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P Berner

Publications and source records attributed to P Berner.

At least 37 records · Page 2Linked to original sources
PubMed1987

Psychopathological concepts of dysphoria.

Dysphoric conditions are increasingly postulated as representing independent mood disorders. However, despite much effort at clarification, their psychopathological definitions remain unclear and variable. This paper reviews some examples of these divergent definitions, most of which are based on quality of mood, as well as responsiveness to external stimuli. The paper then introduces a strategy in possible solution of the above-mentioned definition problems. Setting out from restriction of the term dysphoria to conditions of a morose, tense and irritated mood, as suggested by Snaith and Taylor, we support the opinion that dysphoria should be accepted as a third possibility of mood swing, as a psychopathological disturbance which can be well distinguished from stable and unstable mixed states.

Depressive Disorder↗
PubMed1986

Approaches to the assessment of schizophrenia in Europe.

All definitions of schizophrenia rely more or less on Kraepelin's hypothesis, Bleuler's theory or Schneider's pragmatic criteria. After a discussion on how these assumptions are referred to in classical and operational diagnostic systems in Europe, the results of a survey of 1983 literature are presented to show what kinds of assessments European workers currently employ. Lastly, guidelines are presented to enable psychopharmacological research to make the best use of the diagnostic systems to suit its purposes: essentially, which system or systems (the polydiagnostic approach for example) one should choose depends upon the symptoms the medication to be tested is supposed to treat, keeping in mind that patient sampling varies according to the system in question.

Europe↗
PubMed1986

'Paranoid psychoses'. New aspects of classification and prognosis coming from the Vienna Research Group.

After a presentation of the traditional principles of diagnosis and a precise definition of terms, the Vienna approach to the classification of delusional conditions is introduced. This approach is multiaxial: the first axis consists of a classification of delusional syndromes based on a cross-sectional description of their structural and constituting elements; on the second axis, the relationship between the delusional world and the real one is described; the third axis is for the recording of delusional contents; the fourth axis serves for an attempt at etiological attribution. The Vienna approach differs principally from the usual systems of classification in that it is purely syndromatological and thus it avoids giving an a priori nosological meaning to the various symptoms making up the delusion (for example, certain delusional themes, certain forms of hallucinations). A definitive nosological diagnosis is only possible when an organic cause is clearly evident, otherwise the suffix '-morphic' (endogenomorphic-schizophrenic, endogenomorphic-cyclothymic, and organomorphic axial syndromes) is added to denote the close resemblance of clinical states to certain disorders whose nosological homogeneity should not be taken for granted. Next, the results of our own catamnestic study on a patient population selected solely on syndromatological grounds are presented. It is shown that no prognostic significance can be attributed to the delusional pictures classified according to their description (paranoic syndromes, systematic and unsystematized paraphrenia); on the other hand, such significance certainly falls to one of the axial syndromes formulated on axis 4 (the endogenomorphic-cyclothymic axial syndrome). Nevertheless, a relatively large portion of the patients eluded attribution to one of the axial syndromes, even after a course of several years. Aside from the possibility that a number of them could be so classified after further cross-sectional evaluation, one may suspect that this group contains patients whose delusional formation stems from a psychogenic etiology; or it may be that these patients represent a third illness entity, distinct from the other two groups of endogenous psychoses.

Austria↗
PubMed1986

First-rank symptoms and Bleuler's basic symptoms. New results in applying the polydiagnostic approach.

By comparing six different operational diagnostic systems (International Classification of Diseases, Diagnostic and Statistical Manual; 3rd ed., Research Diagnostic Criteria, St. Louis criteria, Taylor criteria and Vienna Research Criteria), the data presented in this paper illustrate how attribution to various categories of functional psychoses varies according to the applied algorithms. Bleuler's basic symptoms are obviously considered by all of the compared systems to be more significant for attribution to schizophrenia than first-rank symptoms.

Diagnosis, Differential↗
PubMed1986

Delusional psychoses: genetic findings as a critical variable for the validation of diagnostic criteria.

77 patients with delusional psychoses, regardless of their nosological attribution (except severe organicity), and their first-degree relatives were diagnosed with the Research Diagnostic Criteria (RDC) and the Vienna Research Criteria (VRC). The diagnostic procedure was performed blindly in the relatives. Both criteria were sufficiently capable of identifying a schizophrenic and affective subgroup of patients characterized by the appearance of homotypical secondary cases. Apart from a small RDC schizoaffective group differing in genetic pattern, there exists another large group of nonschizophrenic, nonaffective delusional disorders lacking a genetic link to the above-mentioned diagnoses. In respect to the development of the diagnostic criteria, the results of this study call for the formulation of a narrow definition of schizophrenia (as in the VRC) which is based on thought disorder and affective blunting with the exception of so-called productive symptomatology (delusions, hallucinations); separate criteria for schizoaffective disorders (as in RDC), and a broad and nonrestrictive definition for nonschizophrenic delusional disorders.

