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PubMed2000

Proposal for a new five-axis classification scheme for psychoses of epilepsy.

Based on an overview of the literature and a multicenter study in Japan, we propose a new five-axis classification scheme for psychoses of epilepsy: (1) epilepsy variables, (2) psychopathology variables, (3) ictus/EEG variables, (4) precipitating factors of psychoses, (5) organic background. A total of 128 patients, 63 males and 65 females, with epilepsy and psychoses were recruited from five treatment centers. A wide heterogeneity of psychoses of epilepsy was demonstrated and categorization by a single axis was shown to be inadequate. Cluster analysis revealed four subgroups characterized by their psychopathology, temporal relationship to seizure occurrence, and EEG changes during psychoses. By comparing with the control epileptic group without psychoses, higher rates of mild intelligence disturbance and abnormal findings by brain imaging were proven among the psychotic group. The scheme involves a dimensional representation of individual patients to capture the complexity of their clinical background and to relay clinical information accurately and systematically. It is believed to hold direct therapeutic implications and to contribute to promoting research by enabling accumulation of a large number of patients on a multicenter basis.

Journal Article↗
PubMed2004

Cycloid psychoses are not part of a bipolar affective spectrum: results of a controlled family study.

BACKGROUND: Whereas a growing body of evidence suggests that cycloid psychoses have to be separated from schizophrenic psychoses, their relations to bipolar affective disorder are less clear. To further clarify this issue a controlled family study was undertaken. METHODS: All living and traceable adult first-degree relatives of 45 cycloid psychotic, 32 manic-depressive and 27 control probands were personally examined by an experienced psychiatrist blind to the diagnosis of the index proband. Data about not traceable relatives were collected by the "Family-History"-Method. A catamnestic diagnosis was established for each of the 431 relatives blind to family data. Age-corrected morbidity risks were calculated using the life-table method. RESULTS: Relatives of cycloid psychotic patients showed a significantly lower morbidity risk for endogenous psychoses in general and manic-depressive illness compared to relatives of patients with manic-depressive illness. The familial morbidity risk for cycloid psychoses was low and did not differ significantly in both proband groups. Relatives of cycloid psychotic patients however did not differ significantly from relatives of controls regarding familial morbidity. LIMITATIONS: Our time-consuming methodical procedure implicated a relatively small number of participants due to restricted personnel resources. The restriction to hospitalised probands could possibly cause a limited representativity of the study sample. CONCLUSIONS: Our results suggest that cycloid psychoses are aetiologically different from manic-depressive illness and could not be integrated into a spectrum of bipolar affective disorders. The findings provide further evidence for a nosological independence of cycloid psychoses.

Adolescent↗
PubMed2000

Increase in first admissions for schizophrenia and other major psychoses in Italy.

Despite reports of falling first-admission rates for schizophrenia in some Western countries, methodological problems and bias preclude a definite conclusion about a genuine fall in the incidence of schizophrenia. This study set out to test the hypothesis that first admissions for schizophrenia in Italy have fallen in recent years. All admissions rated as 'first contact' in Italy from 1984 to 1994 for severe mental illnesses to general hospital psychiatric services, as reported in the Italian National Institute for Statistics Health-Care Yearbooks, were considered. Data were analyzed as rates per 100000 in the general population, and changes over time in incidence of schizophrenia, paranoia, affective psychoses and drug-induced psychoses (diagnosed according to ICD 9) were recorded. Changes in rates over time, with rates as the dependent variable and years as the independent variable, were the main outcome measure. First-admission rates for schizophrenia and paranoia increased progressively from 1984 to 1994, as did those for affective psychoses, mania and, to a lesser extent, major depression. In the same period, all admissions (both total and rated as 'first-contact') for mental disorders increased. Although linear regression tests for admission rates in most, but not all, cases indicate a significant ascending linear trend, quadratic model results show a significantly better fit than does the simple linear regression model for the majority of data. The change described by the quadratic model suggests an increase in admission rates more marked in the second half than in the first half of the period of the study. First-admission rates for schizophrenia and, to a lesser extent, paranoia seemed to increase concurrent to a decrease in first-admission rates for 'other' non-organic psychoses. Contrary to reports from other Western countries, hospital incidence in Italy for schizophrenia is on the increase, as is that for other severe psychoses. This increase is likely to be a reflection of changes in mental health-care organisation, in treatment and diagnostic patterns, and in cultural attitudes towards mental illness. Radical changes in the true incidence of psychoses, in particular of mood disorders, as described elsewhere, cannot be ruled out as contributing factors. Data bias and limitations preclude a generalisation of results, however.

