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PubMed1975

[Psychoses in epilepsy--classification and EEG-studies (author's transl)].

It is necessary to classify the epileptic psychoses before starting a comparative study between psychopathological and electroencephalographic findings. The knowledge of the epileptic psychoses is at the moment too incomplete for a systematic order following aetiological or topic aspects. The traditionally system of epileptic psychoses distributes in chronic and episodic, phasic, especially circular, reversible and irreversible psychopathological manifestations. We differentiate psychotic states with or without disturbances of consciousness. Well-known in EEG studies of symptomatic and endogenic psychoses is, that in these psychoses the same clinical syndrom can be related to normal and to pathological electroencephalographic findings. This contradiction could often be explained when the activity of the psychoses was taken into consideration. The activity of the psychoses is to be determined by the duration, number, intensity and variability of the psychopathological symptoms. From his own investigations from 30 patients with schizophreniform epileptic psychoses, episode affective disorders and both depressive and manic psychoses, it could be shown, that normal EEGs are markedly infrequent. Most often they occur in subacute schizophreniform epileptic psychoses. The EEG of active and particularly of schizophreniform epileptic psychoses is most often characterized by simultaneous appearance of sharp waves, paroxysmal dysrhythmias and abnormal rhythm formations. Active schizophreniform psychoses correlate usually with abnormal rhythms. These abnormal rhythms ("parenrhythmien") diminish parallel with loss of activity of the psychotic process, are correspondingly seldom seen in subacute psychoses, and are not demonstrable in inactive psychoses. The experience of an alternating correspondence between epileptic psychoses and frequency of seizures could be confirmed.

Acute Disease↗
PubMed1983

[Psychopathology and differential diagnosis of so-called Cannabis psychoses].

From 237 patients examined for drug-induced psychoses, 50 cannabis psychoses were examined according to the criterion "main cause of addiction" and 107 were examined according to the criterion "consumption during the last three months before hospitalization". The cannabis psychoses were compared to the other drug-induced psychoses as well as to a control group consisting of 219 schizophrenic patients. General agreement was found with the other drug-induced psychoses as well as with the group of schizophrenic patients. The variation from the symptomatology of the schizophrenics is generally common to both the cannabis psychoses and the other drug-induced psychoses. Judging by the results of our investigations, it must be concluded that there is no disease "cannabis psychosis" in its own right, just as the disease "drug-induced psychosis" also does not exist in its own right. While there is a certain slight drug-specific psychopathological undertone, it does not entitle us to speak of a syndromatic or indeed a nosological entity. The psychopathological cross section does not permit a differentiation in the individual psychoses groups mentioned, although this has often been attempted in the literature. That there are no relevant psychopathological differences between cannabis psychoses and endogenous schizophrenia could, for one, be based on the fact that we are observing the final stage of one and the same underlying pathological process. In this case both syndromes would in practice be endogenous psychoses, with the cause not being known in one case. The psychopathologic similarity of these two psychoses forms could, however, also be based on the assumption that cannabis psychoses are triggered schizophrenias, so that we could in both cases be dealing with one and the same disease. We see the solution to the problem of diagnosing symptomatic psychoses, and in particular cannabis psychoses, in making a diagnosis that takes the etiology into consideration in addition to the syndrome diagnosis.

Adolescent↗
PubMed1995

Epidemiology, diagnosis, and course of brief psychoses.

