Acute endogenous psychosis. Part 6

Posted onFebruary 9, 2019

For many psychiatrists, it is typical to refuse to isolate and describe these psychoses as a separate group or form. Depending on which of the two endogenous diseases according to Kraepelin’s classification (schizophrenia or manic-depressive psychosis), the authors understand more widely, the psychoses in question are either classified as classic forms of schizophrenia or included in manic-depressive psychosis. This kind of reduction of these psychoses to better known ones is reflected in many textbooks, monographs, articles on acute schizophrenia, on the acute stage of schizophrenia, on the forms of the course of schizophrenia, on atypical forms of manic-depressive psychosis, etc.

Other authors have attempted a new clinical assessment, including psychopathological and nosological. So, T. Ya. Khvilivitsky (1957) subjected to clinical and laboratory study of 100 patients with atypical manic-depressive psychosis. As a type of atypical forms of circular psychosis, the author studied: a group of patients in whom the disease proceeded in the form of brief twilight and oneiroid disorders of consciousness on a depressive or manic background; diseases with oneiric states occurring in phases; cases of manic-depressive psychosis with catatonic symptoms; diseases with a picture of somatophrenia Bechterew; cases of mixed states. The author came to the conclusion that these atypical forms of manic-depressive psychosis are characterized by: the persistence of atypical manifestations over a long time, the possibility of asthenic-abulic personality changes, the presence of microorganic symptoms and other biological deviations. The author noted the paramount importance of exogenous hazards in the origin of these psychoses. He proposes to distinguish these forms from manic-depressive psychosis.

This desire is even more pronounced in the work of L. M. Lesokhina (1957), who believes that periodic psychosis is not reducible to manic-depressive psychosis or schizophrenia. As the general features and symptoms inherent in various types of attacks, the author describes: disorders of consciousness, vivid dreaming experiences, symptoms of depersonalization, various extremely painful sensations, quickly emerging peculiar and pronounced speech incoherence, sharp affective outbreaks (usually occurring outside the attack, etc.). The author describes 5 forms of attacks:

1) paroxysmal pseudo-mania states;

2) paroxysmal stuporous states

3) paroxysmal twilight states,

4) paroxysmal delusions;

5) seizures with a mixed clinical picture, in which episodes of agitation of stupor and delusional states are combined.

NN Bodnyanskaya (1958), entitled “Periodic psychosis in children and adolescents”, describes two types of such psychosis: periodic psychosis with an episodic course and periodic psychosis with a phase course. The first version includes three options:

  1. a) with a predominance of acute disorders of consciousness (pathological drowsiness, oneiric states with fantastic content, twilight states); b) a variant with a predominance of motor disorders (stupor and psychomotor agitation), c) a variant with affective disorders (disinhibition with euphoria and depression).

In the clinical picture of the second type, a combination of disorders of consciousness (oneiric, twilight), affectivity (organic disinhibition with apathy), disorders of effector functions (agitation with elements of violence and catatonic symptoms) is noted. The author believes that infectious diseases with damage to the central nervous system (meningitis, paraencephalitis or secondary encephalitis, and cranial injuries that last suffered) are of primary importance in the occurrence of these psychosis. Psychosis occurs in a period of remote consequences. Age (puberty), infections, and psychogenic are important for the onset of an attack. A large group of Soviet psychiatrists conduct a consistent, long-term study of acute atypical psychoses. These studies, initiated by A. V. Snezhnevsky with employees at the Department of Psychiatry, have expanded considerably since 1962 and are currently being continued by both the staff of the Institute of Psychiatry of the Academy of Medical Sciences of the US and the Department of Psychiatry.

Despite the fact that acute psychosis under the name “periodic schizophrenia” was considered within the framework of schizophrenia, their study was actually conducted and is being conducted as a study of a kind of material that is clinically rather clearly defined.

At the first stage of research, attention, naturally, was directed to the clinical-psychopathological description and selection of the most frequently encountered types (forms) of periodic schizophrenia.

So, Druzhinina (1956), on the basis of a study of 80 patients, described a form of catatonic schizophrenia, which is characterized by the presence of oneiroid disorders – and paroxysmal course.

A detailed description of oneiric catatonia was made by V.N. Favorina (1956). The author highlighted the main clinical and structural features of the attacks. In addition to describing the external (catatonic) and internal (oneiric) aspect of the developed seizure, V.N. Favorina noted that there are certain regularities in the development and in the extinction of seizures. According to the peculiarities of the clinical picture of the attacks, the author divided the patients into a group with an expansive

a form of oneiric experiences and a group with a predominance of depression and stupor.

