The Kraepelian concept of schizophrenia: Dying but not yet dead

The nonsense we used to believe We have seen the dismantling of much of what we believed about schizophrenia (Guloksuz and van Os, 2018). The first rank symptoms, we thought characteristic, also occur in affective psychosis (Picardi, 2019). The supposedly specific familial predisposition is shared with other disorders (Cardno et al., 2002). The curious belief that the incidence of schizophrenia is the same worldwide has been abandoned. The brain changes which accumulate through the illness, initially thought to support the Continuum with adult psychiatric disorders Both schizophrenia and bipolar disorder typically have their onset in early adult life. Their symptoms overlap, with depression and mania common in those who receive a diagnosis of schizophrenia, and psychosis common in people with mania or severe depression (Murray et al., 2004; Demjaha et al., 2011). Many environmental risk factors are shared (Rodriguez et al., 2021b). Both schizophrenia and mania respond to D2 blockade, presumably because the two share liability to excess dopamine synthesis Conclusion Psychosis is subject to the influence of two major aetiological continua. Firstly a predisposition to adult mental illness largely shared with bipolar disorder. Secondly neurodevelopmental impairment. What is termed schizophrenia lies at the confluence of the two. Indeed, one might speculate that many patients who receive a diagnosis of schizophrenia have an underlying bipolar disorder compounded by cognitive impairment.