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PubMed1976

[Cerebral embolism and psychosis with special reference to cardiac surgery (author's transl)].

Cerebral embolism can manifest itself in certain cases as pure psychosis. In the absence of neurological symptoms it might be mistaken for schizophrenia or manic-depressive psychosis. Cardiac disease and cardiac surgery involve a high risk of embolism. Microembolism plays a special role with extracorporal circulation. There is a significant increase of postoperative psychosis in cases with E.C.C. in comparison to closed heart surgery. Immediately post-operatively there occurs what has been described as the "catastrophic reaction" or "immobilization syndrome". This reaction is in fact an akinetic, parkinsonian-like state for which there is good evidence that it is due to transient microembolism of the basal ganglia ("striatum apoplexy"). After its disappearance around the 3rd--5th day "cardiac psychoses" (cardiac delirium) may manifest themselves. Patients who develop these "late" psychoses have a significantly higher correlation with endogenous psychoses in their family histories. On the psychopathological level--in the absence of disturbances of consciousness and orientation--it is not possible to differentiate between "exogenous" and "endogenous" psychosis. A special type of psychopathological reaction is dependent, as in neurological disease, on the severity of brain damage, its localization and on hereditary factors.

Basal Ganglia↗

PubMed1991

[Carbamazepine in the treatment of mania and prevention of recurrence of manic-depressive disorders].

Carbamacepine is an effective drug in the treatment of acute manic states as well as in preventing relapses in the course of manic-depressive illness. Many controlled studies show that carbamacepine is a valuable alternative and an implementation to the existing methods of treatment. Treatment of acute mania can be more rapid, more specific of carbamacepine is used or combined with neuroleptics (or occasionally with lithium). There are less side effects in carbamacepine treatment than in conventional treatment. In relapse prevention carbamacepine is probably as effective as in lithium. The essential progress of using carbamacepine is given, because more patients are eligible for a regime of relapse prevention: Patients that have proven resistant to lithium treatment and patients with contraindications to lithium. Carbamacepine treatment presents an important breakthrough in Rapid Cycling Affective Psychoses. Here it may be superior to all other methods of treatment.

Bipolar Disorder↗

PubMed1976

Clinical response and plasma levels: effect of dose, dosage schedules, and drug interactions on plasma chlorpromazine levels.

Plasma chlorpromazine (CPZ) levels of 50 psychotic inpatients were measured by gas liquid chromatography; the clinical progress of 29 of these patients with acute psychoses was also assessed. CPZ levels of 50-300 ng/ml were usually associated with clinical improvement; there was also a relationship between CPZ levels and increases in certain symptoms. The 50-300 ng/ml level was best attained by doses of 400-800 mg/day. Trihexyphenidyl decreased plasma CPZ by a mean of 44.7% in 12 of 15 patients. A single 400-800-mg dose of CPZ at bedtime produced steady states equal to or better than those achieved with multiple doses. Those patients who failed to attain CPZ levels of more than 70 ng/ml despite doses of 400-1000 mg/day were receiving lithium throughout the study and had discharge diagnoses of manic-depressive psychosis, manic type, and schizo-affective schizophrenia--a finding with implications for future research.

Acute Disease↗

PubMed1978

Secondary mania: manic syndromes associated with antecedent physical illness or drugs.

While mania usually occurs as a phase of manic-depressive disease, it can occur in association with organic dysfunction--medical and pharmacological--in patients with no history of affective disorder. In reviewing the literature, we have found that mania occurs secondary to drugs, infection, neoplasm, epilepsy, and metabolic disturbances. These cases are best considered secondary manias. They suggest that mania--like, for example, hypertension--is a syndrome with multiple causes and that with further research many manic syndromes currently considered primary will be shifted into the secondary category. Furthermore, the concept of secondary mania casts doubt on any unitary or single-agent hypothesis of the etiology of mania and supports the notion of a continuum of psychopathologic syndromes. Clinicians are alerted to the existence of this syndrome and are urged to screen for it when conditions warrant.

Adrenal Cortex Hormones↗

PubMed1978

The course of affective disorders. I. Change of diagnosis of monopolar, unipolar, and bipolar illness.

