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PubMed1990

[Endogenous control and personal self-determination in suicide during manic-depressive psychoses].

According to the "Chronopathological theory of manicdepressive disorder" (Supprian: "Ordnung und Psychose" pubd. by R. Krämer Hamburg 1988, ISBN: 3 926952 07 5), the syndromatic day-to-day shifting of the psychopathological features with manic, depressive and several mixed states has a well-defined time structure, as in 25 patients studied and reported on in this paper. This time structure is given with a chronobiological cycle of an (individual) length and an inherent sequence of psychopathological phenomena (the theory stipulates a series of several cycles--from rapid to long-term-periodicity--and related sequences). Within this order the psychopathological surface of each day is strictly determined by its numeric position in the cycle. The several states and the individual comments on suicide (from announcement to dissimulation or distancing and to trying out and execution, etc.) can be described by means of affective disorders, a special casted typology of 12 types. The material for this study consisted of 25 cases with a well-known time-structure (obtained via previous analyses by computer-aided sequence spectra) and 178 text extracts from patients histories, compiled in a booklet, one for each expert. 10 independent experts (psychiatrists and psychologists) rated the typology of each text. Statistical studies of frequency tables (Chi2-technique) show a close matching between psychopathologic and suicidological states. Final action, for example, is correlated with an overall dysregulation of the mood system (with no dependence on the drive system--contrary to a widespread doctrine). Any lack of drive can be instrumentally compensated. Timing of suicide (and all other types of translation into reality) during the course of an affective disorder could be shown as being strictly determined by the endogenous process and its time structure. The results confirm the chronopathological theory.

Bipolar Disorder↗
PubMed1990

[Autoprotective mechanisms in patients with schizophrenic psychoses--compensation and coping].

For a long time, the coping and compensatory mechanisms of patients with schizophrenic psychoses have mostly been neglected by the psychiatric research. We extended the six categories of coping mechanisms described in the Bonn Scale for the Assessment of Basic Symptoms (BSABS) by three further categories. With fifty schizophrenic patients in different stages of their disease semistructured interviews concerning these categories were done. The main sociodemographic and historical parameters were registered as well. Then the protocols of the interviews were analyzed, the coping strategies were quantified, and it was tried to disclose relations between the disease progress and sociodemographic parameters. Patients used to a certain degree of autonomy e. g. unmarried patients had--compared to less independent patients--stronger coping strategies. Patients with a strong interest for their disease and a positive opinion about neuroleptic therapy had--compared to patients without interest for their disease and/or negative opinion about neuroleptic therapy--stronger coping and compensatory psychisms. It is concluded that the coping strategies might be reinforced by influencing these parameters.

Adaptation, Psychological↗
PubMed1985

[Schizoaffective psychoses in Germany and Japan--a transcultural psychiatric study].

71 Japanese patients, who were diagnosed as a schizoaffective psychosis (ICD-295.7) and admitted in the year of 1979 in the department of psychiatry of Nagoya City University Hospital and psychiatric ward of its branch hospital, were investigated on the following clinical features: Age of the first psychotic manifestation, heredity, premorbid personality, situation of manifestations, symptomatology, clinical course, somatic complications, EEG-findings and sorts of treatments. This group then was compared statistically with 71 German patients with schizoaffective psychoses, who were admitted in the year of 1980 in the psychiatric department of Munich University Hospital. The statistical differences between these two groups revealed mainly in their symptomatology, not in the other clinical features mentioned above exept a certain type of the premorbid personality and a certain situation of falling ill. As for the delusions, the delusion of reference was very commonly found among the Japanese group, but relatively few in the German (p less than 0,01). On the other hand, the delusion of guilt was much frequent among the German, but extremely rare in the Japanese (p less than 0,001). The depressive symptoms were more frequently seen in the German (p less than 0,001), whereas the catatonic symptomes were more commonly found in the Japanese. Delusion of possession was seen in the Japanese group exclusively. On the premorbid personality-types, the trait of the sensitive personality was more frequently found in the Japanese (p less than 0,05), however, when considering the situations of the manifestations, the inner familial conflicts were found much fewer in the Japanese (p less than 0,05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Paranoid hallucinatory psychoses as the first manifestation of HIV infection].