OBJECTIVE: This study investigated acute and nonacute brief psychoses. On the basis of previous work, the authors proposed that 1) acute brief psychoses occur predominantly in females, 2) they often do not conform to the diagnoses of DSM-III-R, 3) they are temporally stable, and 4) nonacute brief psychoses do not share these distinctive features. METHOD: The data are from a follow-up study of 221 first-admission patients with affective and nonaffective psychoses. Patients were given extensive assessments at initial evaluation, 6-month follow-up, and 24-month follow-up. The research team made consensus ratings of the presence of psychosis, DSM-III-R diagnosis, mode of onset of disorder, and course of disorder. Brief psychoses were defined by a diagnosis of nonaffective psychosis at the initial evaluation and a rating of full remission at 6-month follow-up; acute brief psychoses met the additional criterion of acute onset as defined by ICD-10. RESULTS: Twenty (9%) of the 221 psychoses were brief psychoses. Only seven (3%) were acute brief psychoses, but among these, six occurred in women, five were undiagnosable, and none had evolved into an affective disorder or a chronic disorder by the time of the 24-month follow-up. The 13 nonacute brief psychoses did not exhibit distinctive features, and five of them later evolved into chronic disorders. CONCLUSIONS: Acute brief psychoses emerged as a highly distinctive and temporally stable form of psychosis that may merit a separate diagnostic classification. The more numerous nonacute brief psychoses may represent mild forms of nonaffective psychoses such as schizophrenia.

Acute Disease↗
PubMed1975

[Nosological aspects of paranoid psychoses].

The author stresses the lack of nosological entities in psychiatry, and also the necessity of a classification system. Paranoid symptoms are found in most types of psychoses, both functional and organic psychoses. Among the functional psychoses the schizophrenias often have a paranoid picture, and paranoid traits may be found even in the affective psychoses. The Scandinavian concept of reactive psychoses is presented, including reactive psychoses is presented, including reactive psychoses of paranoiac, paranoid and schizophreniform type. Finally, the author presents his own personal follow-up study of paranoid psychoses after an observation time of 5-18 years. This study demonstrates 81% cured, of the patients with the discharge diagnosis of reactive psychoses, as against 23% cured, of the patients with the discharge diagnosis of schizophrenia. The author suggests a continuum of the paranoid psychoses from the schizophrenias via the schizophreniform and paranoid reactive psychoses to the more affective psychoses with slight tendency to paranoid symptomatology.

Humans↗
PubMed1996

The concept of 'atypical psychoses': special reference to its development in Japan.

Reviewing the development of concepts of 'atypical' psychoses in European countries and in the United States shows that there are various terminologies which are given to a group of psychoses unclassifiable within Kraepelinian dichotomy. Bouffée délirante (French school), cycloid psychoses (Leonhard, Perris), reactive psychoses (Scandinavian school) and acute schizoaffective psychoses (Kasanin) are the most common terms. These are consistent in terms of acute onset, polymorphic symptomatology and good prognosis, and are considered to be distinct from major psychoses, especially from typical schizophrenia. The concept atypical psychoses in Japan was developed under the influence of Mitsuda's clinico-genetic studies. According to Mitsuda, atypical psychoses are not mere phenotypical variants of typical schizophrenia and manic-depressive psychosis (MDP) but belong to a genetically different category and are probably heterogeneous. The characteristic features in the Japanese concept of atypical psychoses emphasizes the alteration of consciousness in symptomatology and pays attention to the nosological relationship with epilepsy, as well as with schizophrenia and MDP. Thus, in Japan it is generally considered that atypical psychoses are independent of 'typical' major psychoses and are located nosologically in the border area between typical schizophrenia, MDP and epilepsy.

Adolescent↗
PubMed1989

Phasic and process psychoses: a polydiagnostic comparison among the Frankfurt Classification System, DSM III, RDC, Feighner criteria and ICD-9.

