[Schizophrenia: pathology and therapy of schizophrenic persons].
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Biomedical subjects
Publications and source records attributed to C Scharfetter.
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UNLABELLED: The therapeutic attitude of psychiatric nurses towards inpatients of a mental hospital was studied. Is there a correlation of nurses' attitude and their view of the patients' behaviour, social attractiveness, and prognosis? Are there differences in the therapeutic attitude in regard to different diagnostic groups? A questionnaire was constructed. Probands were 70 female, 40 male nurses. For every proband there was taken a patient: 70 female, 40 male patients (34 schizophrenics, 15 depressive patients, 15 psychogeriatric patients). The data were evaluated by path analysis and analysis of variance. THE RESULTS: Patients with more social interest and more psychotic symptomatology were rated as more socially attractive. The more pathologic patient's behaviour in the wards was judged the worse was the supposed prognosis. Dysphoric-morose patients and patients with low social attractiveness provoke an authoritarian and controlling attitude. Patients held as social competent stimulate nurses' attitude towards promotion of dependence and autonomy. The lower social competence and the worse prognosis is taken the more the attitude is inclined to protective control and isolation. The therapeutic value of personal humane communication and direct social contacts is taken for less important when patients seem to be socially inattractive and incompetent. We did not find any difference in the nurses' attitude in regard to schizophrenic or depressive patients. Schizophrenic patients did stimulate more intentions towards propagation of independence and autonomic activity than psychogeriatric patients do. Between male and female nurses we did not find any difference in their attitudes to the (same sex) patients.
The concept of schizophrenic reaction was introduced in 1920 by Popper for single schizophrenic manifestations of short duration and full recovery, occurring after a traumatic experience. Of the 29 probands with a primary diagnosis of schizophrenic reaction when recruited for study by Rohr (report published 1961), 28 were reevaluated 20 years later. Nineteen subjects now had a clear-cut schizophrenic symptomatology (ICD 295); 16 with, and three without, remaining symptoms and/or relapse. The other nine were now diagnosed under nosologic categories other than ICD 295. Of these subjects, four were symptom free and had suffered no relapse. The study did not reveal criteria suggesting a distinguishable nosologic category 'schizophrenic reaction' with reference to a schizophrenic syndrome of acute or subacute onset after a brief traumatic event (without remaining symptoms and/or relapse). Such probands did not differ from the schizophrenic group in any of the following criteria: psychopathology, heredity data (diagnosis of relatives was undertaken without reference to the respective index cases), time of onset, duration of psychopathologic manifestation, length of hospitalization, period without remaining symptoms or relapse, and frequency and type of traumatic experiences. The two groups with schizophrenic symptomatology (ICD 295) are genetically characterized by the fact that their first-degree relatives had an incidence of schizophrenia of 8.3 +/- 2.6%. On the other hand, no certain cases of schizophrenia were found among such relatives of subjects in other diagnostic groups. The results do not support the concept of schizophrenic reaction.
The frequency of suicide among a population of 675 patients with functional psychoses, within a period of observation between 9 and 24 years, was 5.5%. Suicide was the cause of death in 25.6% of all lethal outcomes. The suicide frequency of schizophrenics was 1.4%, of the bipolar cases 2.4% of the monopolar depressives 10.4%. The frequency of suicide of the parents and sibs of schizophrenics was 1.3%, of schizoaffectives 3.8%, monopolar depressives 4.2%, bipolar affective psychotics 4.3%. There was no sex difference in regard to suicide frequency but in regard to the choice of suicide means (strangulation in male, poisoning and submersion in female relatives).
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The family-heredity findings serving as criteria for the classification of functional psychoses are discussed, presenting recent data. The global morbidity risk of the resp. psychosis showing secondary cases similar (homotypical) to the index case and no increased incidence of cases of the other type may be interpreted by the theory of two separated genetically transmitted diseases (schizophrenias and affective disorders). The classical schizophrenic subtypes differ in their global schizophrenia morbidity risk and show a tendency toward homotypical secondary cases. Monopolar and bipolar affective disorders were found to be very close together concerning family-genetic data-Schizo-affective psychotics were found to have among their relatives the highest incidence of all types of functional psychoses at all, a high rate of schizophrenics (esp. catatonic type) and affective psychotics and no homotypical secondary cases.
