Psychotic illness in people with Prader-Willi syndrome: a systematic review of clinical presentation, course and phenomenology.

BACKGROUND: Prader-Willi syndrome (PWS) is a rare and complex neurodevelopmental disorder resulting from absent paternal expression of maternally imprinted genes at chromosomal locus 15q11-13. This absence of expression occurs as a consequence of a deletion on the chromosome 15 of paternal origin (ca. 70%), a chromosome 15 maternal uniparental disomy (mUPD; ca. 25%), or an imprinting centre defect (IC; ca. 1-3%). At birth, individuals with PWS are severely hypotonic and fail to thrive. Hyperphagia and characteristic physical and neuropsychiatric phenotypes become apparent during childhood. The risk for the development of a co-morbid psychotic illness increases during the teenage years, specifically in those with PWS due to the presence of an mUPD. The primary aim of this literature review is to inform clinical practice. To achieve this, we have undertaken a systematic analysis of the clinical research literature on prevalence, presentation, course, characteristics, diagnosis and treatment of psychotic illness in people with PWS. The secondary aim is to identify clinical aspects of psychotic illness in PWS in need of further investigation. METHODS AND FINDINGS: A systematic literature review on psychosis in PWS was conducted on the databases Web of Knowledge, PubMed and Scopus, using the terms "((Prader-Willi syndrome) OR (Prader Willi Syndrome)) AND ((psychosis) OR (psychotic illness))". All articles written in English and reporting original human research were reviewed. In all but three of the 16 cohort studies in which the genetic types were known, the authors reported higher rates of psychosis in people with PWS resulting from an mUPD, compared to those with the deletion subtype of PWS. When psychosis was present the presentation was psychosis similar regardless of genetic type and was usually characterised by an acute onset of hallucinations and delusions accompanied by confusion, anxiety and motor symptoms. CONCLUSIONS: The onset of confusion, an affective cyclical pattern with the presence of abnormal mental beliefs and experiences, usually of rapid onset is suggestive of the development of psychotic illness. Phenomenologically, this psychosis in people with PWS is atypical in comparison to schizophrenia and bipolar disorder in the general population. The relationship to psychosis in the general population and the optimum treatments remain uncertain.

Empirical validity of Leonhard's psychoses: A long-term follow-up study of first-episode psychosis patients.

The validation of nosological diagnoses in psychiatry remains a conundrum. Leonhard's (1979) nosology seems to be one of the few acceptable alternative categorical models to current DSM/ICD systems. We aimed to empirically validate Leonhard's four classes of psychoses: systematic schizophrenia (SSch), unsystematic (USch), cycloid psychosis (Cyclo), and manic-depressive illness (MDI) using a comprehensive set of explanatory validators. 243 patients with first-episode psychosis were followed between 10 and 31 years. A wide-ranging assessment was carried out by collecting data on antecedent, illness-related, concurrent, response to treatment, neuromotor abnormalities, and cognitive impairment variables. Compared with USch, Cyclo, and MDI, SSch displayed a pattern of impairments significantly larger across the seven blocks of explanatory variables. There were no significant differences between Cyclo and MDI in explanatory variables. Except for the majority of illness-onset features, USch displayed more substantial abnormalities in the explanatory variables than Cyclo and MDI. SSch and MDI showed higher percentages of correctly classified patients than USch and Cyclo in linear discriminant analyses. Partial validation of Leonhard's classification was found. SSch showed differences in explanatory variables with respect to Cyclo and MDI. USch showed also significant differences in explanatory variables regarding Cyclo and MDI, although with a lower strength than SSch. There was strong empirical evidence of the separation between both Leonhard's schizophrenia subtypes; however, the distinction between the Cyclo and MDI groups was not empirically supported. A mild to moderate discriminative ability between Leonhard's subtypes on the basis of explanatory blocks of variables was observed.

Effect of La doping on the structure and cycloidal spin ordering in multiferroic BiFeO3.

