ISSN:0254-4962    

DOI:10.1159/000284422

出版商:S. Karger AG    

年代:1986

数据来源: Karger

ISSN:0254-4962    

DOI:10.1159/000284423

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The classification of functional psychoses is still a controversial issue, as are also diagnoses in psychiatry. The predictive validity of the diagnosis is of crucial importance. Diagnostic systems are discussed. The author presents the Scandinavian concept of reactive psychoses, schizophreniform psychoses and schizophrenia, and demonstrates from his own material on paranoid psychoses the predictive value of these concepts, with a percentage recovery of 81 61 and 23 % after long-term follow-up. The concepts are discussed in relation to ICD-9 and DSM-III. The concepts of paranoid disorders, affective disorders and borderline conditions are mentioned. The paper also introduces other papers to be presented in this volume.

ISSN:0254-4962    

DOI:10.1159/000284424

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

After a presentation of the traditional principles of diagnosis and a precise definition of terms, the Vienna approach to the classification of delusional conditions is introduced. This approach is multiaxial: the first axis consists of a classification of delusional syndromes based on a cross-sectional description of their structural and constituting elements; on the second axis, the relationship between the delusional world and the real one is described; the third axis is for the recording of delusional contents; the fourth axis serves for an attempt at etiological attribution. The Vienna approach differs principally from the usual systems of classification in that it is purely syndromatological and thus it avoids giving an a priori nosological meaning to the various symptoms making up the delusion (for example, certain delusional themes, certain forms of hallucinations). A definitive nosological diagnosis is only possible when an organic cause is clearly evident, otherwise the suffix ‘-morphic’ (endogenomorphic-schizophrenic, endogenomorphic-cyclothymic, and organomorphic axial syndromes) is added to denote the close resemblance of clinical states to certain disorders whose nosological homogeneity should not be taken for granted. Next, the results of our own catamnestic study on a patient population selected solely on syndromatological grounds are presented. It is shown that no prognostic significance can be attributed to the delusional pictures classified according to their description (paranoic syndromes, systematic and unsystematized paraphrenia); on the other hand, such significance certainly falls to one of the axial syndromes formulated on axis 4 (the endogenomorphic-cyclothymic axial syndrome). Nevertheless, a relatively large portion of the patients eluded attribution to one of the axial syndromes, even after a course of several years. Aside from the possibility that a number of them could be so classified after further cross-sectional evaluation, one may suspect that this group contains patients whose delusional formation stems from a psychogenic etiology; or it may be that these patients represent a third illness entity, distinct from the other two groups of endogenous psychoses.

ISSN:0254-4962    

DOI:10.1159/000284425

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

A classification of chronic psychoses including nonparanoid schizophrenia, paranoid schizophrenia, paranoid state and paranoia (delusional disorder) is presented. This classification is dependent on a systematic increase in number of symptoms with each group. In particular, delusional disorder is examined with regard to family history. It is clear from the data which are presented that delusional disorder is more likely to be associated with a family history of such traits as suspiciousness, jealousy, secretiveness, and the presence of paranoid behavior or delusions. There is evidence that such familial traits are not seen in schizophrenia, only in delusional disorder.

ISSN:0254-4962    

DOI:10.1159/000284426

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The nosological concepts of ‘bouffée délirante’, first described by Magnan in the 1880s, and of ‘psychogenic psychosis’, first described by Wimmer in 1916, are still in use in their countries of origin, France and the Scandinavian countries. Both refer to psychotic episodes of good prognosis, not connected with schizophrenia, appearing in a special fragile personality. An examination of the diagnostic criteria of the two categories shows, however, that important differences exist. Contrary to what has been claimed, Wimmer’s original description, although showing an encyclopedic knowledge of the international literature of the day, has not been directly influenced by Magnan. Bouffée délirante and psychogenic psychosis, whatever their differences, have survived in their respective countries of origin against the pressure of the psychiatric consensus of the rest of the world, as evidenced by the frequency of the present use of the two diagnoses. The two categories, after having been considered for a long time as idiosyncratic peculiarities of individual national schools, are now submitted internationally to empirical studies and have become the center of a renewed interest.