Further, the clinical picture of acute paraphrenia was described in detail (N. G. Shumsky, 1958; V. N. Favorina, 1959). The closeness of the clinical picture of attacks to the oneiric stupefaction and the possibility of mutual transitions have been proven. V.N. Favorina observed the course of the disease in the form of acute paraphrenic attacks of the same type as well as in the form of heterogeneous attacks (catatonic, acute paranoid, atypical manic, etc.). As with other attacks of recurrent schizophrenia, a favorable prognosis of attacks (at least at the onset of the illness) and a tendency to relapse were noted.

In the work of B. V. Sokolova (1957), depressive-paranoid schizophrenia was studied. Were described 3 of its varieties:

1) anxiety-depressive variant, which is characterized by prolonged anxious and melancholy states with agitated arousal, fear, confusion, bright Kotar syndrome and the course of psychosis in the form of the same type of attacks;

2) a variant with a predominance of delusional syndrome; when it is dominated by delusions of relationship and persecution, pronounced verbal hallucinosis and Kandinsky’s syndrome — Clerambo or illusory nonsense;

3) option with severe depressive stupor or catatonic disorders.

  1. Ya. Ilon (1957) made a clinical description of circular schizophrenia. The author singled out three options: for the first of them (catatonic), the combination of affective manifestations with severe catatonic disorders was characteristic. The main feature of the second (delusional) variant of circular schizophrenia is, according to the author, a combination of affective disorders with delusions and hallucinations. In the third variant of circular schizophrenia, the author observed, as a distinctive feature, the onset of the disease with disorders characteristic of the first manifestations of a simple form of schizophrenia (a decrease in working capacity, a change in character, a disorder of thought). According to the forecast, this option is the least favorable. L. Ya. Ilon came to the conclusion that the three selected variants of circular schizophrenia can be compared with the three forms of Crepelin’s early dementia: catatonic, delusional and idle.

Thus, the first studies of periodic schizophrenia were characterized by a desire to establish the clinical and psychopathological features of various types of seizures when classifying them as early dementia. In particular, this is evident from the authors’ assertion about the onset of a typical schizophrenic personality change.

AV Snezhnevsky (1960), summarizing the research of his staff at the first stage of studying schizophrenia, came to the following conclusions: periodic schizophrenia can be included as separate clinical options for oneiric catatonia, circular, depressive-paranoid, depressive-stuporous schizophrenia, periodic paraphrenia and febrile catatonia. All these options are combined with the presence of common clinical ingredients: the oneiric-catatonic, affective, fantastically dreamy, and phenomena of mental automatism. The clinical variant of the attack is determined by the relative predominance of one of the many ingredients in the clinical picture.

The predominance of one or the other of the latter often varies from attack to attack in the same patient. So, often the first attack of psychosis in patients with circular schizophrenia proceeded in the form of oneiric catatonia. Acute paraphrenia sometimes occurred as another attack of oneiric catatonia or, more commonly, circular schizophrenia. It was established as a common feature of various options for the frequent occurrence of the next attack under the influence of psychogeny, infection and other harmful factors. Thus, an important clinical fact of the presence of internal kinship (according to the main structure) and the possibility of alternating seizures that are very different in the syndromic structure (affective, catatonic, delusional) were established.

In subsequent years, continued clinical study of recurrent schizophrenia, further differentiation of seizures and their psychopathological characteristics.

Based on a detailed analysis of a large number of patients with hypochondriacal schizophrenia, G. A. Rotshtein (1961) concluded that within the framework of depressive-paranoid (periodic) schizophrenia, episodes of depressive-hypochondriacal structure can be observed. We are talking about acute attacks, which are characterized by a clinical picture of either reduced Comar syndrome (in the form of “outlined hypochondria”), or normal, or paraphrenic-like Coarre syndrome.

A significant result of the study of the psychopathology of attacks of periodic schizophrenia was the description of the successive stages of the development of the oneiric stupefaction. It was proved that the oneiroid states occupy a large place in the clinic of attacks of periodic schizophrenia, and not only periodic catatonia, but also circular and depressive-paranoid (S. P. Stoyanov, 1961).

  1. S. Tiganov (1960) described 4 types of attacks of febrile catatonia: attacks with typical catatonic excitement, attacks with amental-like excitement, type of attacks with hyperkinetic arousal, and the form of attacks with a picture of a sub-attacker. Based on the study of the clinical and psychopathological features of attacks of febrile catatonia, the nature of recurrent attacks, A. S. Tiganov concluded that febrile schizophrenia is a special type of periodic schizophrenia.

Leave a Reply

Your email address will not be published. Required fields are marked *