Biomedical subjects
Publications and source records attributed to K Koehler.
Modern reports on lycanthropy mainly concentrate on the content of patients' beliefs in being transformed into an animal. By contrast, an interest in the form of the symptomatology is usually minimal. This paper draws on Karl Jaspers' phenomenological views and focuses on some important albeit neglected psychopathological issues related to form which are relevant to any comprehensive consideration of lycanthropic phenomena.
The misidentification of person or Personenverkennung (PV) is provisionally redefined in this paper by focusing on four important points of view offered by German-speaking authors, all more or less based on an analysis of content. These deal with the extent of "craziness" of a PV (Leonhard), the degree of personal relationship of the person misidentified with respect to the patient (Kahlbaum/Pauleikhoff), the extent of the incorrect identification (Jaspers), and, lastly, the stage of stability shown by a PV at a particular point in time (Conrad). On this basis it is suggested that it may be best to initially call the PV simply a "delusion" with all further differentiation of types of PV carried out in light of a multidimensional psychopathological model utilizing various combinations of these four aspects of content.
Patients with hemophilia A or von Willebrand's disease who are treated with concentrated preparations of human factor VIII made from unscreened pooled plasma are at substantial risk of contracting human immunodeficiency virus (HIV) infection. The purpose of this study was to investigate whether by treating such patients with a pasteurized factor VIII concentrate that had been heated in aqueous solution at 60 degrees C for 10 hours, HIV infection could be avoided. Eleven hemophilia centers in the Federal Republic of Germany and two in Austria identified 155 eligible patients who had been treated exclusively with pasteurized factor VIII concentrate and had not received any other blood products. Between February 1979 and December 1986 they received a total of 15,916,260 IU of pasteurized factor VIII. The United States was the source of 80 percent of the plasma from which the concentrate was made. By September 1988, these 155 patients had been screened for antibody to HIV type 1 (anti-HIV-1) with a total of 657 tests; all were negative. Sixty-seven patients were also tested once for antibody to HIV type 2 (anti-HIV-2); all these tests were negative as well. It appears that pasteurization effectively inactivates HIV, even in plasma that is likely to be highly contaminated with the virus.
Membrane fluidity, transmembrane signaling responses, and proliferative characteristics of endothelial cells were studied to characterize biochemical and molecular changes after treatment with argon laser energy. Bovine aortic endothelial cells grown in monolayers were irradiated at 50, 100, and 200 J with an argon laser (wavelength, 488 and 514 nm). Proliferation, assayed by [3H]thymidine incorporation, was measured daily for 6 days. An initial lag phase was observed for irradiated cells when compared to nonirradiated controls (P less than 0.03), with eventual recovery by the third day. Membrane fluidity, determined by fluorescence anisotropy, was measured 1 hr after irradiation. A decrease in static rotational motion of 1,6-diphenyl-1,3,5-hexatriene (DPH) was noted in irradiated versus nonirradiated cells indicating a decrease in membrane fluidity (P less than 0.02). Dynamic studies of intracellular calcium and pH flux utilizing fluorescent probes demonstrated a preserved response to mitogenic stimulation. An increase in intracellular Ca2+ with a concomitant alkalinization of the intracellular milieu was observed in irradiated and non-irradiated cells in response to stimulation with endothelial cell growth factor (ECGF). These responses resemble those characterized for other mitogens. Argon laser energy applied to aortic endothelial cells decreases membrane fluidity early after irradiation. These alterations probably cause the initial lag observed in their proliferative response; however, the capacity to respond to exogenous mitogenic stimulation is maintained.
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Modified stricter criteria for DSM-III paranoia were fulfilled by 63 (37%) of 169 Heidelberg probands given a diagnosis of "Case Record Paranoia" (CRP) during a 100-year period (1878-1977). Clinical findings were chiefly interpreted in light of the controversial issues of age, illness duration and type of delusional content pertinent to the formulation of a present-day valid definition for this disorder. With respect to diagnostic consistency over time, 56% of DSM-III paranoia cases with at least one further Heidelberg admission proved to be non-stable, non-consistency being overwhelmingly due to a change in a DSM-III schizophrenic direction.
Recently, provisional research criteria for "schizo-affective" and related psychoses were published by the St. Louis Group. These rigorous criteria were modified and expanded for purposes of the present study in order to analyze the case records of 83 first admissions of Schneider-positive schizophrenics, that is, those with first rank symptoms, hospitalized in a strongly Schneider-oriented German University Clinic during the period 1962-1971. Research diagnosable "schizo-affective" disorder was thus found in 27.7% (23 cases) of these patients; 12 of the 23 satisfied "full" affective research criteria for depression or mania, whereas 11 fulfilled "adjusted" affective criteria geared to cover more "labile" mixed mood states. Moreover, 48.2% (40 cases) and 25.3% (21 cases) of the sample were research-positive for "schizophreniform" illness and "atypical schizophrenia" respectively. Findings such as these suggest that "first rank" schizophrenia, as routinely diagnosed in Germany, may not be all that homogeneous a clinical entity.
The phenomenological criteria of prominent Anglo-American researchers on certain so-called passivity experiences, sense deceptions and delusional phenomena, reflecting their interpretations of Kurt Schneider's first rank symptoms of schizophrenia, are examined. In this way the frequent discrepancies and difficulties in deliminiting the clinical boundaries of these phenomena more clearly come to light.
