Kurt Schneider's schizophrenia--the picture of schizophrenia in a Schneider-oriented university clinic

Even in a Schneider-oriented university clinic, the majority of the diagnoses "schizophrenia" are based on non-first-rank symptoms. About one-fifth of the cases diagnosed as having schizophrenia showed nonproductive symptoms such as disturbances of thought, of affect and of behavior. But the nonproductive forms showed a relatively high density of symptoms. Two-thirds of the patients are women, one-third men. Schizophrenia is most frequently diagnosed in the third decade of life. Single people with a low education are more commonly represented. But all this is not valid any longer if we separate schizoaffective psychoses and other atypical psychoses from "pure" schizophrenia.     

产后精神病42例的临床分析及随访

目的 探讨产后精神病的临床特点及产后精神病是否为独立的疾病单元。方法 对42例产后精神病作回顾性研究,根据中国精神疾病分类方案与诊断标准（CCMD－2－R）对42例产后精神病进行重新诊断分类并对其中23例进行随访调查。结果 42例产后精神病中30例在产后二周内起病,39例呈急性起病,28例有躯体或心理因素作为起病诱因。根据CCMD－2－R诊断为精神分裂症19例,器质性精神障碍13例,抑郁症5例,神经症5例;27例临床短期疗效达痊愈;随访到23例患者7例未再出现精神异常,改诊为精神分裂症10例,情感障碍4例,分裂情感性精神病1例,周期性精神病1例。结论 产后精神病以急性起病,临床症状不典型,易变性和混乱为特点;按国内现有诊断标准本组42例产后精神病均可归类,未发现区别于其它精神障碍的特有症状,提示产后精神病并非独立的疾病单元。     

Heart Disease,Schizophrenia, and Affective Psychoses: Epidemiology of Risk in Primary Care

A retrospective cohort design was used to study risk factors and cardiovascular end points among adults, with and without psychoses, receiving primary care. Earlier onset of risk factors and heart disease was noted among individuals with schizophrenia compared to those with affective psychoses and no disabilities. Patients with schizophrenia had increased relative risk for obesity, congestive heart failure, dementia, depression and death, while patients with affective psychoses had increased risk for dementia and diabetes. This publication was supported by Cooperative Agreement Number R04/CCR418776 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention.     

Interictal psychoses in comparison with schizophrenia--a prospective study

PURPOSE: To prospectively investigate the incidence of interictal psychoses of epilepsy patients, and make a comparison between those with interictal psychoses and patients with schizophrenia in respect to their responses to antipsychotic drugs, as well as psychotic states. METHODS: We undertook a two-part prospective investigation. In Part I, the psychotic episodes of 619 epilepsy patients were investigated, while 182 patients with psychotic syndromes were followed in Part II, of whom 59 were diagnosed with schizophrenia and 13 with epilepsy with interictal psychoses. The Positive and Negative Syndrome Scale was used for efficacy assessment. RESULTS: The average annual incidence of interictal psychosis was 0.42% during the 56-month study period. A significant difference was found between patients with schizophrenia and epilepsy patients with interictal psychoses in respect to results on the negative subscale of the PANSS at the initial examination (mean scores of 18.1 and 13.2, respectively, p = 0.004). The response rates one year later for these groups were 27.1% and 53.8%, respectively, which showed a trend of better response to the antipsychotic medication by the epilepsy group (p = 0.098). Initial and maximum doses of antipsychotic drugs used for epilepsy patients with interictal psychoses were significantly lower than those used for patients with schizophrenia (p = 0.008 and p = 0.006, respectively). CONCLUSIONS: Schizophrenia and epileptic psychosis showed different symptom profiles. On average, epilepsy patients with interictal psychoses achieved higher remission rates with lower doses of antipsychotic drugs as compared to patients with schizophrenia in the present 1-year follow-up study.     

PROGNOSIS OF PARANOID STATES IN RELATION TO THE CLINICAL FEATURES

Scandinavian psychiatrists acknowledge endogenous psychoses which are neither schizophrenic nor manic-depressive, i.e., above all the “reactive psychoses” and the “schizophreniform psychoses”, both of which differ from schizophrenia in their features as well as in their good prognoses. These Scandinavian diagnoses bear relationships to psychoses, which I separate from schizophrenia. In the present paper, paranoid states are discussed with regard to their clinical pictures and their good prognoses. Among these are the “cycloid psychoses”. Patients suffering from these diseases recover from every phase, though most of the German psychiatrists consider them schizophrenic. Among the cycloid psychoses, the “anxiety happiness psychosis” shows ideas of reference on the one hand and ecstatic ideas on the other. In “inhibited confusion psychosis”, the patients are suffering from ideas of reference and ideas of significance; in “excited confusion psychosis”, from misidentifications of persons. The other symptoms which occur - anxiety, happiness, stupor, incoherent pressure of speech - confirm the cycloid psychoses and disprove schizophrenias. Besides the already mentioned psychoses, there is a monopolar psychosis, “suspicious depression”, in which ideas of reference and ideas of guilt mix. It is extremely important, not only for theoretical but also practical reasons, to separate from schizophrenia paranoid states which terminate in complete recovery from every phase.     

