In the first period of development of clinical psychiatry, when psychosis was a very poorly differentiated mass, acute endogenous psychosis, naturally, did not stand out.
The clinical picture of the psychoses discussed here can be found in the descriptions of the concepts “idiocy” (Pinel), “acute dementia”, “mania”, “lipemania” (Esquirol).
As clinical psychiatry developed, mental illness began to be treated more differentially. Boismont in 1845 described in detail the clinical picture of acute delusions and differentiated it from both acute mania and meningitis. Calmeil (1851) clarified the clinical features of delirium acutum to an even greater degree, and since that time the controversy over this acute psychosis began to concern mainly its nosological evaluation. Thus, by the middle of the 19th century, one of the types of acute atypical psychosis was already identified, its clinical-psychopathological features were described quite accurately.
At about the same time, a second clinical type of acute psychosis has been noted in the literature, currently referred to as “periodic catatonia” (or oneiric catatonia). Within the framework of melancholy and acute dementia, Georget (1820) described stupidite, which he identified as a new disease. Ferrus (1838) joined Georget, emphasizing the non-febrile nature of psychosis. This author noted a favorable outcome of the attack. Ferrus described the condition of the patients as “the elimination or rather the delay of all brain processes, rapidly advancing, without temperature,“ curable ”. Soon Baillarger (1843), Griesinger (1845), and then many other psychiatrists recognized the existence of a special form of melancholy — melancholy with a stupor and described it in detail.
By this time, individual forms of mania began to be distinguished, some of which were actually described as independent types of seizures (hyperacute mania, frenzy, madness). Judging by the cited case histories, under this name, the authors described the attacks of the oneiric-catatonic, manic-delusional, paraphrenic structure. Within the framework of a single Grizipger psychosis, the psychoses considered by us were included as options in melancholia, mania and “madness”. Phase affective, affective-delusional and affective-oneiric (according to modern estimates) psychosis related to melancholia and mania. “Madness” is more consistent with modern paroxysmal progredient schizophrenia.
The process of differentiation of mania and melancholia was further intensified after the isolation of various types of circular insanity by French psychiatrists Baillarger (1854) and Falret (1851) in the middle of the 19th century. These studies confirmed the possibility of alternating mania and melancholia, which was noted long ago by doctors, and made it possible to single out a circular insanity with characteristic psychopathological picture and course.
Thus, the clinical-psychopathological contours of certain types of acute psychosis, characterized by seizures in the form of attacks, were described. In subsequent years, a group of acute psychosis began to grow in quantitative terms and be refined in its clinical and psychopathological content. A classification of acute forms of insanity began to appear. It was soon noted that circular insanity, delirium acutum, melancholy with stupor, hyperacute mania, etc., do not exhaust the whole group of acute psychoses. The concept of acute paranoia appeared (Westphal, 1876), which for a long time was the center of numerous discussions. The isolated psychosis soon turned out to be much more complicated than the simply acutely occurring delusional state.
Already in 1879, Merklin noted that acute paranoia is characterized by a darkening of consciousness or confusion, similar to those that occur in dreams or febrile delusions. Dreams, confusion of experiences of patients with acute paranoia have become more and more emphasized by psychiatrists. As a result, acute paranoia was divided into two large groups: psychosis with a predominance of delusional symptoms (without gross disturbance of consciousness) and psychosis, which were characterized not only acutely emerging delusions, but also hallucinatory, affective disorders and blackout. These two main forms of acute insanity remained at the center of controversy over the next two decades. Soon, to overcome the differences that arose, the concept of “amentia” Meinert (1893) was proposed, which included cases of acute paranoia with severe disorders of consciousness and many other acute psychoses. As it is known, the concept of amentia, which is extremely broad in the understanding of Meinert, soon began to narrow, and at present it has limited application.
In the last decades of the XIX century a large number of works appeared in which it was proposed to divide the acute forms of insanity into separate types. V.P. Serbian (1892, 1906) besides mania, melancholia, and acute dementia distinguished acute amentia and acute paranoia. Contrary to the opinion of Meinert, that with amentia there are no cardinal symptoms, V.P. Serbsky singled out as characteristic signs of amentia a disorder of consciousness (according to the dream type), affect lability and disturbance of associative activity. Typical for acute paranoia, V.P. Serbsky believed: acute or subacute occurrence of unstable and unsystematized delusions, the presence of a pronounced affective state (depressive or expansive), a relatively clear consciousness. V. P. Serbsky referred to mixed forms (luck) as paroxysmal psychosis, in the clinical picture of which affective and delusional symptoms are combined with elements of confusion.
