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PubMed1998

Morphological brain imaging studies on major psychoses.

The first application of computed tomographic scan to the schizophrenic brain by Johnstone et al. initiated a new neuroscience research era with new perspectives on the neurobiological aspects of major psychoses. The most common paradigm in the flurry of brain imaging studies following the first report was the case-control study comparing controls and patients with major psychoses. However, some application was also made of sophisticated case-control paradigms, such as comparisons between affected and non-affected identical twins discordant for schizophrenia. Very few prospective cohort studies have been applied in this field. During the past two decades of studies, several brain morphological features have converged. Both schizophrenics and patients with affective disorders showed subtle but significant quantitative differences in brain structures compared with controls. For schizophrenia, the differences were in the lateral and third ventricles, medial temporal lobe, supratemporal gyrus, frontal lobe and such subcortical nuclei as striatum and thalamus. For affective disorders, they were in the cortical sulci, lateral ventricle, striatum, pituitary and adrenal glands. Generally, the differences were greater in schizophrenics, in males and on the left side than in patients with affective disorders, in females and on the right side. Qualitative morphological abnormalities such as T2-weighted hyperintensity were also demonstrated in elderly patients with affective disorders. For both schizophrenia and affective disorders, abnormal anatomical neurocircuit models of the respective pathophysiologies have been proposed to explain the brain multi-lesions. Some recommendations for future research in the structural brain imaging of major psychoses have also been proposed.

Bipolar Disorder↗

PubMed1984

Infantile autism and other childhood psychoses in a Swedish urban region. Epidemiological aspects.

A total population screening of children born during 1962-1976 and living in the Gothenburg region at the end of 1980 was carried out in order to obtain prevalence figures for infantile autism and other childhood psychoses. It was found that the prevalence figure for infantile autism was 2.0 per 10,000 and for other childhood psychoses 1.9 per 10,000. Boys were much more often affected by infantile autism than girls. In the case of other psychoses, no such over-representation was seen. A majority of the children were mentally retarded, and only 4% had tested IQs exceeding 100. The results are in good agreement with the three earlier epidemiological studies concerned with childhood psychosis.

Adolescent↗

PubMed1983

Offspring of women with nonorganic psychoses. Development of a longitudinal study of children at high risk.

This article describes the development of a prospective, longitudinal study of 88 "high-risk" offspring of pregnant index women with a history of nonorganic psychoses and 104 offspring of demographically-similar pregnant control women. The maternal psychoses represented the diagnostic categories, Schizophrenia, Cycloid Psychosis, Affective Illness, Psychogenic Psychosis, Postpartum Psychosis and Other (remaining) Psychoses. The first phase of the study began during pregnancy and continued until the offspring reached 2 years of age. Selected characteristics of the mothers, the offspring and their environments were investigated during this project phase.

Adult↗

PubMed1984

Effectiveness of lithium prophylaxis in schizoaffective psychoses: application of a polydiagnostic approach.

The effectiveness of lithium prophylaxis has been tested in a group of patients fulfilling the relatively broad ICD-9 definition of schizophrenic psychosis, schizoaffective type, and in each of the subgroups resulting from the application to the same patients of four different sets of diagnostic criteria for schizoaffective or cycloid psychoses. Moreover, a comparison has been made, within the whole patient population, between responders and non-responders to treatment, with respect to some clinical and biological variables. The mean number of morbid episodes and the mean total morbidity have been found significantly reduced during the treatment period, as compared with a control period of the same length, in the whole patient population as well as in subjects meeting RDC and Kendell's criteria for schizoaffective disorder (with special regard to schizomanics) and Perris's criteria for cycloid psychoses. No significant difference between the two periods has been observed in patients diagnosed as schizoaffectives according to Welner et al. Clinical/historical variables (with special regard to those concerning the course of the illness and the family history of major psychoses) have been found the most reliable predictors of response, whereas biological variables did not discriminate between responders and nonresponders to prophylaxis.

Adult↗

PubMed1986

The DSM-III classification of the functional psychoses and the Norwegian tradition.

The relationship of the DSM-III categories to the national diagnostic usage of ICD is of importance for communication between psychiatrists. Here the theoretical relationship between the DSM-III categories and the Norwegian use of ICD-8 within the area of functional psychoses is discussed. An empirical investigation of these theoretical assumptions has been done on a hospital material diagnosed independently in the two classificatory systems. The empirical investigation gives support to the concordance of DSM-III schizophreniform, schizoaffective, and bipolar disorder and the Norwegian ICD-8 counterparts. The concordance is less for schizophrenic disorders and major depression. It is also found that the Norwegian diagnoses of reactive psychoses spread over many DSM-III diagnoses. In particular more of the reactive psychoses than predicted fall within the schizophrenic spectrum of DSM-III.

