Development and structure of the DCR Budapest-Nashville.

The DCR Budapest-Nashville was developed by adopting a differentiated concept of the 'full disease entity'. The so-called small disease entity is a preliminary stage in the search for more complicated disease entities. In its present form, the DCR is a diagnostic method for identifying small disease entities in the spectrum of reactive (i.e. psychogenic) and functional (i.e. endogenous) psychoses. The nosological concept of the DCR can be characterized by thirteen paradigms: (1) a nonkraepelinian clinical classificatory system given by Leonhard; (2) the index-psychosis paradigm as opposed to the end-state paradigm; (3) conceptual differentiation of the disease entities as opposed both to the full disease entity paradigm and to the only-one-psychosis (or no disease entity) paradigm, respectively; (4) an aristotelian distinction between content (meaning) and form as opposed to the paradigm of ideas; (5) three-aspect approach to the psychopathological phenomena instead of choosing only one or two of the aspects of experience, of the behavior and of the achievement as special paradigm; (6) gestalt paradigm specified in different ways, as completing the associationist paradigm; (7) structural paradigm, especially concerning the delusions; (8) method of understanding in contrast to the method of causal explanation in distinguishing reactive (i.e. psychogenic) psychoses from functional (i.e. endogenous) psychoses; (9) behavioral symptoms overrule experiential symptoms in the decision-tree process concerning schizophrenias; (10) erosive psychotic phenomena ('minus symptoms') overrule productive phenomena ('plus symptoms') in the decision-tree process concerning hebephrenias in the group of systematic schizophrenias; (11) three-dimensional (polarity, rhythmicity, deterioration) assessment of course of illness; (12) sociological paradigm in reformulation of types of 'defect'; (13) psychosis paradigm concerning the operationalization of applicability of DCR to patients. Some empirical investigations are mentioned concerning the validity of the DCR.

Depth dimension. A psychometric approach and some clinical data.

A psychometric scale based upon phenomenological descriptions was constructed for approaching the emotional depth dimension of personality. Some nosological groups of endogenous psychoses tested in the frame of a controlled follow-up study were characterized by psychometric values which might be discussed both in relation to prepsychotic personality and to course of illness.

Types of complaints in psychiatric and internal medical patients.

A follow-up study was made in groups of female neurotic, depressive, periodic catatonic, hypertonic, hyperthyreotic patients and normal control subjects using self-rating questionnaires to assess disposition, depressivity, neuroticism and subclinical symptoms. The subclinical symptoms scale (Sub-S) was elaborated on the basis of Huber's pure defect. We found that the experience (Sub-Exp) and behavior characteristics (Sub-Be) of the Sub-S form two separate subconstructs. The Sub-Exp belongs to the neuroticism factor and the Sub-Be can be evaluated as a subclinical appearance of manifest psychopathological behavior symptoms. The 'general disposition' construct is divided into subconstructs and shows contextual variants. It is proposed to use different methods for assessing it in the different problem areas simultaneously.

Chronophrenia--a new syndrome in functional psychoses.

The author describes the 12-year history of a functional (endogenous) psychosis in a 25-year-old woman and the subsequent full social remission. The central symptom in the case history is the delusion that the patient has already lived through this life once. This delusion appears as the experience of reduplication, differing from that of déjà vu, based on mental automatism. It is accompanied by euphoria and the distortion of the future time perspective. The hypothesis of a disorder in the function of the limbic system arises as a possible pathophysiological explanation. Schizophrenic symptoms were absent and no defect was formed. This previously unknown syndrome presented by the use of the idiographic method may contribute to the widening of nomothetic nosological research.

Dimensional assessment of the course of psychiatric illness.

After a brief survey of catamnestic studies of the endogenous psychoses and on the basis of his own experiences, the author proposes a three-dimensional (periodization, polarity, deterioration) assessment of the formal characteristics of the course of illness, making a theoretical distinction between these and the characteristics of the outcome.

Hourglass model of psychiatric diseases: the endogenous psychoses.

On the basis of Jaspers' conception, a continuum of disease entities was earlier proposed. According to this linear disease model, a psychopathological syndrome, expanded with course of illness over a specified period of time (small disease entity) and with the etiopathogenesis (etiopathogenetical-syndromatological disease entity), can progress to the full disease entity. In empirical studies, variables indicating psychopathological disorders, on the one hand, and social maladjustment, on the other, form a relatively antagonistic open system in the outcome. Based on this finding and on the conceptions of multi-axial classifications, an hourglass model is proposed as a further development of the linear disease model. The proposed model reflects the intertwining of life history and case history, and offers the opportunity for both the elaboration of hypotheses that lend themselves to testing, and a synthesis of the biological and social psychiatric approaches.

Concepts of Schizo-affective psychoses. History, construct validity and some empirical data.

After offering a brief survey of some major unresolved contradictions in the field of clinical psychiatry, the author looks over the historical development of syndromatological entities related to the so-called schizo-affective psychoses. These syndromes were described with reference to somatogenic, endogenous, and psychogenic psychoses and as (relatively) distinct entities, respectively. For grasping these syndromes as independent entities it seems to be necessary to take into account a few holistic characteristics and to put aside the 'mixture model' while making research diagnostic criteria.

Familially accumulated schizophrenia (folie à cinq) in association with Stein-Leventhal syndrome.

The authors describe the psychosis of both parents and their three daughters. The psychosis of the father and three daughters corresponds to the paranoid schizophrenias (more specifically, the affective paraphrenias), while the mother's psychosis is largely the result of induction. All 3 daughters suffer from surgically confirmed Stein-Leventhal syndrome. Such a close association of the two diseases cannot be by chance.

[The role of high-dosage neuroleptic therapy and electroshock in the treatment of the acute phase of schizophrenia]. / Zur Rolle der neureleptischen Hochdosis-Therapie und des Elektroschocks bei der Behandlung der akuten Phase von Schizophrenien.

The authors studied the effectiveness of neuroleptic high-dosage therapy in comparison to the electroshock treatment in the acute phase of systematic and unsystematic schizophrenia in a total of 75 patients. The results obtained show that the neuroleptic high-dosage therapy exceeds the effectiveness of the electroshock treatment mainly in the group of unsystematic schizophrenia.

[Neuroleptic large dose therapy of schizophrenias]. / Neuroleptische Hochdosistherapie von Schizophrenien.

In recent years, the complex treatment of schizophrenia has been extended by the neuroleptic large-dose therapy. Our investigations carried out so far, which reflect the experiences gained in several years with this form of treatment, include 30 schizophrenic patients admitted in an acute psychotic condition. They were treated for six days running with 40 to 120 (average 65) mg of Haloperidol daily. The results of our studies show that the large-dose therapy with Haloperidol as an initial phase of a combined pharmaco-therapy represents a safe, rapid and effective method.

Clinical notes on the possible anticholinergic reversal of depressive syndromes.

The authors report on the effects of acute confusional states and deliria (pharmacogenic confusional syndromes - PCS), occurring under the influence of psychotropic drugs on the depressive syndrome of three patients. The favourable influence of PCS on the depressive syndrome is considered to be largely linked to the anticholinergic effect of the drugs. The observations made in these three patients may give support to the hypothesis that cholinergic activity has pathogenic significance in depressive syndromes.

[Pathogenesis of the dermatoses delusion]. / Zur Pathogenese des Dermatozoenwahns.

Discussing two cases, the authors describe their opinion on the etiopathogenicity of the dermatozoic delusion. They point to the necessity of a multidimensional examination of the syndrome, to its relative incidence, and to the advantageous possibilities of a therapy.