A series of Bi1-xLaxFeO3 samples with 0.00 ≤ x ≤ 0.30 was synthesized by the sol-gel method. The effects of lanthanum concentration on the phase formation, microstructure and cycloidal spin ordering were studied using X-ray diffraction, scanning electron microscopy and Mössbauer spectroscopy. The crystal structure of the La-doped bismuth ferrite transformed from rhombohedral R3c (x ≤ 0.05) to a mixture of R3c and cubic Pm3m (0.07 ≤ x ≤ 0.15) and finally to a mixture of R3c, Pm3m and orthorhombic Pbam (0.20 ≤ x ≤ 0.30). The Pbam phase, with characteristic porous microstructure shown by microscopy images, was observed in Bi1-xLaxFeO3 compounds for the first time. Based on the Mössbauer spectroscopy, it was found that the cycloidal spin ordering started to disappear at x = 0.07. With increasing La concentration the share of the cycloid decreased from 100% at 0.00 ≤ x ≤ 0.05 to 0% at x = 0.30. At the beginning, for x ≤ 0.02, the anharmonicity parameter, m, of the cycloidal spin ordering was about 0.5, which is typical of a pure BiFeO3 compound. In the range 0.05 ≤ x ≤ 0.25, the m parameter was of the order of 0.1, which indicated the practically harmonic character of the cycloid. The structural transition at x = 0.07 was accompanied by a substantial increase in magnetization.

Classic Text No. 134: 'A case of Wernicke-Bostroem's expansive autopsychosis', by Ib Ostenfeld (1944).

Expansive autopsychosis, grouped with cycloid psychoses - an illness entity of double origin: (1) Morel's notion degeneracy, reformulated by Magnan and Legrain (reflected in Wimmer's concept: psychogenic psychosis); (2) Wernicke's, Kleist's, Bostroem's (and later Leonhard's) notion of these purportedly independent conditions. Locked in the Danish language, Strömgren and Ostenfeld provided important contributions to this field, exemplified by Ostenfeld's casuistry, translated in this Classic Text.

A new approach to solve the Brachistochrone problem by constructing a lattice unit cell.

A simple and general new approach to solve the Brachistochrone problem is presented in this paper. The Brachistochrone problem is concerned with finding the shortest time trajectory of a particlesliding on a frictionless path under gravity. The problem is solved in this project using a solid-state physics mechanism of building a lattice by a unit cell of a suitable lattice parameter and a transformation operator. This problem was solved analytically centuries ago by many scientists. To the author's knowledge, the approach considered here was not used before. The method clearly shows that the Brachistchrone is just a two-dimensional lattice with a parameter and a transformation angle that depend on the size of the trajectory. It has been found that the shortest time track is a cycloid, which is a curve that lies between a straight line and a circle. Thefindings of this work were compared to the exact results found previously and were found to be within an infinitesimally negligible margin of error.

Design considerations for a cycloidal mass analyzer using a focal plane array detector.

With the advent of technologies such as ion array detectors and high energy permanent magnet materials, there is renewed interest in the unique focusing properties of the cycloidal mass analyzer and its ability to enable small, high-resolution, and high-sensitivity instruments. However, most literature dealing with the design of cycloidal mass analyzers assumes a single channel detector because at the time of those publications, compatible multichannel detectors were not available. This manuscript introduces and discusses considerations and a procedure for designing cycloidal mass analyzers coupled with focal plane ion array detectors. To arrive at a set of relevant design considerations, we first review the unique focusing properties of the cycloidal mass analyzer and then present calculations detailing how the dimensions and position of the focal plane array detector relative to the ion source determine the possible mass ranges and resolutions of a cycloidal mass analyzer. We present derivations and calculations used to determine the volume of homogeneous electric and magnetic fields needed to contain the ion trajectories and explore the relationship between electric and magnetic field homogeneity on resolving power using finite element analysis (FEA) simulations. A set of equations relating the electric field homogeneity to the geometry of the electric sector electrodes was developed by fitting homogeneity values from 78 different FEA models. Finally, a sequence of steps is suggested for designing a cycloidal mass analyzer employing an array detector.

A New Species of Parascorpaena Bleeker, 1876 (Teleostei: Scorpaenidae) from Taiwan.