The concept of 'atypical psychoses': Special reference to its development in Japan

Abstract Reviewing the development of concepts of 'atypical' psychoses in European countries and in the United States shows that there are various terminologies which are given to a group of psychoses unclassifiable within Kraepelinian dichotomy. Bouffee delirante (French school), cycloid psychoses (Leonhard, Perris), reactive psychoses (Scandinavian school) and acute schizoaffective psychoses (Kasanin) are the most common terms. These are consistent in terms of acute onset, polymorphic symptomatology and good prognosis, and are considered to be distinct from major psychoses, especially from typical schizophrenia. The concept atypical psychoses in Japan was developed under the influence of Mitsuda's clinico-genetic studies. According to Mitsuda, atypical psychoses are not mere phenotypical variants of typical schizophrenia and manic-depressive psychosis (MDP) but belong to a genetically different category and are probably heterogeneous. The characteristic features in the Japanese concept of atypical psychoses emphasizes the alteration of consciousness in symptomatology and pays attention to the nosological relationship with epilepsy, as well as with schizophrenia and MDP. Thus, in Japan it is generally considered that atypical psychoses are independent of 'typical' major psychoses and are located nosologically in the border area between typical schizophrenia, MDP and epilepsy.     

Schizophrenia and related disorders in children and adolescents

This paper reviews the concept and recent studies on childhood and adolescent psychoses with special reference to schizophrenia. After a short historical introduction, the definition, classification, and epidemiology of child- and adolescent-onset psychoses are described, pointing out that some early-onset psychotic states seem to be related to schizophrenia (such as infantile catatonia) and others not (such as desintegrative disorder). The frequency of childhood schizophrenia is less than 1 in 10,000 children, but there is a remarkable increase in frequency between 13 and 18 years of age. Currently, schizophrenia is diagnosed according to ICD-10 and DSM-IV criteria. The differential diagnosis includes autism, desintegrative disorder, multiplex complex developmental disorder (MCDD) respectively multiple developmental impairment (MDI), affective psychoses, Asperger syndrome, drug-induced psychosis and psychotic states caused by organic disorders. With regard to etiology, there is strong evidence for the importance of genetic factors and for neurointegrative deficits preceding the onset of the disorder. Treatment is based upon a multimodal approach including antipsychotic medication (mainly by atypical neuroleptics), psychotherapeutic measures, family-oriented measures, and specific measures of rehabilitation applied in about 30% of the patients after completion of inpatient treatment. The long-term course of childhood- and adolescent-onset schizophrenia is worse than in adulthood schizophrenia, and the patients with manifestation of the disorder below the age of 14 have a very poor prognosis.     

The incidence of negative symptoms in early schizophrenia, mania and other psychoses

Despite increasing interest in negative symptoms in schizophrenia there has been little work on their incidence in early schizophrenia or in other psychoses. This study examined 79 nondepressive psychotics within 2 years of onset of illness, diagnosed by Research Diagnostic Criteria and assessed for negative symptoms using the Scale for the Assessment of Negative Symptoms. Marked negative symptoms were observed in nearly half of patients diagnosed as suffering definite schizophrenia and were rarely found in other psychoses. Negative symptoms were not significantly correlated with positive symptoms, depression or exposure to neuroleptics, but were correlated with developing extrapyramidal side effects.     

The Stockholm non‐affective psychoses study (snaps): the importance of including out‐patient data in incidence studies

Jörgensen L, Ahlbom A, Allebeck P, Dalman C. The Stockholm non‐affective psychoses study (snaps): the importance of including out‐patient data in incidence studies. Objective: To estimate the incidence rate of schizophrenia and non‐affective psychoses from registers, to highlight the importance of including data from out‐patient care, and to assess the proportion of persons treated in out‐patient care only. Method: Data from out‐patient and in‐patient psychiatric care in Stockholm and information from several national registers constitute ‘The Stockholm Non‐Affective Psychoses Study’ (SNAPS). Incidence rates based on SNAPS data were calculated and compared to in‐patient care incidence rates. Results: The incidence rate was 72/100 000 for non‐affective psychoses (age group 18–44) and 28/100 000 for schizophrenia (age group 18–34) in the SNAPS. This was higher compared to in‐patient based incidence rates (42 and 13/100 000 respectively). The proportion of individuals with psychosis treated in out‐patient care only was 25%. Conclusion: There are substantial differences in the incidence rates of non‐affective psychoses and schizophrenia depending on the availability of data. Not including out‐patient care will underestimate the incidence rates.     

