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.     

Serum creatinphosphokinase (CPK) in endogenic psychoses]

Creatinphosphokinase (CPK) was determined in 141 patients with manic-depressive and schizophrenic psychoses. In general endogenic psychoses of the manic and depressive type as well as chronic schizophrenias show normal CPK values. In acute cases of paranoid-halluzinatory schizophrenias normal values are predominant. In catatonic schizophrenias, as a rule, clearly increased enzyme activities are found. Thise increased values suggest a postulated somatic disease as a cause of the psychosis. Thus, the determination of CPK provides a useful aid in the diagnosis and control of the course of catatonic schizophrenic.     

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.     

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.     

Genetic marker findings in systematic and unsystematic schizophrenias

The systematic schizophrenias are marked genetically by a significant surplus of the Gc serum type 1-1 (p less than 0.0005), what can be demonstrated by the separated analysis of the hebephrenias (p less than 0.0005), paraphrenias (p less than 0.01) and catatonias (p less than 0.05) also. Furtheron there is some evidence that the Gc subtype 1F plays a predominant role within the Gc 1-1 excess (p less than 0.01). The unsystematic schizophrenias (periodic catatonias and affective paraphrenias) do not deviate in their Gc distribution from the corresponding control values, but they exhibit contrary to the systematic forms a surplus of the haptoglobin serum group 2-2 like phasic psychoses. The marker findings are discussed with respect to the relevant data of biological psychiatry and biochemical genetics.     

Neuropsychological Deficits in Childhood Epilepsy Syndromes

Seizure disorders are relatively common in childhood, and the International League Against Epilepsy (ILAE) provides a hierarchical classification system to define seizure types. At the final level of classification, specific epilepsy syndromes are defined that represent a complex of signs and symptoms unique to an epilepsy condition. The present review discusses the issues related to several of these epilepsy syndromes in childhood, including those classified as generalized idiopathic epilepsies (e.g., childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy), focal epilepsies (benign rolandic epilepsy, occipital epilepsy, temporal lobe epilepsy, frontal lobe epilepsy) and the "epileptic encephalopathies," including Dravet's Syndrome, West Syndrome, Lennox-Gastaut Syndrome, Myoclonic Astatic Epilepsy, and Landau-Kleffner Syndrome. For each syndrome, the epidemiology, clinical manifestations, treatments, and neuropsychological findings are discussed.     

Bright light therapy in schizophrenic diseases

20 patients with schizophrenic disorders, displaying a depressive syndrome, were given bright-light therapy, and compared with 11 patients treated by means of partial deprivation of sleep. Against a figure of 27% in the case of sleep-deprivation, syndrome remittance was 55% in the case of bright-light therapy. Psychometric data were obtained by use of three external-assessment schemes (HAMD, BPRS, and NOSIE) and two self-assessment procedures (TSD, POMS). As depressive syndromes improve under bright-light therapy, schizophrenic symptoms also recede, which suggests close syndromatologic links in the sense of a universal genesis of psychoses.     

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.     

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.     

Hemispheric dominance in schizophrenics as determined on extrapyramidal side effects of neuroleptics

Phenomena observed during treatment with neuroleptics were clinically measured in an attempt to determine the difference in vulnerability of the two hemispheres and the relation between this difference and schizophrenic diseases. In the group of systematic schizophrenias the increase in tonus was significantly higher in the dominant hemisphere. This finding is considered a verification of the nosological hypothesis of schizophrenias.     

The epidemiology of the epilepsies in children

The epilepsies are a heterogeneous collection of neurological conditions and syndromes characterized by recurrent, unprovoked, paroxysmal seizure activity. There are several types of epileptic seizures and syndromes that are unique to children, including infantile spasms, Lennox-Gastaut syndrome and absence seizures. Febrile seizures and neonatal seizures, while not epilepsy, are relatively common types of seizures in infants and children and are likely markers of risk of later epilepsy. Thus, it is important to consider the epidemiological features of the epilepsies as they occur specifically in infants and children. The purpose of this review is to summarize what is currently known about the epidemiology of the childhood epilepsies and to identify promising areas for further population-based studies. The epilepsies are an important cause of neurological morbidity in children. The average annual rate of new cases (incidence) of epilepsy is approximately 5-7 cases per 10,000 children from birth to age 15 years, and in any given year, about 5 of every 1,000 children will have epilepsy. There is evidence that the incidence of the epilepsies in some populations of children may be decreasing over time, and this possibility merits further investigation. Factors that are known to increase risk of the epilepsies in children include congenital malformations of the central nervous system (CNS), moderate or severe head trauma, CNS infections, certain inherited metabolic conditions, and genetic factors. However, these account for only 25% to 45% of cases, and thus, the etiology of most cases of the epilepsies remains obscure. The paucity of well-controlled etiological studies is due largely to formidable methodological problems in conducting epidemiological studies of the epilepsies. The prognosis for seizure control is generally good, although children with remote symptomatic seizures and those with additional neurological disabilities do less well.     

Schizophrenic puerperal psychoses. A psychodynamic approach

The author describes the psychodynamics of schizophrenic childbirth psychoses and criticizes attempts to explain these on a one-sided somatogenic basis. Referring to ethnographic material on childbirth customs, he develops therapeutic approaches are intended to bring about a better social integration of the woman as well as a deflection from her uncontrollable aggression against the child.     