S. S. Korsakov (1901) further deepened the clinical analysis of “acute forms of insanity”. He described in detail the varieties of dysnoi (acute psychosis with a disorder of consciousness) and acute paranoia. S. Korsakov considered relative clarity of consciousness to be a characteristic sign of acute paranoia.
A similar point of view was Seglas (1895), who believed that it was necessary to distinguish between acute psychosis and confusion, that is, confusion (confusion mentale), and acute psychosis without stupefaction (acute paranoia). Within the framework of acute paranoia (simple and hallucinatory), he described depressive-paranoid oneiric attacks.
In Germany, by this time we also find a similar division of acute psychosis into psychosis without a sharp disturbance of consciousness (Wahnsinn) into psychosis with confusion (Verwirrtheit) (Kirchof, Zienn, Kraepelin).
Kraepelin himself in 1895 distinguished several forms of acute treatable psychoses: mania, melancholy, delirium, exhaustion psychosis, acute dementia, hallucinatory and depressive forms of acute delirium.
Thus, on the eve of the emergence of Kraepelin’s nosological classification with respect to acute forms of insanity, there were undoubted successes, which concerned mainly the issues of clinical differentiation of these psychoses. Most of the acute forms of psychosis were by this time grouped around affective, psychomotor, delusional disorders, and confusion syndrome.
At the end of the 19th century, principles that did not allow for a fairly complete clinical and psychopathological characterization of these complex psychoses were based on the isolation of individual forms of acute psychosis. Affective disorders (for circular insanity), febrile, catatonia, death (for delirium acutum), catatopic stupor with depressive delusions (for melancholy with stupor) were insufficient to characterize many of these psychoses. The concepts of acute paranoia, mental confusion were also unsatisfactory. As you know, for the psychoses designated by these concepts, a very different course was allowed: an exceptionally benign (one attack followed by recovery), a remitting or recurring course without gross changes (recurrent amentia, paranoia) and an unfavorable course, as a transition to a chronically current psychosis or in a state of dementia.
Particularly difficult to describe and designate were those of the acute forms of insanity, in which there was a complex clinical picture and a large variability of symptoms (affective, psychomotor, hallucinatory-delusional, impaired consciousness, etc.). These psychosis did not fit even in such broad concepts as amentia, acute paranoia, catatonia.
All this indicates that at the time of the emergence of the classifications of Krapelin’s mental diseases, many forms of acute psychosis were not yet sufficiently studied, even in their psychopathological structure. Other forms of acute mental illness were clinically quite clearly outlined, although the principles of their psychopathological description in many respects suffered from the shortcomings inherent in all static psychopathology.
Classification of mental illness Krepelin did not solve the issue of acute atypical psychosis in their essential clinical and psychopathological aspects. Moreover, against the background of a more definite situation in which other acute psychosis (typical manic-depressive psychosis, various forms of early dementia, many febrile, somatogenic and infectious psychosis) found themselves, the clinical “disorder” of acute atypical psychosis immediately appeared before psychiatrists as one of complex clinical problems.
As is known, in the initial nosological classification of Kraepelin, as well as in the classifications of his supporters, at first there was a desire to abstract from many psychopathological, clinical aspects of these psychoses, to a significant simplification of their structure, thanks to which it was possible to attribute them to one of the two main endogenous diseases . Thus, acute delusional psychosis (acute paranoia) was treated by many psychiatrists to manic-depressive psychosis; acute catatonic psychosis without an outcome in dementia was more readily regarded as a catatonic form of early dementia. Such a hasty nosological formulation of insufficiently studied forms of acute psychosis immediately led to difficulties in attempting to classify psychoses that do not fit into the concepts of manic-depressive psychosis and early dementia. This soon led psychiatrists to amend and supplement the original scheme. Such a need was due to the fact that the clinical picture of many endogenous psychosis was closer to early dementia, while their paroxysmal course and the appearance of affective attacks more resembled manic-depressive psychosis. Rehm (1919) described a catatonic form of remitting insanity with a clearly circular course, despite the fact that many attacks were in the nature of a catatonic stupor. Tamburini described catatonic manic-depressive psychosis, etc. Urstein (1912) came to the conclusion that early dementia can occur circularly and that it is legitimate to include manic-depressive psychosis in catatonia. Other psychiatrists described cases of early dementia with a depressive onset (Pascal, 1911).
Thus, almost simultaneously with the spread of the nosological concept of Kraepelin, the disadvantages of the dichotomous division of endogenous psychoses began to be revealed. It is important to note that among the psychoses that do not fit into the scheme, acute psychosis with severe affective disorders and catatonia with remitting course, ie, psychoses, considered up to the present time as acute atypical psychosis, occupied a large place.