Clinical psychopathological characteristics of acute atypical circular affective psychoses

The clinical reality of acute atypical affective psychoses is recognized by almost all psychiatrists. A total of 229 cases of atypical circular psychosis have been studied. In many of these cases the "psychodynamic mobility" of the personality, i.e., the "fixed attitude" according to Usnadse, was studied in addition to a clinical analysis. The method used for this is described, and a number of criteria for evaluation are reported. Also, the thematic apperception test and Rorschach test as well as electroencephalographic examinations have been carried out on many of the patients included in this study. The results of clinical-psychopathological and experimental-psychological examinations enable better diagnoses of acute atypical affective psychoses to be established.     

Psychodynamik und Psychotherapie psychotischer St?rungen

This article gives a review of the options for psychodynamic treatment of patients with psychoses. The various settings for individual treatment as well as group and family therapy will be presented with a special emphasis on modified analytical long-term therapy. For a psychodynamic understanding, which is the basis for this treatment, the most important psychoanalytical models for psychotic disorders will be presented. In addition the current empirical results of non-explicit psychodynamic-oriented research will be referred to, which emphasize the significance of traumatic events in the early phases of life and the importance of narrative elements, whereby the psychodynamic approach experiences both complementation and confirmation.     

Use of the conditional reflex to assess the temporal characteristics of curarization effects on heart rate responding

A Pavlovian methodological counterpart to the use of druginduced changes in operant rates of responding was used to assess the temporal characteristics of d-tubocurarine chloride effects on the heart rate conditional reflex in rats. After a stable conditional reflex had been established, the base heart rate, as well as the unconditional and conditional reflex, was monitored during administration of the drug. A sizable behavioral effect was reflected in all three measures, including a temporary abolition of the conditional and unconditional reflexes. An interpretation of these results was discussed, and further development and application of this specific methodology was explored.     

Higher nervous activity in psychiatric patients

A review is presented of studies of higher nervous activity in psychiatric patients. In neuroses and reactive psychoses the basic pathology appears to be centered around the psychogenic complex structures. In addition, neuroses as well as reactive psychoses reveal general disturbances of higher nervous activity. In the schizophrenic and manic depressive psychoses there are indications of disturbances in deep-lying brain structures. Both types of psychoses are heterogeneous groups of clinical conditions. An important task for future experimental studies is to establish the types of disturbances of higher nervous activity in well-defined clinically homogenous groups. The final section deals with prophylactic psychiatry, with special emphasis on Gantt’s suggestions for an international project.     

Bipolarity, monopolarity and "dichotomous functional decay" as principles of differential diagnosis and "functional pathology" of endogenous psychoses

On the basis of Leonhard's Classification of the endogenous psychoses an attempt is made to trace the phenomenology of the monopolar and bipolar affective psychoses as well as Leonhard's "unsystematic schizophrenias" to three different functional anomalies. The differential diagnosis between the "cycloid psychoses" and the "unsystematic schizophrenias" as well as the problem of the so-called schizoaffective psychoses connected with them, is of particular interest. The arrangement to "functional areas" seems to be suitable.     

Personality disorders and psychosocial changes after intensive psychotherapy: A prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment*

This report presents the results of a 7-year prospective outcome study designed to examine the psychosocial changes during and after therapy among 25 outpatients suffering from personality disorders and psychoses. The therapeutic approach was based mainly on object relations theory and psychodynamic self-psychology, and focused in particular on affect consciousness, parental images, self-image and interpersonal relations. Twenty patients completed the form which measured psychosocial changes during therapy, and 21 persons participated at follow-up. The data show statistically significant changes in the capacity to tolerate intimate relationships and actually establish such relationships, improved quality of contact in relationships with friends, a general raising of socioeconomic status and reduced use of ordinary health and social services. Both the global psychosocial outcome at follow-up as measured by HSRS and the general level of symptoms measured by SCL-90 suggest that 76% of the sample had reached a level of psychosocial functioning and adaptation that can be defined as “no-caseness”.     

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.     

Functional psychosis in Huntington chorea

The paper considers a case of acute paranoid-hallucinatory psychosis that made its appearance in the fifth year after the manifestation of hereditary chorea. A brief account of the problems involved in psychoses when hereditary chorea is present is given. These psychoses are taken to be functional psychoses as according to Wieck.     

