This New Year's edition of Psychiatric Annals has as its focus schizophrenia comorbidity, guest edited by Dr. Michael Y. Hwang. An interesting topic raised in this series of articles is the question of the most useful characterization of schizophrenia — whether as a disorder of syndrome or viewing symptom dimensions to both define the disorder and guide treatment decisions.
Symptom dimensions is a topic that comes up across the range of the disorders we treat. Biological markers seem to correlate best, and pharmacologic treatment decisions seem to be guided primarily by symptom dimensions rather than syndromatic disorders. Depression, anxiety, agitation, psychosis, impulsivity, cognitive impairment, executive functioning, and sleep problems — just to name a few — occur across diagnoses and are addressed specifically with various medications across diagnoses. Even genetic findings may turn out to correlate with symptom dimensions better than with diagnoses.
We try very hard to hang on to diagnostic categories in an attempt to be compatible with medical diagnosis, even though biological measures and psychopharmacologic response may better correlate with symptom dimensions. Perhaps we need some kind of mixed or dual classification, even if that doesn't sound like it would meet the criteria of Occam's razor. It's an interesting question to ponder for the New Year.
I hope I'll see you at the third annual Psychiatric Annals Symposium, this year on the subject of treatment-resistant and bipolar depression. The meeting will be New York City April 1–3. It's a good time to take inventory of how we're spending our precious time as a New Year dawns — and to make some decisions on how we might live it more fully. For more information, including how to register, see the advertisement on pages 26 and 27 of this issue.
A healthy New Year to you and yours!