From the Bonn study including 502 patients followed up an average 22.4 years after onset of schizophrenic disease diagnosed according to the criteria of K. Schneider, we selected 113 cases of schizo-affective, schizophreniform, and cycloid psychoses in accordance to the definitions given by Kasanin, Retterstøl, Angst, and Leonhard. These psychoses have a better prognosis than the whole sample: characteristic residues are seen more rarely, complete remissions and noncharacteristic residues more frequently. This group of psychoses differs from the whole sample in the hereditary taint, too: the morbidity risk with affective psychoses and with schizophrenic psychoses in first- and second-degree relatives is higher than in the total sample of the Bonn study. In spite of the better prognosis and other differences described in the paper, we believe that these results do not justify the classification of schizo-affective and related disorders as an independent disease group. Between these different subtypes of schizophrenia only a differential typology and not a differential diagnostic is possible.
Levels of various compounds related to monoamines were assessed in 96 patients with a variety of depressive and nondepressive syndromes. The diagnostic categories were composed retrospectively after examination of International Classification of Diseases (ICD) classifications and all available data in medical reports. All patients underwent the 8-hour probenecid test. Administration of probenecid was partly intravenous (1 g) and partly oral (4 g). In all patients, the cerebrospinal fluid (CSF) levels of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and probenecid were estimated, while in about half of the patients tryptophan and tyrosine were determined in CSF and serum. When the group is taken as a whole, significant positive correlations are found between the CSF levels of 5-HIAA, HVA and probenecid, between the CSF levels of tryptophan and tyrosine, and between tyrosine levels in serum and CSF. A negative correlation is found between CSF probenecid and serum tryptophan. The group of patients was divided in several ways into various subgroups. Analysis of covariance of clinical and biochemical data indicates no significant biochemical differences between any of the subgroups. This retrospective study lacks supportive evidence that any of the clinical syndromes, including the depressive syndromes, is characterized by specific deficiencies of monoamine neurotransmission.
The prevalence of cerebral malignancy in psychiatric patients is investigated in our own clinical material and compared with literature data. The importance of cellular type and localization of the lesion is checked and related to clinical symptoms such as seizures and psychopathological symptoms. The recognition of cerebral malignancy in psychiatric patients, especially in the early stages when few or no neurological signs are present, is shown to be a complex clinical problem. The possibilities and restrictions of technical investigations in general and of the EEG in particular are stressed.
According to our three series of examinations, we have found a way of differentiating between nuclear schizophrenics and manic-depressives in schizo-affective disorders. Only a very small amount of all people diagnosed as schizophrenics (about 3%) have to be put under the category of schizo-affective disorders (Legierungspsychose) sensu strictiori. But in this well-defined group, there is a relation between the symptomatology of the acute stage and the long-term course of the disorder. There is also a better indication for long-term therapy in schizo-affective disorders, because the differentiation in psychopathology also means a better-differentiated therapy with better long-term results.
The biological base of psychoses is controlled by multifactorial genotype compounds using sometimes the same gene locus or DNA information section for diverse diseases, but always in different and repeatable combinations. These compounds can be formed by special regulatory or junction genes. With the help of inherited serum markers of the haptoglobin and the Gc system including quantitative studies of the ceruloplasmin and transferrin serum level, the combinations of diverse biological factors have been presented especially for cycloid psychoses, unsystematic schizophrenias, and paranoid psychoses with late onset and a cyclic axis syndrome. Considering the specifications of genetic control and clinical course no indefinite mixtures in the sense of schizo-affective psychoses should be discussed furthermore.
269 patients with schizophrenia, schizo-affective or affective disorders admitted to a hospital in Zürich were examined by the AMP system and the syndrome checklist of Wing and co-workers. The data were analyzed using a special set-theoretical similarity measure for nonlinear graduations, multidimensional scaling to achieve a metric representation of the similarity matrices, and a cluster analysis, originally described by Meisel in 1972.
Numerous terms commonly used in psychiatry show a lack of preciseness and logical consistency. This results in an obscuration of the objects under observation and generates fictitious problems which function as a source of permanent confusion. The reasons for this are analyzed and exemplified with respect to organic psychoses.
The present paper deals with the problematic nature of the phenomenological grasping of the consciousness of the body and its pathological modifications. The reasoning is oriented by the doctrine of Husserl of the so-called sentiments as the fundamentals of the experience of the own body. This basic approach does not only seem to be basically for a psychology of the consciousness of the body, but also to give the theoretical-conceptual structure for a great number of psychopathological modifications. Subsequent to a criticism of the conventional use of the term ‘hallucination of the body’ we attempt to chart elements of a scheme of the abnormal consciousness of the body.
