Italian psychiatrists are experiencing great uncertainty regarding acute atypical psychosis. Although they recognize the classification of Kraepelin’s psychosis, with regard to acute psychoses with confusion, Italian psychiatrists are closer to the French. As a result, some of the acute atypical psychosis is included in the framework of mental confusion (episodic twilight states of Kleist, Meduna one-point fermentation, periodic amentia, delirium acutum). With respect to other atypical schizoform psychosis, the authors’ efforts are directed at resolving the issue of their belonging to schizophrenia or manic-depressive psychosis.
Nobile and Sciorta (1953) divided “autonomous” and “mixed” psychoses into three groups:
1) cases in which there is a schizophrenic picture with elements of manic-depressive psychosis. Options: episodes of manic arousal and depression with schizophrenic elements; cyclical forms of schizophrenia; delusional forms with a rich affect (for example, fantastic parafrenia);
2) atypical pictures that can not be attributed either to schizophrenia or to manic-depressive. psychosis (states of inhibition, some manic and depressive states, polymorphic delusional episodes);
3) atypical pictures of manic-depressive psychosis (pictures mostly manic-depressive with schizophrenic elements).
Giannini (1959) divides the “mixed” psychosis into 4 groups: circular attacks with an outcome to dementia; alternation of episodes of clearly schizophrenic and more typical circular; combination of schizophrenic and circular symptoms in one attack; circular schizophrenia without outcome in dementia.
Gregoretti and Gasparone (1961) believe that acute delusional psychosis can be divided into a form with a delusion of interpretation and into a psycho-sensory-interpretative form. Deep anxiety and a narrowing of the field of consciousness are characteristic of all forms. Nosologically, these psychoses are unclear.
Fiume and d’Avossa (1959) described a similar psychosis called “oneiric syndromes”. In their opinion, these psychoses are characterized by the fact that hereditary readiness and psychogenic provocation play a decisive role in their occurrence. Psychopathologically, there is hyper-acidity of consciousness and its affective narrowing, arousal, quickly turning into a stupor, “pendulum transfer from the real world to the world of hallucinations”, fluctuation of affect, loss of temporal-spatial connections of experienced events. This “presence and non-presence in the world” gives rise to disorientation and secondarily delusional mood. The prognosis of the disease is very favorable. The authors attribute these “syndromes” to atypical schizophrenia. In another work – Giannini and Del Carlo Giannini (1959), on the contrary, believe that they should be attributed to atypical manic-depressive psychosis.
A great interest in these psychosis has been shown for many years. Scandinavian psychiatrists. The works of Langfeld (1939, 1961) and his collaborators on the division of “schizophrenia” into procedural and combined groups of “schizoform” psychoses are known. For these works, the desire is primarily with the help of the follow-up check to separate schizophrenia from schizoform psychosis.
Welner and Stromgren (1958) call these psychosis benign schizophrenia and attach great importance to the effects of nonspecific factors, and especially psychogenias. In addition to reactive (paranoid, depressive, confused) psychoses, it is assumed that “schizoform psychosis” sometimes includes true schizophrenia, atypical manic-depressive psychosis, and some organic psychoses (Stromgren, 1965).
In the works of Astrup, Possum and Stolmboe (1963), Astrup and Noreik (1966), “functional psychosis” was subjected to clinical and catamnestic, clinical and genetic studies, the study of prognostic factors, etc. Acute atypical psychosis is located between schizophrenia and manic-depressive psychosis. They are grouped around two diagnostic concepts – “schizoform” and “reactive” psychoses of depressive, paranoid, hysterical and confused types.
For the designation of individual types of attacks, either the terms of the Kleist – Leonhard school (various cycloid psychosis, unsystematic schizophrenia, etc.), or more general concepts: depression, agitation (mania), confusion, paranoid, hebephrenic, catatonic, were used.
The concepts of “schizoform” and “reactive psychosis” used by Scandinavian psychiatrists, as shown by their own tests, do not have a clear content. In a large number of cases [in 37% ‘of Astrup, Dalgard, Itolmboe (1967)] reactive psychosis, a follow-up revealed schizophrenia. The study of the frequency of diagnostic errors revealed some of their decline (Holm-boe, Noreik, Astrup, 1968).
The famous Dutch psychiatrist Rumke (1958) paid attention to the clinical division of pseudochemophrenia. Separating pseudo-schizophrenia from true schizophrenia, the author divides them into atypical circular psychosis, degenerative psychosis, paranoid psychosis, “acute outbreaks in schizoids, and occasional delusions of degenerants” (he refers to pseudoshizophrenia as organic psychoses).
In US psychiatry, the clinical side of these psychoses has been little studied. Some studies recognize the separation of schizophrenia into classical early dementia and reactive schizophrenia (Bellak, 1958). In the manual on psychiatry edited by Arieti (1959), these psychosis are mentioned when describing catatonic and schizoaffective forms of “schizophrenic reaction”, manic-depressive psychosis (acute parafrenia, delirium acutum), paranoid reactions (acute delusional psychosis). Polatin (1964) among atypical forms of schizophrenia describes: 1) acute states of confusion, characterized by sudden onset disorder of orientation and confusion. When they are observed “dreaming experiences and the similarity of the clinical picture with delirium.”
The author considers the clinical type of such psychosis to be transient, so-called “three-day schizophrenic reactions”, observed in the military during the war, some postpartum psychosis. In these attacks, psychomotor disorders (stupor or agitation), hallucinations and illusions also occur. These psychosis can be provoked; 2) “micro-catatonia”, which is “a periodic or cyclic form of schizophrenia with unreal experiences, special behavior and a sudden exit with almost no personality change”; 3) schizoaffective psychosis. Depressive psychosis in a broad sense. At the beginning of attacks to 30 years can not make a prediction.
A group of authors (Wada, Tanaka, Ogasavara and Sacu-rada, 1963), who agree with the concept, divides atypical psychosis into 3 groups: the first group is characterized by a pronounced disorder of consciousness, acute hallucinatory-delusional disorders, a one-way nervosa, delirium or stupor. The attack lasts 1-2 months, the prognosis is good. The second group is characterized by manic-depressive colouration, emotional instability, psychomotor symptoms, delusions and hallucinations. For phase, the duration of attacks 2-3 months., The prognosis is favorable. Patients of the third group have a pronounced “schizophrenic nuance”, catatonic symptoms, and a large variability of affect. The attacks last 4-5 months, the course of the type “continua”, the prognosis is relatively favorable.
Hatotani et al. (1962) believe that atypical psychosis is borderline between epilepsy, manic-depressive psychosis, and the schizophrenia group. According to the clinical picture, they distinguish between acute hallucinatory-delusional, oneiric, and confused-delirious states. The clinical picture is dominated by affective disorders, disorders of consciousness and psychomotor disorders.
Thus, in Japanese psychiatry, we find the same diversity of opinions on the clinical evaluation of these psychoses. In terms of the syndromological designation of seizures, the opinion of Kleist and Leonhard is quite common. In terms of the psychopathological structure, many Japanese psychiatrists accept the concept.
In modern Soviet psychiatry, the clinical assessment of acute atypical psychosis also gives rise to controversy. These disagreements concern not only the issues of nosological assessment, classification, typology, but also the definition of the psychopathological structure of the attacks, their designations, and systematics.