Studies of higher nervous activity in functional psychoses

Psychiatric illnesses can be conceived of as experiments of nature, providing a variety of pathopsychological mechanisms which may elucidate normal psychological processes. Clinically the reactive psychoses are predominantly psychogenic reaction types. They present disturbances of higher nervous activity, similar to those of the neuroses. The unconditional reflex activity is practically as in normal controls, and the most outstanding finding was the large effect of psychodynamic complex structures. This is a physiological parallel to the clinical manifestations with great concern over experienced mental trauma. In the manic-depressive psychoses the most characteristic feature is a marked disturbance of unconditional reflex activity. This factor may be an important physiological mechanism underlying the more biological than psychodynamic reaction type and partly explain the changes of mood and associated interferences with sleep, body weight, sexual activity, aggression and other instinctual and vegetative functions. Schizophrenic psychoses also present changes of unconditional reflex activity, predominantly in the direction of inhibition of response. In addition there are severe dissociations within and between the three levels of unconditional reflexes and the two signaling systems. It is suggested that schizophrenia represents a functional maladaptation, which can be explained from the principles of autokinesis and schizokinesis established by Gantt in animal experiments. Prognostic models based on experimentally established impairment of performances were shown to predict long-term risks of schizophrenic defects just as well as models based on constellations of clinical symptoms. I would predict that psychophysiology and experimental psychology will become increasingly more important for establishing diagnosis and prognosis in the functional psychoses. The data of this article point toward a basis for a prophylactic psychiatry.     

Childhood and adult behavior disorder: Some experimental comparisons

Seventy-six children with diagnoses of behavior disorder were tested with a motor conditional reflex test and a word association test. Essentially no differences were found when test performance was compared with that of 142 normal controls. When the diagnoses were divided into neuroses, adjustment reaction of childhood, and personality disorder, none of these subgroups showed any distinctive difference. Experimental differences between clinically excitatory and inhibitory types could not be established. The Russian reports about abnormal basic Pavlovian parameters could not be confirmed. In adult behavior disorder marked disturbances of functions are found. It is suggested that the worse prognosis in adult neurotic conditions is related to such pathophysiological factors as passive inhibition, weakness of active inhibition, inertness and complex structures with pathological excitation and inertia.     

The story of a ghost

SUMMARY

This paper is concerned with the relationship between psychotherapy and general psychiatry. This relationship is examined from historical, clinical and theoretical perspectives. Psychotherapy is an integral part of psychiatric practice imparting to it a means of participating in, as well as observing, the patient's subjective experiences. Mental illnesses, whatever their nature have fundamental elements in common. This common ground is most apparent when mental illnesses are conceptualised in psychological terms. Such an approach in no way undervalues the importance of the hereditary and somatic influences which contribute to the predisposition to mental illnesses. Viewed in this psychobiological way it is not difficult to discern what is common to neuroses, psychoses and disturbances of the personality. The clinical phenomena provide the basis for a developmental theory which portrays the essential unity of mental illnesses. The paper concludes with a discussion of why psychotherapy is being gradually divorced from clinical psychiatry. The dangers which this separation hold for the clinical tradition in psychiatry are emphasised.     

Indications for the Use of Atypical Antipsychotics in the Elderly

There has been an expanding role for the new generation atypical antipsychotic agents (clozapine, risperidone, olanzapine, and quetiapine) in elderly patients. Their efficacy in the treatment of psychoses associated with schizophrenia is now well established. But psychoses occur in other conditions. This paper will review the current research examining the use of the atypical agents in the treatment of psychoses in the elderly in three somewhat overlapping conditions: schizophrenia, dementia, and Parkinson's disease, as well as in the amelioration of a variety of movement disorders. In the elderly, any of the atypicals can be used to treat schizophrenia, although clozapine may be a second line agent because of its side effect profile. Risperidone may be the drug of choice for the treatment of psychoses and behavioral disturbances in dementia. Clozapine is a primary choice and quetiapine an alternative for the treatment of psychoses in Parkinson's disease; while clozapine and possibly risperidone may be preferred for the initial treatment of some movement disorders. The differential effectiveness of these agents across treatment indications may, in part, be related to their differing affinities at several neurotransmitter receptors. Examination of these relationships in large scale longitudinal studies may help in the development of effective tailored treatments for the elderly.     

