WPA Methods for Subtyping Traditional subtypes based on clinical presentationTraditional subtypes based on clinical presentation Phenomenotype vs. biotypePhenomenotype vs. biotype Positive vs. mixed vs. negativePositive vs. mixed vs. negative

WPA Traditional Subtypes ParanoidParanoid DisorganizedDisorganized CatatonicCatatonic UndifferentiatedUndifferentiated ResidualResidual

WPA Traditional Subtypes Divide patients based on their prominent presenting symptomsDivide patients based on their prominent presenting symptoms Useful for predictionUseful for predictionPrognosis Social and occupational function Response to treatment

WPA Phenomenotype Types of symptomsTypes of symptoms Severity of symptomsSeverity of symptoms Longitudinal courseLongitudinal course Mode of onsetMode of onset Cognitive functionCognitive function Psychosocial adaptationPsychosocial adaptation Response to treatmentResponse to treatment

WPA Biotype Genetic loading and linkageGenetic loading and linkage Birth and pregnancy complicationsBirth and pregnancy complications Viral risk factorsViral risk factors Neurophysiological measuresNeurophysiological measures Neuropsychological measuresNeuropsychological measures Neuroimaging measuresNeuroimaging measures Neurochemical measuresNeurochemical measures

WPA Positive vs. Negative PositiveNegative Poor premorbid Acute onset Psychotic symptoms Intact cognition Poor treatment response Neurochemical mechanism Reversible Good premorbid Insidious onset Negative symptoms Impaired cognition Good treatment response Structural mechanism Irreversible

WPA DSM-IV Criteria for Schizophrenia: The Basics Characteristic symptoms for one monthCharacteristic symptoms for one month Social/Occupational DysfunctionSocial/Occupational Dysfunction Overall Duration > 6 monthsOverall Duration > 6 months Not attributable to mood disorderNot attributable to mood disorder Not attributable to substance use or general medical conditionNot attributable to substance use or general medical condition

WPA Criterion A: Characteristic Symptoms At least two of the following, each present for a significant portion of time during a one month period (or less if successfully treated):At least two of the following, each present for a significant portion of time during a one month period (or less if successfully treated): (1) delusions(1) delusions (2) hallucinations(2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence)(3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior(4) grossly disorganized or catatonic behavior (5) negative symptoms, I.e., affective flattening, alogia, or avolition(5) negative symptoms, I.e., affective flattening, alogia, or avolition

WPA Criterion A: Parenthetical Note [Note: Only one “A” symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.][Note: Only one “A” symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.]

WPA Criterion B: Social/Occupational Dysfunction For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations or self- care is markedly below the level achieved prior to the onsetFor a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations or self- care is markedly below the level achieved prior to the onset OR when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievementOR when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement

WPA Criterion C: Overall Duration Continuous signs of the disturbance persist for at least six monthsContinuous signs of the disturbance persist for at least six months This six-month period must include at least one month of symptoms that meet criterion A (i.e., active phase symptoms), and may include periods of prodromal or residual symptomsThis six-month period must include at least one month of symptoms that meet criterion A (i.e., active phase symptoms), and may include periods of prodromal or residual symptoms During these prodromal or residual period, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in criterion A present in an attenuated form (e.g. odd beliefs, unusual perceptual experiences)During these prodromal or residual period, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in criterion A present in an attenuated form (e.g. odd beliefs, unusual perceptual experiences)

WPA Criterion D: Schizoaffective and Mood Disorder Exclusion Schizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out because of either:Schizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out because of either: (1)No major depressive or manic episodes have occurred concurrently with the active phase symptoms; or (2)If mood episodes have occurred during active phase symptoms, their total duration has been brief relative to the duration of the active and residual periods