A new species of scorpionfish, Poseidon's scorpionfish Parascorpaena poseidon, is described on the basis of ten specimens collected from southwestern Taiwanese waters ranging from Penghu to Chufongbi, Pingtung. The morphological and molecular analyses reveal the new species is clearly separated from the two similar species, P. aurita and P. mossambica. Parascorpaena poseidon is distinguished from congeners by the following combination of characters: three equal-sized suborbital spines without ridge; supraocular tentacle absent or very short; pectoral-fin rays 15-16 (usually 16); pored lateral-line scales 22-26 (usually 22-23); longitudinal scale rows 43-47; pre-dorsal-fin scale rows 2-3 (usually 3); 10-12 scale rows between 6th dorsal-fin spine base and lateral line; 10-12 scale rows between the last dorsal-fin spine base and lateral line; total gill rakers 15-16, gill rakers on hypobranchial 2-3; ratio of 11th and 12th dorsal-fin spine 60%-81% (mean 73%); blackish spots randomly distributed on all fins; absence of a distinct black blotch on spinous dorsal fin in male; body size relatively large.

Psicosis cicloide como diagnóstico válido y específico. A propósito de un caso / Cycloid psychosis as a valid and specific diagnostic. A case report

La psicosis cicloide constituye una entidad nosológica caracterizada por un inicio agudo, un curso remitente, un desenlace favorable y un polimorfismo sintomatológico. Su origen data del año 1928 y actualmente su consideración como diagnóstico independiente es controvertida, puesto que se carece de evidencia científica sólida que lo sustente. Sin embargo, en el presente artículo se defiende su validez como nosología específica, con implicaciones a nivel de tratamiento y, consecuentemente, pronóstico. Para ello, se presenta el caso clínico de una mujer de 37 años, ingresada por primera vez en la sala de hospitalización psiquiátrica por un episodio psicótico, el cual se resolverá en días y se repetirá de manera recurrente, permaneciendo asintomática y sin deterioro cognitivo entre los distintos episodios. (AU)

Cycloid psychosis is a nosological entity characterized by an acute onset, a remitting course, a favorable outcome and a symptomatological polymorphism. Its origin dates back to 1928 and its consideration as an independent diagnosis is currently controversial, since there is a lack of solid scientific evidence to support it. However, this article defends its validity as a specific nosology, with implications regarding treatment and, consequently, prognosis. For this purpose, we present the clinical case of a 37-year-old woman, admitted for the first time to the psychiatric inpatient unit due to a psychotic episode, which will resolve within days and will repeat recurrently, remaining asymptomatic and without cognitive impairment between different episodes. (AU)

Effect of local vibrotherapy in sitting or lying position in two time protocols on the cellulite grade and change of body circumferences in women with cellulite.

BACKGROUND: Vibrotherapy is becoming a new tool which can help to improve aesthetic appearance. One of its basic uses in cosmetology is eliminating cellulite changes. AIM: The aim of the study was to analyze the effect of a 3-week series of local vibrotherapy in two positions and in two time protocols on selected body circumferences, WHR, WHtR and BAI, and the grade of cellulite. PATIENTS AND METHODS: Volunteers underwent vibration treatments in a lying or sitting position for 30 or 60 minutes a day, for 3 weeks. Waist, hip, thigh and calf circumferences were measured before and after the first, and before and after the last treatment. The WHR, WHtR and BAI indicators were calculated. The grade of cellulite was assessed with use of the Nürnberger-Müller scale. A multivariate analysis of variance was performed to assess the impact of individual parameters. RESULTS: After a series of treatments, a significant decrease in the grade of cellulite was noted, regardless of the treatment time or position. The circumferences of the thighs and hips didn't change. Both, the first and the last treatment allowed for change the calf circumference. The applied series of treatments allowed for lower the waist circumference also for change the WHR and WHtR indicators. CONCLUSION: A series of vibration interventions reduced cellulite symptoms without affecting the hip and thigh circumferences. The treatment positions can be adjusted to the individual needs of the client and time of single treatment can be minimized to 30 min a day.

A neuropsychological study on Leonhard's nosological system.

