ISSN:0254-4962    

DOI:10.1159/000284216

出版商:S. Karger AG    

年代:1985

数据来源: Karger

ISSN:0254-4962    

DOI:10.1159/000284217

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The impression that the prevalence of mental disorder has been increasing during the last decades is only partially justified. The considerable increase in the demand for psychiatric and psychotherapeutic help is influenced by quite a number of factors that vary in nature and direction. The most essential contribution was made by changes in the age composition of the population – and here primarily by the growing number of mentally ill elderly persons – and by the enormous increase in life expectancy. In milder psychiatric disorder the increase in the utilization of medical help is mainly due to new ways of treatment and to the great enlargement of psychiatric and psychotherapeutic services in most industrial countries, for which the Zeitgeist of transition from a predominance of natural science to a more psychological understanding of life forms the background. Civilizational factors in a closer sense, like the raising of the achievement level for school beginners or alterations in the threshold of tolerance between mental illness needing medical intervention and mental suffering to be borne with submission to God’s will, play an essential role particularly for the widening of the disease concept and thus for changes in the frequency of certain deficits of achievement and feeling, such as ‘reading disorder’ or depressive states. The fact that the age-corrected risk of falling ill with schizophrenia has remained stable over many decades – wherever it could be investigated – does not point to a relation with variable environmental factors like industrialization, civilization or social order. In contrast with this disease in a closer sense, the rates of psychiatrically relevant forms of deviant behaviour – suicidal attempts, drug- and alcohol-related disorders – show rapidly changing upward and downward variations. Thus, they are more comparable to criminality rates that vary over time and culture. There is obviously a relation between changes in the frequency of deviant behaviour and changing patterns of values in society, such as the reduction of educational intensity and the commitment of adolescents to norms and convictions of their parents. This is why the most distinct changes in these rates occur at the age most accessible to contemporary or fashionable influences: in youth and younger adult age. Except for age-related changes, we do not seem to have become more ill than the generation of our parents, but more pessimistic. Apparently, this change is due to the fact that in public opinion life satisfaction or optimism are based more on hope and perspectives for the future than on a realistic estimation of the present time compared with the past. And when things are going well with us, we seem to bear less hope or strength for optimism in us than in harder times. ‘Nothing is harder to bear than a series of good days.’

ISSN:0254-4962    

DOI:10.1159/000284218

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

In the hope of discovering simple disease entities that could permit specific treatment, much effort is currently directed toward the operationalization of psychopathological syndromes. As a necessary supplement to these endeavors, the pathophysiological aspect is emphasized in this study. The nonspecificity of pathophysiological mechanisms with reference to psychiatric syndromes is illustrated using the example of inhibition of the orienting reaction in schizophrenia and depression. It is demonstrated that these mechanisms are meaningful for therapy despite their nosologic nonspecificity.

ISSN:0254-4962    

DOI:10.1159/000284219

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Syndromes are typical combinations of symptoms. They may be conceived at different levels of complexity, intuitively from a clinical point of view and objectively by means of factor- or cluster-analyses. Primary factors of symptom scores obtained with the aid of psychiatric rating scales represent syndromes of low complexity, secondary factors represent syndromes of higher complexity. The highest level is achieved by rotating only the first factors extracted from the matrix of intercorrelations among primary factors of psychopathology. Principal component analysis of 12 Inpatient Multidimensional Psychiatric Scale factors that reflect the psychopathological states at admission of 1,080 psychotic inpatients yielded the highly complex endogenomorphic syndromes of schizophrenic and manic-depressive symptomatology, respectively, in a two-factor solution. These syndromes were cut down to lower order syndromes in the four-factor solution resulting from rotation according to the conventional Kaiser criterion. They represent a syndrome of psychotic excitement, a paranoid-hallucinatory syndrome, a syndrome of endogenomorphic (retarded) depression and a syndrome of organic symptomatology. The different factor solutions may be useful for describing psychopathological phenoma objectively at different levels of complexity.

ISSN:0254-4962    

DOI:10.1159/000284220

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The purpose of this paper is to discuss possibilities for developing operational criteria in psychopathological states and to identify the parameters that differentiate psychotic patients. Statistical analysis was performed in the first step with the aid of factor analysis with extraction of syndromatic characteristics of so-called psychopathological basis syndromes. By cluster analysis in the second step we found out more approaches to a differentiated definition of psychotic states. The classification of individuals into ‘natural’ and not preestablished groups enabled the construction of descriptive psychopathological algorithms to determine ICD-9 diagnosis within the limitations of descriptive psychiatry.