All patients suffering from affective psychoses (ICD 296) who were admitted to the Psychiatric University Clinic of Zurich between 1959 and 1963 were studied in a follow-up investigation until 1975. Of 254 affective psychoses, 95 were bipolar patients (37.4%) and 159 were monopolar (62.6%). The sample of bipolar patients was complemented with all patients who had been admitted in the period 1959--1963 because of manic or mixed manic-depressive syndromes. This paper describes the change of diagnosis in the two diagnostic groups. In 10% (N = 20) of monopolar depression cases there was a change of diagnosis to bipolar affective illness. An analysis shows that the diagnosis of patients with three or more depressive episodes (unipolar depressives) was especially prone to change. A mathematical correction of some diagnostic errors leads to the conclusion that the ratio of unipolar depression to bipolar illness may be about 1:1. A major source of diagnostic error lies in the change of affective to schizo-affective illness. Up to now, no clinical criterion exists that would exclude this error, which was found in 6% (n=12) of the monopolar but also in 7.5% (n = 3) of the bipolar index patients. It is recommended that studies of affective disorders should be based on truly representative samples of the illness, including patients with one or two episodes, and that the term 'unipolar depression' be used synonymously with the term 'monopolar depression,' originally created by Kleist (1947) and Leonhard (1957).

Affective Symptoms↗

PubMed1991

Stability of diagnoses in affective, schizoaffective and schizophrenic disorders. Cross-sectional versus longitudinal diagnosis.

The present study investigated the syndrome shift during the course of disease in 355 patients with functional psychoses. The mean observation time was 25.2 years. Every episode was diagnosed cross-sectionally as schizophrenic, melancholic, manic, manic-depressive mixed, schizodepressive, schizomanic or schizomanic-depressive mixed. With regard to the whole course, 148 patients fulfilled the diagnostic criteria of schizophrenic, 106 of affective and 101 of schizoaffective disorders. Patients with a schizophrenic initial episode showed the greatest stability: 90% had no other type of episode. The majority of patients who suffered a melancholic initial episode remained unipolar melancholics or developed manic symptomatology, and only a few suffered schizoaffective or schizophrenic episodes. Patients with a manic symptomatology at the beginning had a very unstable and changeable course. The stability of patients with initial schizodepressive episodes lay between that of patients with melancholic initial episodes and that of those with manic initial episodes. The findings demonstrate the relevance of longitudinal considerations in making the final diagnosis.

Bipolar Disorder↗

PubMed1976

A method for testing differences in morbidity risk for affective psychoses.

A modified method for testing differences between two proportions is described and its use for testing differences in the morbidity risk for affective psychoses is discussed. The method is based upon the u test for comparisonof two proportions. An example of the application of the method to study sex differences in morbidity risk for affective psychoses in parents of probands with unipolar depression and manic-depressive psychosis presented.

Bipolar Disorder↗

PubMed1975

The common pathophysiology of monaminergic psychoses: a new hypothesis.

Several recent data indicate the blood-brain transport of amino acids as a critical factor in the synthesis of monoamines. The complex, peripheral and central regulation of TP transport plays an essential role sine TP-hydroxylase is not a saturated enzyme. The hydroxylated derivatives 5-HTP and dopa are probably transported into the brain by similar mechanisms as their precursors TP and tyrosine, respectively. The maic-depressive patients show an increased uptake of administered L-5-HTP in the depressive phase, whereas L-dopa uptake is enhanced in the manic phase. Heuristically, we propose a biochemical model of manic-depressive psychosis in which an increased TP uptake causes alternation in the balance of monoaminergic system activity. Depression is possibly characterized by a hyperserotonergic and a relative hypocatecholaminergic activity. In contrast, mania is possibly determined by a hypercatecholaminergic (NA and DA) and a relative hyposerotonergic activity. The data offered by the physiology of monoamines, the semeiology and the biological alterations of the manic-depressive psychosis, as well as the monoaminergic and the electrolyte theory of manic-depressive psychosis. A diminution of the transport of TP with consequent increase of that of tyrosine represents a possible biochemical model of schizophrenia which may be well explained by a hyposerotonergic-hyperdopaminergic activity, with or without noradrenergic insufficiency. This model is compatible with our knowledge on the monoamine physiology, the biological alterations of schizophrenia, the therapeutical results as well as with the classical clinical notions (typology, intermediate syndromes and crossed heritance).

5-Hydroxytryptophan↗

PubMed1978

Serum dopamine-beta-hydroxylase in affective disorders.

Serum dopamine-beta-hydroxylase (DBH) activity was tested in 160 psychiatric patients suffering from affective disorders. The patients were divided into subgroups according to strict diagnostic criteria and clinical state at the time of the examination. Since no relationship was found between DBH activity and age or sex, these variables have been discarded from further analyses. Bipolar (manic-depressive) patients had lower (p less than 0.05) BDH mean values than patients suffering from unipolar, recurrent depressive psychoses. No other differences were found either among group or in relation to the clinical state. As such a wide range of DBH values was recorded in all the groups examined, measurements of DBH activity do not seem to be useful as a diagnostic acid, or as an indicator of the clinical state of patients suffering from affective disorders.

