ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Schizoaffective disorders should be divided by polarity. Much of the data on schizoaffective mania indicate that most cases are very similar in symptomatology, course, family history, and response to treatment to bipolar affective disorder patients. They may be the most severe episodic affective disorder patients. A few are probably excited schizophrenics. The data on the Schizoaffective depressed patients are far more confusing. No clear data emerge from these studies, except when using biological markers of sleep and dexamethasone suppression on these patients. Future work must be concentrated on these patients.

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The concept of “a motility psychosis” was introduced by Wernicke at the turn of the century in opposition to Kraepelin's “two entities principle.” The term cycloid psychosis was utilized by Kleist in 1926 for this group, which was further subdivided into “anxiety-elation,” “confusion,” and “motility” psychoses by Leonhard. This diagnostic concept is presently used in Germany and Scandinavia, but two recent British investigations have shown that similar patients occur in London, where they comprise 8 to 10 per cent of admissions for acute psychosis. The diagnosis depends on the presence of “confusion” or a polymorphic disease picture with a mixture of affective and schizophrenic symptoms, often rapidly changing from one to the other. Some of these patients would be diagnosed as mania, others as schizophrenia in Britain and as schizoaffective or mood-incongruent affective disorder in the United States.Follow-up of the London patients showed that the cycloids had an exceptionally good prognosis—much better than schizophrenia, and at least as good as manic-depressive patients, but their clinical picture did not correspond to the group of patients diagnosed as suffering from bipolar affective disorder. However, there is some evidence to suggest a relationship between cycloid and manic-depressive disorders, including the beneficial effect of electroconvulsive therapy (ECT) and lithium in both the cycloid patients and the bipolar affective disorder patients.American psychiatry has recently decided to adopt a very strict view of schizophrenia, limiting the diagnosis to patients with hebephrenia or chronic paranoid hallucinatory psychoses. This will leave a large group of patients previously considered to be suffering from “acute schizophrenia” who fit very awkwardly into the category of the affective disorders. It is from this group that cycloid patients are recruited so that the concept may enable psychiatrists to collect and study a fairly homogeneous group which was previously scattered among several widely different diagnostic classes.

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Scandinavian psychiatrists have been pre-eminent in elucidating the concept of reactive psychoses. This diagnosis has never found much acceptance except in Scandinavia, and the newDiagnostic and Statistical Manual of Mental Disorders, 3rd Editioncategory of brief reactive psychosis is quite different from reactive psychosis as described by most Scandinavian clinicians and researchers. The concept of psychogenic psychoses is, however, not new. Indeed, many psychiatrists of the early 20th century stressed the psychogenic factors in psychotic mental disturbances. Reactive psychoses have generally been considered illnesses distinct not only from schizophrenia but also from manic-depressive psychosis with a distinctive genetic component.Of 283 hospitalized patients at Johns Hopkins for whom long-term follow-ups were available and of whom all were first admissions, Astrup retrospectively diagnosed 91 as reactive psychoses. A contrasting group of 78 “systematic schizophrenics” by Leonhardt's criteria were identified. Stephens found that these two groups differed significantly in that the reactive patients had a) a more acute onset, b) more precipitating stress, c) more affective symptoms, d) more confusion, e) less affective blunting, f) a better premorbid adjustment, g) less premorbid schizoid traits, h) fewer schizophrenic relatives, and i) a much more favorable long term outcome.

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The episodic disorders can be clearly differentiated from schizophrenia as now rigorously defined inDiagnostic and Statistical Manual of Mental Disorders, 3rd Edition.Because the affective disorder is a more heterogeneous one, the boundaries between this group and episodic disorders is less precise, but this boundary could be clarified with a rigorous definition of the affective disorders comparable to that utilized for schizophrenia. The acute mode of onset and the remitting course are the most useful differentiating features between schizophrenia and the episodic disorder. The presence of toxic or other organic symptoms, including clouding of sensorium, illusions, visual hallucinations, formes frustes of epilepsy, childhood history of minimal brain dysfunction or attentional deficits, and soft neurological signs, aid in differentiating the episodic disorders from manic and depressive episodes.There is a subgroup of episodic disorders that can be differentiated from the epileptoid or organic episodic disorders as well as from the major psychoses by psychodynamic factors alone.

