Differential diagnosis and different etiologies of monopolar and bipolar phasic psychoses

Monopolar and bipolar phasic psychoses can be differentiated not only on the course but also on the symptom pattern. This applies also to the euphoric forms which usually are still assigned to Manic-depressive illness. The differential diagnosis is presented. Aetiology is completely different in the monopolar and the bipolar phasic psychoses. Manic-depressive illness has a hereditary basic, whereas in the monopolar ("pure") forms loading is very low. Particularly few psychoses among the relatives have been found in the euphoric forms which demonstrates their independency for if they would belong to Manic-depressive illness they necessarily would show the heavy genetic loading of this bipolar illness. In the pure phasic psychoses external causes were detected when we focused on the sibships in which the probands had grown up. The euphoric patients had relatively many older siblings, the depressive ones relatively few older siblings. A similar difference was found in two cycloid psychoses. Transcultural observations as well as shifts in the incidence rate of the psychoses in our times confirmed our results. Prophylactic measures can be derived.     

Transference: current concepts and controversies

In this paper I have presented a brief outline of some of the more important issues regarding transference. To summarize I shall restate ten transference issues heretofore discussed: What should be included in the definition of transference? Should it be defined narrowly or broadly? In what ways can transference be usefully viewed in relation to reality? What merit is there in distinguishing the working alliance from transference? Should self and object transference be differentiated? Should transference neuroses be discriminated from transference reactions on the one hand and from transference psychoses on the other? In addition to sexual and aggressive transferences, should sexualized and aggressivitized transferences, respectively, be distinguished? How may transference be conceived of as a vehicle of cure and yet also as a resistance to cure? What is to be said for the relative merit of the "here and now" versus the "there and then?" What is the role of transference in relation to insight on the one hand and to the therapeutic object on the other? What are some of the basic issues in countertransference?     

The problem of apparent schizophrenic symptoms in juveniles]

In the clinic we frequently come across cases of indistinct accentuated schizophrenic behaviour in youth. We mention here a casuistry which can be considered as a juvenile asthenic denial syndrome with coenaesthetic symptoms. This picture can be differentiated from coenaesthetic schizophrenia, hebephrenia, neurotic symptoms and physical psychoses which can be proven. The problem of differential diagnosis is considered with particular regard to progressive diagnosis.     

Mood theme and bizarreness of delusions in schizophrenia and mood psychosis.

Narratives of the delusions of 83 schizophrenic and 55 nonschizophrenic psychiatric subjects were categorized as of one or more of 12 types. Narratives were also independently assessed along dimensional scales of bizarreness and mood theme. Schneiderian and grandiose types were found to be more common in schizophrenics and mood psychotics, respectively. Dimensional measures showed that the delusions of schizophrenics were more unlikely and that those of mood psychotics had a stronger mood theme. Regression analysis determined that Schneiderian delusions and a dimensional estimate of mood theme best differentiated schizophrenics from mood psychotics. Assessments along dimensions of other parameters, particularly those represented by Schneiderian delusions, may further discriminate the functional psychoses.     

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.     

Provoking endogenous psychoses

For six forms of endogenous psychosis, causal agencies were sought to establish endogenous, physical, and mental provocation. Endocrine causes were found most frequently, 17.5%, in mixed bipolar disorders, followed by cycloid psychoses, 8.5%, which in this respect appear to be closer to the mixed bipolar psychoses, than the unipolar forms at 4.4%. Among the physical causes, the difference in affective psychoses is not particularly great. Cycloid psychoses head the list at 9%. Among the mental causes, pure phase psychoses account for the greatest number, 12.7%, by a wide margin. The three unsystematic forms of schizophrenia revealed a slender link with their causes. Clear distinctions among the causes of the six forms were thus demonstrated.     

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.     

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.     

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.     