Aspects of the course of bipolar manic-depressive,schizo-affective,and paranoid schizophrenic psychoses

Summary The study deals with the course of three diagnostic groups, namely 50 bipolar manic-depressive, 50 bipolar and manic schizo-affective, and 50 recurrent paranoid psychoses. The patients course was observed over 14–17 years, at least 5 years prospectively. The study concentrates mainly on the prognosis based on the symptomatology observed during the first episode, the stability of the symptoms over several episodes, the residual symptomatology, and the degree of remission during the intervals.Bipolar and schizo-affective psychoses show a similar periodicity. The study further reveals that the periodicity of schizo-affective disorders is mainly linked with the affective symptoms of this disorder. Qualitatively the residual symptoms of bipolar and schizo-affective psychoses differ.Bipolar and phasic paranoid psychoses are quite different with regard to their periodicity and their symptomatology during the episodes and during the intervals.From the Psycho-Neurological Institute in Warsaw, Poland, at present working at the Psychiatric University Hospital, Research Department (Scholarship holder of the Roche Research Foundation and Sandoz, Basel, Switzerland)     

First admissions for psychosis in Turku. A time trend study.

Patients over 15 years of age from Turku hospitalized for psychosis for the first time during the years 1949-50, 1959-60 or 1969-70 were investigated. The incidence of hospitalized psychoses (per 100,000 inhabitants) was 115, 136 and 160, respectively. The increase in incidence was greater in women than in men. The incidence remained approximately the same in patients aged 30 to 59, but increased in the younger and older groups. The incidence of functional psychoses increased; in schizophrenia, however, it declined, while in paranoid and effective psychoses it increased. In organic psychoses, the admission frequency of psychoses of old age rose in the 1950's, but declined in some measure in the 1960's. The incidence of psychosis increased for single persons. The ratio of the incidence between single and married persons rose in men, whereas in women it fell. This was particularly pronounced in schizophrenics. The incidence of psychosis was highest in unskilled laborers. The overrepresentation of schizophrenia and paranoid psychoses seemed to have become more pronounced in this occupational group.     

Onset of acute psychotic states in India: a study of sociodemographic,seasonal and biological factors

This is a comparative study of patients with acute-onset, non-affective, non-organic, remitting psychoses and with non-remitting or schizophrenic psychoses in India. Two groups of patients with acute remitting and non-remitting or schizophrenic psychoses were compared with regard to the following variables: month of onset of psychosis; presence of stress, particularly fever, within 4 weeks preceding the onset of psychosis; childbirth within 12 weeks preceding the onset of psychosis; gender differences. It was found that the acute remitting psychoses showed an overrepresentation of females, a higher frequency of associated stress preceding the onset of psychosis, more often had onset during the summer months, i.e. between May and September, and had fever and childbirth preceding the onset of psychosis in a significantly higher proportion of patients, compared to acute non-remitting psychoses or schizophrenia. The implications of the findings which point towards biological factors in the aetiology of acute remitting psychoses are discussed.     

A controlled family study of chronic psychoses. Schizophrenia and schizoaffective disorder

Two hundred thirty-seven relatives of 48 patients with chronic psychosis, diagnosed as either schizophrenia or schizoaffective disorder, along with 380 relatives of psychiatrically normal controls, were studied using systematic diagnostic interviews, information from relatives, and review of medical records where appropriate. A variety of nonbipolar psychotic disorders was found in the relatives of the patients. Comparing relatives of patients with schizophrenia with relatives of patients with schizoaffective disorder, there was no tendency for schizoaffective diagnosis or acute psychoses to aggregate separately from schizophrenia. Increased incidence of bipolar disorder was found in relatives of patients with schizoaffective disorder but not in relatives of patients with schizophrenia. Incidence of major affective disorder (bipolar and unipolar) was increased in relatives of probands with both types of psychoses. If we subdivide the ill probands according to whether or not they had a history of substance abuse, relatives of probands with substance abuse had greater frequency of affective disorder and substance abuse, but there were not significant differences in the number of relatives with nonbipolar psychoses.     

