ISSN:0254-4962    

DOI:10.1159/000283868

出版商:S. Karger AG    

年代:1980

数据来源: Karger

ISSN:0254-4962    

DOI:10.1159/000283869

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

It would be unrealistic to try to turn psychiatry in all its aspects into an exact science. It is realistic to accept that it also deals with non-measurable phenomena; this we should always remember, so as to remain doctors and to preserve what is personal, warm and humane in our work. It is unrealistic to believe that the neurosciences are beginning today to explain all levels of psychic life. While fully recognizing the magnificent achievements of the neurosciences in explaining some basic elements of psychic life, we should keep ourselves aware that the psychic spheres of man remain inaccessible to the purely somatic explanations and are outside their influence. It is unrealistic to claim that our best and most effective treatment of schizophrenic psychoses is ‘merely’ symptomatic. It is realistic to accept the probability that it is appropriate to the nature of many schizophrenias and that it is radical. It is unrealistic to believe that our only task is to cure illnesses. Often it falls to us simply and in all modesty to accompany patients through their lives along a path chosen entirely by themselves and to be allowed now and then to give a little help to them. It is unrealistic to believe that psychiatry provides a key to improve the world. It is realistic if we concern ourselves in the main with helping the sick, if we critically reflect on the effect our work may have beyond our patient, on society, and if we keep pointing out again and again the good which is in every human being and that we may sometimes bring out this goodness in

ISSN:0254-4962    

DOI:10.1159/000283870

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

This contribution to a symposium on our ability to affect the course of psychiatric illnesses deals with psychopathology and uses a syndrome-oriented approach. The core of the idiopathic syndromes consists of the bipolar affective psychoses, including the predominantly affective-psychotic psychoses of the schizoaffective borderland. The underlying dynamic constellation is determined by restriction and expansion, whereas schizophrenic phenomena arise when the dynamic becomes unstable. One can differentiate between the central affect-psychotic type, the purely depressive dysphorias, and the schizophrenic syndromes which are complicated by a dynamic insufficiency and a structural change and which are normally no longer completely reversible. The real psychotic core of the idiopathic syndromes on which the thymotropic drugs act, lies in the derailments of the psychic dynamic of the three types: restriction, expansion and instability. Within the structural-dynamic framework the psychotic derailments and personality with its biographical and situational background are closely linked. The cope and limitations of the treatment of the idiopathic syndromes are discussed from a structural-dynamic viewpoint.

ISSN:0254-4962    

DOI:10.1159/000283871

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

A retrospective study of 266 patients treated with neuroleptics and 130 patients treated with antidepressants divided the patients according to a global assessment after termination of therapy into responders and non-responders. The two groups were compared in respect to their psychopathological symptoms as assessed by the AMP system on days 0, 5, 10 and 20. Keeping the initial findings, comparable responders and non-responders showed statistically significant differences in the target syndrome from the 5th day onwards. The same applied to the findings on the 20th day (end result of treatment). The improvements found at the several points of testing, expressed as a percentage of the overall improvement after 20 days, show that the major part of the total improvement has taken place already after the first 10 days. The statistically significant changes were examined as to their practical relevance by giving their declared variance as a proportion of the total variance.

ISSN:0254-4962    

DOI:10.1159/000283872

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

Since 1976 a group of 229 patients with schizophrenic or other paranoid illnesses (9 patients) were treated for about 14 weeks with intramuscular or intravenous injections of fluphenazinedecanoate. During the first 2 weeks, three injections of 250 mg were given after which time the injections were given at three weekly intervals with slowly decreasing dosage. The patients also received tablets of procyclidine and 100–150 mg of amitriptyline per os. After the initial intensive phase the patients received an average of 145 mg i.m. every 3 weeks. A total of 209 patients could be followed up. Of those, 127 had for various reasons not continued with oral medication. The course of their illnesses was compared with that of the patients who had complied. The present report which represents a 3-year follow-up study confirms the findings of an earlier paper which showed the rapid onset and stability of remission, the absence of relapses among the patients who were under continued treatment, and the relative freedom from relapses among the patients who did not continue to have further neuroleptic medication. The anticipation that the initial high-dosage medication would have deleterious effects on the personality, producing robots or zombies, was shown to be groundles

