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PubMed1999

A follow-up study of postpartum psychoses: prognosis and risk factors for readmission.

OBJECTIVE: The aim of this study was to describe the prognosis and risk factors for the first readmission after postpartum psychosis. METHOD: Linking the Danish Medical Birth Register and the Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1173 women diagnosed with a psychosis within 91 days of delivery. The relative risk (RR) of readmission was estimated using Cox proportional hazard regression models. RESULTS: An increased risk of readmission was found for women with a diagnosis of schizophrenia (RR = 2.4, 95% CI = 1.9-3.1) and for women with a history of previous psychiatric admission (RR = 1.8, 95% CI = 1.5-2.1) compared to first-admitted women with other functional psychoses. Unmarried women also showed an increased risk of readmission, and only preterm delivery was associated with a reduced risk of readmission. CONCLUSION: Preterm delivery predicts the best prognosis after postpartum psychosis. The majority of readmissions were related to the psychopathology of the patient and to lack of social support.

Adult↗
PubMed2006

Good school performance is a risk factor of suicide in psychoses: a 35-year follow up of the Northern Finland 1966 Birth Cohort.

OBJECTIVE: Our aim was to analyse the relationship between good school performance and risk of suicide in the Northern Finland 1966 Birth Cohort, especially in psychoses. METHOD: A total of 11,017 cohort members who were alive at the age of 16 years were followed up to the age of 35 years. School performance was measured by the school marks given at age 16 at the end of comprehensive school. School, diagnostic and mortality data were based on national registers. RESULTS: For psychotic persons having good school performance (highest 20%), the adjusted hazard ratio (HR) for suicide was 3.56 (0.97-13.05) compared with the remaining 80%. In the non-psychotic population (97% without psychiatric hospitalization), accordingly, adjusted HR was 0.28 (0.07-1.16). Interaction (school performance x psychiatric diagnosis) was significant (P = 0.01) even when adjusted with gender, social class and age of onset of illness. CONCLUSION: Good school performance at age 16 years is associated with increased risk of suicide (before age 35 years) in persons who develop psychosis, whereas in persons who do not develop psychosis, it is associated with lower suicide risk.

Achievement↗
PubMed2006

The interaction between TPH2 promoter haplotypes and clinical-demographic risk factors in suicide victims with major psychoses.

Tryptophan hydroxylase isoform 2 (TPH2) is a rate-limiting enzyme in the biosynthesis of serotonin (5-HT) and is predominantly localized in the brain. Previous studies have suggested that there is an association between serotonergic dysfunction in the brain and suicidality. This study was designed to examine whether the -473T > A and -8396G > C polymorphisms of the TPH2 gene may be associated with completed suicide in subjects with major psychoses from the Stanley Foundation Brain Bank sample. TPH2 genotypes were determined in 69 subjects with a diagnosis of schizophrenia or bipolar disorder, among which 22 died by suicide. Genomic DNA was amplified by polymerase chain reaction and typed by automated methods. Both markers were found to be in Hardy-Weinberg equilibrium and in strong linkage disequilibrium. No association with history of suicide was found for either polymorphism. Haplotype analysis with EHAP showed no association between completed suicide and haplotype distribution (chi2 = 1.877; 3 df; P = 0.598). Nor was there any association between suicide and these genetic markers even when clinical-demographic factors were considered as covariates in the haplotype analysis. These findings suggest that these 5' marker haplotypes in the TPH2 gene do not influence suicidal behaviour.

Adult↗
PubMed1993

Dorsolateral prefrontal cortex dysfunction in the major psychoses; symptom or disease specificity?

Neurophysiological deficits in the left dorsolateral prefrontal cortex (DLPFC) have been described in positron emission tomography studies of schizophrenia and depression. In schizophrenia and depression this deficit has been associated with the syndromes of psychomotor poverty and psychomotor retardation, respectively. Such findings lead to a prediction that DLPFC dysfunction is symptom rather than disease related. This prediction was empirically tested in a retrospective study that pooled data from 40 patients meeting research diagnostic criteria for depression and 30 patients meeting DSM-III R criteria for schizophrenia. The patients were categorised into those with and without poverty of speech, a symptom that is an observable manifestation of psychomotor impairment. The profile of regional cerebral blood flow (rCBF), measured in all subjects under resting conditions, was subsequently compared in these two groups. Patients with poverty of speech had significantly lower rCBF in the left DLFPC. This reduction of rCBF was independent of diagnosis. The findings support the view that the study of symptoms, or symptom clusters, can provide information additional to that of traditional diagnostic systems in the study of the major psychoses.

Adult↗
PubMed1983

Schizo-affective psychoses from a phenomenological-anthropological point of view.

