid Transition to Mania

Forty-two clinically diagnosed schizophrenic patients were re-diagnosed by Bleuler’s 4A, Schneider’s FRS, ICD-9, DSM-111, Research Diagnostic Criteria and St. Louis criteria. Defining schizophrenia by the presence of at least one of the 4A allocates the largest number of patients (36 cases), while St. Louis criteria attribute only 13 cases to the diagnosis of schizophrenia. All the criteria diagnosed 6 cases as schizophrenia, but 2 cases are diagnosed by none of them. There are different overlapping patterns among the criteria. Three groups are separated by using the cluster analysis. Almost all of the criteria attribute the cases to one group (concordant group, N = 17), and most of them don’t allocate the cases to another group (undiagnosed group, N = 14), and discordance among the diagnoses is seen in the third group (discordant group, N = 11). In the concordant group, “restlessness” and ”lack of concentration,” as well as “any delusion,” “any hallucination” and 7 items in FRS, are observed more frequently than in the other groups (p < .05). The discordant group shows the same pattern of symptom set, but the presence rate is less than the concordant group, while the undiagnosed group shows a different pattern, less auditory hallucination, delusion, and more depressive episodes. A Forensic-Psychiatric Case Showing Symptoms of So-called Atypical Psyehosis