Concept and classification of schizophrenia in the Soviet Union

Abstract

The Snezhnevsky classification of schizophrenia recognizes 3 forms based on clinical course: continuous, shift-like, and periodic. The diagnostic process takes into account family history of mental illness, life history of the patient, premorbid personality, psychopathological signs during illness, level of adjustment during remission, and the nature and rate of progression of the clinical course of illness. Each of these factors weighs heavily, in addition to presenting clinical picture, in arriving at subtypes that are descriptive of the type and nature of the total clinical course which the patient has experienced. These subclassifications are of prognostic value, since the future clinical course of the patient can be predicted from them. It is believed that these forms are closer to a more basic and natural subdivision of schizophrenia which may eventually be clarified at a biological level. The 3 forms of Snezhnevsky use broad limits for the definition of schizophrenia, including patients with only predominantly pseudoneurotic symptoms and, on the border with manic-depressive psychosis, excluding only those patients with purely affective symptoms. Within these broad limits, there is a gentle gradation of clinical picture from one form to another, allowing for patients to be classified as 'borderline' or 'nearer to' one form or another. It is felt, however, that when the initial diagnosis is correct, patients do not change form, and hence there is usefulness in consistency of diagnosis, as opposed to conventional classifications which lead to diagnosis of inconsistent subtypes on repeated hospital admissions. Supporting a flexible system of clinical subtypes within the schizophrenic classification based on clinical course from unremitting in type to intermittent psychotic episodes interspersed with normal functioning, these theories and practices deserve further study by psychiatrists of other theoretical orientations.