THE TRANSITION from ICD-10 to ICD-11 has introduced substantial revisions in the classification of schizophrenia and catatonia, reshaping diagnostic approaches for clinicians worldwide. The updated system reflects over a century of evolving psychiatric thought, from early descriptions of catatonic states by Karl Ludwig Kahlbaum to Emil Kraepelin’s classification of psychotic syndromes and Eugen Bleuler’s introduction of the term schizophrenia.
One of the most notable changes in ICD-11 is the removal of schizophrenia subtypes. Under ICD-10, clinicians could diagnose variants such as paranoid, hebephrenic, and catatonic schizophrenia. ICD-11 eliminates these distinctions, instead using symptom and progression classifiers that capture both categorical and dimensional elements of the disorder. This hybrid model is designed to improve the precision of diagnosis and treatment planning.
Additionally, the prominence previously given to Schneider’s first-rank symptoms, such as auditory hallucinations and thought insertion, has been reduced. This shift acknowledges that these symptoms are not always specific or sufficient for a definitive diagnosis. Instead, a broader clinical picture is emphasized, with attention to patterns of symptoms and course of illness.
Perhaps the most transformative change involves the classification of catatonia. Previously grouped within schizophrenia under ICD-10 code F20.2, catatonia is now recognized in ICD-11 as a distinct diagnostic entity. This revision reflects its cross-diagnostic relevance, as catatonia can occur in various psychiatric and medical conditions beyond schizophrenia. The recognition of catatonia’s independent status is expected to enhance detection, promote timely intervention, and foster research into its underlying mechanisms.
For healthcare professionals, these changes underscore the importance of adapting to diagnostic frameworks that better reflect clinical realities. ICD-11’s approach may help refine treatment decisions and support more individualized patient care, while also aligning diagnostic categories with advances in psychiatric research.
Reference: Falkai P et al. Schizophrenia and catatonia: from ICD-10 to ICD-11. World Psychiatry. 2025. https://doi.org/10.1002/wps.22154