All parts of the central nervous system may be involved in HIV infection, resulting in a variety of neuropsychiatric syndromes some of which resemble functional psychoses. Corresponding to the HIV-associated disease these syndromes differ in course and severity. A very common form is the AIDS-dementia complex, especially late in the course of disease. Up to now, however, a specific therapy is not available. A case of severe psychosis with paranoid delusions and hallucinations in a patient with otherwise asymptomatic HIV infection is reported. From her biography it was concluded that the infection occurred 10 years earlier. During therapy with azidothymidine, symptoms disappeared within 3 months, and more than one year after admission to our hospital the patient was still able to work. According to the course of the disease in this patient, reports from the literature and pathogenetic theories, an early therapy with antiviral agents is recommended in HIV-induced subacute encephalitis.

AIDS Dementia Complex↗
PubMed1987

Early physiological effects of lithium treatment: electrooculographic and adaptometric findings in patients with affective and schizoaffective psychoses.

Electrooculography allows to measure the fundocorneal potential, a standing potential of the eye, under the conditions of light and dark adaptation. The results are expressed as the so-called Arden ratio. As was demon-strated by others in healthy volunteers, the Arden ratio, on the average, de-creases under Lithium treatment. However, in individual cases it can also remain unchanged or even rise. We have performed electrooculographic and adaptometric examinations in ten patients with affective disorders (DSM-III, 296. XX) and schizoaffective psychoses (DSM-III, 295.70). The criteria for the assignment of patients to lithium treatment were derived from a study by Angst. Arden ratios were determined six times, respectively, before lithium application and after a therapeutic lithium serum level (0.6-0.8 mmol/l) had been reached (cf. 5). The values observed during lithium treatment were significantly lower than those measured before lithium application. Dark adaptation, as measured using an adaptometer according to Goldmann-Weekers, was disturbed under lithium. The potential predictor function of these findings with regard to the lithium response is being investigated by means of a prospective study.

Adaptation, Ocular↗
PubMed2003

Organizational and visual memory deficits in schizophrenia and bipolar psychoses using the Rey-Osterrieth complex figure: effects of duration of illness.

Verbal declarative memory deficits in schizophrenia are well documented whereas visual declarative memory is less studied. Moreover, there are limited data on whether organizational and visual memory deficits are specific to schizophrenic psychoses. We compared visual memory and organizational function in patients with chronic schizophrenia (n=79) and chronic bipolar psychotic disorder (n=14), and in healthy controls (n=84) using the Rey-Osterrieth Complex Figure (ROCF), testing whether organizational impairments (i.e., executive dysfunctions) account for the visual memory deficit. Groups were comparable on age, handedness and expected intellectual ability (based on single word reading). Using analyses of covariance with sex, parental SES and ethnicity as co-variates, patients with schizophrenia were significantly more impaired than controls on copy accuracy, on recall accuracy, and on percent accuracy of recall. Patients with schizophrenia used a more detail-oriented style on copy and recall and had significantly worse recognition memory. After co-varying IQ, copy organization was also significantly different between the groups. Results for accuracy of copy and recall were not significantly attenuated when controlling for copy organization. Duration of illness was associated with visual memory. Bipolar patients performed at an intermediate level between controls and patients with schizophrenia. The data suggest that in schizophrenia, patients have a visual memory disorder characterized by both organizational processing impairments and retention difficulties, and that there is a decline in visual memory functions with duration of illness. Further research is required to determine whether similar mechanisms underlie the neurocognitive deficits in these psychotic disorders.

Adult↗
PubMed1993

Hypnotic assessment and treatment of trauma-induced psychoses: the early psychotherapy of H. Breukink and modern views.

The role of hypnotizability assessment in the differential diagnosis of psychotic patients is still unresolved. In this article, the pioneering work of Dutch psychiatrist H. Breukink (1860-1928) during the 1920s is used as early evidence that hypnotic capacity is clinically helpful in differentiating highly hypnotizable psychotic patients with dissociative symptomatology from schizophrenics. Furthermore, there is a long tradition of employing hypnotic capacity in the treatment of these dissociative psychoses. The ways in which Breukink used hypnosis for diagnostic, prognostic, and treatment purposes are summarized and discussed in light of both old and current views. He felt that hysterical psychosis was trauma-induced, certainly curable, and that psychotherapy using hypnosis was the treatment of choice. Hypnosis was used for symptom-oriented therapy, as a comfortable and supportive mental state, and for the uncovering and integrating of traumatic memories. For the latter purpose, Breukink emphasized a calm mental state, both in hypnosis and in the waking state, thereby discouraging emotional expression, which he considered dangerous in psychotic patients. In the discussion, special attention is paid to the role and dangers of the expression of trauma-related emotions.

