The classification of chronic schizophrenia. A follow-up study.
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Biomedical subjects
Publications and source records attributed to C Astrup.
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Psychiatric illnesses can be conceived of as experiments of nature, providing a variety of pathopsychological mechanisms which may elucidate normal psychological processes. Clinically the reactive psychoses are predominantly psychogenic reaction types. They present disturbances of higher nervous activity, similar to those of the neuroses. The unconditional reflex activity is practically as in normal controls, and the most outstanding finding was the large effect of psychodynamic complex structures. This is a physiological parallel to the clinical manifestations with great concern over experienced mental trauma. In the manic-depressive psychoses the most characteristic feature is a marked disturbance of unconditional reflex activity. This factor may be an important physiological mechanism underlying the more biological than psychodynamic reaction type and partly explain the changes of mood and associated interferences with sleep, body weight, sexual activity, aggression and other instinctual and vegetative functions. Schizophrenic psychoses also present changes of unconditional reflex activity, predominantly in the direction of inhibition of response. In addition there are severe dissociations within and between the three levels of unconditional reflexes and the two signaling systems. It is suggested that schizophrenia represents a functional maladaptation, which can be explained from the principles of autokinesis and schizokinesis established by Gantt in animal experiments. Prognostic models based on experimentally established impairment of performances were shown to predict long-term risks of schizophrenic defects just as well as models based on constellations of clinical symptoms. I would predict that psychophysiology and experimental psychology will become increasingly more important for establishing diagnosis and prognosis in the functional psychoses. The data of this article point toward a basis for a prophylactic psychiatry.
The great contributions of Gantt to the problems of prophylactic psychiatry are pointed out. The author reviews his experiences with a 30-year follow-up of a population of 1800 persons. Over the 30 years, there appeared to be a 50% increase of neuroses, which raises great problems for mental health services. The Berlevåg population was offered optimal psychiatric services. Behavior therapy of neuroses and drug treatment of depression may possibly have lowered the prevalence of mental disorders. Psychophysiologic tests were used in the project. It is hoped that such tests may be utilized for early detection and treatment of mental disorders.
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Desensitization of psychological and physiological complex structures may be the most important element of flooding treatment. The implosive sessions are assumed to represent a supramaximal stimulation of pathologically excited and inert complex structures resulting in protective inhibition, irradiation of excitation, reduction of the excitation and inertness, and a decrease of the overshooting autonomic reactivity of the complex structures, leading to reduction of anxiety, aggression, and other pathologically increased feelings. Advantages such as stronger and improved flooding can be achieved by a flooding in hypnosis. The therapeutic indications go beyond the usual treatment of phobic states. In order to establish the psychological and physiological mechanisms in implosion there is a need for psychophysiological investigations. However, much is unknown about mechanisms. Controlled comparisons with other treatments give limited answers. Perhaps an international case history bank might establish which clinical conditions might benefit by technical modifications of flooding.
A review is presented of studies of higher nervous activity in psychiatric patients. In neuroses and reactive psychoses the basic pathology appears to be centered around the psychogenic complex structures. In addition, neuroses as well as reactive psychoses reveal general disturbances of higher nervous activity. In the schizophrenic and manic depressive psychoses there are indications of disturbances in deep-lying brain structures. Both types of psychoses are heterogeneous groups of clinical conditions. An important task for future experimental studies is to establish the types of disturbances of higher nervous activity in well-defined clinically homogenous groups. The final section deals with prophylactic psychiatry, with special emphasis on Gantt's suggestions for an international project.