[On the 200th birthday of psychiatry]. / Die Psychiatrie hat 200. Geburtstag. Ein Grund zum Feiern?

Two hundred years ago the term "psychiatry" (first named "psychiatery") was introduced by Johann Christian Reil in the city of Halle, Germany. With the word's composition Reil demonstrated that psychic disorders belong to the medical domain, which he justified in a long paper explaining why psychiatry must be one of the three major branches of medicine (the others being surgery and pharmacy). Further he emphasized that psychosomatics and medical psychology are part of the comprehensive new discipline psychiatry. He described psychotherapy as an essential treatment for mental and somatic diseases and having equivalence with pharmacological and surgical methods. Johann Christian Reil launched an antistigma campaign and a crusade towards humanization of psychiatric asylums. Two hundred years later psychiatry is well established as a medical discipline and has become self-confident through its self-determination, in spite of certain setbacks and some objectives that have not yet been achieved.

[Differentiation of impulsive crimes from crimes of passion]. / Zur Abgrenzung von Affekttaten und Impulstaten.

In this article we try to differentiate between impulsive crimes and crimes of passion. The former are all impulsively executed and unplanned aggressive acts where we can find no specific preceding events which can be derived from a relevant relationship between offender and victim. Crimes of passion on the other hand are also impulsive and aggressive acts executed in a highly stressful affective state, but they are directed towards another relevant person and characterized by specific preceding events derived from the relationship between offender and victim. Thus they result from a perceived threat to the offender's self-image. We outline features for assessing crimes of passion as well as some indications which could facilitate them. The above mentioned differentiation between impulsive crimes and crimes of passion is relevant in forensic practice. Assessment of the psychological and psychopathological processes and states described in this article allows forensic psychiatric experts to give more reliable and more distinct recommendations to a court regarding the offender's criminal responsibility.

[Mixed affective disorders]. / Gemischt-affektive Störungen.

The Kraepelin concept of "mixed states" has experienced a renaissance over the last two decades. This has been caused by clinical as well as theoretically relevant factors. Of particular clinical relevance is the fact that more than 40% of all patients with bipolar disorders show at least one mixed affective episode during the course of their illness. However, the correct assessment and the precise classification of the symptoms are very important. A diagnosis according to the tight criteria of ICD-10 or DSM-IV, or perhaps based on the moderate Pisa or Cincinnati criteria, is recommended, whereas the use of broader definitions cannot be advised. Mixed schizoaffective episodes are under-diagnosed in comparison to pure affective mixed episodes, although both are defined by ICD-10 as well as by DSM-IV, and the frequency of occurrence is almost the same. Mixed schizoaffective episodes appear to be one of the most severe forms of bipolar disorders. Their clinical relevance is mainly caused by their unfavourable prognosis and difficulty in treatment. Atypical neuroleptics combined with anticonvulsives have proved to be more effective than any other psychopharmacological substances. The occurrence of mixed depressive and manic symptoms during one and the same episode is theoretically important, especially in the sense of their nosological and etiological differentiation.

[Bipolar affective and schizoaffective disorders of older age -- classification, symptoms and course]. / Bipolare affektive und schizoaffektive Störungen des höheren Lebensalters.

Bipolar affective and schizoaffective disorders of older age are underdiagnosed, although they are of growing importance for psychiatric services. In this review article, we present and discuss results concerning classification, psychopathology, epidemiology, course, prognosis, neuroimaging, family studies and therapy. Bipolar (schizo)affective disorders of older age are a diagnostic heterogeneous group, especially as secondary manias must be separated from "endogenous" bipolar disorders nosologically. Bipolar (schizo)affective disorders of older age show some peculiarities: Gender ratio, age at onset, mortality and comorbidity with neurological disease are amongst them. Nevertheless, in many other aspects bipolar (schizo)affective disorders of older age do not differ from bipolar disorders of younger patients. For the acute and maintenance treatment there is a dearth of controlled studies. Lithium is of great importance. Other substances, as well as psychoeducation and ECT may be used analogously as in younger patients, if age specific factors are taken into account (as for example the danger of falls).

