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PubMed2003

Neuropsychiatric interpretations of postencephalitic movement disorders.

This study reviews the impact of encephalitis lethargica (EL) on concepts of behaviour and movement during the 1920s and 1930s. Clinicopathological correlations were imprecise but supported the role of subcortical structures in complex patterns of motor behaviour. This possibility challenged the widely assumed hegemony of the cerebral cortex. There was a perceived link between involuntary movements and reduced impulse control and also between parkinsonism and a defect in volition. Contemporary observers interpreted postencephalitic phenomena such as oculogyria in psychodynamic as well as in neurophysiological terms. EL also gave some support to the idea that neuroses such as obsessional neurosis and hysteria might have an organic basis. These speculations recently have acquired more credibility. The large amount of literature on EL and its sequelae could perhaps make further contributions to understanding the pathology of voluntary movement and action.

Acute Disease↗
PubMed1975

[The influence of an early brain damage on psychic diseases in adulthood. A study documented by the AMP-system (author's transl)].

The data of 1926 psychiatric in-patients documented by the AMP-system were evaluated with respect to the anamnestic item "early brain damage". There were 82 cases (4.26%). For each patient with an early brain damage a control-case matched for age, sex and diagnosis was selected. Patients with mental handicaps were examined seperately. For methodical reasons the demonstrated frequencies are an underestimation, and subtle differences between index- and controlgroups are not expected to be visible, but those differences which could be found, will be real. The highest frequency for "early brain damage" was found in the diagnostic group which also contained the psychic disturbances in epilepsy. Among neuroses and schizophrenia the item was found with the average-frequency of the total psychiatric population. It was under-represented among affective psychoses and involutional diseases. An early brain damage predisposed to an earlier age of first manifestation, and the psychic disease showed a more chronic course. Hypotheses concerning the uneven distribution over the diagnostic spectrum were discussed with particular emphasis on the fact that hypoxic perinatal disturbances do not lead to diffuse and unspecific consequences, but predominantly to a sensory impairment and possibly to a deficit in the aminergic system. Early brain damage was also discussed as one mode of the transmission of psychic diseases.

Affective Symptoms↗
PubMed1982

[Modification of psychiatric diagnostic schemata by implicit nosological theories].

Diagnostic schemes of psychiatrists are explained by two components, a general explicit nosological theory and an individual implicit theory. An experimental study is devoted to the analysis of diagnostic schemes in three groups with different degrees of internalization of explicit nosological theory: (1) a non-psychiatrist group without nosological knowledge (2) a non-psychiatrist group, who obtained nosological knowledge in a 40-min session, and (3) a group of psychiatrists. Four structural components of diagnostic schemes were analyzed: stability, complexity, relevance for therapy of the individual diagnostic scheme, and interindividual homogeneity within groups. The diagnostic schemes of psychiatrists showed no more stability and relevance for therapy than those of group (2), whereas interindividual homogeneity as well as complexity were higher. Results indicate that the diagnostic schemes of psychiatrists are determined to a great extent by individual implicit theories.

Depressive Disorder↗
PubMed1982

[Evaluation of community care of psychiatric patients. Results of 4 years' scientific association with the building phase of the Mannheim model].

The implementation of a community mental health service in Mannheim (FRG), a city with 315,000 inhabitants, is being evaluated by means of the data of the Cumulative Psychiatric Case Register at the Central Institute of Mental Health. Within a four-year period of extending services for crisis intervention and emergency care, aftercare (sheltered apartments, homes, workshops) and of providing psychiatric beds in the city, the total number of treatment episodes has increased by more than 100% from about 1.1 to about 2.2 per 1000 inhabitants aged over 14, mainly at the out-patient level of care. Admissions to hospital showed an increase of about 40% whereas bed occupancy remained stable at a rate of about 1.7/1000-respectively 1.3/1000 if beds provided by a psychogeriatric nursing home are deducted. This development can be attributed to various factors: (1) A true increase of morbidity may occur mainly in diagnostic groups I.C.D. No.300, 301, 305-308, especially an increase in attempted suicides and in alcohol- and drug-related diseases. (2) The increased provision of help, mainly on the sector of crisis intervention and emergency care and - in diagnostic categories - mainly in minor neurotic disorders, crises, and affective psychoses, has resulted in a large rise in utilization. (3) The continuous decrease of long-term hospital stays, above all in schizophrenic patients, has led to increased utilization of out- and in-patient services in the community when crises and relapses occurred. A comparison of two cohorts of "old" and "new" patients, the latter having accumulated under the conditions of a community mental health service, has shown that these patients are admitted for a long-term hospital stay considerably later and less frequently than formerly, mostly only after several attempts for rehabilitation. In the group of schizophrenic patients, only about 5% of all first admissions stayed in a psychiatric hospital for more than one year in 1979/80. About the year 1900, this group had still amounted to between 60% and 70%. A comparison with evaluations of comprehensive community care systems in other countries shows that there are largely identical trends, although the initial rate for psychiatric beds was comparably lower in Mannheim.