Adolescent↗
PubMed1977

Demographic aspects of functional psychoses in Canada.

Canadian national data for functional psychoses (classified as schizophrenia, effective psychoses, paranoid states and reactive psychoses) are analyzed for age, sex, marital status, expectancy for first admissions and length of stay for discharges. Differences are found such that each psychosis can be distinguished from the others, thus providing indirect evidence supporting the use of the different diagnoses. The demographic characteristics of reactive psychoses from North American data have not been previously described, and are found to be similar to Scandinavian descriptions. Sex ratios for subgroup diagnoses whow similarities between catatonic schizophrenics, manic (bipolar) affectives, and reactive psychoses. Schizoaffective psychoses resemble affectives more than schizophrenia, and paraphrenia is similar to affectives. Total expectancies for functional psychosis (4.4% for males, 5.5% for females) are similar to Scandinavian figures, but the distribution by diagnosis differs, perhaps representing different diagnostic practices, but generally similar sex ratios and high rates in single persons are found.

Adolescent↗
PubMed1985

Implications of the distinction between organic and functional psychoses.

On the basis of their symptomatology, some psychoses are called organic. The remaining psychoses are called functional. It is generally supposed that symptomatically organic psychoses have organic causes and thus call for medical investigations, while the functional psychoses are not so caused, and call for a dynamic formulation rather than an organic one. The author examines the basis for this distinction, and argues that it is logically unsound. He gives examples of exceptions to the rule, both organic-seeming illnesses that are the consequence of psychological mechanisms, and symptomatologically functional psychoses with organic antecedents. The exceptions prove to be so numerous that a different approach to the investigation of the psychoses, an approach stressing antecedents rather than symptomatology, appears to be called for.

Diagnosis, Differential↗
PubMed1999

The fertility and fecundity of patients with psychoses.

OBJECTIVE: Previous research has suggested that patients with schizophrenia have fewer offspring compared to the general population. Reduced fertility in a disorder with a strong genetic component and an apparently stable incidence has implications for models of genetic transmission. There is also a need to obtain contemporary estimates of the prevalence of parenthood among subjects with psychotic disorders in order to inform service planning. The aim of this study was to determine the fertility and fecundity of a representative sample of individuals with psychoses who were in contact with mental health services, and to explore the interactions between age at first diagnosis and fertility. METHOD: All clients of two community mental health clinics and an extended-care psychiatric hospital were surveyed. Data on diagnosis, age at first diagnosis, and the number and age of offspring were collected. Based on interviews with the proband and chart review, a genogram of the probands' family was drawn that identified sex, age, affected status and the number of offspring for each patient and their siblings. RESULTS: In total, 36% of all patients were parents. Most women with psychoses (59%) were mothers. Patients with psychoses had fewer offspring compared to their unaffected same-sex siblings. This was especially the case for men with non-affective psychoses. Higher levels of fertility were associated with a later age at first diagnosis. CONCLUSION: The consistent finding of reduced 'reproductive fitness' in those with non-affective psychoses needs to be incorporated in the genetic epidemiology of these disorders. Despite this reduction in fertility and fecundity, many patients with psychoses are parents. Services need to remain mindful of the special needs of these patients.

Australia↗
PubMed2004

Classification of functional psychoses and its implication for prognosis: comparison between ICD-10 and DSM-IV.

