Andreas Marneros - Böcker

Many clinicians and researchers are convinced that there is an overlap between affective and schizophrenic spectra. In this book, an international team of experts discuss aspects of comorbidity, genetic models, clinical course, phenomenology and therapies. This is the first comprehensive overview of the schizoaffective spectra. Challenging cases presenting clinical and paraclinical features of both spectra are surprisingly numerous. Not only the phenomenology but also the course, outcome and treatment of such cases have their own characteristics. Recent research shows that the overlap also involves genetics and biological processes related to psychotic disorders. Within the overlap of affective and schizophrenic spectra it is possible to identify some groups of disorders having similar clinical and non-clinical features: the 'schizoaffective' group, 'Acute and Transient Psychotic Disorder' or 'Brief Psychosis', and other groups found in so-called 'Atypical Forms'.

Brief and acute psychotic disorders with a short duration and a generally good prognosis have long intrigued psychiatrists. Although they are included in internationally accepted diagnostic systems, understanding of these disorders remains minimal. This book is the first comprehensive overview of the clinical features, biology, course and long-term outcome of brief and acute psychoses. The authors review the world literature on the topic and they also present data from their own longitudinal study - the most complete investigation of this group of disorders so far conducted. The book concludes with considerations of the nosological status of brief and acute psychoses and their impact on our understanding of the continuum of psychotic and affective disorders.

Bipolar disorder manifests itself in a variety of forms. It can coexist with other psychiatric conditions, and treatment efficacy can depend on the type of bipolar state. This book covers the full range of atypical, rapid cycling and transient forms of bipolar disorder, from atypical and agitated depression to schizoaffective mixed states. The most recent ICD category is covered, and the authors also look at the biology and genetics of bipolar disorder, along with issues relating to age (children and the elderly), comorbidity, choice of drug treatment and investigational strategies.

Brief and acute psychotic disorders with a short duration and a generally good prognosis have long intrigued psychiatrists. Although they are included in internationally accepted diagnostic systems, understanding of these disorders remains minimal. This book is the first comprehensive overview of the clinical features, biology, course and long-term outcome of brief and acute psychoses. The authors review the world literature on the topic and they also present data from their own longitudinal study - the most complete investigation of this group of disorders so far conducted. The book concludes with considerations of the nosological status of brief and acute psychoses and their impact on our understanding of the continuum of psychotic and affective disorders.

Many clinicians and researchers are convinced that there is an overlap between affective and schizophrenic spectra. In this book, an international team of experts discuss aspects of comorbidity, genetic models, clinical course, phenomenology and therapies. This is the first comprehensive overview of the schizoaffective spectra. Challenging cases presenting clinical and paraclinical features of both spectra are surprisingly numerous. Not only the phenomenology but also the course, outcome and treatment of such cases have their own characteristics. Recent research shows that the overlap also involves genetics and biological processes related to psychotic disorders. Within the overlap of affective and schizophrenic spectra it is possible to identify some groups of disorders having similar clinical and non-clinical features: the 'schizoaffective' group, 'Acute and Transient Psychotic Disorder' or 'Brief Psychosis', and other groups found in so-called 'Atypical Forms'.

Die steigende Zahl von Publikationen und internationalen Kongressen über die schizoaffektiven Psychosen waren Anlaß, dieses Thema erstmalig ausführlich und umfassend in Buchform darzustellen. Namhafte Wissenschaftler aus dem In- und Ausland vermitteln praktische, klinisch relevante Informationen über die Diagnose, den Verlauf, die Therapie und die Prophylaxe der schizoaffektiven Psychosen. Angesprochen werden auch genetische und soziale Aspekte sowie Zukunftsperspektiven.