Adult↗
PubMed1978

From measurement to interpretation of change in psychopathology.

The experimental literature on changes in verbal self-report, psychophyiological reactions and overt motor behavior under stress or therapy is reviewed. The concordance of changes across the systems is generally low, their order difficult to predict. The correlation of changes is interpreted to depend--besides crucial methodological issues--on the preparedness of the subject to test and to modify his propositions defining in which situations he might experience certain somato-visceral reactions and emit certain overt motor acts successfully.

Behavior Therapy↗
PubMed1981

[The potential of psychopathological symptoms to differentiate diagnostic groups (author's transl)].

We investigated the extent psychiatric illnesses can be differentiated by means of psychopathological symptoms. The present condition of 2269 patients was analyzed; they had been admitted to the psychiatric clinic of the Free University of Berlin during 1971-1976, as documented by the AMP (PAS) documentation system. The most frequent diagnosis in the sample was schizophrenia (32%), followed by neurosis (22%), affective psychosis (14%), addiction (6.7%), and organic psychosis (6.2%). We could demonstrate that even such diagnostic groups are usually discernible by symptoms, where the differential diagnosis is often difficult. Organic psychosis vs paranoid schizophrenia and depressive neurosis vs depressive psychosis can be determined, but manic syndromes in schizoaffective psychosis vs manic syndromes in affective psychosis are hardly discernible. The potential to differentiate, however, only pertains to diagnostic groups, since many individual patients cannot accurately be classified into diagnostic groups by psychopathological symptoms alone. Only a few symptoms are pathognomonic, and if there are pathogomonic symptoms characterizing a diagnostic group, only a few patients in this group show these symptoms. These results indicate, at least for the high number of patients without severe and typical symptomatology, that we must: 1. Achieve better differentiation on the diagnostic axis "psychopathology" by means of empirically derived syndromes instead of isolated symptoms. 2. Use other diagnostic axes (like etiology and course) for differential diagnostic purposes.

Adult↗
PubMed1982

Some problems concerning the reliability and structure of the scales in the inpatient multidimensional psychiatric scale (IMPS).

Two problems concerning the IMPS are revealed. First, the importance of an appropriate reliability measure is demonstrated in a sample of 124 inpatients. Widely divergent results are found using three different intraclass correlation coefficients. The one producing the highest results was used by Klett and McNair (1966) and by Behrends et al. (1971). However, the results from this measure only apply to certain types of investigation. A measure more applicable to most investigations in psychiatric research (the intraclass correlation coefficient of individual ratings with between-rater variance included) produced results that were clearly lower, although still acceptable, with an average correlation of 0.72 between the 12 scales. Secondly, the multiplication of item scores by 2 or 8 when forming the scale scores is shown to lead to unusual and undesirable scale distributions in a sample of 1932 inpatients. The resulting implications for assessing change scores on some of the IMPS scales are discussed.

Adolescent↗
PubMed1976

[Concepts of psychiatric diagnoses: a further investigation of the reliability of psychiatric diagnoses (author's transl)].

A total of 128 physicians and psychologists, working in six psychiatric hospitals, were asked to allocate 10 psychiatric diagnoses on the basis of typical clinical criteria (symptoms, course of illness, etiological and anamnestic data), with which they were supplied. The correct diagnosis was made in 45.3%, while in 82% the broad diagnostic group was correctly ascribed. The respondents were divided into two groups, according to the amount of diagnostic data they had been given (though in fact the information necessary for differential diagnosis was given equally to both groups). The group which made diagnosis on the grounds of more comprehensive data (ten characteristic diagnostic items) did significantly worse them the group which had few data (six characteristic items). The stereotypes for mania, endogenous depression, obsessional-compulsive neurosis, and antisocial personality disorder were correctly defined by 75% of more of the respondents. The profiles of the remaining six diagnostic groups were associated with the corresponding diagnoses by 50% or fewer of the respondents.

Adjustment Disorders↗