Anxiety as a primary symptom in cycloid psychosis

Psychotic anxiety has not been systematically included in standard psychopathologic and diagnostic literature, presumably because anxiety is implicitly perceived to be an emphatically comprehensible consequence of the cognitive symptoms of psychosis. This review gives an overview of neurophysiologic studies that indicate different pathogenic mechanisms for different types of psychosis. Convergent and complementary structural and functional imaging findings, biochemical and neuropsychological data allow conjecture as to neurophysiologic-psychopathologic links in cycloid psychosis. Intriguing results suggest that in cycloid psychosis, a generalized hyperasousal related to the tonus of the noradrenergic system may be the basic disturbance causing the delusionary and perceptual psychotic distortions. The findings are specific for cycloid psychoses, which are diagnosed as polymorphous psychosis in the International Classification of Diseases and Related Health Problems, 10th Edition. Furthermore, these findings are consistent with the author's hypothesis that the emotional derailment is the primary disturbance in cycloid psychosis (anxiety-elation). In contrast, cognitive disturbances are secondary and remit after the exceptional emotional state is rebalanced.     

Psychotherapie der Psychosen

In this paper the psychotherapy of patients with schizophrenic, schizoaffective and affective psychoses is outlined. Psychoanalytic, cognitive-behavioural and systemic approaches and their theoretical concepts as well as the therapeutic techniques are de- scribed. The settings of individual, group and family therapy are also presented. A survey of the types of psychoanalytic therapy with their eldest historic roots is given with the development of the various psychodynamic concepts for schizophrenic and affective psychoses including schizoaffective psycho-ses. The different kinds of psychotherapy are compared to each other with respect to the aims. Finally this paper deals with the effectiveness of the therapies and discusses the pros and cons of relatively short randomised controlled trials compared with long term psychotherapies without control groups.     

Psychodynamische Zusammenh?nge zwischen Psychose und Lebensgeschichte

Using two cases as examples it is shown how psychotic experiences and behaviour are psychodynamically associated with the biography of affected patients and can be beneficially used in therapy. Based on the historic pioneer work of Sigmund Freud who, with his psychoanalytical interpretation of Daniel Paul Schreber??s autobiography Memoirs of my nervous illness (Denkwürdigkeiten eines Nervenkranken) from 1903 shortly after his death 100 years ago, was the first to attempt to construct an association between Schreber??s delusional symptoms and his past history, this approach will be extensively discussed for patients with schizophrenia and similar psychoses. Particular attention is paid to trigger situations for the occurrence of psychotic conditions and the interpretation of certain delusional symptoms with respect to conflictual subjects from the past. In patients suffering from monopolar or bipolar affective disorders or psychoses, the symptoms are generally less exaggerated and extravagant than in schizophrenic psychoses. However, in such cases it can also be beneficial for the therapy in depressive or manic episodes to follow up the long-lasting conflicts which existed prior to the psychosis, where they either experience an escalation or describe an attempt to free themselves from previous pathogenic settings.     

Need-informational interaction of brain structures

The data presented deal with the role of four main brain structures in the development of emotional states and the organization of purposeful behavior. According to these data, the frontal neocortex orients behavior towards signals of highly probable events (reinforcement), whereas the hypothalamus is the basis for satisfaction of the dominant need. Unlike the neocortex, the hippocampus reacts to events of low probability, which is typical of emotionally stressed brain activity. Unlike the hypothalamus, the amygdala creates the balance, the dynamic coexistence, of competing needs (motivations) and emotions generated by such needs, which makes behavior more adequate. Individual characteristics of the interaction among the four brain structures is the basis for the individual types of higher nervous activity.     

The cultural approach of ethnopsychiatry: A review and critique

Ethnopsychiatrists have consistently maintained that the perceptions, inclinations, and behavior of mentally ill persons are never a simple reflection of their illness: the mentally ill tend to behave in some ways in some cultural contexts and in other ways in others. This pathoplasticity shows, we are told, that abnormality is, primarily, the manifestation of a phenotype, not a genotype. Hence, any diagnosis and treatment of the affected individual must be grounded in some knowledge of the environment within which he or she functions. Postulating the existence of such an intimate and harmonious connection between psychopathology and social conditions, however, overlooks a pivotal distinction: while it is true that local norms and values can and do affect most neurotic presentations, those same standards have at best a marginal influence on psychotic reactions. Some pathogenic features are so overwhelming that they will be expressed in any environment. Accordingly, I conclude, we shall have progressed significantly in our understanding of the nature of mental disorders once we begin to associate neuroses with culture and psychoses with biology.     

The concept of phylogenetic inheritance in Freud and Jung.

