Wöller W
Fortschr Neurol Psychiatr. 1983 Sep;51(9):295-312. doi: 10.1055/s-2007-1002235.
There is a substantial need, based on the heuristic principle, to arrive at a valid classification of schizophrenic psychoses. According to the modern theory of science bases on critical rationalism, nosological classifications in psychiatry are regarded as "useful" conventions requiring precise operational definitions. There are several methods of classification, typological classifications having gained widest acceptance in nosology. The multiaxial classification approach allows to document separately data from different levels of data collection, such as symptomatological, etiological, psychosocial and family data, as well as personality factors. However, it is always necessary to render any classification empirically valid by verifying it by means of empirically observed data. In this review, some frequently used classifications of schizophrenic psychoses are evaluated regarding their "usefulness". Usefulness of a classification is assumed if its sub-grouping of data on one level of data collection is validated by data from another level, or if there is sufficient evidence that this classification can generate hypotheses which lend themselves to empirical testing. The traditional sub-classification of schizophrenias into hebephrenic, paranoid, catatonic, and simple forms lacks clear rules for allocating patients to one of the sub-groups; moreover, these sub-groups have not proved reliable. Some authors have tried to classify schizophrenic psychoses via the course of the illness. Methodological difficulties are considerable, and hence most of these classification still await validation. On the other hand, the course of premorbid personality development has been shown to be very important for the sub-grouping of schizophrenics: Good vs. poor premorbid adaptation dichotomy has been validated by prognostic and psychophysiological studies, by therapy response and by family data. Any distinction between acute and chronic types is bound to be of rather questionable value. Symptom criteria have also been proposed for differentiating between schizophrenic psychoses. Paranoid vs. nonparanoid dichotomy has been supported by several biochemical, psychophysiological, familial and therapy response studies. There is a great deal of evidence from prognostic and genetic studies that the presence of a valid sub-group of schizophrenic psychoses. Sub-grouping schizophrenics according to narrowly defined symptom criteria such as Schneider's first-rank symptoms and Langfeldt's, Feighner's and Spitzer's research symptom criteria is of limited value for a valid sub-classification. An approach to classification based on the distinction between the predominance of positive vs. negative schizophrenic symptomatology is of heuristic usefulness in that it generates biochemical and pathophysiological hypotheses which can be tested empirically.
基于启发式原则，迫切需要对精神分裂症性精神病进行有效的分类。根据基于批判理性主义的现代科学理论，精神病学中的疾病分类被视为需要精确操作定义的“有用”惯例。有几种分类方法，类型学分类在疾病分类学中得到了最广泛的认可。多轴分类方法允许分别记录来自不同数据收集层面的数据，如症状学、病因学、心理社会和家庭数据以及人格因素。然而，始终有必要通过经验观察数据对任何分类进行验证，使其在经验上有效。在本综述中，对一些常用的精神分裂症性精神病分类的“有用性”进行了评估。如果一个分类在一个数据收集层面上的数据子分组能够通过另一个层面的数据得到验证，或者如果有足够的证据表明该分类能够产生适合经验检验的假设，那么就认为该分类是有用的。将精神分裂症传统地细分为青春型、偏执型、紧张型和单纯型，在将患者分配到其中一个子组方面缺乏明确的规则；此外，这些子组尚未被证明是可靠的。一些作者试图通过疾病过程对精神分裂症性精神病进行分类。方法学上的困难相当大，因此这些分类中的大多数仍有待验证。另一方面，病前人格发展过程已被证明对精神分裂症患者的分组非常重要：病前适应良好与不良的二分法已通过预后和心理生理学研究、治疗反应和家庭数据得到验证。急性和慢性类型之间的任何区分必然具有相当可疑的价值。也有人提出了用于区分精神分裂症性精神病的症状标准。偏执型与非偏执型的二分法得到了多项生化、心理生理学、家族性和治疗反应研究的支持。预后和遗传学研究有大量证据表明存在有效的精神分裂症性精神病子组。根据狭义定义的症状标准（如施奈德一级症状以及朗费尔特、费格纳和斯皮策的研究症状标准）对精神分裂症患者进行分组，对于有效的细分分类价值有限。基于精神分裂症阳性症状与阴性症状占主导地位的区分的分类方法具有启发式的用处，因为它产生了可以进行经验检验的生化和病理生理学假设。
