Biomedical subjects
Publications and source records attributed to S von Trostorff.
The validity of the current systems of classification of endogenous psychoses has not yet been unambiguously demonstrated using the criterion of prognosis. An alternative to these systems may be seen in the Leonhard classification of endogenous psychoses. In a catamnestic study, 93% of the initial diagnoses and prognoses made between 1969 and 1973 could be confirmed in 1986.
Drawings done by a patient before examination led to the suspicion of cataphasia, in view of previous experience of similar pictures drawn by verbigerate patients, and this proved to be so. We assume that the verbigerate affection of the thinking process is pictorially reflected in spontaneous casual drawing. In a less spontaneous situation, on other hand, the patient will not be so completely disorganised, and thus the author of an utterly confused drawing can still retain some measure of mental control in the course of tests.
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According to our investigations the incidence of cataphasia, which is a subtype of schizophrenia, has become more common in the last years and on average, has started earlier in life. As the central disorder of this illness concerns thinking perhaps there exists a relation of our finding to the rapid modern development of techniques, insofar as the cognitive function is overstrained in childhood and adolescence, when the nervous system has not matured yet. Introverted individuals seem to be at a particular risk. However, it must not be disregarded that cataphasia is an inherited illness which cannot be caused by external influences, but can only be promoted in its manifestation.
Catamnestic studies ware performed on 15 subjects (13 female und 2 male) who were treated individually with Leonhard's method for puberal emaciation between 1960 and 1970. 14 of the patients, then children, now have a good physical status with normal weight, are coping well with life and are most cases married. One female patient died at age 31 years; when accepted for treatment 15 years ago there was some doubt regarding the diagnosis of a genuine puberal emaciation, and this doubt grew in the subsequent course of events. No connection could be found between her death and emaciation. We can thus consider that the success of individual treatment with Leonhard's method has been confirmed.
In 143 patients suffering from periodic catatonia we found the disease in a direct succession five times in four generations and 17 times in three generations. With direct succession in four generations we found in two cases manifest psychosis in all generations, in three generations one member was formed by a most severely abnormal personality. In the sequence of three generations, the psychosis occurred continuously in ten families, in seven cases an abnormal personality pointed to the disease by his peculiarities. Since the occurrence of psychic diseases and abnormalities in the family is frequently concealed, the cases found are of great importance and indicate a dominant hereditary course. This assumption is substantiated by number of diseased half-brothers and sisters. Cataphasia in several generations in a direct sequence is a rarer phenomenon. Besides periodic catatonia, it showed the greatest affliction among the various forms of schizophrenia.
Since I have dealt with hospitalised patients I could on principle hardly make any contribution to the question whether there is a connection between reduced endowments and endogenic psychosis. It is, however, very remarkable that half of the patients showed bad school performances, that 3.3 per cent had difficulties in learning, 40.4 per cent stayed down at school and 6.1 per cent attended a special school. In view of the fact that the patients with cyloid and unipolar phasic psychoses also showed bad performances at school, one cannot derive a connection between endowments and schizophrenia. Probably the peculiar findings are due to the fact that psychic patients who at the same time show reduced endowments are much more frequently hospitalised than others. Also with regard to the vocational development, the patients with cycloid psychoses do not show any better results than those with schizophrenia. Because of the large number of patients, it was not possible to ascertain afterwards with sufficient accuracy to what extent vocational failures are due to reduced endowments and to what extent they are due to a beginning psychosis.
If it is desired to evaluate the products of artistic activity of subjects of endogenous psychosis, then new aspects arise from an attempt to find special forms of drawing and painting for special forms of endogenous psychosis instead of generally speaking of schizophrenia and manic-depressive disease. Some information has been obtained in this connection. Catatonic iterations can be seen to be reflected in pictures. Thought disorders in subjects of paraphrenia are often seen to be mirrored in products of artistic activity. The "disorder of speech" of subjects of cataphasia is sometimes reflected in a "disorder of the drawing or painting" produced. Expansive paraphrenia patients are fond of painting in order to give themselves airs. Happiness psychosis, because of the ecstatic emotions associated therewith, often involves a direct drive to do artistic work.
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