BACKGROUND: The aim was to examine the agreement and differences between ICD-10 and DSM-IV in the classification of functional psychoses. SAMPLING AND METHODS: In a sample of 218 first-hospitalised patients, ICD-10 diagnoses were compared with DSM-IV diagnoses. Functional psychoses of both diagnostic systems were classified into the four diagnostic groups schizophrenia, transient/episodic psychoses, delusional disorders and affective disorders. Based on information from a 15-year follow-up, it was examined which course is associated with each diagnostic group. RESULTS: Although in ICD-10 there was a higher frequency of schizophrenia and a lower one of affective disorders, a high agreement between ICD-10 and DSM-IV (kappa value of 0.82) was found. In both diagnostic systems, transient/episodic psychoses and affective disorders were mainly associated with a non-chronic course and schizophrenia was mainly associated with a chronic one. Nevertheless, several patients with transient/episodic psychoses showed a chronic course (ICD-10: 10%, DSM-IV: 15%) and more than one third of patients with schizophrenia a non-chronic one (ICD-10: 40%, DSM-IV: 33%). CONCLUSIONS: In the cross-sectional assessment, there is a high diagnostic agreement between ICD-10 and DSM-IV. With respect to the long-term course, the delimitation of transient/episodic psychoses from schizophrenia was neither completely achieved by ICD-10 nor by DSM-IV.

Adult↗
PubMed1983

Paranoiac psychoses: a follow-up.

74 patients with paranoiac psychoses were followed up. Paranoiac psychoses are characterized by affect-laden delusions, resemble the paranoias of Kraepelin, but have a better prognosis. 18 cases appeared to show a chronic course of illness, but only 1 case needed prolonged hospitalization in a mental hospital. Paranoiac psychoses are considered benign insofar as they have a nonschizophrenic long-term outcome. They resemble schizophrenic psychoses because the familial loading of psychoses is predominantly schizophrenic. To a great extent, the clinical picture revealed typical schizophrenic symptoms at the onset of the illness, so that at discharge from hospital there were often doubts as to whether psychoses should be classified as schizophrenias.

Aged↗
PubMed2000

Low prevalence of psychoses among the Hutterites, an isolated religious community.

OBJECTIVE: The authors estimated the prevalence of psychoses among the Hutterites in Manitoba, Canada, who lived in 102 communal farms or colonies. The study stemmed from an earlier epidemiological survey of North American Hutterite colonies (1950-1953), in which a low prevalence of psychoses was documented. METHOD: Psychiatrically ill individuals identified during the previous survey were rediagnosed with DSM-IV criteria. A current provincial health insurance claims database was queried anonymously for the period June 1992-May 1997, and the prevalence rate of disease among Hutterites, identified by distinctive surnames and unique postal addresses, was compared with the rate in the entire population of the province of Manitoba and in a comparison group of persons with Hutterite surnames but with addresses outside the Hutterite colonies. RESULTS: The annual prevalence of schizophrenia among the communal Hutterites, estimated from the database search by using ICD-9 criteria, was consistent with the prevalence found in the prior epidemiological survey (annual mean of 1.2/1,000 population, compared with 1.3/1,000 in the prior survey). The database search yielded a significantly lower prevalence for schizophrenia and other functional psychoses among communal Hutterites as well as among the comparison group, compared to the total Manitoba population. There was also lower prevalence for affective psychoses and adjustment reaction disorders among the communal Hutterites, compared to the total Manitoba population. Rates for neurotic disorders were elevated both among the communal Hutterites and the comparison group. CONCLUSIONS: The prevalence of specific psychoses was reduced among the Hutterites, although neurotic disorders were more prevalent. These findings suggest some specificity, although possible artifacts such as ascertainment bias must be considered. Further research is needed to examine genetic and environmental factors that may contribute to reduced prevalence of specific psychoses among the Hutterites.

Age of Onset↗
PubMed1975

[Disturbances of orientation with functional psychoses (author's transl)].