The classification of endogenous psychoses is a controversial sector of psychiatry. Differences with regard to the evaluation of course and outcome contribute to this controversy. The course and outcome of a psychiatric illness are basic to the Frankfurt Classification System (FC) of endogenous psychoses. The main groups are process and phasic psychoses (typical and atypical). A third group, encompassing cases which could not be definitely classified at the time of examination, is entitled 'nonclassified endogenous psychoses'. This system was outlined according to the AMDP system and SANS using the cases of 100 patients admitted to the hospital (aged 18-86 years; 57 men, 43 women) and compared with four classifications (ICD-9, RDC, DSM III and Feighner). The listed definitions do not state whether or not a defective symptomatology is absolutely irreversible. Most of the atypic-phasic psychoses of the FC (50-78%) were schizoaffective psychoses according to the other classifications (Feighner, RDC, ICD-9) and most of the process psychoses (85-97%) were schizophrenias according to Feighner, ICD-9, RDC and DSM III. The major reason for the great correspondence (97%) between process psychoses (FC) and DSM III schizophrenias appears to be that 85% of the sample consisted of chronic and not subchronic schizophrenic disorders according to DSM III. On the other hand, about 45% of the ICD-9 and RDC schizophrenias (principally acute and subacute) were not diagnosed as process psychoses according to the FC. In the case of the typic-phasic psychoses, there was almost complete agreement with the other diagnostic systems. Most of the cases in which classification into the group 'process' or 'phasic psychosis' was unclear were diagnosed as schizophreniform disorders according to DSM III (70%) or into nearly equivalent groups according to RDC or ICD-9. Nonetheless, complete equivalency among these similar groups was not possible. In the context of some research aims (e.g. definitions of phenomenological or biological parameters), a classification system based on clearly-defined inclusion and exclusion criteria of such concepts as phasic and process psychoses (in shifts or insidious) is methodologically useful. The FC is suggested as a step in this direction.

Adolescent↗
PubMed1995

Postictal and chronic psychoses in patients with temporal lobe epilepsy.

OBJECTIVE: This study sought to elucidate the relation of clinical, neuropsychological, and seizure variables to chronic and postictal psychoses in patients with temporal lobe epilepsy. METHOD: Forty-four patients with treatment-refractory temporal lobe epilepsy were given formal psychiatric evaluations; 29 patients had no psychiatric disorder or a nonpsychotic disorder, eight patients had postictal psychoses, and seven patients had chronic psychoses. Comparisons of clinical, neuropsychological, magnetic resonance imaging, and seizure variables were made between the nonpsychotic and the psychotic patients and, secondarily, between the patients with transient postictal psychoses and those with chronic psychoses. RESULTS: Bitemporal seizure foci, clustering of seizures, and absence of febrile convulsions were associated with both postictal psychoses and chronic psychoses. Younger age at onset of epilepsy and lower verbal and full-scale IQs differentiated the patients with chronic psychoses from those with postictal psychoses. CONCLUSIONS: Patients with temporal lobe epilepsy with chronic and postictal psychoses show similar profiles of clinical and seizure variables, suggesting shared etiologic factors. These factors may increase the propensity to develop psychotic symptoms, while other factors, such as time of onset of epilepsy and underlying neuropathology, may determine whether transient or chronic psychotic symptoms develop. Even among patients with treatment-refractory temporal lobe epilepsy, a specific subgroup of patients, characterized by bitemporal seizure foci, an absence of febrile convulsions, and a history of clustering of seizures, appears to be particularly prone to develop psychotic disorders. A process similar to secondary epileptogenesis may be involved in the development of the psychoses.

Adult↗
PubMed1994

The validity of the Scandinavian concept of reactive psychoses.

