[Function psychoses and endogenous psychoses. A mosological comparison].
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Eighty-three acutely disturbed, psychotic patients were included in an open multicentre study. The aim of the study was to evaluate the clinical effect of zuclopenthixol acetate in Viscoleo (CPT-A). Each patient received from one to four intramuscular injections of CPT-A during the 6-day study period. The duration of action after one injection was between 2 and 3 days and doses from 50 mg to 150 mg were sufficient for most patients. Treatment with CPT-A caused a pronounced and rapid reduction of the psychotic symptoms. At the end of the 6-day test period the mean total score on BPRS in acute non-manic and exacerbated chronic patients was reduced by more than 50 per cent. In acute manic patients the mean total score on BRMS was reduced by 57 per cent already 1 day after injection. Rapidly after the injection of CPT-A a useful short-acting sedation can be expected, but the risk for oversedation even after a second injection is low. The frequency of unwanted effects, including extrapyramidal reactions, was low and the severity of symptoms was most often mild. With a rapid onset of action, a duration of effect of 2 to 3 days, and few and mild side effects, CPT-A offers advantages over the neuroleptic preparations conventionally used in the initial treatment of acutely disturbed, psychotic patients.
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Sixty-nine patients, each with a combined diagnosis of epilepsy and psychosis, were compared with 53 patients with a diagnosis of functional psychosis. The epileptic affective patients often lacked convincing psychotic features; ECT and lithium were rarely prescribed; only three showed evidence of bipolarity. The epileptic schizophrenic patients were judged to have the better premorbid personality; experienced more paranoid delusions and delusions of reference, and showed less catatonic features than the functional schizophrenic patients. The course of the epileptics' illness was more variable. The concept that the schizophrenia-like psychosis associated with epilepsy is a distinct nosological entity is supported, but not the suggestion of a relationship between affective psychosis and epilepsy.
Emil Kraepelin's (1856-1926) famous lecture "Zur Diagnose und Prognose der Dementia praecox" was held in Heidelberg 100 years ago on 27. November 1889. In this lecture Kraepelin suggested for the first time his famous "nosological dichotomy" between the group of "manisch-depressives Irresein" and the so-called "Dementia-praecox-Gruppe". This dichotomy became world famous since the publication of his "Lehrbuch der Psychiatrie", 6th edition 1899. Kraepelin founded his psychiatric system on outcome observations and the nosological principles of Kahlbaum. His nosology is very influential to the present day. The revision of American psychiatry in the 1970's and 1980's is unthinkable without Kraepelin's concept. Therefore the name "Neo-Kraepelinianism" was created.
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