Affective Disorders, Psychotic↗

PubMed1997

Psychogenic (reactive) and hysterical psychoses: a cross-system reliability study.

The aim of this study was to investigate the concepts of reactive and hysterical psychoses and how they are classified in standardized diagnostic systems. To this end we identified all of the patients who had been admitted to a psychiatric in-patient unit and diagnosed as suffering from psychogenic psychosis, reactive psychosis, hysterical psychosis or hysteria, using ICD-9 criteria. The case notes of these patients were then re-examined and diagnoses reached using DSM-III-R, DSM-IV and ICD-10 criteria and the Present State Examination (PSE)/CATEGO computer program. The objective of this study was to evaluate the agreement between the diagnoses of reactive and hysterical psychosis obtained using ICD-9 criteria with those obtained using the DSM-III-R, DSM-IV, ICD-10 and PSE diagnostic systems. A total of 67 case notes were identified in which the above diagnoses had been made: 27 cases with ICD-9 'hysteria' and 26 cases with 'other reactive and not otherwise specified psychoses'. Using the DSM-III-R criteria, 27 cases were diagnosed as psychotic disorder NOS, 12 as brief reactive psychosis and 11 as bipolar disorder. Using the DSM-IV criteria, 21 cases were diagnosed as psychotic disorder NOS, 11 as mood disorder, 7 as brief disorder without stressor, and 12 as brief disorder with stressor. Using the ICD-10 criteria, 18 cases were diagnosed as unspecified non-organic psychosis, 12 as mood disorder, 10 as acute and transient psychotic disorder without stressor and 13 as acute and transient psychotic disorder with stressor. Using the PSE/CATEGO program, the most common diagnoses were class 'S' schizophrenia (17), class 'P?' uncertain psychosis (16) and class 'M+' mixed and manic affective disorder (11). Using the kappa coefficient a very low level of agreement was found between ICD-9 'hysteria' and 'other reactive and non-specified psychoses' and the corresponding categories of DSM-III-R and the PSE/CATEGO program. We concluded that, although DSM-III-R provides operational criteria for brief reactive psychosis, and DSM-IV and ICD-10 provide such criteria for brief or acute psychotic disorder, these bear little relationship to the original concept of the disorder. The PSE/CATEGO program provides a very systematic approach to symptomatology, but the diagnostic classes have little clinical usefulness.

Adjustment Disorders↗

PubMed1979

Psychoses in drug-resistant temporal lobe epilepsy.

In the survey of 74 Danish patients with temporal lobe epilepsy who underwent temporal lobectomy, a total of 20 patients were psychotic. Nine of these became psychotic during the follow-up period, six of them after cessation of their epileptic seizures. There were 13 schizophrenia-like psychoses, six paranoid delusional and depressive psychoses, and one childhood psychosis. Operation was on the right side in 39 and on the left side in 35 patients. When the various psychotic groups were compared with each other or with the nonpsychotic patients, the side of operation was not found to be statistically important. The patients with psychoses were older at operation and showed a higher rate of focal lesions in the resected specimens. Although more psychotic patients were bright or normally gifted, and had achieved a higher standard of schooling than nonpsychotic patients, their social status after operation was inferior. Surgery had no effect on psychosis present preoperatively nor on its possible postoperative onset. The diagnosis of psychosis was not considered to be contraindication to temporal lobectomy.

Age Factors↗

PubMed2004

Nonschizophrenic psychotic disorders: the case of cycloid psychoses.

BACKGROUND: Cycloid psychosis is a psychiatric disorder known for about 100 years. This disorder is at present partly and simplified represented in the ICD-10. SAMPLING AND METHODS: Over a period of 15 months, 139 consecutively acutely admitted psychotic patients were assessed, by means of different diagnostic instruments, in order to investigate the prevalence and the symptom profile of cycloid psychoses. In addition, the concordance between the diagnoses cycloid psychosis, brief psychotic disorder, and acute polymorphic psychotic disorder with or without symptoms of schizophrenia was calculated. RESULTS: Cycloid psychoses were present in 13% of the patients. There was a significant but small overlap with the DSM brief psychotic disorder and the ICD acute polymorphic psychotic disorder. CONCLUSIONS: This study demonstrates that cycloid psychoses can be identified with the proper diagnostic instruments in a proportion that is also found in other studies. Since this type of psychosis entails a distinct prognosis and may require a specific treatment, its identification is of clinical importance. Limitations are the nature of the psychiatric facility with an inherent bias in the selection of patients and the lack of a long-term evaluation.

Acute Disease↗

PubMed2006

Characterization of patients with schizophrenia and related psychoses: evaluation of different diagnostic procedures.