Adult↗
PubMed2002

Symptoms profile and quality of life in rural and urban patients with chronic psychoses.

The symptoms profile (modified Positive and Negative Syndrome Scale, PANSS) and the quality of life (Lancashire Quality of Life Profile, LQLP, and the Quality of Life Scale 100, QLS-100) were compared between two groups of patients with chronic psychoses: a rural group of 19 patients living in villages with < or =300-10,000 inhabitants and far away from a large city, and an urban group of 19 patients living in a major city with 250,000 inhabitants. The patients were matched pair-wise for sex, age, global assessment of functioning (GAF) and psychiatric symptoms (modified PANSS, total score). Seventeen of the pairs were diagnosed with schizophrenia, and two pairs with delusional disorder. The symptoms profile indicated more negative symptoms and less positive symptoms for the rural group, compared with the urban group, with a significantly lower degree of spontaneity in the rural group. No group differences were found in the QLS-100, or in the specific quality of life variables according to LQLP. However, the rural group had significantly higher self-rating of the general quality of life variables of the LQLP, i.e. satisfaction with well-being, general health and mental health. The results are discussed in view of a possible relation between negative symptoms and impairments in social cognition and insight.

Adult↗
PubMed2005

Occurrence and treatment of depressive comorbidity/cosyndromality in schizophrenic psychoses: conceptual and treatment issues.

Depressive symptoms are a common feature of schizophrenic disorders, a fact that has become increasingly apparent over the last two decades. Apparently the introduction of standardized rating scales in cross-sectional and longitudinal investigations played an important role in the recognition of the relevance of depressive symptoms. They can be interpreted as being cosyndromal or comorbid, depending on the conceptual perspective applied. This is not simply a difference in terminology but is of great aetiopathogenetic relevance. Of particular clinical relevance is the observation that schizophrenic patients with concomitant depressive symptoms have a greater risk of suicidality or an unfavourable disease course. For this reason it is important that sufficient attention is paid to the diagnosis and treatment of depressive symptoms occurring during schizophrenic psychoses. Besides treatment with antidepressants, modern neuroleptics are of great importance in this context as they are more efficacious than classical neuroleptics in treating depressive symptoms.

Antidepressive Agents↗
PubMed1998

Support for a chromosome 18p locus conferring susceptibility to functional psychoses in families with schizophrenia, by association and linkage analysis.

The action of antipsychotic drugs on dopamine receptors suggests that dopaminergic signal transmission may play a role in the development of schizophrenia. We tested eight candidate genes (coding for dopamine receptors, the dopamine transporter, and G-proteins) in 59 families from Germany and Israel, for association. A P value of .00055 (.0044 when corrected for the no. of markers tested) was obtained for the intronic CA-repeat marker G-olfalpha on chromosome 18p. The value decreased to .000088 (.0007) when nine sibs with recurrent unipolar depressive disorder were included. Linkage analysis using SSLP markers densely spaced around G-olfalpha yielded a maximum two-point LOD score of 3.1 for a marker 0.5 cM distal to G-olfalpha. Multipoint analysis under the assumption of heterogeneity supported this linkage-whether the affected pheotype was defined narrowly or broadly-as did nonparametric linkage (NPL). In 12 families with exclusively maternal transmission of the disease, the NPL value also supported linkage to this marker. In order to test for association/linkage disequilibrium in the presence of linkage, the sample was restricted to independent offspring. When this sample was combined with 65 additional simplex families (each of them comprising one schizophrenic offspring and his or her parents), the 124-bp allele of G-olfalpha was transmitted 47 times and was not transmitted 21 times (P=.009). These results suggest the existence, on chromosome 18p, of a potential susceptibility locus for functional psychoses.

Chromosomes, Human, Pair 18↗
PubMed2001

Update and recommendations for the use of antipsychotics in early-onset psychoses.