The effect of one night’s total sleep deprivation (SD) on the dexamethasone suppression test (DST) was studied in groups of endogenously and nonendogenously depressed patients who were diagnosed according to different research classification systems. The DST was normal ( < 5 µg/dl) before and after SD in the group of nonendogenously depressed patients. Deterioration, no change or only slight clinical response in single items occurred. In the group of endogenous depressives 8 out of 11 were baseline nonsuppressors ( > 5 µg/dl). After SD a large variability of cortisol nonsuppression was found in this group. Clinical response occurred in the majority of these patients but was more favorable in those who had a trend for normalization of DST. Clinical diagnosis as well as DST seem to have a therapy-predictive value for one night’s total SD in patients with affective disorders.
The position taken in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III), which holds that schizo-affective psychoses cannot be defined unequivocally, that no unambiguous criteria for these psychoses can be determined, and that they cannot be placed into either of the two main groups of functional psychoses, illustrates the present status of schizo-affective psychoses. The study of their position in relation to schizophrenia and manic-depressive psychoses is also essential: after all, the placing of a patient into either category plays a crucial role in the choice of treatment. For example, recent research on the success of lithium treatment in schizo-affective psychoses shows the practical relevance of this line of study. It seems that, like many other mental disorders, the internal structure of schizo-affective psychoses is highly heterogenous, and it is therefore not always possible to place them as a whole into either of Krae-pelin’s diagnostic categories.
The author stresses the importance of diagnosis in psychiatry and gives a short presentation of the Scandinavian concepts of reactive psychoses and schizophreniform psychoses. On the basis of his own personal follow-up investigations on 301 consecutively admitted patients to the University Psychiatric Clinic in Oslo, followed up through 5-18 years, he concludes that the schizophreniform (schizo-affective) psychosis also in prognostic respects is a group in between. Of the patients with a discharge diagnosis of reactive psychosis, 81% had a favourable course compared to 61% of the patients with a discharge diagnosis of psychosis e genere incerto (Langfeldt's schizophreniform psychoses) and only 23% of the patients with a discharge diagnosis of schizophrenia.
The presence of schizo-affective psychosis is postulated psychopathologically, if schizophrenic as well as manic or depressive cyclothymic symptoms, respectively, are to be found in the same clinical picture. This circumstance rises the question with what legitimation do we designate a symptom as schizophrenic, etc.? Generally, we call a symptom, e.g., schizophrenic, if: (1) like with K. Schneider’s first-rank symptoms the presence of a schizophrenic called entity of syndrome and course of illness is very easy to be recognized by means of the symptom, and (2) the symptom is statistically significantly correlated with this entity. In both definitions the schizophrenic nature of the single symptom remains undetermined. Here the attempt is made to work out a specificity of manic and depressive phenomena, a phenomenological determination of manic-depressive psychosis as an essential entity, respectively, by tracing structural signs of the moods and delusions as well as of the personality of manic-depressives. The same could be done in some way also with schizophrenic psychoses. We believe that only if we arrive at a clearer determination of what is meant by schizophrenic, manic, and depressive not only in a correlative statistical, but also in a phenomenological sense, we might have a chance finally to classify schizo-affective psychosis psychopathologically on an empirical basis.
Vertebro-basilar insufficiency produces a rich spectrum of psychological and neurological symptoms. Where psychological symptoms dominate the picture, the patient may be presented first to a psychiatrist. The phenomenology of vertebro-basilar insufficiency is discussed with special reference to hallucinatory syndromes, memory disturbance, affective disorders, akinetic mutism, 'unusual reports', cortical blindness, agitated delirium, the Capgras syndrome and normal pressure hydrocephalus. Finally, the case of a 61-year-old man illustrating a variety of the neurological and psychological features described in this paper is presented.
The perplexity psychiatry is faced with when approaching the problem of 'schizo-affective disorders' is the result of two characteristic features of human psychology: The first consists in the tendency to pick up quickly attractively formulated terms and to prefer them to others designating the same facts. The second psychological trend referred to concerns the use of a well-sounding term in a definition which deviates from the original one. The nosological implications of the existence of the 'cases in between' (K. Schneider), attributable neither to schizophrenia nor to cyclothymia, are briefly reviewed. It is suggested to speak of schizo-affective disorders only if the criteria for both disorders manifest simultaneously. Applying the Vienna Research Criteria we found that 'schizo-affective' disorders occur rarely as compared to other frequently used less restrictive diagnostic instruments.