[Anxiety disorders comorbid with unipolar depression. Clinical diagnoses versus standardized diagnostic interview]. / Angststörungen bei unipolaren Depressionen. Klinische Diagnosen vs. standardisiertes Interview.

Anxiety disorders frequently co-occur with affective disorders. It is well-known that such comorbid anxiety disorders are more frequently diagnosed with standardized interviews than during the "daily routine." In 117 consecutive inpatients with major depression we assessed the frequency of DSM-IV anxiety disorders and compared it to the routine diagnoses of the discharge letters to analyze underlying principles of such diagnostic strategies. According to SCID-I (DSM-IV) 36 patients fulfilled criteria for a comorbid anxiety disorder, while this was only true for 17 patients according to discharge letters. Logistic regression revealed that clinically recognized cases had higher anxiety levels (higher diagnostic threshold). At the same time, in patients with higher depression scores anxiety syndromes tended not to be seen as separate disorders. This strategy is in line with "classic psychopathology," where severe depression (or melancholia) "included" anxiety symptoms. The borderline between depressive disorders and anxiety disorders is not as clear-cut as DSM-IV and ICD-10 try to indicate.

Affective disorders: basic principles regarding clinical course, long-term therapeutic and prophylactic strategies.

Affective disorders, mainly depressive and bipolar afflictions are life-long recurrent diseases and require constant treatment and prophylaxis. Both acute and maintenance therapeutic strategies have to be applied to the special subgroups of the depressive and bipolar spectrum. Despite the development of new pharmacological agents and psychotherapeutical settings, the long-term prognosis, especially functional outcome, did not change considerably in comparison to past decades.

[Categorical and dimensional assessment of "psychopathy" in German offenders. Prevalence, gender differences and age factors]. / Kategoriale und dimensionale Erfassung von "psychopathy" bei deutschen StraftäternPrävalenz, Geschlechts- und Alterseffekte.

The personality construct "psychopathy" is of utmost importance in legal prognosis. In the last 20 years, a multitude of empirical research proved the predictive validity of this concept concerning the degree of dangerousness represented by an offender. In the present study, a representative, nonselected sample of 416 offenders was examined using the Screening Version of the Psychopathy Checklist (PCL:SV). The data were analysed both categorically and dimensionally according to the three-factor model proposed by Cooke and Michie. In comparison to North American Studies the prevalence of high scorers was significantly lower, implicating intercultural differences. Analyses of the effects of gender yielded higher scores on each of the three factors in male offenders. Concerning different age cohorts, it turned out that the arrogant and deceitful interpersonal style and deficient affective experience remained stable, whereas the impulsive and irresponsible behavioral style decreased with increasing age. Therefore, our results point out intercultural differences already shown in the prevalence of "psychopathy" and confirm the effects of gender and age concerning this construct.

Brief and acute psychoses: the development of concepts.

This paper reviews the conceptual history of brief and acute psychoses. As psychotic disorders of usually dramatic symptomatology but nevertheless with a usually benign course, brief and acute psychoses have the air of a paradox. Thus, they have posed specific problems in regard to nosology, diagnostics and aetiology. Despite a strong convergence of the descriptive elements, the historical concepts of brief and acute psychoses have yielded different answers to the questions raised. Kahlbaum and Kraepelin set the stage on which brief and acute psychoses appeared "atypical". The concept of "bouffée délirante" used degeneration theory as a background for nosological and aetiological allocation. Similarly, the concepts of cycloid psychoses, reactive (psychogenic) psychoses, emotional psychoses and atypical psychoses have provided diverging but interrelated ways to delineate brief and acute psychoses, to determine their nosological status and to explain the coexistence of severe disorder and favourable prognosis. Modern classifications, namely the acute and transient psychotic disorder of ICD-10 and the brief psychotic disorder of DSM-IV, reflect the varied history of the concept.

The schizoaffective phenomenon: the state of the art.