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A careful study of 106 patients, diagnosed as borderline using the criteria of theDiagnostic and Statistical Manual of Mental Disorders, 3rd Edition, is in progress at a private psychiatric facility. Three distinct Subcategories of the borderline personality disorder have been identified: history of no organicity, history of trauma, encephalitis, or epilepsy, and history of attentional deficit disorder/learning disabilities. A discriminant function analysis approach clearly distinguishes the three borderline Subcategories from one another and from a schizophrenic control group. Borderline patients also show significant sex differences. The borderline personality disorder is viewed as either on a continuum with affective disorders and atypical psychoses, or with organic brain dysfunction including the episodic dyscontrol syndrome and/or adult minimal brain dysfunction. Future research should be directed toward further classifying homogeneous subgroups of borderline patients in order to provide more specific and effective treatment.

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This paper reports the neurological findings in 286 patients with a history of recurrent attacks of uncontrollable rage occurring with little or no provocation and dating from early childhood or from a physical brain insult at a later date.Objective evidence of developmental or acquired brain defects was found in 94 per cent. The most common abnormality was minimal brain dysfunction, which was present in 41 per cent. The diagnosis was not made on behavioral symptoms alone; there had to be positive neurological and/or laboratory evidence (electroencephalogram, computerized axial tomography scan, x-rays, psychological tests). The most common symptom apart from episodic dyscontrol was complex partial seizures which had occurred at some time in the life of 30 per cent of the patients. In many the seizures had not been recognized as epileptic because of their subtle form and rare occurrence. Convulsions and dramatic attacks with unconsciousness were rare.One third of the patients presented a variety of psychiatric disorders persisting for days, weeks, or months in addition to episodic rage. Another type of periodicity was exhibited by women whose episodes occurred solely or mainly in the premenstrual week. Detection of both adult minimal brain dysfunction and complex partial seizures requires detailed and well informed interrogation because many of the symptoms are far from obvious and are unlikely to be uncovered by a superficial medical history or neurological examination.

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Kraepelin used a disease entity concept to define the two major functional psychoses (i.e., distinctive patterns of onset, symptoms, and course of illness). There have been many subsequent studies using patient outcome or distribution of illness among relatives to test the validity of these nosological classes. Differences between chronic schizophrenia and (predominantly nonchronic) affective disorders are often reported, but it is difficult to discern whether these differences are associated with diagnostic symptomatology rather than premorbid prognostic status. The evidence suggesting a genetic link between good prognosis schizophrenia and affective disorders may be misinterpreted if premorbid prognostic processes are the distinguishing heritable components between chronic schizophrenia and nonchronic illnesses.Which components of severe psychiatric disorders are heritable is not yet clear. The developmental, psychological and neurological processes associated with premorbid and early morbid characteristics of illness appear good candidates. Considering such variables as prognostic (early morbid or premorbid) rather than diagnostic would permit examination of class assignment (e.g., schizophrenia, bipolar affective disorder) and premorbid development. The literature now suggests that chronicity in psychiatric illness breeds true and that symptom constellations breed true. Both of these views may be correct, and the taxing study design required to simultaneously study these two attributes of disease entities is warranted. This may establish good prognosis schizophrenia as a “third psychosis,” or may affirm its standing within traditional nosology.

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Recent findings from several research projects on the role of family factors in the onset, course, and treatment of schizophrenia are discussed. The report emphasizes several key issues facing researchers in this field such as how family characteristics associated with onset are related to the course of schizophrenia, replicability of findings on expressed emotion and relapse rates, and the construct validity of measures of familial characteristics. Ongoing studies employing neuroleptic treatment and family therapy are outlined, and the implications of these preliminary findings are discussed.

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1982

数据来源: OVID