ISSN:0254-4962    

DOI:10.1159/000283873

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

Controlled studies have revealed that neuroleptic treatment alone has a significant effect in schizophrenic patients and that with parenteral treatment with depot neuroleptics the relapse rate after 1 and 2 years is significantly lower than with oral neuroleptic medication. About 20% of schizophrenic patients do not have relapses even without treatment. The effectiveness of neuroleptic long-term medication with regard to the prevention of relapses was proved by discontinuation trials for a period of up to 3 years. Up to now, however, there is no proof that drug therapy influences the long-term prognosis beyond the 3 years. The results of the Bonn schizophrenia study show the extraordinary variability of the courses and outcomes. Although some anamnestic and clinical prognostically favourable or unfavourable factors could be found, a reliable individual prognosis at the onset of the disease is not possible. Initially phasic courses with complete remission of the early psychotic features can later nevertheless lead to residual syndromes; on the other hand, chronic persistent psychoses can show a permanent remission leaving only slightly, non-specific residual states even as late at the 2nd to the 4th decade of the disease independent of the therapy. Some findings of the Bonn study, indicating a favourable influence of psychical treatments on the long-term course are described. They include the so-called catastrophic schizophrenia which at a rate of 4% occurs less frequently than in the past, the significantly poorer long-term prognosis of those patients who had not been treated in the beginning of the disease (taking into account subgroups with peracute, acute and subacute onsets on the initial psychotic manifestations), the significantly less favourable long-term prognosis of patients whose disease began prior to the era of psychopharmacological drugs, and the significantly more frequent occurrence of complete remissions of patients of the subgroups with peracute and acute onsets of the psychosis who had started treatment within 1 year after the onset of the disease (including the prodromal stage). Early diagnosis and treatment of the prodromal symptoms can probably improve the chance of a complete remission. The finding of a higher rate of patients with mixed residual states at the expense of the typical schizophrenic defect psychoses within the partial subgroup of the specific residual states with long-term neurolepsy could suggest that long-term medication is responsible for the ‘partially pharmacogenic change in symptomatology’ of schizophrenia in as far as it causes or favours a shift from the typical syndromes to the mixed residual states mainly brought about by a potential reduction in sympt

ISSN:0254-4962    

DOI:10.1159/000283874

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

After 10 years experience with Dapotum D the statistically elaborated studies of catamnesis deal with 76 patients with more than 5 years permanent adjustment. The objective and subjective tolerance is compared (1) with patients with continuous ambulatory adjustment up to now; (2) patients with continuous in-patient adjustments, and (3) patients who withdrew Dapotum D or changed the medicaments after 5 or more years of permanent adjustment. The study shows a significant stabilization of the clinical picture and a surprisingly good permanent compatibility. This compatibility explains itself by the reduction of objective side effects in comparison with the phase of adjustment; the simultaneous habituation to slight extrapyramidal phenomena effects a very high degree of subjective contentment (90% of the patients). This may be supported by the fact that complete withdrawal of such permanent medication causes, in 36.9% of the patients, late diskynesias with a tendency to slow remission; the latency of which binds doctor and patient, as indicated, to the successful therapy.

ISSN:0254-4962    

DOI:10.1159/000283875

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

The author compares his own schizophrenic patients treated by him and his co-workers at the Vienna Psychiatric University Clinic between the years 1949 and 1959 by ‘bifocal family therapy’, a method developed by him with a control group. In his own patients he has carried out a 20-year follow-up study assessing the subsequent course of their lives. The control group consisted of schizophrenic patients treated in 1970 at the Vienna Psychiatric Hospital along routine lines by pharmacotherapy. The psychotherapy group (n = 116) assessed by social criteria such as work record, partner relationships, children, or social isolation, invalidism at home or in hospital is clearly superior and approaches normality. Yet even they show ongoing signs of dynamic disturbance in the sense described by Janzarik expansive derailment, instability, emptiness) which have statistical relationships with the types of breakdowns in their life history and the kinds of later partner relationships. The author interprets this socially successful psychotherapy as a help in achieving emancipation in relation to a certain situation which arose in its development, but sees in the continued affinity to the basic dynamic disturbance and its influence on partner choice a risk factor of the newly formed family and the issuing child

ISSN:0254-4962    

DOI:10.1159/000283876

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

The author reviews briefly the recent history of psychiatric hospitals, with particular reference to changes which have taken place in the Scandinavian countries. He also reviews the new expectations society has of psychiatric hospitals and of their role. He concludes that the psychiatric hospital has still an important role to play but that its organization and aims will have to change. He gives a number of guidelines for the changes and describes his own experience as director of two psychiatric hospitals in Norway which under his guidance underwent the transition from the old to their new function. The hospital here described in detail is called ‘Gaustad’, situated in Oslo. He outlines the planning procedure and the way the plans were implemented. Finally he asked each professional group working in the hospital as well as the patients to evaluate the changes. By and large, all groups seemed to welcome the new way of working. Finally staff and patients give opinions as to what functions should be expected of the hospital in the future and the author gives his own ideas. He feels the psychiatric hospitals will have to change, but they have to continue to play an important and, in some ways, unique r

ISSN:0254-4962    

DOI:10.1159/000283877

出版商:S. Karger AG    

年代:1980

数据来源: Karger