OBJECTIVE: Schizoaffective disorders are well established. Nevertheless, the definition in the International Classification of Diseases (ICD)-10 and the Diagnostic and Statistical Manual (DSM)-IV are insufficient. METHOD: Critical review of the literature from Kahlbaum (1863) to the 21st century. RESULTS: Many authors have described people suddenly developing a disorder with both 'schizophrenic' and 'affective' symptoms. In DSM-IV and ICD-10, the schizoaffective disorder is defined as the concurrent occurrence of schizophrenic symptoms with a major affective disorder. However, there is no reason for a chronological distinction regarding the co-existence of schizophrenic and affective symptomatology. Moreover, longitudinal aspects are not included in the definitions. CONCLUSION: Two types of schizoaffective disorder must be distinguished: the 'concurrent' and the 'sequential' type. The first includes people having only a coincidence of schizophrenic and affective symptoms. The 'sequential' type is defined as the schizoaffective disorder under a longitudinal aspect subsuming disorders with a symptom change between different episodes. Consequences for further research are discussed in detail.

[Temperament and affective disorders--historical basis of current discussion]. / Temperament und affektive Erkrankungen--geschichtliche Grundlagen einer aktuellen Diskussion.

The history of the temperament concept begins in ancient Greece. The humoral theory remained influential over the centuries. At the beginning of the 20 th century, both Wilhelm Wundt and his pupil Emil Kraepelin formulated new aspects. Wundt described two dimensions: "speed of variability of emotions" and "intensity of emotions". Kraepelin observed four fundamental states (depressive, manic, irritable and cyclothymic), which he linked to manic-depressive illness. Since then different lines of temperament research have evolved: (1) psychiatric-psychopathological theories (e. g. Ewald, Kretschmer and Sheldon), which tend to see temperament as a dilution of full-blown affective disorders; (2) neurobiological theories (e. g. Pavlov, Eysenck and Gray), which understand temperament as determined by underlying neurobiological processes - especially levels of arousal; and (3) developmental theories (e. g. Chess & Thomas, Rothbart and Kagan), which derived their temperament concept from early childhood observations. Recent theories (e. g. those of Cloninger or Akiskal) combine different aspects. After reviewing the historical temperament concepts we present underlying factors which are linked to affective disorders (such as emotional reactivity, cyclicity or trait affectivity). Finally, we illustrate the importance of temperament concepts for research in affective disorders.

Personality features of patients with mixed and pure manic episodes.

OBJECTIVE: To test the hypothesis that patients with a mixed manic episode show different personality features than patients with a pure manic episode. METHOD: Sixteen patients with a mixed manic episode (broad criteria) and 26 patients with a pure manic episode were assessed with diagnostic interviews (SCID I/II) as well as instruments for depression, mania and personality. RESULTS: Even after controlling for age as well as depression and mania score at assessment, no differences between the two groups emerged concerning either personality features as assessed with the NEO-five-factor inventory (NEO-FFI) or personality disorders. CONCLUSION: We found no difference between patients with mixed mania and patients with pure mania concerning their personality features. Possible reasons for this are being discussed.

The concordance of ICD-10 acute and transient psychosis and DSM-IV brief psychotic disorder.

BACKGROUND: ICD-10 acute and transient psychotic disorder (ATPD; F23) and DSM-IV brief psychotic disorder (BPD; 298.8) are related diagnostic concepts, but little is known regarding the concordance of the two definitions. METHOD: During a 5-year period all in-patients with ATPD were identified; DSM-IV diagnoses were also determined. We systematically evaluated demographic and clinical features and carried out follow-up investigations at an average of 22 years after the index episode using standardized instruments. RESULTS: Forty-two (4.1%) of 1036 patients treated for psychotic disorders or major affective episode fulfilled the ICD-10 criteria of ATPD. Of these, 61.9% also fulfilled the DSM-IV criteria of brief psychotic disorder; 31.0%, of schizophreniform disorder; 2.4%, of delusional disorder; and 4.8%. of psychotic disorder not otherwise specified. BPD showed significant concordance with the polymorphic subtype of ATPD, and DSM-IV schizophreniform disorder showed significant concordance with the schizophreniform subtype of ATPD. BPD patients had a significantly shorter duration of episode and more acute onset compared with those ATPD patients who did not meet the criteria of BPD (non-BPD). However, the BPD group and the non-BPD group of ATPD were remarkably similar in terms of sociodemography (especially female preponderance), course and outcome, which was rather favourable for both groups. CONCLUSIONS: DSM-IV BPD is a psychotic disorder with broad concordance with ATPD as defined by ICD-10. However, the DSM-IV time criteria for BPD may be too narrow. The group of acute psychotic disorders with good prognosis extends beyond the borders of BPD and includes a subgroup of DSM-IV schizophreniform disorder.