The subjects of this study are prisoners who were hospitalized from custody in a psychiatric clinic. All of such patients of one psychiatric clinic during the period from 1976 till 1978 were compared with a random sample of other psychiatric patients using case reports and other data. Differences were found concerning social, personal, psychiatric, and criminal history as well as psychopathological state and diagnosis. Compared to the complete population of prisoners of the area, prisoners from solitary confinement (mostly remanding custody) were overrepresented. Other risk factors for psychiatric hospitalization of prisoners are described. The results are discussed from prophylactic, therapeutic, and humanitarian points of view.
The report is based on 1,165 medical inpatients seen by the consultant psychiatrist within a 3-year period. During the last year evaluated for this study psychiatric consultation was requested for 2,8% of the total non-psychiatric hospital admissions. Questions to the consultant are most often referred to psychogenic factors, depression and suicidality. The most frequent psychiatric diagnosis was neuroses/reactions/ personality disorders followed by suicidality, organic psychoses, psychosomatic illnesses, endogenous psychoses, somatopsychic syndromes and addictions. Further details and problems in psychiatric consultation are discussed.
A 1-year sample of consecutively admitted patients between 18 and 40 years of age is studied. Psychopathology has been elicited by the Schedule for Affective Disorders and Schizophrenia (SADS), and diagnoses have been set according to Research Diagnostic Criteria (RDC). The sample consists of 57 cases with schizophrenia, 8 cases with schizo-affective psychosis and 23 cases with affective psychoses. Bellak's Ego Function Assessment Test was given to all these patients. The test does not show any significant differences between the schizo-affective and the schizophrenic groups. Some significant differences are found between the schizo-affective group and the group of affective psychosis. The findings do not validate schizo-affective psychosis as a diagnostic category.
15 patients diagnosed as schizophrenics (ICD 295) under long-term neuroleptic treatment were compared with 15 neurotic and normal persons concerning their ability at a psychomotor task. There was no difference between both groups; no correlation between performance and neuroleptic dosage was found. However, motoric coordination of a small group was impaired. The authors discuss several hypotheses referring to these findings.
Among the first-degree relatives of 77 patients with delusional functional psychoses the authors found 13 schizophrenics (3.10%), 8 manic-depressives (1.91 %) and 14 cases with atypical psychoses (3.34%), following ICD-9 criteria. These figures were compared with the figures in the literature on the genetics of paranoid schizophrenics and nonschizophrenic paranoids, regarding the different composition of the samples. Subdivision of the original 77 patients, using the concept of the axial syndromes, was able to form two homogeneous subgroups of first-degree relatives: one with a schizophrenia prevalence of 6.52% (uncorrected) and without any manic-depressive secondary cases (endogeno-morphic-schizophrenic axial syndrome) and another with a manic-depressive illness (MDI) prevalence of 6.58% (uncorrected) without any secondary cases with schizophrenia or atypical psychosis. The first-degree relatives of the patients with an ‘organomorphic’ axial syndrome (usually excluded in other studies) had an increased rate of manic-depressive secondary cases (3.57%, uncorrected) and the highest rate of atypical psychosis (7.14%) without any schizophrenics, according to the etiopathogenetic heterogeneity of this group. 37 of the 77 patients were not assignable to any of the axial syndromes. In the first-degree relatives of these patients – best comparable to Kendler’s criteria for ‘delusional disorder’ – an increased rate of schizophrenics and atypical psychoses was found (3.59 and 3.08%, uncorrected); the figures for MDI were within normal limits. Our results suggest that the axial syndromes are a useful diagnostic instrument in identifying – from the genetic standpoint – in part very homogeneous subgroups. This allows the conclusion that they are indicators for hypothetical basic disturbances.
The concept of 'schizo-affective psychoses' covers favourable as well as unfavourable forms of endogenous psychoses. Thus, it does not help us for a nosological classification which must also allow for the prognosis. In order to make a prognostic distinction we have to subdivide the schizo-affective psychoses into the 'cycloid psychoses' and the 'non-systematic schizophrenias'. Also the latter display affective symptoms and can take a bipolar course, but, despite this, tend to deterioration; they do so increasingly shift after shift, whereas the cycloid psychoses completely recover after every phase. Even during the first phase or shift a reliable differential diagnosis can be made. This has been confirmed by follow-up examinations, as the cycloid psychotics, in fact, had recovered. Only very few misdiagnoses could be detected. If we want to classify prognostically, we must separate the cycloid psychoses from the true schizophrenias.