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The correlation of social class and diagnosis, therapy, mode of admission, frequency of hospitalization was tested in a population of 2103 inpatients of the two governmental and of two private mental hospitals of the Canton Zurich. The results fit to the correlations expected from the literature. The therapeutic procedures as far as reported in the case histories are mainly determined by the hospital type, not so clearly by the subject's social class. High educational status and psychotherapy are correlated. The correlation between social class and therapy is resulting of the class specific admission to one of the two hospital types. There was no sign that within one hospital patients of lower social class were placed at a disadvantage in regard to therapeutic procedures.
The instrumental construction of 5 basic dimensions of ego-consciousness (ego-vitality, -activity, -consistency, -demarcation, -identity) is presented as a means of synopsis the clinical polymorphism of schizophrenic experience and behaviour. Such consideration leads to the insight how deep in their basic feelings of vitality the schizophrenic person may be endangered. From that a body-oriented therapy is conceived, which is presented in datail. The commentary of G. Benedetti points out, how in different therapeutic approaches a common basic attitude of the therapist and a unifying synthetic relationship between therapist and patient can be seen: in duality, empathic sharing of psychotic experience, symbolic realization the narcissistic deficit is overcome. The resynthesis of the ego starts from the present experience rather than from analytical interpretative historical reconstruction.
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Correlations of (christian) religiosity and religious thematization in functional psychoses with paranoid syndromes (60 pat.) were studied by an extensive questionnaire. In regard of the frequency of religious themes in the paranoid syndromes there was no difference between catholic and protestant confession. Probands with religious experiences in their psychoses had other religious socialization (a home with special interest in religious subjects). They are themselves more active in regard to religious practices, more interested in religious problems, refer more often to fear of devil and hell, feel themselves more frequently close bound to the church. The premorbid religious activity increased in the period of 6 months before hospitalisation. They judge their fathers retrospectively more often as permissive. Concerning psychopathology probands with religious thematization in their psychosis had higher values of "grandiosity" in the IMPS (LORR), had more often experiences of immediate inspiration, evidence and clearness. They were hospitalized for a longer period than probands without religious thematization.
A historical transcultural comparison of paranoid psychoses (ICD 295.3, 297. 0-9) was done by evaluating the data of 200 case histories (I: 100 from 1911, II: 100 from 1973). An interrater reliability test was performed. 1. Stable delusions were: delusions of reference, religious delusions, delusions of persecution. 2. There was a significant increase in hypochondriacal delusions. 3. Megalomania and erotomania decreased. 4. There is in the "old" and "new" group a significant correlation between megalomania and the male sex. 5. The significant correlation between erotomania and the female sex found in the "old" group could not be found in the "new" group. 6. Constancy and change of delusion is due to both sexes, differing in degree, in part contrarotating. 7. The decrease of "sex-specific" delusions (megalomania and erotomania) is due to the sex concerned. 8. With increasing age there is a reduction of delusion themes in group II: delusions of special descent, paranoid identity change, erotomania were not found after age 30. Querulant paranoia did not occur. In group I querulant paranoia did not appear before age 30. 9. There was a significant correlation between megalomania and the item "development in rural country". 10. In our material there was no correlation between delusion and intelligence and religious confession. 11. Paranoid ideas of hypochondriasis and persecution show changes in the thematics (organs, disease, means of persecution) subject to time. 12. A tendency to change of content of the main delusion is discussed.
The results of a comparison between the clinical diagnoses of 115 probands with functional psychoses, made on the basis of careful clinical history-taking, interviewing and examinations, and those made by computerized evaluation (CATEGO) on the basis of the present state examination (PSE) were presented. The clinical diagnoses of the project psychiatrist and the provisional classification resulting from the application of the CATEGO program to the PSE symptom profiles were in an overall concordance of 82%. In a second step the 20 cases with differences in diagnoses were reevaluated on the basis of the full history and psychopathology and a syndrome checklist was completed. This reevaluation led to a practically full diagnostic agreement.