Hereditary and psychosocial causes of schizophrenia

On the basis of the examination of patients with endogenic psychosis, indications were obtained that there are forms that mainly develop on a hereditary basis, and forms determined by psychosocial causes. In unsystematic schizophrenia the chief factors are hereditary, above all in periodic catatonia. On the other hand, there are a few indications of a hereditary genesis in systematic schizophrenia although it is just these forms that are distinguished by the severity of their course. By studying twins, cases of schizophrenia in infancy, and the circumstances of brothers and sisters, strong indications of psychosocial causes of systematic schizophrenia were found. Lack of contacts in the course of development appears to the determing factor. In motility psychosis, one of the cycloid psychoses, indications were found that excessive encouragement by other children can be a cause of overstrain and thus may be detrimental. The conclusions drawn are based on concrete findings obtained in a total of 1,114 cases and are for the most part statistically significant.     

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.     

Does symptomatic schizophrenia exist?

The question if there are "symptomatic schizophrenias" has been discussed since the 20s. Schizophrenic psychoses caused be definable and well known brain diseases are presented. All schizophrenic symptoms and syndromes, the first rank symptoms (K. Schneider) too, occur in somatically founded psychoses. The group of paroxysmal transition syndromes in the sense of aura prolongata (continua) and the episodic schizophrenic psychoses in psychomotor epilepsy may be a model for the schizophrenia research. Vital threatening, so-called pernicious catatonic schizophrenias are found on the basis of infectious brain diseases, sometimes only diagnosed in autopsy. Beside acute and reversible symptomatic schizophrenic psychoses there are, even if rarely, recurrent and chronic courses of symptomatic schizophrenias. That certain conditions for the developing of symptomatic schizophrenias are rarely realised, could be an explanation for their rarity. Some findings indicate that the limbic system is significant for symptomatic (and idiopathic) schizophrenic psychoses and the pre- and postpsychotic basic stages determined by dynamic and cognitive basic symptoms, which are phenomenologically very similar to aura symptoms released by stereoelectroencephalographic depth recordings (Wieser). The characteristic features of marked fluctuation, discontinuity and insteadiness of the cognitive thought, perception, psychomotor and cenesthetic phenomena do not speak against an organic brain disorder provided that the traditional process hypothesis is abandoned in favor of a neurobiochemic disorder, fluctuating on its part depending on endogenous as well as psychic-reactive factors.     

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.     

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.     

Clinicogenetic studies within the scope of Leonhard taxonomy

Using conventional genealogical methods and genetic correlation analysis, the author investigates Leonhard's classification of schizophrenias and cycloid psychoses. According to the second of these methods, the systematic schizophrenias and cycloid psychoses definitely diverge on account of the phenotypic correlations, whereas the unsystematic group presumably occupies a median genetic position between the two categories first mentioned.     

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.     

Episodic psychoses in epileptic juveniles with reference to electroencephalographic findings]

The present paper describes three juveniles affected with epilepsy, who suffered from episodic psychoses. Such disorders are a very rare occurrence in young persons. The patients had grand mal epilepsy with "secondary temporalization". Clinical and electroencepholographic aspects are discussed by reference to these particular cases. Also, the authors deal with questions of classification and etiopathogenesis. Finally, possible causes producing such psychoses and giving rise to the psychopathological character thereof are pointed out within the framework of a multiconditional approach.     

Characteristics of true versus false allegations of sexual offences

The goal of the study was to establish whether false allegations of sexual offences with an unknown perpetrator can be distinguished from accurate allegations. Case files of 27 true allegations of sexual offences with an unknown perpetrator were compared to those of 14 false allegations. The comparison was guided by a list of 43 criteria that are hypothesized to differentiate between true and false allegations of sexual assault. Analyses indicated the employed criteria differentiated true from false allegations to a certain extent. However, the discriminative strength of some criteria appeared to be stronger than that of others. Research is required to assess further the discriminative power of these criteria.     

Differentiation: Field dependence,spatial ability,and hemispheric specialization1

Psychological differentiation, as measured by field independence, is studied in relationship to cerebral hemispheric differentiation as assessed through dichotic listening and spatial task performance. Predictions regarding right-hemisphere functions and field independence were confirmed. More differentiated versus less differentiated right-hemisphere superiorities are distinguished and discussed in light of the field-dependence construct. The dimension of integration, characteristic of increasing differentiation, frames the prediction that field independents are better able to utilize the right hemisphere on typically left-hemisphere tasks. The results are discussed in relationship to the potential role of cerebral mechanisms underlying different defensive styles, and in regard to the neurophychological search for covariance between psychological and neurophysiological parameters.