It was supposed by clinical impressions that disturbances of orientation do not appear only in severe degrees of a transit-syndrome, but also in the light stadium of such a physically founded psychosis. In order to verify these impressions, a questionnaire was developed which permitted an objective scoring. This Q-Test consists of 37 questions (items), which measure the orientations of time, space, situation, and person. On the base of this questionnaire two samples were tested, the one consisting of 50 patients with functional psychoses (reversible physically founded psychoses), the other consisting of 50 patients with only neurological disturbances. The degree of the functional psychoses was determined by the "Syndrome-Test" (F. Bocker, 1959). The range of the scores corresponded with the clinical categories from a low degree of the transit-syndrome to a medium degree of disturbances of consciousness. The scoring was based on an standard system derived from the results of the control group (patients with only neurological disturbances). The clinical impressions could be verified by empirical and statistical methods. According to the test results, disturbances of orientation already appear during the light stadium of the transit-syndrome. Furthermore there is a high significant correlation (p. less than 001) between the degree of the functional psychoses and the degree of the disturbances of orientation. This applies to all categories of orientation. The orientation concerning time, space and situation proved to be more susceptible to disturbances than the orientation concerning the person. The very close correlation between the degrees of the functional psychoses and the degrees of the disturbances of orientation make it possible to determine the stadium of the functional psychoses promptly. The complete and very handy "short-time-test" will be published in a special paper.

Consciousness Disorders↗
PubMed1975

[Childhood psychoses. Classification and clinical picture].

The classification of childhood psychoses formulated by the "Group for the Advancement of Psychiatry" (G.A.P.) is reviewed. Infantile psychoses are divided into three groups: A) Psychoses in infancy and early childhood. B) Psychoses in late childhood. C) Psychoses in the adolescence. The second part of this paper describes the different clinical pictures of infantile psychoses, including case histories.

Autistic Disorder↗
PubMed1987

[Differential diagnosis and different etiologies of monopolar and bipolar phasic psychoses].

Monopolar and bipolar phasic psychoses can be differentiated not only on the course but also on the symptom pattern. This applies also to the euphoric forms which usually are still assigned to Manic-depressive illness. The differential diagnosis is presented. Aetiology is completely different in the monopolar and the bipolar phasic psychoses. Manic-depressive illness has a hereditary basic, whereas in the monopolar ("pure") forms loading is very low. Particularly few psychoses among the relatives have been found in the euphoric forms which demonstrates their independency for if they would belong to Manic-depressive illness they necessarily would show the heavy genetic loading of this bipolar illness. In the pure phasic psychoses external causes were detected when we focused on the sibships in which the probands had grown up. The euphoric patients had relatively many older siblings, the depressive ones relatively few older siblings. A similar difference was found in two cycloid psychoses. Transcultural observations as well as shifts in the incidence rate of the psychoses in our times confirmed our results. Prophylactic measures can be derived.

Bipolar Disorder↗
PubMed1983

Schizophrenia-like psychoses associated with organic cerebral disorders: a review.

This review aims to collate some of the extensive literature on the schizophrenia-like psychoses occurring in association with organic cerebral disorders. Their relationship to "true' schizophrenia is considered clinically, genetically and conceptually. The conclusions reached are as follows: The association of many organic cerebral disorders with schizophrenia exceeds chance expectation. Although there may be group differences, these psychoses include a range of symptoms similar to those found in the general run of psychoses diagnosed as schizophrenia. These psychoses usually occur in patients without genetic loading for schizophrenia. Organic cerebral disorder occurs in a substantial minority of patients diagnosed as schizophrenic and is of particular importance in the psychoses of childhood and old age. The site of the brain lesion is more important than the predisposition of the patient in the genesis of these psychoses, and lesions in the temporal lobe and diencephalon are of particular significance.

Basal Ganglia Diseases↗
PubMed1984

[Psychogenic psychoses].

The term psychogenic or reactive psychosis is used to describe a psychotic state which is experience-related and triggered by a precipitating event. Experimental studies have confirmed that under total sensory deprivation man responds by exhibiting psychotic reactions within a short time. Emotion psychoses, brief reactive psychoses are psychotic reactions due to an emotional shock. They usually go beyond the usual pathological psychoreactions in terms of quality, intensity and duration. Emotion psychoses show schizophrenia-like symptoms; the duration of illness varies from a few hours to several weeks. Emotion psychoses are observed in other cultural groups, too. Two case reports are mentioned. The differential diagnosis of emotion psychoses, of psychotic reactions induced by extreme situations, and the question whether chronic psychoses may have psychogenic causes, are discussed.