Gender differences in first onset Schizophrenia spectrum psychoses

Background: Mental health profiles differ between boys and girls from puberty onwards. It is not known whether differences also extend to symptom presentation in schizophrenia spectrum disorders. It may be that girls and boys are not treated entirely equally by the professionals.

Aims: To study gender differences in symptom profiles, family adversities, pathway to care, and characteristics of inpatient treatment at the first episode of diagnosed schizophrenia spectrum disorder (F20–29) among adolescents aged 13–17.

Methods: A retrospective chart review of all (n?=?106) consecutive adolescents diagnosed for the first time with schizophrenia spectrum disorder (F20–29) in a specified catchment area. Girls and boys were compared with regard to sociodemographics, pathways to care, living arrangements, symptom profiles, and treatment received.

Results: During the study period more adolescent girls (n?=?70, 66%) than boys (n?=?36, 34%) were diagnosed with schizophrenia spectrum (F20–29) psychoses, most commonly F29. Girls were moreover younger (mean age?=?15.46) than boys (mean age?=?16.62) at admission. Girls more often displayed mood symptoms and boys aggressive behaviours, alcohol abuse problems, and isolation. Family adversities recorded as current stressors were more numerous among girls. Girls were more likely to be referred to specialized after-care than boys.

Conclusions: The gender differences observed in symptoms presentation are reminiscent of differences encountered in the general adolescent population. Prior to transition to psychosis, girls and boys are equally in contact with psychiatric services due to other (possibly prodromal) symptoms/disorders. Family adversities may be more stressful for girls vulnerable to psychosis than to boys.     

Late-Onset Anorexia Nervosa in Schizophrenia: A Case Report

The authors report a case of a woman with chronic schizophrenia who developed anorexia nervosa in middle age. The reported rarity of this diagnostic combination and the need to be aware of treatment issues in all patients with coexisting psychoses and eating disorder symptoms are discussed.     

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.     

Prader–Willi syndrome and psychotic symptoms: I. Case descriptions and genetic studies*

Six people with Prader–Willi syndrome (PWS) who developed psychoses are described. Along with other literature reviewed in the present paper, the results imply an association between PWS and psychotic symptoms. Genetic studies were possible in five cases and SNRPN expression was examined in three cases. Maternal uniparental disomy and 15qllq13 deletions were found, demonstrating that psychotic symptoms are not associated with a single type of genetic abnormality.     

The psychopathology of anancastic endogenous depression.

From a sample of 1,005 patients admitted to the Psychiatric Hospital in Aarhus for the first time during the period 1950-1959 and diagnosed as suffering from manic-depressive psychosis or endogenous depression (affective psychoses), a subsample of 104 manic-depressive patients with anancastic symptoms in the history was selected. The 104 probands were individually matched with 104 non-anancastic probands with affective psychoses. The study was designed as a follow-up study, and the patients who were still living were seen personally. In the search for factors which could be used to distinguish affective psychoses with anancastic symptoms from affective psychoses without these traits, the incidence of a number of psychopathological features was evaluated based on the case histories and the information given by the patients at the follow-up. There was no difference as far as atypical, schizophrenia-like symptoms were concerned between the anancastic probands and the controls. Manic and hypomanic features were more frequent among the controls, corresponding to a greater number of bipolar psychoses among them. At the same time, the controls showed a significant preponderance of decidedly psychotic symptoms such as disturbances of consciousness, delusions and delusion-like ideas and hallucinations. Furthermore, retardation was more frequent among the controls. There was no difference in the suicidal behaviour of the two groups. Symptoms which were more often met among the anancastic depressives were: anxiety, agitation, diurnal variation of mood and early awakening. Seasonal variation in symptomatology was also more frequent among the anancastic probands. The same held true for depersonalization. The anancastic probands showed a significant preponderance of anancastic premorbid personality features. A positive correlation was found between the number of anancastic personality features and the following symptoms: agitation, anxiety, diurnal fluctuation, seasonal variation, hypochondriacal attitude and depersonalization. On the other hand, objective retardation or flight of ideas showed a significant negative correlation. The pattern of the anancastic symptoms was rather uniform; aggressive obsessions, mostly in the form of suicidal and homicidal obsessions, were present in more than two thirds of the cases. The anancastic depressions were often less severe than non-anancastic depressions in that the latter were more often complicated by decidedly psychotic symptoms. It is possible to interpret the symptomatology of anancastic depressions as a pathoplastic influence of the anancastic personality, but it cannot be excluded that some of the symptoms like anxiety and agitation are linked to the presence of anancastic symptoms as such.