This paper reports on a relative rarity, the case of a 41-year-old male who, after receiving an original admission diagnosis of clear-cut acute mania, actually turned out to be suffering from herpes simplex encephalitis. Interestingly enough, his illness was unusually "benign" in the sense that at no time during massive cycling bipolar mood disturbances did any clinically apparent neurological signs and symptoms or other serious somatic complications or any psychopathology pointing to an acute organic brain syndrome appear. Karl Bonhoeffer's often forgotten but still relevant clinical insights on acute organic psychoses are then discussed in the light of recent research attempting to link manic states and infectious illness.
The rigorous neo-Kraepelinean research criteria of the St. Louis/Iowa and Taylor groups were applied to case record data of 116 first admissions of Schneider-negative schizophrenics--that is, those without first-rank symptoms (FRSs)--hospitalized in a strongly Schneider-oriented German University Psychiatric Clinic from 1962 to 1971. This sample had a total of 45.7% (53 cases) of psychiatric illness diagnosable by research methods. Indeed, only 31% (36 cases) of Schneider-negative schizophrenics turned out to have research-positive Kraepelin-oriented schizophrenia; and of these, 21 fulfilled both sets of research criteria for schizophrenia. It is important that 14.6% (17 cases) of Schneider-negative schizophrenia consisted of research-diagnosable affective disorder, with mania making up 5.2% and depression 9.4% of this figure. The findings suggest that a sample of Schneider-oriented schizophrenia without FRSs as routinely diagnosed in Germany does not seem to represent a clear-cut homogeneous and 'uncontaminated' group of schizophrenics.
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Emil Kraepelin's paper on false memories (Erinnerungsfälschungen) was probably the most extensive and incisive analysis of these phenomena ever made. Using his views as a starting point, the concept of confabulation is then defined in a Kraepelin-oriented manner, making it also applicable to the phantastic false memories found in some rarer forms of functional psychotic illness. Kraepelin and Leonhard have been preeminent in their concern with such clinical states; thus, Leonhard's confabulatory euphoria and confabulatory paraphrenia can be symptomatically and syndromally linked up with points of view on paranoid mania and confabulatory paraphrenia held by Kraepelin. An "ideally typical" case is also presented to highlight some of the difficulties involved in trying to distinguish mania from schizophrenia when the clinical picture is dominated by phantastic "functional" confabulations.
A slightly modified version of provisional research criteria for so-called 'schizo-affective and related psychosis', as recently published by the St. Louis Group, was used to investigate the case records of 116 Schneider-oriented first admissions of schizophrenics without first rank symptoms (Schneider-negative) who were hospitalized in a German center during the years 1962-1971. The sample contained 19.8% (23 cases) of research diagnosable schizo-affective illness as thus defined. 'Full' affective research criteria were satisfied by 13 of these schizo-affectives, and 10 were able to fulfill the 'adjusted' affective criteria assumed to be indicative of labile mixed mood states. The sample was then further analyzed in terms of 'schizophreniform' psychoses and 'atypical schizophrenia'. The findings seem to support the view that a non-negligible segment (23.3%) of Schneider-negative schizophrenia actually may represent either research diagnosable schizo-affective or affective disorders or satisfy criteria for both diagnoses.
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First-rank symptoms of schizophrenia, such as thought insertion, thought broadcasting, "made" volition, and delusional perception, were introduced for purposes of diagnosis into a German university clinic. Such "Schneiderian" criteria were evaluated in 210 case records. Ratings employed formal definitions. Of 210 records examined, 69 (33%) of the schizophrenic patients had first-rank symptoms. The frequency of finding such symptoms in a group of schizophrenics is compared to other reports. There are considerable differences in frequency of individual symptoms as well as total number of such symptoms across centers, but the use of precisely agreed on definitions of first-rank symptoms may lead to better agreement.
The general importance of paying attention to symptomatology in psychiatry is stressed. Research in this area has been advanced by modern psychopathometric methods. A renewal of general interest in the "classical" symptomatology of the older German authors is also shown by research involving Kurt Schneider's first rank symptoms of schizophrenia in England and the USA. Important papers concerned with this latter trend are discussed.
Most earlier studies and all studies on national samples in Scandinavia and in England and Wales have shown that schizophrenics have a significant excess of births in the early months of the year when compared with the expected distribution of the normal population. The present German study, carried out on schizophrenic patients diagnosed in a strongly Kurt Schneider--oriented clinic, in contrast to almost all other authors, demonstrated no such significant overrepresentation of births in the winter months. Thus, the findings of Danneel's (1973) German report, also utilizing Schneider-diagnosed schizophrenics, seem, at least for the present, to be confirmed.
"Thought insertion" is one of Kurt Schneider's first rank symptoms of schizophrenia. Earlier, Karl Jaspers had made a finer distinction, differentiating between "thought insertion in a narrower sense" and "made thoughts." However, most German and English writers have dispensed with the Jasperian criteria for this differentiation and consequently their use of the term "thought insertion" is broader. Such authors, including Kurt Schneider and Weitbrecht, usually speak of "thought insertion", "made thoughts", and "influencing of thoughts" as if they were identical phenomena. In contrast, Jaspers' differentiation offers us the possibility of more clearly distinguishing such symptoms and thus his distinction should not be neglected. Furthermore, the Jasperian criteria can be logically and usefully extended to all "made and passivity experiences" enabling one to recognise four aspects of such phenomena. Some general differential diagnostic considerations with respect to "thought insertion" are then presented.