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Use of antidepressants in schizophrenia: diagnostic problems.

To the Editor.— Kramer et al 1 reported on a controlled trial of antidepressants in actively psychotic inpatients with DSM-III schizophrenia. Notably, all patients met Research Diagnostic Criteria (RDC) 2 for schizoaffective disorder, the "mainly schizophrenic" subtype. This study amplifies others' observations 3 that the RDC mainly schizophrenic subtype of schizoaffective disorder has a poor outcome. However, for the clinician in practice who is using the current DSM-III-R criteria, there is a dilemma: to which patients does this study apply? To be considered mainly schizophrenic in the RDC, the patient must have either of the following: "A. Core schizophrenic symptoms... were present for at least 1 week in the absence of... depressive features. B. Prior to the onset of the affective features, patient exhibited the following features which are often associated with schizophrenia: social withdrawal, impairment in occupational functioning, eccentric behavior, or unusual thoughts or perceptual experiences." If the