The presence of schizo-affective psychosis is postulated psychopathologically, if schizophrenic as well as manic or depressive cyclothymic symptoms, respectively, are to be found in the same clinical picture. This circumstance rises the question with what legitimation do we designate a symptom as schizophrenic, etc.? Generally, we call a symptom, e.g., schizophrenic, if: (1) like with K. Schneider's first-rank symptoms the presence of a schizophrenic called entity of syndrome and course of illness is very easy to be recognized by means of the symptom, and (2) the symptom is statistically significantly correlated with this entity. In both definitions the schizophrenic nature of the single symptom remains undetermined. Here the attempt is made to work out a specificity of manic and depressive phenomena, a phenomenological determination of manic-depressive psychosis as an essential entity, respectively, by tracing structural signs of the moods and delusions as well as of the personality of manic-depressives. The same could be done in some way also with schizophrenic psychoses. We believe that only if we arrive at a clearer determination of what is meant by schizophrenic, manic, and depressive not only in a correlative statistical, but also in a phenomenological sense, we might have a chance finally to classify schizo-affective psychosis psychopathologically on an empirical basis.

Anthropology, Cultural↗
PubMed1984

Course and prognosis of endogenous-phasic psychoses in adolescence.

The course and the prognosis of endogenous-phasic psychoses in adolescence were discussed on authentic cases with a long enough period of observation. In atypical psychosis, the length of episodes was longer when productive symptoms were present, while the defect symptoms were quite scarce when affective features dominated the episodes. In contrast to adult cases, myth formation was not recognized, while the tendency to repeat the same clinical picture was not consistent. In affective psychosis, the precipitating factors were significantly frequent in the initial episodes. The length of episodes tended to become longer along with the increase in age, but fairly long-lasting remissions were observed in a few patients.

Adolescent↗
PubMed1985

On the nosology of post-partum psychoses.

The author discusses whether post-partum psychoses are to be considered as a clinical entity per se. The studies conducted in Lausanne seem to demonstrate that the authors of DSM III were correct in excluding this possibility - of all the patients with a post partum episode, 65% had one or several relapses without connection with the puerperium.

Female↗
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

Classification of chronic psychoses including delusional disorders and schizophrenias.

A classification of chronic psychoses including nonparanoid schizophrenia, paranoid schizophrenia, paranoid state and paranoia (delusional disorder) is presented. This classification is dependent on a systematic increase in number of symptoms with each group. In particular, delusional disorder is examined with regard to family history. It is clear from the data which are presented that delusional disorder is more likely to be associated with a family history of such traits as suspiciousness, jealousy, secretiveness, and the presence of paranoid behavior or delusions. There is evidence that such familial traits are not seen in schizophrenia, only in delusional disorder.

Chronic Disease↗
PubMed1986

Status of twin research in functional psychoses.

After briefly reviewing the main findings of twin research in functional psychoses, the author focuses the attention on neglected aspects of twin research, such as the study of co-twins of monozygotic (MZ) subjects with functional psychosis, and the study of life histories of discordantly affected twins. Through a thorough investigation of the nonpsychotic co-twins of MZ subjects, one might be able to identify vulnerability factors. By studying the life course of the twins in a pair, discovery of environmental etiological factors are possible. By including twins with both schizophrenic, manic-depressive and reactive psychotic symptomatology, one should be able to discover whether the environmental factors are of a specific kind.

Borderline Personality Disorder↗
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↗
PubMed1987

Present state of reactive psychoses in Scandinavia.

The diagnosis of reactive psychosis is more commonly used in Denmark and Norway, where 50 and 40%, respectively, of first-admitted patients with functional psychoses will be diagnosed as having a reactive psychosis. The predictive validity of the concept is discussed. The concept has to be better operationalized and limited in the future.

Adjustment Disorders↗
PubMed1987

On organically based hallucinatory-delusional psychoses.

In an investigation of 70 chronically mentally ill patients in a district psychiatric hospital, 11 cases were discovered which had been diagnosed up to now as schizophrenia, but could now be diagnosed as being of organic origin. In group 1 (cases 1-6) there are dementive states after toxic, inflammatory or early childhood brain damage and familial epileptic malady with slowly progressive brain atrophy. They were easy to recognize clinically in their organic psychosyndromes, dementia, neurological symptoms and CT findings showing extensive, massive brain damage. In group 2 (cases 7-11), in contrast, there are patients with chronic psychoses of remittent course, with brain findings indicative of centrencephalic damage. On superficial examination they give a schizophrenic picture, but can be differentiated from this by the absence of schizophrenic personality changes and thought disturbances, and also by the form of the hallucinations. These are distinguished by their plastic character, and show the criteria which Schröder had already pointed out 60 years ago for the differentiation of exogenous and endogenous hallucinations.