A review was undertaken of studies evaluating the efficacy and tolerability of antipsychotic medications for the management of psychosis in children and adolescents. All identified published and unpublished studies from 1996 onward were included for review. The search located one randomized control trial, seven open-label trials, six retrospective chart reviews, and nine case reports. The studies assessed the use of haloperidol, clozapine, risperidone, olanzapine, and quetiapine in the management of psychosis in children and adolescents. Most studies reported reasonable treatment response; however, extrapyramidal side effects, sedation, and weight gain are concerning. This points to the need for appropriate baseline assessments prior to initiating treatment with these agents. Particular attention should be given to assessment of the extrapyramidal system as well as to baseline weight, lipid profile, and blood glucose. Further study is needed to refine the use of antipsychotic medications in children and adolescents in order to minimize adverse effects while conferring an optimum therapeutic response. The importance of instituting effective early treatment in youth with psychoses is an important goal that may serve to lessen the long-term morbidity of the illness.

Adolescent↗
PubMed2003

The structural brain correlates of neurological soft signs in AESOP first-episode psychoses study.

Patients with schizophrenia and related psychoses have an excess of minor neurological abnormalities (neurological soft signs) of unclear neuropathological origin. These include poor motor coordination, sensory perceptual difficulties and difficulties in sequencing complex motor tasks. Neurological soft signs seem not to reflect primary tract or nuclear pathology. It still has to be established whether neurological soft signs result from specific or diffuse brain structural abnormalities. Studying their anatomical correlates can provide not only a better understanding of the aetiopathogenesis of soft signs, but also of the pathophysiology of schizophrenia. Surprisingly few studies have investigated the brain correlates of neurological soft signs. In the present study, we investigated the relationship between brain structure and neurological soft signs in an epidemiologically based sample of 77 first-episode psychosis patients. We used the Neurological Evaluation Scale for neurological assessment and high-resolution MRI and voxel-based methods of image analysis to investigate brain structure. Higher rates of soft neurological signs (both motor and sensory) were associated with a reduction of grey matter volume of subcortical structures (putamen, globus pallidus and thalamus). Signs of sensory integration deficits were additionally associated with volume reduction in the cerebral cortex, including the precentral, superior and middle temporal, and lingual gyri. Neurological soft signs and their associated brain changes were independent of antipsychotic exposure. We conclude that neurological soft signs are associated with regional grey matter volume changes and that they may represent a clinical sign of the perturbed cortical-subcortical connectivity that putatively underlies psychotic disorders.

Adolescent↗
PubMed2004

Clinical and etiopathogenic specificities of the French concept of psychose hallucinatoire chronique compared to schizophrenia.

The French concept of psychose hallucinatoire chronique (PHC) is characterized by late-onset psychosis, occurring predominantly in females. Symptoms are rich and frequent hallucinations but almost no dissociative features or negative symptoms. This diagnosis is classified among schizophrenia disorders (paranoid type) according to DSM-IV. PHC may also describe a group of patients with original clinical presentation and etiopathogenic factors. We compared 38 female PHC patients with two groups of female schizophrenia patients, matched for age at interview for the first group (n = 35), and duration of the disorder for the second group (n = 36). PHC subjects were relatively older patients with homogeneous clinical features characterized by predominantly positive symptoms without deterioration and fewer relatives with schizophrenia than schizophrenia patients. This first controlled study underscores clinical, phenomenological, and possibly etiopathogenic factors that characterized the PHC patients, even when the impact of late onset and late age at interview were taken into account. This study provides evidence that PHC may be a possible diagnosis in clinical practice, although it is difficult to reach a conclusion on its relationship with schizophrenia.

Adolescent↗
PubMed1999

Premorbid personality in psychoses.

This study aimed to establish correlates of the dimensions of schizophrenia in the premorbid personality traits of patients. A sample of 112 patients of relatively recent illness onset who were admitted for a psychotic episode were assessed with a semistructured interview for schizophrenia. Positive and negative symptoms were evaluated with the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms at the time of hospital discharge; positive, negative, and disorganization scores were obtained from these scales. Premorbid personality was assessed blindly through a partially modified version of the Personality Assessment Schedule using interviews with the parents or a close relative. Schizoid traits were significantly associated with negative and positive dimensions. Sociopathic traits were related to the disorganization dimension. Trends toward significance were obtained between passive-dependent traits and the negative and disorganization dimensions, and between the schizotypal dimension and the positive dimension. Partial correlational analyses were used to control for the effect of the remaining personality dimensions on the above relationships. Schizoid premorbid traits were still significantly related to the negative dimension but to a lesser degree to the disorganization and positive dimensions. The association between sociopathic premorbid traits and the disorganization dimension remained significant. These results suggest the preexistence of a three-dimensional structure predisposing to psychoses within the premorbid personality; this structure is more evident in patients with short illness duration.