ISSN:0254-4962    

DOI:10.1159/000284221

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The first purpose of the paper is to sketch the development of the concept of axial syndromes, starting with the generation of the hypotheses in Berner’s monograph on ‘The paranoiac syndrome’ published in 1965 and leading to the last formulation of the Viennese Research Criteria in 1983. The second purpose is to draw the attention on a series of empirical studies which have been undertaken in order to evaluate the classificatory validity of the concept, studies dealing with the long-term course of paranoid psychoses (both in a retrospective and a prospective design) and secondary cases of different diagnostic classes in the families of the same patients (first-degree relatives).

ISSN:0254-4962    

DOI:10.1159/000284222

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The LICET system is a polydiagnostic instrument permitting recording of diagnostic criteria and assignment by diagnostic algorithms as proposed in a number of different classification systems, including the Viennese Research Criteria. In the present report, French diagnostic practices are compared with the Viennese Research Criteria for endogenomorphic-schizophrenic and endogenomorphic-cyclothymic axial syndromes.

ISSN:0254-4962    

DOI:10.1159/000284223

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Psychopathological, nosological, and prognostic aspects of basic stages and basic symptoms, in particular consideration of formal thought disorders, are outlined. In view of the far-reaching overlap of the psychopathological pictures of the pre- und postpsychotic basic stages a Bonn Scale for the Assessment of Basic Symptoms (BSABS) including all types of basic stages was constructed. Subjective cognitive thought disorders were recorded from 69% of the patients in pure defective states, from 78% in postpsychotic reversible basic stages and from 67% in prodromes. In contrast to incoherence of thoughts, including the symptoms of the endogenomorphic-schizophrenic axial syndrome (Berner), these thought disorders are registered only on the basis of the reports of the patients and not through observation by the investigator. The difference between subjective and objective thought disorders is presumably only conditioned primarily by differences in the degree and secondarily by the psychopathological quality of the disorders. If the criteria concerning formal thought disorders and affective blunting of the schizophrenic axial syndrome or of SANS (Andreasen) are fulfilled, as a rule the patient loses the ability of perceiving, communicating, and coping with the disorders, and at the same time there is a break from an only quantitative to a qualitative abnormal phenomenon. The presence or absence of subjective or objective formal thought disorders in the beginning of the disease had no significant influence on the long-term outcome in the main sample of the Bonn study. Proceeding from the initial psychopathological syndromes 54% of the female hebephrenics with the most unfavorable long-term prognosis showed incoherence of thoughts in the first 2 years of the illness; in contrast, incoherence was seen in only 16% of the male hebephrenics for whom the long-term outcome did not differ from that of the whole sample. This and other data of the Bonn schizophrenia study seem to argue in favor of the assumption that typical incoherence of thoughts might be valuated as a criterion of unfavorable prognosis only when the phenomenon appears within the context of a hebephrenic initial syndrome in the beginning of the schizophrenic disease.

ISSN:0254-4962    

DOI:10.1159/000284224

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

56 patients with RDC diagnoses of schizophrenia (n = 40) and mania (n = 16) were interviewed with a structured interviewing procedure. The evaluation was performed by 2 raters who were blind for diagnosis. Two instruments were used for evaluation concerning thought and language disorders: the ‘Scale for Assessment of Thought, Language and Communication’ developed by Andreasen and the ‘Endogenomorphic Schizophrenic Axial Syndrome’ by Berner with its emphasis on thought disorders. The interrater reliability for both instruments was found to be good to acceptable for the essential items. A comparison of the frequency of thought disorders according to the two different instruments showed an occurrence of derailment and incoherence of the Andreasen scale in both diagnostic groups, while thought disorders of the schizophrenic axial syndrome were represented only in the group of schizophrenics. This is because in contrast to the Andreasen scale, the presence of pressure of speech is considered as an exclusion criterion for the schizophrenic axial syndrome. Thus, thought disorders according to the schizophrenic axial syndrome are seen to possess diagnostic significance.

ISSN:0254-4962    

DOI:10.1159/000284225

出版商:S. Karger AG    

年代:1985

数据来源: Karger