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The authors present a schema for conceptualizing psychiatric illness in terms of state and trait disorders. These disorders are relatively independent components, one or both of which can be present in one patient. They usually require treatment by different methods. State disorders, such as schizophrenic psychosis, mania, and depression, are time-limited and autonomous and respond better to pharmacological than psychosocial therapy. Trait disorders, such as neurotic and characterological disturbances, are long-lasting and respond better to psychosocial therapies. The authors discuss the implications of this schema for the integration of pharmacological and psychosocial treatments.
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PMID:State and trait in psychiatric practice. 43 48

German language psychiatry has had and still has much difficulty in getting rid of the dichotomy of endogenous psychosis as set by Kraepelin. The concept which makes a distinction between schizophrenic psychosis and manic-depressive psychosis grants the former a predominant position by applying Jasper's hierarchic rule: the presence of symptoms regarded as schizophrenic indubitably attributes the disorder to schizophrenia. Such classification, however, does not necessarily imply that schizophrenia and cyclothymia (word proposed by K. Schneider for manic-depressive psychosis) represent separate nosological entities. It is admitted that it is possible for each group to include diseases whose hereditary transmission is not necessarily due to the same genetic predisposition. Thus, German language psychiatry has well accepted the possibility that bipolar manic-depressive psychosis and unipolar depressions represent separate etiologies. For most German-speaking psychiatrists, however, the distinction between endogenous and psychogenic depressions still remains a current assumption. The distinction between these two types of depression is generally made with reference to an "endogenous item profile" or to a depressive endogenomorphous axial syndrome. Only a few authors have accepted the model of continuity between these two types of depression proposed by the London school. The Hamburg school gave a new dimension to the conceptualization of manic-depressive psychosis by drawing attention on the existence of "rapidly alternating mixed states" which are much more common than the stable mixed conditions described by Kraepelin. On the basis of this concept and by questioning the validity of Jaspers' hierarchic rule, the Vienna school has considerably extended the limits of affectives psychosis to the detriment of the wide concept of schizophrenia described by K. Schneider.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Development of the manic-depressive concept in German language psychiatry]. 160 Sep 5

In a catchment area study of 101 first inceptions of schizophrenia, mania and atypical psychoses, women were significantly more likely to have atypical psychosis and men were more likely to have definite schizophrenia. Negative symptoms such as affective flattening and poverty of speech were already present in many cases, and were significantly increased in patients with definite schizophrenia (geometric mean 5.6) compared with those with atypical psychosis (geometric mean 3.2) and mania (geometric mean 1.5). Negative symptoms were also twice as severe in men (geometric mean 5.5) than women (geometric mean 2.6). There was a significant increase in negative symptom severity with longer illness and greater depression, but the diagnosis and the sex effects were not caused by these factors. We suggest that our findings are further support for the hypothesis that men have a greater biological vulnerability to negative symptoms and consequent social disability in the face of psychosis, particularly a schizophrenic psychosis, and that this may be one explanation for the apparently greater risk of definite schizophrenia and its poorer prognosis in men.
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PMID:Gender differences in the incidence of definite schizophrenia and atypical psychosis--focus on negative symptoms of schizophrenia. 179 20

In individual analytically oriented psychotherapy as a research method, observing a random sample of 34 schizophrenics with the symptoms of depressive syndrome, the author has found that depression in schizophrenia is determined by narcissistic injuries, by a collapse of narcissistic satisfactions through the loss of "ego" functions, completeness, competitiveness, and competence. The depressive model is most frequently encountered in florid schizophrenic psychosis, at the beginning of hospitalization, but depending on the intensity and depth of narcissistic traumas and losses, it can develop also in any phase of the therapeutic process and the course of illness. In the author's view, the depressive model in schizophrenia is not conditioned by the neuroleptic treatment. Its recognition is very important for the therapy of suicidal tendencies, and for their prevention in particular.
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PMID:[Narcissistic depression in schizophrenia]. 233 68

The most prescribed type of psychotropic medication in maghrebian psychiatry is neuroleptics. It is therefore legitimate to study the epidemiology of the most frequent side-effect of long-term treatment with neuroleptics: Tardive Dyskinesia (TD). At the moment, a collaborative study is under way on epidemiology of TD within the framework of the Maghrebian Association of Biological Psychiatry; several studies have also been conducted on this topic in the University Psychiatric Centre Ibn Rochd, Casablanca, Morocco in 1984, 1986 and 1987. For the maghrebian study, only preliminary results from Tunis will be presented. These studies have been interested in two epidemiological aspects: prevalence of TD in hospitalized and out-patients treated with neuroleptics; prevalence of TD-like movements among never treated schizophrenics. The assessment tool used for all the studies was the Abnormal Involuntary Movement Scale (AIMS). Main results of these studies are: 1) General prevalence of TD and risk factors in neuroleptized patients: In Tunis, Douki and Benamor in their on-going study, found a general prevalence of 20.50% (N = 200 in patients). A multi-factor analysis showed that risk factors are (in decreasing order): female gender, age above 60, associated depression, total duration of neuroleptic treatment above 20 years, a frequently discontinued treatment, shock therapies in antecedents or associated, a diagnosis of non schizophrenic psychosis, haloperidol intake below 25 mg and fluphenazine depot above 100 mg daily. In Casablanca, in 1984, Chorfi found a general prevalence of 10% (N = 50 out-patients). In 1986, Bentounsi found a 14.50% prevalence in Casablanca (N = 400 out-patients) and 63.97% in the oldest psychiatric hospital in Morocco in Berreshid (N = 605 in-patients).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Epidemiology of tardive dyskinesias in the Maghreb]. 290 47

