Catatonia is now very, very rare. I think I see one or two cases every year, at most. Much more common is hallucinations and delusions, particularly of persecution, with less organization, and often an affective component.

Which I currently call “psychosis NOS”.

I don’t think any one is that happy with the current DSM: the hypomania/mania split, the issue of affective elements in psychosis, and the lack of acknowledgement that we don’t know at first presentation what we are dealing with are all problems.

However, we have not a replacement, nor will we, until we understand the biology of these things. Current theories relating to synaptic networks have more face validity than the dopamine/receptor hypothesis.

But we have been wrong before. My skepticism remains.

The two most interesting papers on schiophrenia in recent years that I have found most interesting are:

The failure of the schizophrenia concept and the argument for its replacement by hebephrenia: applying the medical model for disease recognition. Michael Alan Taylor, Edward Shorter, Nutan Atre Vaidya and Max Fink
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2010.01589.x/full

Which suggests that Kallbaum’s original hebephreia was a much more coherent category than Kraepelin’s Dementia Praecox (the damage done by Kraepelin’s ‘lumping togther’ tendency, amplified by the Neo-Kraepelinians of the late 20th century, would be hard to exaggerate!)

and

The incidence of admissions for schizophrenia and related psychoses in two cohorts: 1875–1924 and 1994–2010. David Healy, Joanna Le Noury, Stefanie Caroline Linden, Margaret Harris, Chris Whitaker, David Linden, Darren Baker, Anthony P Roberts
http://bmjopen.bmj.com/content/2/1/e000447.full

Which suggests that schizophrenia (?hebephrenia) may have been a disease arising with the industrial revolution, which is now dwindling – this may give clues to its aetiology.

Hope you enjoy!