The diagnostic dilemma of psychosis. Reviewing the historical case of pseudoneurotic schizophrenia

The term “pseudoneurotic schizophrenia” was introduced in 1949 by Hoch and Polatin to describe apparently neurotic patients showing formal thought disorders, emotional dysregulation, and transient psychotic symptoms. Even if this diagnostic entity is no longer included in modern diagnostic systems, its evolution is intertwined with the history of schizophrenia in the 20th century. This article retraces the development of pseudoneurotic (or “borderline”) schizo- phrenia in modern psychiatry, finding it a pioneering concept in psychopathology. In particular, we demonstrate that recent findings about the positive syndrome, good-outcome, type I “distress” subtype of schizophrenia (associated with high emotionality, including anxiety, depression, and sensitivity to stress) show surpris- ing consistency with the clinical concept of pseudoneurotic schizophrenia. Finally, we discuss the historical development of pseudoneurotic schizophrenia in modern psychiatry as a meaningful example of the difficulty of confining severe psycho- logical disturbances lying at the edge of full-blown schizophrenia within a widely accepted diagnostic category.