Course Outcome of Delusional Psychoses

Abstract

The authors reinvestigated 84 out of a sample of 90 patients with delusional psychoses after an interval of 6–9 years. The results of the follow-up showed a pattern of episodic versus chronic course which compares to follow-up studies on classically diagnosed schizophrenias. The authors found evidence for their hypothesis concerning the nosological heterogeneity of this group of psychoses and propose a syndromatological classification apart from the delusional symptomatology itself. What they call background symptomatology was divided into axial syndromes. The authors feel that this results in subgroups that are more homogeneous for course and outcome than the usual classification systems.

Clinical Evaluation of Language and Thought Disorders in Patients with Schizophrenic and Affective Psychoses

“…Nevertheless, there are indications that it might be possible to distinguish between incoherent manic speech and incoherent schizophrenic speech by linguistic means [15], a differentiation that does not seem to be feasible on the level of psychopathological symptoms. Finally, the question of the possible prog nostic implications of the presence of symp toms of thought disorders included in the schizophrenic axial syndrome shall be raised: Berner et al [6] have been able to show in a follow-up investigation on delusional pa tients, that when the schizophrenic axial syn drome could be substantiated, a chronic course with development of deficiency states proved to be the rule. The same was true for a group of schizoaffective patients followed up to determine their course under lithium [ 10].…”

Conceptualization of Schizophrenia: The Symptom-Oriented Approach

“…Thus diagnostic systems which allow the attribution to schizophrenia on the basis of psychotic symptoms alone may entail the danger to group disorders of divergent origins under this heading. This objection, corroborated by several studies o f our group [16][17][18][19], concerns, for instance, the symptomatological schizophrenia criterion of D SM -IV [20], which allows two psychotic symptoms to determine the diagnostic attribution. Like other operational classifications D SM -IV tries to counterbalance this risk with the help of additional course-or severity-related criteria.…”

The Concepts of Axis Syndromes 1965–1983

“…Diagnostic critcria for schizophrénie and affective psychoses [Berner et al, 1983] Topic: theoretical; definition of operational research criteria for schizophrenic and affective psychoses Formulation: using the concept of axial syndromes; introducing the criterion 'definite' versus 'probable'; introducing the term 'endogenomorphic' to avoid misunderstandings Purpose of focusing axis syndromes: reducing opera tional criteria for the respective psychoses to symptomatological criteria; offering an operational instru ment which is theory oriented (endogeny hypothesis, relationship to the Bleulerian concept); widening of the typology of the cyclothymic axial syndrome by including a dysphoric axial syndrome and an axial syndrome of unstable mixed states the long-term evolution of so-called late schizophrenias in the sense of M. Bleuer [1943] which was based on the material of the Enquête of Lausanne [Gabriel, 1978]; the other study was a prospective follow-up study on paranoid functional psychoses exe cuted in Vienna from 1969 on. In both stud ies the main interest was given to the course (episodic versus chronic) [Gabriel, 1975a[Gabriel, , 1978Berner et al, 1980Berner et al, , 1984 and to sec ondary cases among first-degree relatives of the probands [Berner and Gabriel, 1973;Ga briel, 1975b;Schanda et al, 1983a, b], both with regard to the axis syndromatology. The results of these two studies are consistent.…”