Thirty-four newly admitted patients who met the Research Diagnostic Criteria for schizophrenia were assessed on admission and in their 8th week of hospitalization. The data were obtained using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HAM-D), and the Extrapyramidal Involvement Rating Scale (EPRS). A significant reduction in BPRS scores was observed on Week 8 scores compared with baseline scores (p less than .001); however, no significant difference could be found between baseline and Week 8 HAM-D scores. In addition, no significant correlation between the HAM-D scores and the EPRS scores was seen. Depressive symptoms appear to be present during the acute phase of schizophrenic psychosis and do not remit as rapidly as the psychotic symptoms.
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PMID:Depressive symptoms in acute schizophrenic hospitalized patients. 405 8

The literature describing symptomatic recovery in schizophrenic psychosis is reviewed. The dimensional and categorical models which have been used in this context are examined separately, and the phenomena of postpsychotic depression and style of recovery are also discussed. A model is then suggested in which the process of recovery is related to five dimensions of psychopathology. Such a model may be of use in efficiently describing the short-term course of psychosis in which symptom patterns or states, having relevance for clinical practice and research, could be defined.
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PMID:Recovery from schizophrenia: a review of patterns of psychosis. 684 92

The survey was carried out during 1979 (September-December). The sample covered the whole Federal District and the nineteen counties of the Greater Buenos Aires with a population of 9.908.001 persons; 18.61% in F. D. and 10,24% en G.B.A. refused to answer; 3411 were interviewed. The responses to the Present State Examination (PSE) were used for case-finding. The PSE is a semistructured interview that has been extensively tested with inpatients and outpatients. It has a technique for case-defining: the index of Definition (I.D.). A set of rules were developed to allocate the profile of symptoms present in the PSE (ninth edition) to one of the eight levels of definition. The rules were incorporated in a computer program called Catego. The prevalence of cases, as defined in the study, is 26% (ID 5-8) (30.8% in the feminine population and 20.3% in the masculine). If the threshold level (5) is excluded, the rate is 10,2%. (6,9% among males and 11,9% among females). The diagnosis derived from the Catego Program, fitted descriptively with the International Classification of Diseases (chapter 5) show the 13% of the population with neurotic perturbations, specially of depressive type, 6% with affective psychosis, 4% of schizophrenic psychosis and 1,3% of paranoic states. The major associations of prevalence rates are with sex and socioeconomic level. There is a preponderance of women with high Index of Definition. Future studies must prove the relationships between disorders and sex. We think that the interdependence of being married, children at home below 14 years, having no employment, can explain the high rates in the female population. The highest levels of the Index of Definition are associated with the lowest socioeconomic levels. The analysis of data presented here suggests more detailed studies, specially on the aetiology of depression and on the relationship between women and mental disorders.
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PMID:[Prevalence of mental disorders in the metropolitan area of the Republic of Argentina]. 713 34

The prolactin (PRL) response to 0.5 mg of intravenous haloperidol (HPL) IV may be a measure of tuberoinfundibular dopaminergic activity. Our earlier reports, using multidiagnostic strategies in schizophrenia, suggested that psychoses characterized by the absence of affective syndromes (Keks et al 1990) and the presence of thought disorder and passivity delusions (Keks et al 1992) are linked to blunted PRL responses. In this paper we evaluated the relationships between basal and HPL-stimulated PRL concentrations, and a number of potentially relevant symptom measures. Basal PRL was lower in patients without a depressive syndrome and suicidal ideation. Stimulated PRL was lower in patients without neurovegetative symptoms (versus patients with neurovegetative symptoms and controls), with depression (versus patients with no depression and controls) and those with disorder of associations (versus patients without association disturbance and controls). These findings can be interpreted as indicating a link between endocrine measures of dopaminergic function and a subtype of schizophrenic psychosis characterized by the presence of thinking disturbance in the absence of depression.
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PMID:Basal and haloperidol-stimulated prolactin and symptoms of nonaffective and affective psychoses in neuroleptic-free men. 771 Nov 59

Dexfenfluramine (DF) is contraindicated in severe psychiatric disorders and in depression. We used DF in 3 patients with chronic psychosis and severe overeating without changes in psychiatric pharmacotherapy. Two patients had paranoid schizophrenic psychosis with hallucinations, one patient mixed psychosis, beginning with lactation psychosis, and several attacks of hallucinations and depression later. Overeating was removed in all 3 patients without any negative effect on the psychotic state. All patients were able to maintain their body weight. Two patients with poorly controlled diabetes improved markedly their metabolic status. Doses up to 75 mg per day of DF were necessary during binge eating episodes in one patient. We conclude that DF can be used with care under close psychiatric supervision in psychotic patients with severe overeating.
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PMID:Dexfenfluramine in psychotic patients. 974 Oct 46


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