[2 cases of suicidal lithium intoxication].
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Biomedical subjects
Publications and source records attributed to E Gabriel.
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The prognostic and therapeutic aspects of catathymic delusional formations, excluding those associated with organic psychoses, are comprehensively presented from five points of view: (1) the present possibilities of psychiatric prognostication; (2) prognostic implications of nosological classifications; (3) prognostic significance of nosographic characteristics; (4) relationship to general rules of psychiatric prognostics; (5) therapautic points. Under (3) we report our own findings concerning the long-term development of delusional formations and the long-term course of delusional illnesses classified as 'schizophrenia of late onset'; we report their relationships to the formation of defect syndromes and to the psycho-organic deterioration in old age.
Clinical-psychopathological and electroencephalographic investigations are reported, carried out on patients with delusions of the paranoic and of the paraphrenic types. Abnormal EEGs were found more frequently in patients with a paraphrenic syndrome, and there was also a relatively more frequent response to flickering lights than in the paranoic group. There was also a more frequent response to flicker in patients with auditory hallucinations. Psychopathologically more florid delusional syndromes appear to produce abnormalities in the EEG more readily than do psychopathologically less elaborate syndromes.
Two groups of patients with delusional illnesses (previous paranoics and previous 'late schizophrenics' with delusional syndromes) with similar backgrounds, were followed up after many years and were re-examined in the same way. They were compared with each other as regards further developments of delusional formations and their psychopathological determinants. In the group of 'late schizophrenics' the delusions disappeared more frequently than in the groups of paranoics, and the delusional productivity diminished more often. On examination of various psychopathological characteristics and their influence on the further development of delusional formations (core syndromes of the general psychiatric symptomatology, appearance of affective changes, further development of the delusional productivity) only tendencies are shown, never obligatory relationships. The order of the relationships which we found remains uncertain; it is not likely that we are dealing with relationships of the first order.
After pointing to the heterogeneous results of past investigations into the genetics of catathymic delusional illnesses we present our own findings. By grouping the primary probands according to their psychopathology we showed that the relatively few schizophrenic secondary probands are fairly equally distributed over all the subgroups of the case material, whereas the relatively frequent manic depressive secondary probands are related exclusively to those primary probands whose general psychiatric symptomatology, irrespective of the catathymic delusional syndrome, was classified psychopathologically as manic-depressive.
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Empirical findings are reported concerning the relationship between psycho-organic deterioration in old age and the course and clinical symptoms (delusions, presenting symptoms) of the so-called late schizophrenias. The probands were reexamined in their senium decades after the onset of the illness. A significant relationship was found between severe psychoorganic detorioration occurring in old age and a chronic course of the psychoses, generally and particularly in the seniun, and between severe psychoorganic deterioration and the occurence of schizophrenic thought-disorder as the main symptom. Absent or slight psychoorganic deterioration in old age was found significantly co-related to manicdepressive systhymia as the main symptom. Further development of delucions appears to be independent of the degree of psychoorganic deterioration in old age.
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