At the height of their collaboration in late 1911, Freud had succeeded in persuading Jung of the role of phylogenetic factors in the etiology of neuroses and psychoses. Phylogenetic considerations play an important part in the formulation of Jung's genetic standpoint of psychology with its conception of a desexualized primal libido, which figured prominently in the dispute which ended the relations between Freud and Jung. Freud's unpublished draft of "Overview of the Transference Neuroses" was in part an attempt to counter Jung's revisions of libido theory by using phylogenetic considerations to reaffirm his original conception of a unified sexual libido. Despite the sharp divergence of many aspects of their respective psychologies after the break, a conception of phylogenetic inheritance continued to play an important role in their developing theoretical formulations.     

Pavlov’s “higher nervous activity”

The term higher nervous activity was introduced by Pavlov about 1909 to replace what he previously called “psychical” or “mental.” In Russia “higher nervous activity” is now used for what we often designate as psychophysiological or psychosomatic. “Higher nervous activity” was not a synonym in Pavlov’s use for psychical or mental; it indicates what physiology can deal with and measure as opposed to our subjective feelings and representations. The philosophical differences underlying Pavlov’s concepts, as well as the philosophical basis for distinguishing between what we measure physically and the subjective correlates, are discussed.     

In defense of sabina spielrein

Abstract

Of all the master-disciple encounters, the most fruitful and fateful was the one between Freud and Jung, ending in a painful parting of the ways, all depicted in the Freud/Jung letters. In some quarters the Freud/Jung split is explained by the old recipe of cherchez la femme, blaming Sabina Spielrein for causing trouble between the two men. In addition, Spielrein was “diagnosed” as schizophrenic. Both the blame and the diagnosis are false. The record shows, as amply reflected in the Freud/Jung correspondence and in the letters exchanged by each of them with Spielrein (as well as Spielrein's diary), that the relations between the two men were not complicated by Spielrein. New confirmatory evidence comes from letters released by the Jung family at a later date and the recently published clinical chart of Spielrein with details about her family background, her stay at the Burgholzli Asylum, and her condition at discharge. The cumulative effect of the evidence leads to a reappraisal of the Jung/Spielrein love affair. As an aside, the Freud/Jung split had other causes. Evolving against the backdrop of the rupture with Adler, it had to do with disagreements over matters of doctrine, specifically, the sexual etiology of neuroses and psychoses, and was fought out in the arena of interpreting Schreber.     

Zur Beendigung von Lehranalysen

An attempt is made to give an open account about the goals, problems and results concerning the ending of eight training analyses. The connection of trauma, individual defence structure and mental disturbances as well as the need for their therapeutic change is emphasized. Three problems are offered for further discussion: 1. to transform acting outs of training analysts standing under the pressure of the projections by training analysands onto the institute, into interpretation; 2. the difficulty to understand the varieties of the depressive position within the mental patterns of foreign civilisations; 3. the hypothetical effect of the analysis of character neuroses on the abstinence of training analysts and on the decision for lower frequency by former training analysands.     

Biochemistry of nervous dogs

Previous behavioral studies on a nervous strain of pointer dogs have demonstrated genetic as well as environmental components in the nervous trait. Behaviorally these animals are extremely hypervigilant, with an apparent low threshold to fear and show strong avoidance of humans. In addition, the nervous E strain dogs show an unusually high degree of sensitivity to the mange mite. These observations led to the initiation of studies to determine whether differences exist between the normal A strain and the E strain of dogs at the biochemical level. Although a number of biochemical parameters examined have shown no statistically significant difference between the two strains, the modification of serum creatine phosphokinase (CPK) activity in response to various types of stress does differ as a function of strain—the nervous dogs being less, not more, responsive than the healthy dogs. When not specifically subjected to stress the serum CPK levels in both strains were highly related to age. Significant differences between strains also have been demonstrated in the cerebrospinal fluid acetyl cholinesterase activity levels in older animals. Tryptophan loading experiments, conducted in the presence and absence of the monoamine oxidase inhibitor, tranylcypromine, resulted in no readily observable behavioral modification of either strain and the response of the cerebrospinal fluid 5-hydroxyindoleacetic acid levels was similar for the two strains.     