Affective Disorders, Psychotic↗
PubMed1986

Alcohol and depression.

The relationship of alcohol and depression has always been a subject of clinical and scientific interest. Though many studies have been carried out to clarify the mode of this relationship it still remains in its complexity an area for further research. The two basic ideas of a possible connection are on one hand symptomatic alcoholism with a preexisting depression and on the other hand alcoholism leading to a symptomatic depression. There is in literature a great variability of results with regard to this problem which will be discussed in view of the results of an own study on 444 chronic alcoholic patients.

Alcoholism↗
PubMed1986

[Psychiatric systemization and diagnosis].

The forms of the orders of psychiatric systemization according to the etiological, the pathogenetical, and the symptomatological principle are presented. The necessity of multiaxial diagnostics is presented while special reference is made to the diagnostic systems "ICD" and "DSM". "DSM 3" is critically examined and the necessity of separation of clinical-pragmatical diagnostics from research diagnostics is discussed.

Humans↗
PubMed1984

Course and outcome of delusional psychoses.

The authors reinvestigated 84 out of a sample of 90 patients with delusional psychoses after an interval of 6-9 years. The results of the follow-up showed a pattern of episodic versus chronic course which compares to follow-up studies on classically diagnosed schizophrenias. The authors found evidence for their hypothesis concerning the nosological heterogeneity of this group of psychoses and propose a syndromatological classification apart from the delusional symptomatology itself. What they call background symptomatology was divided into axial syndromes. The authors feel that this results in subgroups that are more homogeneous for course and outcome than the usual classification systems.

Adolescent↗
PubMed1984

Heterogeneity of delusional syndromes: diagnostic criteria and course prognosis.

In addition to genetic findings and treatment response, the course prognosis is also meant to be a possible validating criterion for diagnosis and diagnostic systems. In our study we used the polydiagnostic approach (i.e. the simultaneous application of various criteria for diagnosing a given disorder to one and the same population) to test the ability of several diagnostic systems to create homogeneous groups regarding the course (episodic/chronic). We applied Schneider's FRS, ICD-9, DSM-III, Spitzer's RDC and the Vienna Research Criteria to 90 patients with the diagnosis of delusional syndrome (aside from any nosological classification), who underwent 6-9 years of follow-up. At the index examination, schizophrenia was most frequently diagnosed with Schneider's FRS, which apparently encompasses a very heterogeneous group of patients regarding psychopathology and course. Diagnostic systems which allowed the diagnosis of affective disorders despite the presence of mood-incongruent delusional symptomatology (DSM-III, RDC, Vienna Criteria) or offered the diagnosis of schizoaffective disorder (DSM-III, RDC) succeeded in separating subgroups with an episodic course on a statistically significant level. In ICD-9 this significance appeared only after exclusion of the schizoaffective cases from the group of schizophrenias. Our data thus uphold the old rule of thumb that affective symptomatology apparently has a very high prognostic value regarding the course of the illness and is in this respect superior to productive symptomatology (such as delusions and hallucinations), still taken to be pathognomonic for schizophrenia by some of the diagnostic criteria under study. This aspect warrants further investigation and should be taken into account in the development and improvement of diagnostic manuals (e.g. ICD-10, DSM-IV).

Adolescent↗
PubMed1983

The genetics of delusional psychoses.

In a genetic study of the first-degree relatives of 77 patients with delusional (paranoid) psychoses, the morbidity risks for schizophrenia, affective disorders, and atypical psychoses were evaluated using ICD-9 criteria. The prevalence of schizophrenia was 3.10 percent (4.12 percent with age correction to 40 years and 4.94 percent with age correction to age 60), which is higher than in investigations of paranoid psychoses, but lower than in studies of paranoid schizophrenia. The prevalence figure for affective disorders (age-corrected 3.04 percent for unipolar plus bipolar patients) is also intermediate to those for relatives of paranoid schizophrenics and paranoid psychotics. When the 77 index delusional patients were subdivided into axial syndromes (endogenomorphic-schizophrenic, endogenomorphic-cyclothymic, and organomorphic axial syndromes), two very homogeneous subgroups emerged. The endogenomorphic-schizophrenic subgroup showed high rates of schizophrenic secondary cases, whereas the endogenomorphic-cyclothymic subgroup showed high rates of affectively disordered secondary cases. The third organomorphic subgroup showed a high prevalence of atypical psychoses among first-degree relatives. Thirty-seven of the 77 index patients could not be assigned to any axial syndrome; their first-degree relatives had an increased prevalence of schizophrenia, but affective disorders were no more frequent than in the normal population. These data suggest that the heterogeneous group of paranoid psychoses can be meaningfully subdivided by use of axial syndromes which are viewed as representing "basic" disturbances underlying delusional symptomatology.