Catalysts for psychic change: Perspectives from contemporary psychoanalysis

This paper was given as the inaugural ‘Ellen Noonan Counselling Lecture’ on 3 July 2007, at Birkbeck College, University of London, and I have retained some of the spoken style of the original lecture. Since the 1960s, psychoanalytic models of change and growth have in themselves undergone radical changes. The aims of psychoanalytic and psychodynamic work are now less tied to a model of ‘health’ or ‘normality’ and more linked into processes that enable people to keep developing throughout life. The lecture examines some of the new theories of psychic change and growth from the contemporary Independent, Lacanian and post-Kleinian schools of psychoanalysis and, using clinical illustrations, explores the implications of these new theories for psychodynamic practice.     

Orienting reaction,organizing for action,and emotional processes

In the first half of the sixties, general notions were formulated concerning the functional role of the orienting reaction (OR) in adaptive activity, its elicitation and habituation. These notions included the following: a) The OR is elicited only by significant changes in a situation. This implies that OR elicitation is preceded by brain processes (usually unconscious) pertaining to the evaluation of the significance of changes according to an existing hierarchy of motivations, attitudes, and goals. Therefore, the OR is of an active (vs. reactive) nature, i.e., is inevitably determined by internal factors of brain activity. b) The OR is not a unitary reaction, but a complex polyfunctional activity, different aspects of which are reflected in different OR components which can be modified rather independently. c) The OR represents the processes of organizing new (non-standard) actions: sensory, motor, or intellectual. OR habituation is a manifestation of attenuation of the active control of an action, and an increase in its automation. Thus, the emphasis in understanding the OR has shifted from a predominantly “sensualistic” platform to a predominantly “actualistic” one. In recent experiments, the role of emotional processes in the elicitation and habituation of components of the OR has been analyzed. Complex relations between the GSR and anxiety were found in a study of patients with acute alcohol withdrawal syndrome treated with different psychopharmacological agents. The study of auditory evoked potential habituation in depressive patients has shown the emotional state influence on sensory aspects of the OR with the participation of the OR brain mechanisms in perceptual defense. The possible significance of some new ideas from the field of non-linear dynamics for perspectives on future investigations of the OR are discussed.     

Measurement of muscle reflex time in radicular disorders of the lumbosacral region]

The results of studies performed by the authors show that time measurements of proprioceptive muscular reflexes (triceps surae and tibialis posterior reflexes) may be considered a valuable addition to methods of topical diagnosis of radicular disturbances in the lumbosacral region. The reflexes were tested in twenty normal subjects. There were found an intraindividual constancy of the respective reflex time with a maximum deviation of 2 ms as well as a lateral variability up to 1.3 ms. Radicular compressions resulted in an increase in reflex time by 2 to 66 ms or failure of the reflex potential to be recorded. The pathological cases were compared with clinical and neurological studies, positive myelographies using radiopaque substances, and results of surgical operations. Compared with the results of surgical operations, changes in reflex time indicated damage to the reflex arc in ninety percent of the cases.     

An information-processing model of the BOLD response in symbol manipulation tasks

Two imaging experiments were performed—one involving an algebraic transformation task studied by Anderson, Reder, and Lebiere (1996) and the other an abstraction symbol manipulation task studied by Blessing and Anderson (1996). ACT-R models exist that predict the latency patterns in these tasks. These models require activity in an imaginal buffer to represent changes to the problem representation, in a retrieval buffer to hold information from declarative memory, and in a manual buffer to hold information about motor behavior. A general theory is described about how to map activity in these buffers onto the fMRI blood oxygen level dependent (BOLD) response. This theory claims that the BOLD response is integrated over the duration that a buffer is active and can be used to predict the observed BOLD function. Activity in the imaginal buffer is shown to predict the BOLD response in a left posterior parietal region; activity in the retrieval buffer is shown to predict the BOLD response in a left prefrontal region; and activity in the manual buffer is shown to predict activity in a motor region. More generally, this article shows how to map a large class of information-processing theories (not just ACT-R) onto the BOLD response and provides a precise interpretation of the cognitive significance of the BOLD response.     

EEG performance spectral mapping during drug therapy in a patient with schizophrenic psychosis

In a paranoid-hallucinatoric patient with chronic course and acute exacerbation a EEG mapping study during neuroleptic treatment was carried out. The typical changes of the alpha power spectra in schizophrenic psychoses as well the normalization after neuroleptic treatment could be found in the alpha map. The changes were in correlation to the clinical state.     