Several contributions in our first book about schizo affective disorders (Marneros and Tsuang, Schizoaffective Psychoses, Springer-Verlag, 1986) supported the assumption that schizoaffective disorders differ in relevant ways from schizophrenic disorders. The classification of schizo affective disorders as a subgroup of schizophrenia has also been criticized, and empirical research in clinical, genetic, therapeutic, and prognostic areas supports the idea that there are some strong similari­ ties between schizo affective and affective disorders. Of course, there are not only similarities between these two groups, but also differences just as there are between schizo affective and schizophrenic disorders. It is precisely the existence of similarities and differences between schizo affective disorders and the other two so-called typical mental disorders, i.e., schizophrenia and affective disorders, which makes them a challenge in psychiatric research, a challenge to the traditional dichotomy in the classification of disorders which originated with Kraepelin. This challenge is certainly proving fruitful in psychiatric research. These "cases in between" may well demonstrate that sep­ arating, dividing, and limiting is not always meaningful. Sometimes it can be more meaningful to unify; to unify in the sense of building bridges between typical groups. It is here that the assumption of a "psychotic continuum" can become relevant, and the investigation of schizoaffective disorders is of prime importance in research on a possible continuum of psychosis.

The positive versus negative distinction of schizophrenic disorders has pro- moted ongoing research. Phenomenology, psychopathology, biology, genet- ics, pharmacological and nonpharmacological treatment, psychosocial and longitudinal research: all have found a new focus of interest. This volume attempts to provide an unbiased picture of the status of American and Eu- ropean knowledge regarding the positive/negative distinction. Researchers from North America and Europe describe the relation of modern concepts of positive and negative symptomatology to the original models of Rey- nolds and Jackson. Integrating phenomenological, genetic, and biological factors, the authors depict current methods of assessing positive and nega- tive symptomatology, differentiating between primary and secondary symp- tomatology, and using pharmacological and nonpharmacological treatment. The stability of positive and negative symptoms over time and evidence for the occurrence of separate positive and negative episodes over a long-term course of schizophrenia are extensively discussed in terms of their implica- tions on the positive/negative construct.The relevance of the positive/nega- tive dichotomy to child and adolescent schizophrenia is also debated. The main aim of this book is not to advocate a single concept and present only arguments supporting it, but to discuss important controversies. Prob- lems concerning a concept cannot be solved by ignoring them. However, unanswered questions may be resolved through discussion, debate, and con- structive compromise.

Der vorliegende Band beinhaltet klinisch relevante Beitr{ge wie etwa die Beziehung der Prim{rpers|nlichkeit zur Melancholie, Manie, Schizophrenie, Migr{ne, pr{menstruellen Syndrom sowie die therapeutischen Implikationen einer solchen Beziehung. Dar}ber hinaus finden sich theoretische Beitr{ge, die sich mit Grundsatzfragen der Pers|nlichkeit, ihrer Bedeutung und ihrer Wandlungen besch{ftigen. Methodische Wege und die damit verbundenen Schwierigkeiten zur Erfassung von Pers|nlichkeitsstrukturen sind exemplarisch dargestellt. Konzepte der Pers|nlichkeitsst|rung und ihre m|gliche Beeinflussbarkeit geh|ren auch zum Inhalt dieses Buches. Die Selektion der Themen aus einem breiten Spektrum zielt auf eine paradigmatische Umschreibung der vielf{ltigen Beziehungen zwischen Pers|nlichkeit und psychischer Erkrankung.