Phenotype validation of endogenous psychosis is a problem that remains to be solved. This study investigated the neuropsychological performance of endogenous psychosis subtypes according to Wernicke-Kleist-Leonhard's classification system (WKL). The participants included consecutive admissions of patients with schizophrenia spectrum disorder or mood disorder with psychotic symptoms (N = 98) and healthy comparison subjects (N = 50). The patients were assessed by means of semi-structured interviews and diagnosed through the WKL system into three groups: a manic-depressive illness and cycloid psychosis group (MDC), unsystematic schizophrenia (USch) and systematic schizophrenia (SSch). All the participants completed a comprehensive neuropsychological battery. The three Leonhard's psychosis subtypes showed a common neuropsychological profile with differences in the severity of impairment relative to healthy controls. MDC patients showed better performance on premorbid intelligence, verbal memory and global cognitive index than USch and SSch patients, and they showed better performance on processing speed, and working memory than SSch patients. USch patients outperformed SSch patients in verbal memory, working memory and global cognitive index. Neuropsychological performance showed a modest accuracy for classification into the WKL nosology. Our results suggest the existence of a common profile of cognitive impairment cutting across WKL subtypes of endogenous psychosis but with significant differences on a severity continuum. In addition, classification accuracy in the three WKL subtypes by means of neuropsychological performance was modest, ranging between 40 and 64% of correctly classified patients.

Does a Lack of Awareness of Cycloid Psychosis Hamper Adequate Treatment for Patients Suffering From This Disorder? A Case Report.

Categorial systems of nosology are based on a cross-sectional enumeration of symptoms with a predefined cut-off, but hardly capture rapid fluctuations of manifestation nor longitudinal characteristics, e.g., cyclicity. Especially with disorders presenting with an admixture or frequent change of psychotic and affective symptoms, diagnostic specifity of the DSM and ICD diminishes. In those instances, alternative concepts as cycloid psychosis might display more accurately the very characteristics and course of a mental disorder and help to tailor individualized treatments. Karl Leonhard described three major subtypes of cycloid psychosis: anxiety-happiness psychosis, confusion psychosis, and motility psychosis, all showing a pleiomorphic symptom profile resembling intraphasic switching of poles. Here we present the case of a 59-year-old woman suffering from cycloid psychosis as defined by the criteria of Perris. Between 2013 and June 2019, the patient was admitted 35 times for compulsory treatment. A frequent change of diagnoses, ranging from adjustment disorder to complex PTSD, and from unipolar depression to "pseudoneurotic schizophrenia," resembles the puzzling manifestations. Most of the time the patient was labeled as schizoaffective disorder despite never displaying clear psychotic core symptoms. Despite treatment with different antipsychotics including LAI the cumulative length of hospitalization increased steadily from 74 days in 2014 to 292 days in 2017. When reviewing the case in 2017 the longitudinal pattern of her disorder and the diverse acute manifestations were finally conceptualized as a cyclic on-off of an atypical psychosis. After starting lithium to pre-existing LAI antipsychotics and valproic acid, the number of days per year spent in inpatient care sharply dropped to 136 in 2018. We propose to reconsider cycloid psychosis as a useful clinical concept whose descriptive value, validity and utility for treatment decisions should be further evaluated. Lithium alone or in addition to valproic acid may act on cyclicity as a core symptom of cycloid psychosis as well as of bipolar disorder, even in the absence of major affective symptoms.

Wernicke-Kleist-Leonhard phenotypes of endogenous psychoses: a review of their validity
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While the ICD-DSM paradigm has been a major advance in clinical psychiatry, its usefulness for biological psychiatry is debated. By defining consensus-based disorders rather than empirically driven phenotypes, consensus classifications were not an implementation of the biomedical paradigm. In the field of endogenous psychoses, the Wernicke-Kleist-Leonhard (WKL) pathway has optimized the descriptions of 35 major phenotypes using common medical heuristics on lifelong diachronic observations. Regarding their construct validity, WKL phenotypes have good reliability and predictive and face validity. WKL phenotypes come with remarkable evidence for differential validity on age of onset, familiality, pregnancy complications, precipitating factors, and treatment response. Most impressive is the replicated separation of high- and low-familiality phenotypes. Created in the purest tradition of the biomedical paradigm, the WKL phenotypes deserve to be contrasted as credible alternatives with other approaches currently under discussion.
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[The development of temperaments typology in E. Krestchmer's concept]. / Razvitie tipologii «temperamentov¼ v kontseptsii E. Kretschmer.