ISSN:0254-4962    

DOI:10.1159/000284427

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Approximately 200 out of 301 first-admitted hospitalized patients with paranoid psychoses earlier studied by Retterstøl are still alive. These subjects are at present being interviewed semistructurally by the author, making a total follow-up period of 22–37 years after index admission. Before the interviews, diagnoses at discharge and at previous follow-ups based upon the records are established. Different diagnostic procedures are used. Preliminary results from the first 125 interviews indicate a small change to the worse as to psychopathology during the last 20 years. Outcome in DSM-III schizophreniform disorder, RDC schizoaffective disorders, Kendlers delusional disorders and ICD-9 reactive psychoses differs distinctly from the less favorable outcome in DSM-III schizophrenia.

ISSN:0254-4962    

DOI:10.1159/000284428

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

In the Bonn Schizophrenia Study (Huber et al, Monogr. Gesamtgebiete Psychiat., vol. 21, Springer, Berlin 1979) 113 cases fulfilled the criteria for four types of schizo-affective and/or cycloid psychoses. Each of these subgroups had a significantly more favorable long-term prognosis than that of the Bonn sample as a whole. Several prognostically favorable factors found in the Bonn Study are identical to criteria used to classify schizo-affective, schizophreniform and cycloid psychoses, e.g., acute onset, endogenomorph-depressive symptoms, and psychoreactivity. In the Bonn main sample of 502 schizophrenics, 22% demonstrated complete recovery and 40% more or less noncharacteristic types of remission (pure asthenic defect); 56% were socially recovered, two thirds reaching their premorbid level and one third remaining below it. The 12 different types of course are described. There are four course type groups, the prognostically favorable (types I–III), the relatively favorable (types IV–VI), the relatively unfavorable (types VII-IX), and the unfavorable group (types X–XII), each embracing about one quarter of all schizophrenics. The long-term prognosis is dependent on factors such as primary personality, school success, precipitating factors and certain psychopathological initial symptoms and syndromes. The results support the assumption that early treatment, including that of the prodromes, improves the long-term prognosis or at least the chance of complete remission of the subgroup with peracute and acute onset. In spite of the more favorable long-term outcome of the schizo-affective psychoses the results cannot justify the nosological differentiation and classification of these and related psychoses as an independent disease entity but only as different prognostically favorable types of endogenous psychoses. In this respect it is possible to make a distinction between a nuclear group of schizophrenia and a different group with a better prognosis, variously termed schizophreniform, schizo-affective or psychogenic psychoses, which with respect to prognosis is an intermediate group.

ISSN:0254-4962    

DOI:10.1159/000284429

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

This paper deals with the prognosis of schizophrenic psychoses in Helsinki in 1950–1955, 1960–1965, 1965–1970, 1970–1975, and 1975–1980. The first 4 cohorts each include a sample of 100 patients taken in 1950, 1960, 1965, and 1970. The patients were admitted for the first time to a psychiatric hospital because of schizophrenic and paranoid psychoses. The 1975 material includes all (n = 94) first admissions for schizophrenia, fulfilling the DSM-III criteria of schizophrenia or schizophreniform psychosis.

ISSN:0254-4962    

DOI:10.1159/000284430

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The follow-up studies of borderline schizophrenia, the borderline syndrome and borderline personality disorder are examined in the light of modern methodological demands. Few studies reach these standards. The outcome of borderline schizophrenia is variable and close to schizophrenia. Approximately 20% of the cases develop true schizophrenia over time. Grinker’s borderline syndrome has also a variable outcome but mostly a poor prognosis. Borderline personality disorder has a variable outcome but better than for schizophrenia. Concomitant major affective disorder is frequently present in borderline personality disorder and influences outcome. The wide range of outcome does not support a single ‘natural history’ of these disorders. Few predictive factors have been identified. Better studies with the aim of identifying predictive factors are mandatory.

ISSN:0254-4962    

DOI:10.1159/000284431

出版商:S. Karger AG    

年代:1986

数据来源: Karger