One of the most important questions of our previous common volumes about affective, schizoaffective, and schizophrenic disorders was the question of what connects and what separates psychotic disorders (Marneros and Tsuang, Schizo­ affective Psychoses, Springer-Verlag, 1986; Marneros and Tsuang Affective and Schizoaffective Disorders, Springer-Verlag, 1990; Marneros, Andreasen, and Tsuang, Negative and Positive Schizophrenia, Springer-Verlag 1993). The boundaries between various psychotic disorders are not always clearly defined. Some groups of psychotic disorders, such as schizoaffective disorders and all the other "atypical" psychoses, occupy a position between "typical" mental disorders, such as schizophrenia, and affective disorders. The question is: Do psychotic disorders form a continuum, or are they, despite their unclear boundaries, distinct entities? On what basis should we assume there is a continuity of psychotic disorders? Solely symptomatology? Or perhaps also a continuity in genetic predispositions? Or in biological, pharmacological, and other dimensions? Is the old idea of "Einheitspsychose" (unitary psychosis) really always wrong? The contributions contained in this new volume cannot provide a definite answer to the above questions. But they try to describe some relevant aspects of the problem, and to give some partial answers. Halle-Wittenberg, Germany A. MARNEROS Brockton, USA M. T. TSUANG Iowa, USA N. C. ANDREASEN October 1994 Contents Part I Psychotic Continuum: An Introduction A. MARNEROS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Psychotic Continuum or Distinct Entities: Perspectives from Psychopathology CH. MUNDT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 7 Psychotic Continuum Under Longitudinal Considerations A. MARNEROS, A. ROHDE, and A. DEISTER. . . . . . . . . . . . . . . . . . . . . . . . . . 17 Psychotic Continuum or Distinct Entities: Perspective from Psychopharmacology H. Y. MELTZER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Es handelt sich um die international erste Studie, die die drei wichtigsten Formen endogener Psychosen umfassend unter- sucht und miteinander vergleicht. In der vorliegenden Mono- graphie werden die Ergebnisse einer empirischen Vergleichs- studie (K|ln-Studie) zum Langzeitverlauf und Langzeitausgang affektiver, schizoaffektiver und schizophrener Psychosen dar gestellt. Die Darstellung gr}ndet sich auf die Analyse des Krankheitsverlaufes von insgesamt 355 Patienten }ber einen Zeitraum von durchschnittlich 25 Jahren (mindestens 10 Jahre maximal 61 Jahre). Es wurden dabei neueste und international anerkannte diagnostische Kriterien, Erfassungsinstrumente und statistische Methoden zugrunde gelegt. Neben der Darstel lung psychopathologischer Verlaufs- und Ausgangs-Parameter wurden eine Vielzahl von sozialen Merkmalen untersucht. Be- sonderer Wert wurde auch auf die Darstellung klinisch rele- vanter Fragestellungen gelegt, so da~ den Ergebnissen eine direkte Bedeutung f}r die Diagnose, Therapie und Prophylaxe endogener Psychosen zukommt. Die Monographie enth{lt eine ausf}hrliche englische Zusammen fassung, die s{mtliche relevanten Ergebnisse umfa~t.

Die Neuerzählung des Klassikers der Weltliteratur aus der Feder eines namhaften Psychiaters – mit dem Ziel, Ur-Themen der menschlichen Psyche und deren Bewältigungsstrategien als aktuelles Epos in rezitierender Form neu verständlich und zugänglich zu machen. Der Autor bedient sich des Kunstgriffs, Homer selbst seine Ilias neu erzählen zu lassen.

Es geht um Irrungen und Wirrungen, Intelligenz und Durchhaltevermögen, Gefühle der Ohnmacht, Akzeptanz des Unabwendbaren, aber auch das Nicht-Erkennen des eigenen Paradieses. Damit wird gezeigt, wie Probleme, Hoffnungen und Sehnsüchte der Menschen von damals auch heute noch hoch aktuell sind.

Archetypen der griechischen Mythologie – wie Sisyphos, Minotauros, Prometheus, Tantalos, Ödipus, Adonis, Midas oder Kassandra – haben Modell gestanden für verschiedene Konzepte der modernen Psychiatrie, Psychologie, Psychosomatik und Psychoanalyse.

Ödipus, Iokaste, Laios, Antigone, Elektra oder Adonis – diese und viele andere Vertreter der griechischen Mythologie werden seit Sigmund Freud als Namensgeber für Komplexe, Syndrome oder Theorien der Psychoanalyse verwendet.

Zudem steht hinter einem psychiatrischen oder psychologischen Eponym nicht nur ein klinisches Bild oder eine psychopathologische Konstellation, sondern auch ein Mythos, eine Geschichte oder eine Biographie, sprich ein kultureller Hintergrund.