The second signal system as conceived by Pavlov and his disciples

Pavlov clearly formulated his ideas on thesecond signal system (specifically, language) in the 1930s. This occurred in conjunction with his interest in interspecies differences and in the study of human neuroses. Pavlov proposed that conditional reflexes signal concrete reality while symbolic-language provides abstractions of reality. Phylogenetically, language emerged in the humans because this form of communication had survival value to the species. Pavlov’s disciples L. A. Orbeli and N. I. Krasnogorskii had considered the ontogenetic development of language. The experimental investigation of A. G. Ivanov-Smolenskii extended Pavlov’s empirical study of the function of language in psychopathology. Notwithstanding a sustained interest in language, Pavlov did not develop a theory of language acquisition based upon the conditioning principle. Pavlov’s conceptualization of language may not have been original, nor did it contribute significantly to modern linguistics. It is now mainly of historical interest. It was, nevertheless, important to the conceptualization of neuroses within the context of the theory of higher nervous activity and it had far-reaching political implications for Soviet psychology in the immediate post-World War II period.     

Studies on protein genetic factors in multiple sclerosis and psychoses]

In more than 200 cases of multiple sclerosis, psychosis and cyclothymia, the Hp types are studied with the help of polyacrylamide gel electrophoresis (Schreyer and Schaible, 1967) and the Gc types wtih agar gel electrophoresis (Schlesinger, Vogt and Prokop, 1963). All Hp and Gc types were found in these diseases, but there was no frequent occurence of any particular type in multiple acleroses of psychoses. According to our results, there is no interdependence between these diseases and the Hp and Gc types.     

Social-information-processing factors in reactive and proactive aggression in children's peer groups

We examined social-information-processing mechanisms (e.g., hostile attributional biases and intention-cue detection deficits) in chronic reactive and proactive aggressive behavior in children's peer groups. In Study 1, a teacher-rating instrument was developed to assess these behaviors in elementary school children (N = 259). Reactive and proactive scales were found to be internally consistent, and factor analyses partially supported convergent and discriminant validities. In Study 2, behavioral correlates of these forms of aggression were examined through assessments by peers (N = 339). Both types of aggression related to social rejection, but only proactively aggressive boys were also viewed as leaders and as having a sense of humor. In Study 3, we hypothesized that reactive aggression (but not proactive aggression) would occur as a function of hostile attributional biases and intention-cue detection deficits. Four groups of socially rejected boys (reactive aggressive, proactive aggressive, reactive-proactive aggressive, and nonaggressive) and a group of average boys were presented with a series of hypothetical videorecorded vignettes depicting provocations by peers and were asked to interpret the intentions of the provocateur (N = 117). Only the two reactive-aggressive groups displayed biases and deficits in interpretations. In Study 4, attributional biases and deficits were found to be positively correlated with the rate of reactive aggression (but not proactive aggression) displayed in free play with peers (N = 127). These studies supported the hypothesis that attributional biases and deficits are related to reactive aggression but not to proactive aggression.     

Trialog und Psychosenpsychotherapie

?Trialogue in this context is defined as the equal encounter of people with experience of psychoses, relatives and therapists in the sense of reciprocal learning and mutual respect. This concept has its origins in Germany in the so-called psychosis seminars but has now become of importance for experiences with other diseases and for other levels of encounters ?C for psychiatric practice, anti-stigma work, tribunals, for psychiatry planning and quality assurance, teaching, congresses, further education and also for research. In this article the trialogue will be presented based on the targets, experiences and results of psychosis seminars and compared with the results of psychoeducation. Finally, the concept of trialogue will be placed in context with the development of the psychotherapy of psychoses: are experiences of trialogue also relevant for psychotherapy? Can not only form but also content impulses be derived? Can trialogue strengthen and support the psychotherapy of psychoses as a whole? In this context the empirical results of the trialogue research project SuSi on the subjective meaning and significance of psychoses will be presented showing a surprisingly clear case for sense orientation and for a biography-oriented psychotherapy of psychoses.     

Psychodynamische Aspekte der Ged?chtnisfunktionen

Based on Freud??s early thinking this paper tries to give an overview about the current state of the art related to psychodynamic aspects of memory functions. Freud began with the investigation of retrieval alterations, especially keeping content away from the experiencing ego to avoid unpleasurable states. Under the influence of new knowledge about war neuroses he tried to tackle the question of what might happen to the memory system if in the encoding situation the protecting shield is broken down through the impact of the stimuli. He came to the conclusion that such situations might lead to an omnipresence of the destructive content which could no longer be subsumed under the pleasure principle. Their permanent presence and the defense against them form the difference between traumatic disturbances and those based on unconscious conflicts. Most processes cannot be subsumed under repression but as a change of reality perception. It is shown that the models explaining the change from one state to the other is still not satisfactory. The analysis of peritraumatic states make it clear that they alone, like dissociative states, have an influence but posttraumatic experiences are just as decisive for the future development leading either to a pathogenic unconscious conflict or long-term posttraumatic disturbances with all kinds of comorbid states or healing.