The historical background of the Scandinavian concept of reactive psychoses is presented. The reactivity concept consists of several elements. There has to be a traumatic life event of psychological or somatic nature but its duration can be discussed. What is the time lag between the life event and the psychotic reaction? Some say one week, others up to one year. Is a personal disposition (vulnerability) a necessary condition for the psychotic reaction? Are emotional turmoil or non-organic confusion specific symptoms of the reactive psychotic reaction? Does the psychotic reaction have a meaning as an escape or a defense? What is the duration of the psychosis in relation to the duration of the life event? Does reactive psychoses always imply full recovery (good outcome)? The various editions of the ICD- and the DSM-classification include some of these features in their definition of reactive psychoses. Scandinavian experts also emphasize various aspects in their descriptions of these psychoses. Studies have shown that reactive psychoses can be diagnosed reliably. Work on the operatinalization of "reactivity" is under way. In the Scandinavian tradition there is a diagnostic shift from reactive psychoses to schizophrenia in later admissions. Generally, the reactive psychoses have a good outcome, and the outcome is significantly better than for schizophrenia and as good as for manic-depressive psychoses. Most cases of reactive psychoses are treated with neuroleptic drugs for some months. Electroconvulsive treatment is rarely given for reactive psychoses. Scandinavian psychiatrists think that DSM-IV and ICD-10 have not taken the concept of reactive psychoses seriously, and that research work has to be done to convince international psychiatry of the value of the concept.

Humans↗
PubMed1990

Switch processes and rapid cycling in bipolar affective disorders, cycloid psychoses and nonsystematic schizophrenia.

Leonhard conceived a hierarchical classification system for endogenous psychoses consisting of a small number of vast, clinically heterogenous main categories. These are subdivided into more homogenous and narrower subcategories: Bipolar affective psychoses, cycloid psychoses and unsystematic schizophrenias are subcategories of a main category of psychopathologically polymorphic, episodic bipolar psychoses. Common features of these related forms of psychoses are syndrome lability, bipolarity and switching. Rapid cycling is a course complication in bipolar affective psychoses as well as in cycloid psychoses and in nonsystematic schizophrenias. Empirically established ideal types of idiopathic psychoses are the foundation of psychiatric classification systems, not only in Leonhard's classification, but also in others. In the description of the features of diagnostic categories based on psychotic ideal types, Leonhard accounted for the low degree of diagnostic specificity of isolated symptoms in so far as he recognised that in bipolar affective psychoses, in cycloid psychoses and in unsystematic schizophrenias intra-episodic syndrome-dynamical features are of greater diagnostic importance. The phenomenon of intra- and interepisodic syndrome lability as a dynamic feature finds its strongest expression in the switch processes.

Bipolar Disorder↗
PubMed1979

[Acute pharmacotoxic psychoses in patients with chronic cerebral disorders].

269 patients suffering from progredient, chronic either primary or secundary cerebral diseases (Parkinson's disease, cerebral vascular diseases, cerebral atrophic dystrophy, Huntington's chorea, muliple sclerosis have been studied in the last two years. 44 of these patients developed pharmaco-toxic psychoses during drug treatment (low and medium dosis). The psycho-pathological rating resulted in an acute organic brain syndrome with predominance of confusion, sometimes progressing to delirium. EEG was changed during the psychotic stage. These changes cannot be decided from organic psychoses, which are not related to drugs. Patients with Parkinson's disease showed a relatively high incidence to psychoses during drug treatment (51.47%). In patients without Parkinson's disease, but on treatment with antidepressants, neuroleptics, diuretics and digitalis, pharmacotoxic psychoses only could be observed in 4.4% of the patients. However, the same group of patients showed an acute organic brain syndrome in 12.43%, when not on treatment. Combined treatment with L-DOPA plus peripherally acting decarboxylase inhibitors resulted in a high incidence to psychoses in idiopathic Parkinsonism but the same dosis produced this side effect only in a few patients with cerebral atrophic dystrophy. The ratio was 5:1 between the former group and the later one. That means, that L-DOPA is a much more psychotoxic substance in Parkinsonism when compared to other cerebral diseases. These pharmacotoxic psychoses could be correlated with the progredience of the disease. These pharmacotoxic psychoses are not only dependent from age and duration of treatment. Evidence exist, that there might be a correlation between the incidence for pharmacotoxic psychoses and the lack of surviving dopaminergic neurons in the nigro-striatal areas. Treatment with very low doses of neuroleptics suppresses pharmacotoxic psychoses but allow a further anti-Parkinson therapy which is of vital necessity.

Aged↗