Adult↗

PubMed1979

Cognitive and affective responses to lithium in patients with organic brain syndrome.

The authors describe a series of patients with organic brain syndrome who showed a dramatic clinical response to lithium carbonate therapy. None of the patients had been diagnosed as manic-depressive. Most had extensive psychiatric treatment experiences and had been given both affective and cognitive diagnoses. Six of the eight patients also qualified for the diagnosis of alcoholism. They had been treated with a wide variety of psychotherapeutic medications. Lithium was found to be rapidly and dramatically effective in patients with static lesions of the central nervous system who showed a combination of dementia and agitated depression.

Affect↗

PubMed1976

Schneider-oriented versus Conrad-oriented psychiatric diagnosis in the same German clinic.

The Chair of the University Nervenklinik in Homburg/Saar was held by Klaus Conrad from 1949-58 and by H.-H. Meyer, a former pupil and colleague of Kurt Schneider, from 1962-72. As the catchment area and admission policy of the clinic remained substantially unchanged throughout, comparison of the relative proportions of all admissions allocated to different diagnostic categories in 1949-58 and 1962-72 can be used to elucidate the similarities and differences between Conrad's and Schneider's diagnostic criteria. The results of this comparison indicate that Schneider's concept of schizophrenia was broader than Conrad's, and his concept of manic-depressive depression more restricted. More detailed comparisons are complicated by differences in nomenclature and in the varieties of functional mental illness recognized in the two periods. However, it seems that Conrad's concept of mania was wider only when the atypical schizophrenia-like psychoses diagnosed during the Conrad era were added to the Conrad-oriented cases of mania; when this was not done, the Schneiderian concept of mania was broader.

Adjustment Disorders↗

PubMed1977

Genetical analysis of unipolar and bipolar endogenous affective psychoses.

The mode of inheritance of affective psychoses was studied in 800 first degree and 582 second degree relatives of 122 probands. Morbidity risk for unipolar depression was 12.0+/-3.2 and 11.4+/-2.7 per cent respectively for parents and siblings of probands suffering from unipolar depression. Morbidity risk for manic-depressive psychosis for the respective groups of first degree relatives of manic-depressive probands was 15.1+/-3.2 and 16.9+/-3.2 per cent. In second degree relatives the morbidity risk was 3.4+/-1.0 and 5.3+/-1.4 per cent for unipolar depression and manic-depressive psychosis respectively. The results indicate the role of genetical factors in the etiology of both types of affective disorder and show that unipolar depression and manic-depressive psychosis are distinct entities. The hypothesis of X-linked dominant transmission was not confirmed in either of these affective disorders. By means of the computational model of Slater, no results compatible with a polygenic inheritance of unipolar depression or manic-depressive psychosis were found.

Adolescent↗

PubMed1975

[Presentation of information for the diagnostic-therapeutic decision of the psychiatrist].

So far, little systematic work had been done to investigate how information regarding psychiatric cases should best be presented in order to facilitate important medical decisions. For each of three groups of diseases: (a) schizophrenic reaction, paranoid, (b) manic-depressive, depressed, and (c) anxiety neurosis, we have described four different cases, systematically varying both quantitatively and qualitatively the information in each description. Categorical judgement was given by 15 psychiatrists on a nine-step rating scale with regard to three dimensions. In order to investigate the constancy of the judgements, the method of scaled pair comparisons was used according to the law of comparative judgement. After examination of the adequacy of the scaling models, the following results, among others, were obtained from the scale scores: the discrimination of the two cases of psychoses was highly significant, that of the anxiety neurosis was not significant.

Anxiety Disorders↗

PubMed1976

[Dynamics of the clinico-pathophysiologic characteristics of psychoses in old age under the influence of azafen].

A study of singular doses and subsequent maintenance therapy by azafen on the higher nervous activity of mental patients in presenile age (67 cases) revealed that its action depends upon the dosage of the preparation and the nosological syndrome. A depressive involutional psychoses can be controlled by azafen in doses up to 75 mg daily. By dosages of 25 mg azafen reduces or cessates completely the syndrome of changed consciousness due to disorders of brain circulation. An arrest of a depressive syndrome in manic-depressive psychosis in old age can be attained by an introduction of 150-200 mg of azafen daily.

Aged↗

PubMed1991

[Affective, schizoaffective and schizophrenic psychoses. A comparative long-term study].