Adolescent↗
PubMed1983

Approaches to an exact definition of schizo-affective psychoses for research purposes.

The perplexity psychiatry is faced with when approaching the problem of 'schizo-affective disorders' is the result of two characteristic features of human psychology: The first consists in the tendency to pick up quickly attractively formulated terms and to prefer them to others designating the same facts. The second psychological trend referred to concerns the use of a well-sounding term in a definition which deviates from the original one. The nosological implications of the existence of the 'cases in between' (K. Schneider), attributable neither to schizophrenia nor to cyclothymia, are briefly reviewed. It is suggested to speak of schizo-affective disorders only if the criteria for both disorders manifest simultaneously. Applying the Vienna Research Criteria we found that 'schizo-affective' disorders occur rarely as compared to other frequently used less restrictive diagnostic instruments.

Diagnosis, Differential↗
PubMed1983

[Family picture studies in patients with paranoid psychoses].

Among the first-degree relatives of 77 patients with delusional functional psychoses the authors found 13 schizophrenics (3.10%), 8 manic-depressives (1.91%) and 14 cases with atypical psychoses (3.34%), following ICD-9 criteria. These figures were compared with the figures in the literature on the genetics of paranoid schizophrenics and nonschizophrenic paranoids, regarding the different composition of the samples. Subdivision of the original 77 patients, using the concept of the axial syndromes, was able to form two homogeneous subgroups of first-degree relatives: one with a schizophrenia prevalence of 6.52% (uncorrected) and without any manic-depressive secondary cases (endogenomorphic-schizophrenic axial syndrome) and another with a manic-depressive illness (MDI) prevalence of 6.58% (uncorrected) without any secondary cases with schizophrenia or atypical psychosis. The first-degree relatives of the patients with an 'organomorphic' axial syndrome (usually excluded in other studies) had an increased rate of manic-depressive secondary cases (3.57%, uncorrected) and the highest rate of atypical psychosis (7.14%) without any schizophrenics, according to the etiopathogenetic heterogeneity of this group. 37 of the 77 patients were not assignable to any of the axial syndromes. In the first-degree relatives of these patients--best comparable to Kendler's criteria for 'delusional disorder'--an increased rate of schizophrenics and atypical psychoses was found (3.59 and 3.08%, uncorrected); the figures for MDI were within normal limits. Our results suggest that the axial syndromes are a useful diagnostic instrument in identifying--from the genetic standpoint--in part very homogeneous subgroups. This allows the conclusion that they are indicators for hypothetical basic disturbances.

Adolescent↗
PubMed1982

[Under what conditions can further course research still be expected to produce new knowledge on endogenous psychoses?].

Exhaustive follow-up studies of schizophrenia from Zürich, Bonn and Lausanne have produced strikingly similar results, despite considerable methodological differences. These 'classical' modes of differentiating the endogenous psychoses are critically analyzed. In contrast, the application of the operational research criteria recently developed by American authors results in a narrowing of the concept of schizophrenia and a proportional broadening of the cyclothymic disorders. Use of the Viennese research criteria, the definition of an 'axial syndrome' of schizophrenia, has the identical nosological effect. While the American diagnosis is phenomenological and essentially 'atheoretical', the Viennese view is based on the hypothesis of a core disorder. Further comparative polydiagnostic studies are called for in order to determine the relative value of these various research instruments.

Diagnosis, Differential↗
PubMed1980

Nonschizophrenic paranoid syndromes.

After presenting their model for the description of delusions, the authors report some results of two catamnestic studies in patients with delusional syndromes. There is evidence for the hypothesis that the usual classification of such patients as paranoid schizophrenics is frequently not justified. A reasonable number of the cases might belong to cyclothymia or at least approach it. Disappearance of delusions and complete restitution frequently occur in this group, while chronicity seems connected with persistent psychopathological signs in the accompanying symptomatology supposed to represent--in part--organic brain syndromes or congenital or acquired psychopathic personalities.

Adolescent↗