Aged↗
PubMed1987

Hypochondriacal delusions in paranoid psychoses. Course and outcome compared with other types of delusions.

From a large series of patients with delusional psychoses, first-time admitted to the Psychiatric Department, University of Oslo, hypochondriacal delusions were coded as the main delusion in 15 patients (0.4% of all admissions). These patients have been personally followed up by one of the authors (N.R.) after 5-18 years, and by the other author (S.O.) after 23-39 years (mean 30 years). The results are presented, also according to the newer diagnostic systems (DSM-III, DSM-III-R), and the course and outcome of hypochondriacal delusions are compared with those of other types of delusions. Course and outcome are mainly dependent on the diagnostic category, not the type of delusion. It is also demonstrated that the course and outcome in major affective disorders are more favourable than in paranoid disorders, with the latter being significantly different from schizophrenia.

Adolescent↗
PubMed1988

Position of affective symptomatology in the course of delusional psychoses.

The present study investigates the frequency, gender distribution, mode of appearance, and prognostic value of affective symptoms in a group of 90 patients with paranoid disorders of various etiologies (with the exception of marked organicity) who underwent a follow-up control. It appears that affective symptoms manifest more frequently than the brunt of delusional and hallucinatory ones, whereby the pronounced differences in gender (preponderance of females) that appear in acute states disappear in the course of the illnesses. Altogether, the frequency of affective symptoms diminishes just as that of delusions and hallucinations. Paranoic syndromes (simple delusional syndrome with a logically organized structure corresponding to the classical concept of paranoia) are characterized by a particularly frequent occurrence of dysphoric (irritable) mood, systematic and unsystematic paraphrenias by a depressive mood. Delusion subsided in all three delusional entities in about 50% of the cases; however, defect develops in unsystematic paraphrenias more often to a statistically highly significant degree than in the other two forms. Despite the expected low stability of affective symptoms over longer periods of time, the presence of affective syndromes has a high prognostic value, even in a population characterized primarily by the presence of a mood-incongruent delusion. The results of this investigation suggest that Jaspers' hierarchical principle, still important for many diagnostic systems, according to which the presence of delusions and hallucinations is considered to be pathognomonic for schizophrenia and takes priority over any affective ones, be abandoned. The consequence this would have for the theoretical basis of the diagnosis of endogenous psychoses is that apart from affective syndromes only schizophrenic nuclear symptoms would form the basis of nosological diagnosis, and so-called productive symptoms (delusions and hallucinations) would be construed as a superstructure.

Adolescent↗
PubMed1989

Basic symptoms in schizophrenic and affective psychoses.

The study compares schizophrenic and affective psychoses with regard to basic symptoms. 30 patients in schizophrenic pre-, intra-, and postpsychotic basic stages and 30 patients in endogenous-depressive phases were examined according to the Bonn Scale for the Assessment of Basic Symptoms. The most important result is that certain cognitive basic symptoms and cenesthesias which are decisive for the development of florid productive-psychotic phenomena are found more frequently in the group of schizophrenias.

Adult↗
PubMed1989

Course and outcome in delusional psychoses. A 4-year re-follow-up.

The purpose of the study was to examine the 4-year course and outcome in first-admitted patients with delusional psychoses, and to compare the findings with those of a 2-year follow-up. The index population comprised 88 patients. At follow-up one-fifth of the patients revealed positive psychotic symptoms, half of the patients had experienced psychotic relapse, and one-fourth had remitted fully. Compared with the findings 2 years before, some statistically significant changes were disclosed: the number of patients with positive psychotic symptoms had decreased, more patients had frequent social contacts, and more patients had good outcome according to the Strauss-Carpenter outcome scale. The findings suggest that some patients need a couple of years to improve from the clinical and social aftermaths. However, in most aspects, the findings of the 2-year and the 4-year follow-ups are comparable and predict poor course and outcome for the majority, while only a minority of the patients manage fairly well.

Adolescent↗
PubMed1990

Relations between the classification of endogenous psychoses by Leonhard, the doctrine of pathoclisis by Vogt and the neurological conception of system diseases.

On the basis of 30 years of cowork with Leonhard it is attempted to enlighten the theoretical background of his classification of endogenous psychoses. Inspired by the conceptions of Wernicke and Kleist he explained the differentiation of symptomatology by the model of system diseases applying this in completing and improving the psychopathological classification. His ideas about the origin of a differentiated vulnerability of brain structures are very similar to the doctrine of pathoclisis of Vogt, although Leonhard did not use this term.

Germany↗