BACKGROUND: We aimed at estimating the value of structured interviews, medical records and clinical diagnoses for assessing lifetime diagnosis of patients with schizophrenia. In addition, the validity of the Operational Criteria Checklist (OPCRIT) system was analysed. SAMPLING AND METHODS: Swedish patients (n = 73), diagnosed with schizophrenia and related disorders by their treating physician, were scrutinized. Independent research diagnoses according to the Diagnostic and Statistical Manual, ed. 3, revised (DSM-III-R) were obtained by (1) a structured interview; (2) the OPCRIT algorithm, based on record analysis only; (3) the OPCRIT algorithm, based on record and interview analysis, or (4) a separate traditional research diagnosis based on both record and interview analysis. In addition, clinical International Classification of Diseases (ICD) diagnoses, given by the treating physician, were obtained from the case notes. Concordance rates for the different psychosis diagnoses were calculated. RESULTS: Diagnoses based on interviews only showed poor to fair agreement with the other research diagnoses, but patients diagnosed with schizophrenia or schizophrenic psychoses (i.e. schizophrenia, schizophreniform or schizoaffective disorder) at the interview almost always also obtained a corresponding research diagnosis based on record or combined sources. Diagnoses based on records only showed a good to excellent agreement with diagnoses based on records and interviews. Clinical ICD diagnoses generally displayed poor agreement with the research diagnoses, but 94% of patients ever given a clinical ICD diagnosis of schizophrenic psychosis received a corresponding traditional research diagnosis. OPCRIT diagnoses and independently assigned research diagnoses, based on the same information, displayed excellent concordance. CONCLUSIONS: Structured interviews performed with Swedish long-term-treated psychosis patients during non-hospitalization are a poor source for the evaluation of psychosis diagnoses, but a good screening instrument for the detection of DSM-III-R schizophrenia. In the investigated population, medical records are a valuable source for diagnostic assessment of psychoses and may serve as a stand-alone procedure in this patient category. Swedish clinical ICD diagnoses have a high positive predictive power identifying DSM-III-R diagnoses of schizophrenic psychoses, indicating validity of register-based research focusing on these diagnoses. The OPCRIT system is a valid tool for assessing DSM-III-R psychosis diagnoses. It should be emphasized that the present conclusions are based on the investigated Swedish psychosis population and cannot be generalized to populations composed of other patient groups or sampled in other settings, with other traditions regarding the use and availability of medical records.

Adult↗

PubMed1985

Persecutory affective psychoses: a follow-up.

A series of 66 cases with persecutory affective psychoses was followed up between 5 and 44 years. These psychoses can be considered as a subgroup of catamnestically verified paranoid reactive psychoses. They comprise cases with and without clouded consciousness. The long-term prognosis is best for cases with clouded consciousness at the initial stage of the psychosis. The characteristics of premorbid personality, psychological precipitating factors and psychotic symptomatology are illustrated by several tables.

Adult↗

PubMed1983

The importance of the schizo-affective psychoses within the psychopathological and nosological systematics.

Schizo-affective psychoses lead more often to reintegration of the paranoid-hallucinatory pattern than schizophrenic psychoses. The author interprets schizo-affective psychoses in the light of his systematic psychopathology and concludes that excitation is intensified in comparison with cyclothymia. Ego destruction is more serious, but paranoid manifestations decrease in the course and emotional syndromes become more pronounced. Prognosis depends on the intensity of therapeutic efforts in the sense of psychopharmacological and supportive therapies and is not prestabilized.

Bipolar Disorder↗

PubMed1983

Course of paranoid psychoses in relation to diagnostic grouping.

The author stresses the importance of diagnosis in psychiatry and gives a short presentation of the Scandinavian concepts of reactive psychoses and schizophreniform psychoses. On the basis of his own personal follow-up investigations on 301 consecutively admitted patients to the University Psychiatric Clinic in Oslo, followed up through 5-18 years, he concludes that the schizophreniform (schizo-affective) psychosis also in prognostic respects is a group in between. Of the patients with a discharge diagnosis of reactive psychosis, 81% had a favourable course compared to 61% of the patients with a discharge diagnosis of psychosis e genere incerto (Langfeldt's schizophreniform psychoses) and only 23% of the patients with a discharge diagnosis of schizophrenia.

Adjustment Disorders↗

PubMed1987

The development of the concept of reactive psychoses.

Although reactive (psychogenic) psychoses have no doubt occurred throughout the history of mankind, it is only during the last century that the corresponding concept has been defined, beginning with Sommer's definition of the term 'psychogenic' and Jaspers' distinctions between 'reaction' and 'process', and between 'neurosis' and 'psychosis', respectively. A change in Kurt Schneider's nosological concepts induced the majority of German-speaking psychiatrists to avoid the concept of psychogenic psychoses. The very varying use of the concept of reactive psychoses in different countries is described and discussed, with special regard to implications for psychiatric epidemiology.

