The Natural History of Mania, Depression, and Schizophrenia

The 1990s have been a decade of rapid change for psychiatry as well as the entire medical community. Increasing external pressures from managed care companies and other third-party payers have led to dramatic shifts in practice standards. More rapid means of diagnostic assessment, follow-up, and treatment institution, as well as ultra-brief hospital stays, are becoming the new standard of care. Unfortunately, these realities have pressed many practitioners, and perhaps even more regrettably so, many students of the mental health and behavioral sciences, into taking a symptom-checklist and content-only approach to diagnosis, thus leaving longitudinal course and the evolution of signs, symptoms, and syndromes over time to take a distant back seat.