A total of 402 patients were followed up for, on average, 25 years after the onset of their illness. The diagnoses, made longitudinally, were as follows: schizophrenic disorder (n = 148); schizoaffective disorder (n = 101); affective disorder (n = 106). The remaining 47 patients did not fulfil the criteria for any of these diagnoses. A distinction was made between "episode" (cross-sectional diagnosis) and "illness" or "disorder" (longitudinal diagnosis). The "episodes" (cross-sectional diagnosis) were classified according to slightly modified DSM-III criteria into schizophrenic, affective (melancholic, manic, manic-depressive mixed), schizoaffective (schizodepressive, schizomanic, schizomanic-depressive mixed) and non-characteristic episodes. The criteria for the episodes are: Schizophrenic episode: criteria of DSM-III, slightly modified. Melancholic episode: according to "Major Depression, Melancholic Type" of DSM-III-R. Manic episode: according to the criteria of DSM-III, slightly modified. Manic-depressive mixed episode: Presence of manic and depressive symptomatology during one episode. Schizodepressive episode: Presence of schizophrenic and depressive symptomatology during one episode. --Schizomanic episode: presence of schizophrenic and manic symptomatology during one episode. Schizomanic-depressive mixed episode: Presence of schizophrenic, manic and depressive symptomatology during one episode. The diagnosis of an "illness" or "disorder" (longitudinal diagnosis) took account of all the kinds of episodes that occurred during the whole course. The final diagnosis (longitudinal diagnoses) were defined as follows: Schizophrenic disorder: only schizophrenic episodes during the whole course Affective disorder: only affective episodes during the whole course (melancholic, manic, manic-depressive mixed episodes). Schizoaffective disorder: at least one schizoaffective episode during the course (schizodepressive, schizomanic, schizomanic-depressive mixed episode), independently of the type and number of other episodes, or sequential manifestation of schizophrenic and affective episodes. The principal instruments of investigation and evaluation were: Global Assessment Scale (GAS); Disability Assessment Schedule (WHO/DAS); Psychological Impairment Rating Schedule (WHO/PIRS); Present State Examination (PSE); Criteria for social class and social mobility according to Kleining and Moore (also transferred to the criteria of Hollingshead and Redlich) - A pool of items based on WHO instruments for social parameters; Items for pharmacological treatment and prophylaxis.

Activities of Daily Living↗

PubMed1991

New admissions to a psychiatric ward in a general hospital.

A study of 343 new patients in the first psychiatric department in a general hospital in Singapore revealed a large proportion (40%, n = 137) of neurotic patients, especially neurotic depressives (n = 76). The next largest group is the non-organic psychoses 35% (n = 120), most of which were schizophrenic psychoses (n = 73). The other major diagnostic groups were adjustment or acute stress reactions, alcohol or drug dependence and personality disorders. The neurotic patients were generally older than the psychotic patients at the time of admission (p less than 0.02). More of them were married (62.7%) compared with the psychotics of whom 51.5% remained unmarried (p less than 0.02). Comparison between neurotic depressives and manic-depressive psychotics should have no difference in sex ratio and marital status. However, the duration of admission for the latter was longer.

Adolescent↗

PubMed1979

[Genetics of endogenous psychoses].

As the endogeneous psychoses do not show a Mendelian mode of inheritance, empirical risk figures have to be calculated. They are heterogeneous and nurture as well as nature have a share in the manifestation of illness. The genetic basis of the schizophrenias is demonstrated by twin and adoption studies. The concordance rate in monozygotic twins is four times the rate in dizygotic twins. Schizophrenia is to be found in the biological families of schizophrenic adoptees but not in the adoptive families. However, despite their genetic identity, monozygotic twins do not show 100% concordance but 60% only. Nongenetic factors must be considered. Obviously they are nonspecific and vary between individuals. The same principles apply to the affective psychoses. At present research is most interested in the problem of heterogeneity. Do pure depressive and manic-depressive disease form one genetic entity, or two different ones, or have they in common part of their genetic basis? Some remarks on genetic counselling are made.

Adoption↗

PubMed1977

[Use of long-acting lithium carbonate--micalite--in the treatment of affective psychoses].

Micalite (microcapsulated lithium carbonate with a retarded action) was used for the treatment of manic states and the prevention of attacks of manic-depressive psychosis in 40 patients. The preparation was administered once daily. This provided the necessary concentration of lithium in the blood on a stable level. According to its therapeutical effectiveness and the frequency of side-effects micalite does not differ from other lithium preparations with a simgle daily administration of micalite there are much less distubrances in the treament regime.

Bipolar Disorder↗