[Temperament and affective disorders. The TEMPS-A Scale as a convergence of European and US-American concepts]. / Temperament und affektive Störungen. Die TEMPS-A-Skala als Konvergenz europäischer und US-amerikanischer Konzepte.

In temperament research, three traditions can be found: (1) in psychiatry or psychopathology, (2) in neurobiology, and (3) in developmental psychology. After giving an overview, we present results and theories concerning the relation between temperament and affective disorders. Based on Kraepelin's concept of the fundamental states ("Grundszustände"), we describe four types of temperament: hyperthymic (manic), depressive, irritable, and cyclothymic. A fifth anxious temperament is added. Clinical description and scientific implications are described in the light of recent work by Akiskal and the German version of the TEMPS-A scale, a self-report questionnaire for assessing temperament.

The relation of "acute and transient psychotic disorder" (ICD-10 F23) to bipolar schizoaffective disorder.

The aim of this work is to investigate differences between acute and transient psychotic disorders (ATPD; F23 of ICD-10) and bipolar schizoaffective disorders (BSAD). In a controlled prospective and longitudinal study, we compared all inpatients with ATPD treated at Halle university hospital during a 5-year period with matched controls with BSAD. Sociobiographical data were collected using a semi-structured interview. Follow-up investigations were performed at a mean of 2.2-3.3 years after the index episode or 8.2-16.1 years after the first episode by means of standardized instruments. ATPD differs significantly from BSAD on various relevant levels, such as gender (more female), age at onset (older), development of the full symptomatology (more rapid), duration of the symptomatology (shorter), acuteness of onset (more acute), preceding stressful life-events (more frequent) and long-term prognosis (better). It is concluded that ATPD and BSAD are different nosological entities.

Personality disorders in offenders: categorical versus dimensional approaches.

The present study focused on the consequences of cut-off scores in personality disorder diagnoses for their association with criminal behavior. Using ICD-10 personality disorder criteria eliminating offence-related symptoms, we studied the distributions of categorically diagnosed personality disorders and of dimensional personality disorder scores in a group of offenders and a noncriminal control group. Whereas the dimensional scores of the offender group differed significantly from those of the control group for all personality disorders under study, the frequency of categorical diagnoses differed significantly for two personality for two personality disorders only. Moreover, prediction of group membership (offenders vs. nonoffenders) from personality disorder scores was substantially more precise than prediction from categorical diagnoses. It is concluded that a dimensional approach to personality disorder diagnosis is not only superior theoretically but also yields more precise information about the specific associations with criminal behavior.

Clinical genetics of familial keloids.

BACKGROUND: Keloids are proliferative fibrous growths that result from an excessive tissue response to skin trauma. Most keloids occur sporadically, but some cases are familial. However, the genetics of keloid formation have only rarely been documented, and the mode of inheritance is not known. OBJECTIVE: To elucidate the clinical genetic characteristics of keloid wound-healing disorder. OBSERVATIONS: We studied the clinical and genetic characteristics of 14 pedigrees with familial keloids. The ethnicity of these families is mostly African American (n = 10), but also white (n = 1), Japanese (n = 2), and African Caribbean (n = 1). The pedigrees account for 341 family members, of whom 96 displayed keloids. Of the affected family members, 36 are male and 60 are female. The age of onset varies from early childhood to late adulthood. There is variable expression of keloids within the same families: some affected members have only minor earlobe keloids, whereas others have very severe keloids affecting large areas of the body. In the described pedigrees, 7 individuals are obligate unaffected carriers, revealing nonpenetrance in about 6.8% of keloid gene carriers. Syndromes associated with keloids, namely Rubinstein-Taybi and Goeminne syndrome, were not found in these families. Additionally, linkage to the gene loci of these syndromes and X-chromosomal linkage were excluded. CONCLUSIONS: The pattern of inheritance observed in these families is consistent with an autosomal dominant mode with incomplete clinical penetrance and variable expression. This is the most comprehensive collection of keloid families described to date, and it allows for the first time the elucidation of the clinical genetic characteristics of the familial form of this wound-healing disorder.

