Psychotic Continuum or Distinct Entities: Perspectives from Psychopathology

  • Ch. Mundt
Conference paper

Abstract

The pursuit of clear-cut and theoretically convincing classifications of the idiopathic psychoses by means of operationalized psychopathology was instigated 30 years ago in order to carry out epidemiological studies, studies of the long-term-course, and studies of treatment efficacy. Today, the revitalized genetics need sound categorical classification. However, one has to bear in mind that this is but one reason for typing psychiatric patients. A psychotherapist who wants to address coping behavior, or avoidance of precipitating life events, or training methods for deficits will have quite different diagnostic demands; again other aspects of typing may serve the pharmacologist, such as the Kielholz design, which in the meantime is questioned. Thus, the following considerations will leave aside pragmatic aspects of classification, e.g., for treatment, but instead refer to classical nosological research, the principles of which were outlined by Kraepelin (1903) and, in the English scientific world, by Cullen in 1803 (see Berrios and Beer 1992) as follows:

Disease entities are determined by identical symptoms, course, etiology, and pathomorphology. The research process is meant to follow a constant approximation of this ideal. Hence, outlining perspectives from a mere psycho- pathological point of view is a difficult task, since psychopathological validation of a nosological concept usually implies external validation with course, outcome, biological parameters, genetics, and personality and will probably result in outlining a type of mental disorganization, perhaps inherent to its structure, rather than producing stringent mental concomitants of particular biological disturbances.