Adjustment Disorders↗
PubMed1983

Is the concept of 'schizo-affective psychoses' prognostically of value?

The concept of 'schizo-affective psychoses' covers favourable as well as unfavourable forms of endogenous psychoses. Thus, it does not help us for a nosological classification which must also allow for the prognosis. In order to make a prognostic distinction we have to subdivide the schizo-affective psychoses into the 'cycloid psychoses' and the 'non-systematic schizophrenias'. Also the latter display affective symptoms and can take a bipolar course, but, despite this, tend to deterioration; they do so increasingly shift after shift, whereas the cycloid psychoses completely recover after every phase. Even during the first phase or shift a reliable differential diagnosis can be made. This has been confirmed by follow-up examinations, as the cycloid psychotics, in fact, had recovered. Only very few misdiagnoses could be detected. If we want to classify prognostically, we must separate the cycloid psychoses from the true schizophrenias.

Bipolar Disorder↗
PubMed1980

[Incidence and features of the clinical picture of psychoses with an attack-like course].

A comparative epidemiological study was performed in 3 groups of affective psychoses: manic-depressive psychoses (25,8%), periodical schizophrenia (59,5%), and attack-like organic psychoses (14,7%). In the group of endogenous psychoses there was a predominance of females (60% and 61%), while in the group of organic psychoses of males (77%). Psychotic conditions, remissions, late states of organic attack-like psychoses (schizophrenoform, bipolar, depressive) are described.

Adult↗
PubMed1977

[Concept determination and classification of the so-called epileptic psychoses].

Some concepts and classifications of the epileptic psychoses are discussed with special regard to their capacity of being integrated into a multiconditionel view. In epileptics, too, the term of "psychosis" should no longer be connected to the axiom of the somatic origin of the psychic syndrome. The term of "twilight state" should be reserved to those among the epileptic psychoses which go along with troubles of consciousness. The socalled episodic morbid moods of the epileptics are no more merely to be understood as psychoses of somatic origin. They may as well develop as a psychic reaction. If one conceptualizes the psychic troubles of the epileptics as "transient syndrome" (Durchgangssyndrom), as functional psychosis, or as psychosyndrome originating from local or diffuse brain damage, their classification must be limited to the undoubtedly somatogenic psychoses. The term of "epileptic psychosis", however, includes the somatogenic, endogenic, as well as the psychogenic psychoses of the patients with epilepsy. The question of the psychogenesis of schizophrenia-like, maniac or depressive psychoses in epileptics until now cannot be answered because the psychosocial patterns which might condition them have not jet been investigated upon. Anyhow, the exclusive psychogenesis of a schizophrenialike epileptic psychosis leaves to be proved.

Catatonia↗
PubMed1999

Epileptic psychoses and anticonvulsant drug treatment.

Forty four consecutive patients with epilepsy and psychoses were studied retrospectively for psychotic episodes associated with changes in antiepileptic drug therapy. Twenty seven patients (61%) developed their first episode of psychosis unrelated to changes in their antiepileptic drug regimen. Twenty three of these patients developed psychoses with temporally unrelated changes in seizure frequency. Many patients had chronic schizophrenia-like psychotic symptoms. Seventeen patients (39%) developed their first episode of psychosis in association with changes in their antiepileptic drug regimen. Twelve patients developed psychoses temporally related to seizure attenuation or aggravation. Many of their psychotic symptoms were polymorphic with a single episode or recurrent episodes. No marked differences were found in the various clinical backgrounds between the two groups. In the drug-related group, seven patients developed psychoses after starting add-on therapy with a new antiepileptic drug, six after abruptly discontinuing their drugs, and four after taking an overdose of antiepileptic drugs. Based on the present findings, drug regimens should be changed gradually and compliance should be maintained to prevent epileptic psychoses.

Adult↗