[Carl Wernicke: his impact past and present]. / Carl Wernicke: Wirkung und Nachwirkung.

From April 1904 until his premature death due to an accident in June 1905, Carl Wernicke was head of the Department of Psychiatric and Nervous Diseases at the University of Halle-Wittenberg, Germany. We report on Wernicke's work and activities during this short but influential period in the context of his biography and scientific development. Archive materials reveal some interesting details concerning Wernicke's appointment and his diagnostic practice in Halle. As the most outstanding representative of 19th century neuropsychiatry, Wernicke constantly strove to base his psychiatric doctrine on the brain research of the time. In Breslau, his former place of employment, his scientific working environment had dramatically deteriorated. In Halle, Wernicke found not only a well-functioning clinical institution but also an important neurobiological tradition inaugurated by Eduard Hitzig. He immediately resumed his research programme. Fields of interest included the implementation of his nosological system in clinical practice, the study of aetiological factors of mental diseases and the use of a new method of puncture for the localisation of brain tumours. Wernicke's biological research agenda was interrupted not only by his premature death but also by historical developments. Many aspects of this agenda, however, have been raised anew by today's psychiatry.

Affective symptoms at index hospitalization in childhood and depressive symptoms in adulthood: a "catch-up" study.

PURPOSE: To analyze whether affective symptoms during psychiatric treatment in childhood or adolescence could predict the later development of depressive symptoms. METHOD: We used a "catch-up" design. A cohort of former child and adolescent psychiatric patients was assessed in adulthood with standardized instruments according to the criteria of ICD-10 (SCAN) and dimensional values for depression (both self-reported and observer-rated). Initial affective symptoms had been extracted from clinical records according to a standardized system (AMDP). RESULTS: We assessed 164 former patients. Twelve percent of these fulfilled diagnostic criteria of an affective disorder (F3) according to ICD-10. In univariate analyses of variance the depression scores were significantly related to affective symptoms during childhood treatment, even if the presence of an affective disorder at catch-up was considered as an independent covariate variable. Nevertheless, the latter variable explained a large part of the variance of depression scores, while initial affective symptoms explained no more than 6%. CONCLUSION: Affective symptoms in childhood and adolescence may predict the later development of subthreshold depressive symptomatology.

The role of collagen-derived proteolytic fragments in angiogenesis.

Basement membrane molecules and fragments derived from them are regulators of biological activities such as cell growth, differentiation and migration. This review describes proteolytically derived fragments from the non-collagenous (NC1) domain at the C-terminus of the basement membrane collagens type IV, XV and XVIII, which have been implicated as regulators of angiogenesis. Endostatin is an endogenous collagen XVIII/NC1 derivative, inhibiting endothelial cell proliferation and migration in vitro and tumor-growth in vivo. A homologous NC1 domain fragment of type XV collagen has anti-angiogenic activity as well. Furthermore, NC1 domain fragments of the most abundant basement membrane collagen, type IV collagen, have been shown to inhibit induced vessel growth.

Gene for the human transmembrane-type protein tyrosine phosphatase H (PTPRH): genomic structure, fine-mapping and its exclusion as a candidate for Peutz-Jeghers syndrome.

Mutations in the serine/threonine kinase STK11 lead to Peutz-Jeghers syndrome (PJS) in a subset of affected individuals. Significant evidence for linkage to a second potential PJS disease locus on 19q13.4 has previously been described in one PJS family (PJS07). In the current study, we investigated this second locus for PJS gene candidates. We mapped the main candidate gene in this region, the gene for the transmembrane-type protein tyrosine phosphatase H (PTPRH), within 15 kb telomeric to the marker D19S880. We determined its genomic structure, and performed mutation analysis of all exons and the exon-intron junctions of the PTPRH gene in the PJS07 family. No disease causing mutation was identified in PTPRH in affected individuals, suggesting the existence of an as yet not identified gene on 19q13.4 as a second PJS gene.