Keywords

Depression Schizophrenia Serotonin Neurol Bark 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Andreasen NC, Olsen S (1982) Negative vs positive schizophrenia. Definition and validation. Arch Gen Psychiatry 39:789–794PubMedGoogle Scholar
  2. Barnes TRA, Curson DA, Liddle PF, Patel M (1989) The nature and prevalence of depression in chronic schizophrenic in-patients. Br J Psychiatry 154:486–491PubMedCrossRefGoogle Scholar
  3. Barnett W, Mündt C (1992) Are latent thought disorders the core of negative schizophrenia? In: Spitzer M, Uehlein F, Schwartz MA, Mündt C (eds) Phenomenology, language, and schizophrenia. Springer, Berlin Heidelberg New York, pp 240–257CrossRefGoogle Scholar
  4. Berner P (1982) Achsensyndrome endogener Psychosen. In: Huber G (ed) Endogene Psychosen: Diagnostik, Basissymptome und biologische Parameter. Schattauer, Stuttgart, pp 77–96Google Scholar
  5. Berrios GE, Beer D (1992) Unitary psychosis in English speaking psychiatry: a conceptual history. In: Mündt C, Sass H (eds) Für und wider die Einheitspsychose, Thieme, Stuttgart, pp 12–21Google Scholar
  6. Bilder RM, Mukherjee S, Rieder RO, Pandurangi AK (1985) Symptomatic and neuropsychological components of defect states. Schizophr Bull 11:409–419PubMedGoogle Scholar
  7. Bleuler E (1969) Lehrbuch der Psychiatrie, 11th edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  8. Bonhoeffer K (1910) Die symptomatischen Psychosen im Gefolge von akuten Infektionen und inneren Erkrankungen. Deuticke, LeipzigGoogle Scholar
  9. Carpenter WT, Heinrichs DW, Alphs LD (1985) Treatment of negative symptoms. Schizophr Bull 11:37–49Google Scholar
  10. Conrad K (1958) Die beginnende Schizophrenie. Thieme, StuttgartGoogle Scholar
  11. Crow TJ (1986) The continuum of psychosis and its implication for the structure of the gene. Br J Psychiatry 149:419–429PubMedCrossRefGoogle Scholar
  12. Harvey PC, Serper MR (1990) Linguistic and cognitive failures in schizophrenia. J Nerv Ment Dis 178:487–493PubMedGoogle Scholar
  13. Heimann H (1986) Spezifität und Unspezifität bei psychiatrischen Erkrankungen. Schweiz Arch Neurol Psychiatry 137:67–86Google Scholar
  14. Janzarik W (1988) Strukturdynamische Grundlagen der Psychiatrie. Enke, StuttgartGoogle Scholar
  15. Jaspers K (1965) Allgemeine Psychopathologie, 9th edn. Springer, Berlin Heidelberg New YorkCrossRefGoogle Scholar
  16. Johnstone EC, Crow TJ, Frith CD, Carney MWP, Price JS (1978) Mechanisms of the antipsychotic effect in the treatment of acute schizophrenia. Lancet 1:848–851PubMedCrossRefGoogle Scholar
  17. Kane J, Honigfeld G, Singer J, Meitzer H, the Clozapin collaborative study group. (1988) Clozapin for the treatment-resistant schizophrenic. Arch Gen Psychiatry 45:789–796PubMedGoogle Scholar
  18. Kendell RE, Brockington JF (1980) The identification of disease entities and the relationship between schizophrenia and affective psychoses. Br J Psychiatry 137: 324–331PubMedCrossRefGoogle Scholar
  19. Kendell RE, Gourley J (1970) The clinical distinction between the affective psychoses and schizophrenia. Br J Psychiatry 117:261–266PubMedGoogle Scholar
  20. Kick H (1981) Die Dichotomie der idiopathischen Psychosen im Syndromprofilvergleich der Kraepelin’schen Krankheitsbeschreibungen. Nervenarzt 52:522–524PubMedGoogle Scholar
  21. Koehler K, Seminario J (1979) Research diagnosable“schizo-affective” disorders in Schneiderian “first rank” schizophrenia. Acta Psychiat Scand 60:347–354PubMedCrossRefGoogle Scholar
  22. Kraepelin E (1903) Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Barth, LeipzigGoogle Scholar
  23. Landmark J, Merskey H, Cernovsky Z, Helmes E (1990) The positive triad of schizophrenic symptoms. Its statistical properties and its relationship to 13 traditional diagnostic symptoms. Br J Psychiatry 156:388–394PubMedCrossRefGoogle Scholar
  24. Liddle PF (1987) The symptoms of chronic schizophrenia. A re-examination of the positive-negative dichotomy. Br J Psychiatry 151:145–151PubMedCrossRefGoogle Scholar
  25. Lindenmayer J-P, Bernstein-Hyman R, Grochowski S, Bark N (1995) Psychopathology of schizophrenia: Initial validation of a 5-factor model. Psychopathology 28:22–31PubMedCrossRefGoogle Scholar
  26. Lorr M, Klett CJ, McNair DM (1963) Syndromes of psychosis. Pergamon, Oxford Mündt Ch (1985) Das Apathiesyndrom der Schizophrenen. Eine psychopathologische und computertomographische Untersuchung. Springer, Berlin Heidelberg New York Mündt Ch,Google Scholar
  27. Kasper S (1987) Zur Schizophreniespezifität von negativen und Basissymptomen. Nervenarzt 58:489–495PubMedGoogle Scholar
  28. Mündt Ch, Kasper S, Huerkamp M (1989) The diagnostic specificity of negative symptoms and their psychopathological context. Br J Psychiat 155 [Suppl 7]:32—36Google Scholar
  29. Mündt Ch (1989) Die psychopathologischen Grundlagen der Psychopathometrie des schizophrenen Residualsyndroms. Fundam Psychiatr 3:2–11Google Scholar
  30. Schneider F (1992) Psychophysiologische Unspezifität schizophrener Erkrankungen. Fischer, StuttgartGoogle Scholar
  31. Silverstein ML, Arzt AT (1985) Neuropsychological dysfunction in schizophrenia. J Nerv Ment Dis 173:341–346PubMedCrossRefGoogle Scholar
  32. Tsuang MT, Lyons MJ, Faraone SV (1990) Heterogeneity of schizophrenia. Br J Psychiatry 156:17–26PubMedCrossRefGoogle Scholar
  33. Von Praag HM, Kahn RS, Asnis GM, Wetzler S, Brown SL, Bleich A, Korn ML (1987) Denosologization of biological psychiatry or the specificity of 5-HT disturbances in psychiatric disorders. J Affective Disord 13:1–8CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • Ch. Mundt
    • 1
  1. 1.Psychiatrische KlinikUniversitat HeidelbergHeidelbergGermany

Personalised recommendations