Adult↗
PubMed2000

A prognostic study of clinical dimensions in adolescent-onset psychoses.

Adolescent-onset psychoses often raise diagnostic difficulties because of the mixture of schizophrenic and affective features. This study examined prospectively which clinical dimensions contribute to difficulty in initial diagnosis and which clinical features have predictive value for outcomes of schizophrenia or affective disorders, and for eventual psychosocial functioning. Thirty-six adolescents consecutively admitted for a psychotic episode were followed up for 1 to 4 years. Symptoms were assessed at admission, at discharge, and once a year. DSM-III-R (APA 1989) diagnoses were assessed at admission and once a year. Comparisons were performed across initial and followup diagnostic groups. Positive symptoms did not differentiate the initial clinical pictures, while negative symptoms, manic symptoms, and disorganization differentiated the manic and depressive episodes in the acute phase. When initial positive symptoms (mainly delusions) were severe, they predicted a final diagnosis in the schizophrenia spectrum. Poor outcome was associated with more anhedonia-associality and lower functioning scores at admission. Results suggest (1) a higher vulnerability to positive symptoms in adolescents who will further develop schizophrenia and (2) the low specificity of affective symptoms at this age.

Acute Disease↗
PubMed1992

The Iowa prospective longitudinal study of recent-onset psychoses.

In this article, the methods of a prospective longitudinal study of recent-onset psychoses are described. Methodological issues that may be common to studies employing a similar design are discussed in the context of the rationale behind this study's strategies. Particular attention is paid to statistical strategies that maximally exploit longitudinal data.

Humans↗
PubMed1980

Course of schizoaffective psychoses: results of a followup study.

The course of illness was investigated retrospectively and prospectively in a sample of 150 hospitalized schizoaffective patients and 95 hospitalized bipolar manic-depressive patients. The two disorders showed more similarities than differences in their course; this was true for the age of onset (31.8 versus 34.7 years) and the length of illness until the end of the observation period (22.5 versus 23.8 years). Schizoaffective disorders took a more benign course than bipolar disorders, as measured by the frequency of the episodes (median 7 versus 9 episodes). Accordingly, periods of remission between episodes were longer in schizoaffective patients. The length of the episodes themselves was about the same in both disorders (median 3 months). Although subjects had reached an average age of 60 years, 63% of schizoaffective and 82% of bipolar patients had experienced new episodes during the last 5 years of the observation period. Patients with schizoaffective psychoses were less likely to achieve a full remission than patients with bipolar disorders. A residual state was observed in 57% of schizoaffective and 24% of bipolar patients during the intervals between episodes. Because both schizoaffective and bipolar disorders showed a highly recurrent course, many patients received long-term treatment with neuroleptic drugs, antidepressants, or lithium.

Antidepressive Agents↗
PubMed1981

The genetics and biochemistry of paranoid schizophrenia and other paranoid psychoses.

Genetic and biochemical findings in paranoid schizophrenia and other paranoid psychoses are reviewed. Although the data suggesting a lower genetic loading for schizophrenia in paranoid versus nonparanoid schizophrenia are unclear, paranoid schizophrenia does, to a limited extent, breed true within families. Monozygotic twins concordant for schizophrenia tend to be either both paranoid or both nonparanoid schizophrenics. In all studies, the risk for schizophrenia in the relatives of patients with paranoid psychosis is close to that found in the normal population. Genetic studies provide no evidence for a link between affective illness and either paranoid schizophrenia or paranoid psychosis. Although reports of low platelet monoamine oxidase activity in paranoid schizophrenia have not been confirmed, recent results suggest that brain norepinephrine levels may be higher in paranoid than in nonparanoid schizophrenics. Genetic and biochemical findings suggest some differences between paranoid and nonparanoid schizophrenia, but definitive clarification of the relationship between these two syndromes must await future research. From a genetic perspective, paranoid psychosis appears to bear little relationship to schizophrenia.

Adolescent↗