The development of E. Kretschmer's concept of temperaments throughout fifty years is analyzed. The small changes in terminology that occurred in the fourth edition of «Body type and character¼ took place due to the introducing E. Bleuler's termin «synton¼ for the intermediate affective states of healthy cyclothymic temperaments and E. Kretschmer's termin "leptosom" for the body type that before was delineated as "asthenic". However, the transition from the systematics with 3 types of physique and corresponding 2 types of mental constitutions to the systematics, including separate temperament of athletic physique («viscous¼), took place much later. This was preceded by the delineation of epileptic mental constitution by E. Bleuler (1916) and the description of epileptoid constitution. The clinical descriptions of cycloid and schizoid temperaments as the descriptions of corresponding «healthy¼ constitutional types of cyclothyms and schizothyms in the monograph «Body type and character¼ has not changed till the last lifetime edition of the author.

Compact Gearboxes for Modern Robotics: A Review.

On the eve of Human-Robot-Interaction (HRI) becoming customary in our lives, the performance of HRI robotic devices remains strongly conditioned by their gearboxes. In most industrial robots, two relatively unconventional transmission technologies-Harmonic Drives© and Cycloid Drives-are usually found, which are not so broadly used in other industries. Understanding the origin of this singularity provides valuable insights in the search for suitable, future robotic transmission technologies. In this paper we propose an assessment framework strongly conditioned by HRI applications, and we use it to review the performance of conventional and emerging robotic gearbox technologies, for which the design criterion is strongly shifted toward aspects like weight and efficiency. The framework proposes to use virtual power as a suitable way to assess the inherent limitations of a gearbox technologies to achieve high efficiencies. This paper complements the existing research dealing with the complex interaction between gearbox technologies and the actuators, with a new gearbox-centered perspective particularly focused on HRI applications.

Investigation of Polyol Process for the Synthesis of Highly Pure BiFeO3 Ovoid-Like Shape Nanostructured Powders.

Exclusive and unprecedented interest was accorded in this paper to the synthesis of BiFeO3 nanopowders by the polyol process. The synthesis protocol was explored and adjusted to control the purity and the grain size of the final product. The optimum parameters were carefully established and an average crystallite size of about 40 nm was obtained. XRD and Mössbauer measurements proved the high purity of the synthesized nanostructurated powders and confirmed the persistence of the rhombohedral R3c symmetry. The first studies on the magnetic properties show a noticeable widening of the hysteresis loop despite the remaining cycloidal magnetic structure, promoting the enhancement of the ferromagnetic order and consequently the magnetoelectric coupling compared to micrometric size powders.

[Mental constitution and mental disease: from Th. Tilings's to E. Kretschmer's concepts]. / Psikhicheskaia konstitutsiia i psikhicheskaia bolezn': ot kontseptsii Tilinga k kontseptsii Krechmera.

The dynamics of the concept of the continual development of mental disease from the constitution that was the most clearly formulated by a Russian psychiatrist Th. Tiling in the discussion with the German psychiatrist C. Neisser is presented. The concept of Th. Tiling influenced E. Bleuler's approach to the description of basic and accessory symptoms of schizophrenia and also on E. Kretschmer's concept of constitution and mental disease. Main characteristics of cycloid and schizoid personality of E. Kretschmer's concept are presented. The author notes the very broad E. Kretschmer's understanding of 'psychesthetic proportion', which state explains not only the diversity of schizoid types but also many psychotic psychopathological phenomena. In addition to the altered affectivity, autism was the second basic symptom of schizophrenia, which mild manifestations form the basis for E. Kretschmer systematics of schizoid types. E. Kretschmer's understanding of autism was broader than Bleuler's and was presented by E. Kretschmer as a symptom derived from special schizoid affectivity (psychesthetic proportion). The critics of E. Kretschmer's concept by some contemporary German psychiatrists is also considered.

Cycloid Psychosis Comorbid with Prader-Willi Syndrome: A Case Series.

Psychosis is a relatively common psychiatric phenomenon seen in patients with Prader-Willi Syndrome (PWS). However, the presentation is atypical and difficult to classify within currently defined affective or psychotic disorders. This distinct presentation may be better understood as a phenomenon called "cycloid psychosis," described as an episodic psychosis with rapid full recovery between episodes. This study retrospectively analyzed the cases of 12 patients with genetically confirmed PWS who presented to an ambulatory psychiatric center for a change in behavior consistent with psychosis. Each case was then assessed for symptoms of cycloid psychosis, bipolar disorder, depression with psychotic features, schizophrenia, and schizoaffective disorder. Out of the 12 patients, 11 (91.7%) met the currently described diagnostic criteria for cycloid psychosis. Of the 12 patients, 7 (58.3%) also met the diagnostic criteria for bipolar disorder, and 1 (8.3%) also met the diagnostic criteria for schizoaffective disorder. None of the patients met the criteria for schizophrenia or depression with psychotic features. The findings in this study suggest that cycloid psychosis and bipolar disorder may both be comorbid with PWS. Psychiatric comorbidities in patients with PWS are atypical and clinicians should be aware of conditions such as cycloid psychosis when managing this vulnerable population.