Adjustment Disorders↗

PubMed1987

Toward an operationalization of reactive paranoid psychoses (reactive delusional disorder).

Reactive psychoses are relatively often diagnosed in Norway, although they are not operationalized in any classificatory system and the reliability may be questioned. The aim of this study was to define a group of reactive paranoid psychoses and compare its long-term outcome to the group of nonreactive paranoid psychoses and to paranoid schizophrenia. Approximately 200 out of 301 delusional subjects earlier studied by Retterstöl have recently been interviewed semistructurally, making a total follow-up period of 22-38 years. Diagnoses at discharge have been assessed retrospectively before the present interview, with a polydiagnostic approach. Based upon Kendler's criteria of delusional disorder and influenced by Jaspers, the concept of reactive delusional disorder has been operationalized. Results from the first 125 interviews show 31 cases of Kendler's delusional disorder, of which 16 are diagnosed as reactive delusional disorder. Outcome in this group is most favorable, and especially good outcome is found in acute reactive delusional disorder.

Adjustment Disorders↗

PubMed1987

Continental viewpoints on the concept of reactive psychoses.

Although the Scandinavian concept of reactive psychoses relates to K. Jaspers and although Kretschmer described the prototype of a psychosis of psychogenic/reactive origin (Der sensitive Beziehungswahn), the concept is not so commonly used in German-speaking countries. Important reasons for this refusal may be (1) the sharp distinction between psychosis (which may be explained but not understood) and understandable reactions, which was stressed in rather influential German psychiatric schools in the middle of the century, and (2) the aim of stressing psychological understanding in a broad spectrum of psychiatric illnesses in the Swiss tradition, where the demarcation of particular reactive psychoses seemed to be superfluous. The development of modern concepts stressing the multidimensionality in the etiology of the main groups of psychiatric disorders was certainly influenced by the concept of reactive psychoses but passed it.

Adjustment Disorders↗

PubMed1990

A dimensional approach to severe delusional psychoses.

By use of latent trait models a 7-item rating scale of severe delusional psychoses was established based on the PSE interview. Data from 88 first-admitted patients with delusional psychoses were analysed. These data assigned good internal validity of the scale and revealed a dimensional rather than a categorical distribution of severe delusional psychoses. Using schizophrenia as a reference, the scale with a cut-off point greater than or equal to 1 established the diagnosis with a sensitivity of 0.84 and a specificity of 0.95. In a study to come a latent class analysis among deluded patients will be performed.

Delusions↗

PubMed1990

Prognostic validity of the cycloid psychoses. A prospective follow-up study.

In a prospective 4-year follow-up study, 26 out of 31 patients initially diagnosed as cycloid psychoses were investigated (anxiety-happiness psychosis n = 15; confusion psychosis n = 8; motility psychosis n = 3). Patients were independently interviewed by two clinical researchers. 61.5% showed one or several 'first-rank symptoms' according to Schneider. In addition, the SADS-LA was applied for RDC and DSM-IIIR diagnoses. According to these classification systems most of the patients were diagnosed as schizophrenic or schizoaffective. Personal interview as well as application of the Strauss-Carpenter Outcome Scale indicated a highly favorable clinical outcome, i.e. lack of affective or behavioral defective states in literally all patients of the study. These results justify the distinction of the cycloid psychoses as a nosological entity in general and--less convincingly--of the three subtypes of cycloid psychoses.

Adult↗

PubMed1990

Clinical pharmacology and Leonhard's classification of endogenous psychoses.

Introduction of therapeutically effective psychotropic drugs focused attention on the heterogeneity of psychiatric populations within the traditional diagnostic categories of psychiatric disorders. Recognition that valid diagnostic concepts are essential for progress in the biology and pharmacotherapy of psychiatric disorders resulted in a revival of interest in psychiatric nosology with a special emphasis on Leonhard's classification of 'endogenous psychoses'. Of particular importance for psychopharmacology in Leonhard's system is the recognition of two distinctive populations within the schizophrenic disorders, i.e., 'unsystematic schizophrenias' and 'systematic schizophrenias'; three distinctive populations within the bipolar disorders, i.e., 'manic-depressive illness,' 'cycloid psychoses' and 'unsystematic schizophrenias'; and two distinctive populations within depressive disorders, i.e., 'unipolar depression' and 'bipolar depression'. In this paper supporting data for Leonhard's classification of 'endogenous psychoses' are presented.

Antidepressive Agents↗