Learning myopia: an adaptive recency effect in category learning

Recency effects (REs) have been well established in memory and probability learning paradigms but have received little attention in category earning research. Extant categorization models predict REs to be unaffected by learning, whereas a functional interpretation of REs, suggested by results in other domains, predicts that people are able to learn sequential dependencies and incorporate this information into their responses. These contrasting predictions were tested in 2 experiments involving a classification task in which outcome sequences were autocorrelated. Experiment 1 showed that reliance on recent outcomes adapts to the structure of the task, in contrast to models' predictions. Experiment 2 provided constraints on how sequential information is learned and suggested possible extensions to current models to account for this learning.     

Conditional mechanisms of decision making

Decision making is an important link in the central part of a reflex—the “mental element” according to Sechenov. The reflex nature of this mental process is revealed in experiments where a voluntary motor reaction is chosen unconsciously as a response to subliminal conditional visual stimuli. Thus, learning which is reflected by “advance” or prior decision making can be performed unconsciously through a conditional reflex. But, once elaborated, temporary connections are preserved only in shortterm memory. They are not transferred to long-term memory, as in the case of recognition of signals. Decision making, being the central mental part of the reflex, like any activity of the brain, is performed in time by a certain cortical structure. Analysis of P₃₀₀ amplitudes shows that decision making is related to local activation of the frontal parts of the cerebral hemispheres. We suggest that the local activation of these areas is induced by conditional excitation of the neuronal mechanisms of focused attention. It provides a “command” to perform a voluntary motor reaction adequate to the conditions at hand. A large part of latency of voluntary motor response of man is spent on decision making, especially in discrimination of signals and in choice of reactions.     

Neue Felder in der Operationalisierten Psychodynamischen Diagnostik

After the operationalized psychodynamic diagnostics (OPD) system became well established in clinical as well as research contexts, especially in German speaking countries, the OPD task force now focuses on issues, such as modules and new manuals which are related to various clinical contexts. In this article new modules and manuals are presented and discussed in summarized form: the modules for addiction disorders and for forensic patients, the new OPD-2 manual for children and adolescents, an OPD-based manual for formulating initial assessment reports for insurance companies as well as a conceptualization for an operationalized psychodynamic therapy (OPT).     

“MY RESISTING GETTING WELL”: NEURASTHENIA AND SUBCONSCIOUS CONFLICT IN PATIENT‐PSYCHIATRIST INTERACTIONS IN PREWAR AMERICA

This study examines experiences of individual patients and psychiatrists in the Henry Phipps Psychiatric Clinic at Johns Hopkins between 1913 and 1917. The dynamics of these patient‐psychiatrist interactions elucidate the well‐known conceptual shift in explanations of mental illness during the twentieth century, from somatic models rooted in the logic of “neurasthenia” and damaged nerves to psychodynamic models based on the notion of “subconscious conflict.” A qualitative analysis of 336 cases categorized as functional disorders (a catchall term in this period for illnesses that could not be confirmed as organic diseases), shows that patients explained their symptoms and suffering in terms of bodily malfunctions, and, particularly, as a “breakdown” of their nervous apparatus. Psychiatrists at the Phipps Clinic, on the other hand, working under the direction of its prominent director, Adolf Meyer, did not focus their examinations and therapies on the body's nervous system, as patients expected. They theorized that the characteristic symptoms of functional disorders—chronic exhaustion, indigestion, headaches and pain, as well as strange obsessive and compulsive behaviors—resulted from a distinct pathological mechanism: a subconscious conflict between powerful primal and social impulses. Phipps patients were often perplexed when told their physical symptoms were byproducts of an inner psychological struggle; some rejected the notion, while others integrated it with older explanations to reconceptualize their experiences of illness. The new concept also had the potential to alter psychiatrists' perceptions of disorders commonly diagnosed as hysteria, neurasthenia, or psychoneuroses. The Phipps records contain examples of Meyer and his staff transcending the frustration experienced by many doctors who had observed troubling but common behaviors in such cases: morbid introspection, hypochondria, emotionalism, pity‐seeking, or malingering. Subconscious conflict recast these behaviors as products of “self‐deception,” which both absolved the sufferer and established an objective clinical marker by which a trained specialist could recognize functional disorder. Using individual case studies to elucidate the disjunction between patients' and psychiatrists' perspectives on what all agreed were debilitating illnesses, this analysis helps to illuminate the origins of a radical transformation in psychiatric knowledge and popular culture in the twentieth century—from somatic to psychodynamic explanations of mental illness.