Psicoses Cicloides. Passado e futuro / Cycloid Psychosis. Past and future / Psychoses cycloïdes. Passé et future / Psicosis cicloides. Pasado y futuro

Este artigo pretende rever a origem do conceito de Psicoses Cicloides, a sua psicopatologia e a sua evolução. Através de uma análise da literatura, os autores procuram perceber a validade nosológica deste conceito, assim como o seu enquadramento atual e a sua utilidade futura na psiquiatria.

This paper intends to review the origin of the concept of cycloid psychoses, its psychopathology and its evolution. By analyzing the literature, the authors seek to delineate the nosological validity of this concept, as well as its current delimitation and its future utility in psychiatry.

Cet article a pour but de passer en revue l'origine du concept des psychoses cycloïdes, sa psychopathologie et son évolution. Une analyse de la littérature a permis aux auteurs de déterminer la validité nosologique de ce concept, ainsi que sa délimitation actuelle et son utilité future pour la psychiatrie.

Este artículo pretende revisar el origen del concepto de Psicosis Cicloides, su psicopatología y su evolución. A través de un análisis de la literatura, los autores buscan percibir la validez nosológica de este concepto, así como su actual marco y su utilidad futura en la psiquiatría.

Dieser Artikel hat zum Zweck, den Ursprung des Konzepts der Zykloiden Psychosen, seine Psychopathologie und seine Entwicklung zu untersuchen. Anhand einer Literaturanalyse versuchen die Autoren, die nosologische Gültigkeit dieses Konzepts, seine aktuelle Abgrenzung und seinen zukünftigen Nutzen für die Psychiatrie zu erörtern.

Considerations of psychotic symptomatology in anti-NMDA encephalitis: Similarity to cycloid psychosis.

Most patients with anti-NMDA receptor (NMDAR) encephalitis present with acute psychosis which is difficult to differentiate from psychotic episodes related to a primarily psychiatric disease. A precise description of the psychiatric phenotype of this disease would greatly facilitate the early diagnosis of these patients. We provide here a detailed description of three of these patients and the similarity of the clinical features with cycloid psychosis. All three patients met Perris and Brockington's criteria for cycloid psychosis in the initial phase of the autoimmune process, including among other an acute and polysymptomatic onset, polymorphous psychotic symptomatology, mood swings, and changes in psychomotricity. In addition, none of the patients had experienced an extended psychiatric prodromal phase. External stress factors preceded symptom onset in the three patients, who also showed common base personality traits and intolerance to a range of antipsychotic treatments. Complementary studies disclosed that the three patients had ovarian teratoma as well as abnormal EEG, and CSF antibodies against NMDAR. Patients with anti-NMDAR encephalitis may present with clinical features that resemble cycloid psychosis. In addition, our patients did not have prodromal history of psychiatric symptoms and showed intolerance to antipsychotic medication, which all should raise concern for anti-NMDAR encephalitis, prompting CSF antibody testing.

[Doctrine of psychopathies: the Kretschmer's constitutional-morphologic concept]. / Uchenie o tipologii psikhopatii: konstitutsional'no-morfologicheskaia kontseptsiia É. Kretchmera.

The morphological landmarks suggested by E. Kretschmer for delineation of three basic types of somatic constitutions: picnic, athletic and leptosome are analyzed, the critics of declared affinity of bodily structure to cycloid or schizoid type of psyche is also considered. The influence of the ideas of Italian anthropometric school on the Kretschmer's morphologic concept is marked. E. Kretschmer's negation of 'degeneration' theory that was the ground for the development of psychopathy doctrine is underlined. Due to that negation physical stigmata (dysplastic bodily structure), sexual anomalies and character disharmonies having been described according to 'degeneration' concept as general signs of predisposition to mental disorders were included according to the Kretschmer's concept into 'schizoid' group.