Course of Endogenous Affective Psychoses and its Modification by Prophylactic Administration of Imipramine and Lithium

Abstract

1. In spite of the wide-spread use of antidepressants during psychotic episodes, it is still true that the course of endogenous affective psychoses is characterized by a decrease of the average duration of the cycles with the increase in the number of episodes. In bipolar manic-depressive psychoses as well as in schizo-affective psychoses every subsequent cycle is shorter by 10 % than the previous one. The corresponding percentage for recurrent depression is 20 %. As schizo-affective and bipolar manic-depressive psychoses start with much shorter cycles, they definitely take a more malignant course than recurrent depression. 2. These courses can not be modified in severely depressed patients by long term Imipramine treatment. In spite of this medication the cycles get shorter and the rate of admissions to a hospital increases. 3. Lithium has genuine prophylactic properties. This result is based on 50 patients from Zurich and 41 patients from Prague. It increases the length of cycles significantly and decreases the rate of admissions by about a third when equal periods of time before and under Lithium medication are compared. It has prophylactic effects on the following diagnostic groups: schizo-affective psychoses, bipolar manic-depressive psychoses and endogenous recurrent depression. The results of Baastrup and Schou (1967) are thus confirmed by two other independent investigations.

The course and prognosis of manic-depressive psychosis: A quantitative analysis of episodes and intervals.

“…Number of episodes and length of intervals corresponding to 80% cumulative relative frequency in our study were very much alike to those counted from the report by Angst et al (1969). However, we are not able to demonstrate the change of length of intervals in the later course of illness, as suggested by them.…”

“…Definition of an episode depends on Angst et al (1969). The beginning of an episode is rather easy to determine.…”

“…However, quantitative analysis has been performed recently only in a few reports (Angst et al 1969;Dunner et al 1979). The authors have studied the influence of treatment method to the prognosis and the distribution of ages of onset in manic-depressive psychosis (Fukuda et al 1975(Fukuda et al , 1979.…”

The Full Story of Lithium

“…The academic world Mogens Schou had to fi ght against is clearly illustrated by the conclusion Blackwell and Shepherd [8] published in 1968 after re-examining the data from Baastrup and Schou, stating that prophylactic lithium is just another therapeutic myth. However, in 1969, Angst et al [9] statistically showed the prophylactic effect of lithium in endogenous depression, bipolar disorder and schizo-affective disorders. In 1970, Baastrup et al [10] eventually demonstrated signifi cant results in a placebo-controlled study of the mood-stabilising effect of long-term lithium therapy in patients with manic-depressive disorder.…”

“…In contrast, in 1970 Mogens Schou had developed a close relationship with the clinical psychiatrists with experience of the prophylactic effect of lithium in mood disorder, especially Jules Angst [9] . Thus, Schou was eager to confi rm the effect of lithium in the prevention of mood disorder and not simply for maintenance (i.e.…”