A Systematic Review of Psychiatric and Psychosocial Comorbidities of Genetic Generalised Epilepsies (GGE)

Psychiatric disorders and associated poor psychosocial outcomes are recognised to be a common sequelae of epilepsy. The extent to which this is true of genetic generalised epilepsies (GGE), particularly syndromes other than juvenile myoclonic epilepsy (JME) is unclear. This systematic review synthesises findings regarding psychiatric and associated comorbidities in adults and children with GGE. Systematic review yielded 34 peer-reviewed studies of psychiatric and psychosocial outcomes in adults and children with GGE. Clinically significant psychiatric comorbidity was reported in over half of all children and up to a third of all adults with GGE. There was no evidence to support the presence of personality traits specific to JME or other syndromes; rather rates mirrored community samples. A small number of studies report poor psychosocial outcomes in GGE, however the interpretation of these findings is limited by paucity of healthy comparison groups. Some evidence suggests that anti-epileptic drug polytherapy in children and seizure burden at all ages may constitute risk factors for psychopathology. Findings highlight the importance of early screening so as not to overlook early or developing symptoms of psychopathology.     

Value of neuroleptic therapy in the self assessment of schizophrenic patients

On the basis of clinical self-assessment scales (von Zerssen) and the Frankfurt questionnaire of complaints, it is demonstrated by the comparison of three groups of schizophrenic patients with one control group which is not undergoing therapy with neuroplegics that within the "genuine" groups the psychopathological factors investigated recede, sometimes quite significantly. Cross-over design treatment involving the control group has not revealed any significance. We conclude that when treating schizophrenic psychoses, psychosocial measures must accompany biological measures.     

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.     

Autogenic training within the therapeutic scope of schizophrenic patients]

The author calls the reader's attention to the rather strange fact that autogenic training, in spite of worldwide recognition and extensive uses of the method in various disciplines of medicine and spheres of live, has not so far been finding wide application in the medical specialty dealing with mental disorders. After discussing some possible causes of this situation and commenting on first signs of a necessary change in attitude toward autogenic training, he reports his own experience in the treatment of schizophrenic patients with this psychotherapeutic method, emphasizing the need for including psychotherapy in a complex concept of the treatment of psychoses.     

Seizure types, epilepsy syndromes, etiology, and diagnosis

The clinical manifestation of epileptic seizures may vary widely from patient to patient, depending on the region of the brain involved. Over the centuries, many seizure classification systems have been used, and the current most widely used classification system is that of the International League Against Epilepsy (ILAE). The ILAE system divides seizures into those of partial onset and those of generalized onset, depending on whether the initial clinical manifestations indicate that one cortical region or both hemispheres are involved at the onset of the seizure. Partial seizures are then divided into simple partial seizures, in which a fully conscious state is retained, or complex partial seizures, in which consciousness is impaired. A more recent classification system based purely on symptom features and signs has been proposed, and this system may provide advantages for localization, and especially for surgical evaluation. Epilepsy is a condition characterized by recurrent unprovoked seizures. Epilepsy may be idiopathic, cryptogenic, or symptomatic. Idiopathic epilepsies are generally genetic, and while many such syndromes have been described, advances in molecular genetics will undoubtedly reveal many more syndromes in the near future. Cryptogenic epilepsies are those in which an underlying cause is suspected, but the etiology remains undetected. Epilepsies for which there is an underlying structural cause or major metabolic derangement are considered symptomatic. Common causes and diagnostic evaluation are described in this article.     

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.     

Psychic skin: psychotic defences, borderline process and delusions

In this paper, I apply the concept of psychic skin to analytic work with people suffering from personality disorders and psychoses. When psychoses emerge, the defensive skin which protects the ego is breached and violent unconscious forces rip through the personality. Some of the patients diagnosed as schizophrenic with whom I work have identified with archetypal characters such as Christ, Satan, John Lennon and the Queen. I attempt to show how the adoption of these inflated personas can serve as secondary psychic skins. Such delusional identifications can provide a protective shield to hide the denuded self and prevent intrusion from the external world. Through clinical example, I try to demonstrate how these archetypal 'second skins' can preserve life until internal and external conditions make it possible for the self to emerge. I contrast such psychotic identifications with 'thin-skinned' and 'thick-skinned' narcissism as well as 'defences of the self' in borderline states where the psychic skin may be damaged but does not disintegrate. I also look at the ways in which Jung's own personal experience was different from this and how he managed to avert psychotic breakdown.     

Rorschach indices for discriminating between two schizophrenic syndromes

Thinking disturbance and disorder of affects may be different in two subtypes of schizophrenia, the "florid" and the "withdrawal" syndromes. In Exner's approach to the Rorschach system, the diagnostic indicators of disordered thinking may point out large differences not only between schizophrenic and control subjects but also between different types of schizophrenics. The Rorschach protocols of 45 subjects (15 "florid" schizophrenics, 15 "withdrawn" schizophrenics, and 15 controls of the same age and education, matched by sex) were examined on several Exner indices. Compared with the control group, both schizophrenic types confirmed an impairment of perceptual accuracy and of reality testing as well as a reduced emotional control. Compared with the "withdrawn" group, the "florid" schizophrenic subjects showed significantly higher indices of poor perceptual functioning, of an inadequate organizational activity (more Whole and Z responses characterized by negative Form Quality) and greater disordered ideational production.