[Schizophrenic psychoses with affect-dominant symptoms : Contribution to a system-specific approach]. / Schizophrene Psychosen mit affektdominanter Symptomatik : Ein Beitrag zu einem systemspezifischen Ansatz.

BACKGROUND: In order to reduce heterogeneity in schizophrenia a system-specific approach consisting of the domains 'language', 'affect' and 'motor behavior' was proposed namely the Bern psychopathology scale (BPS). Using the example of the affective domain we examined this system-specific approach for its applicability to clinical practice using a qualitative-casuistic method. Moreover, we examined the possibility to identify a homogeneous subgroup of patients applying this approach. MATERIAL AND METHODS: From a sample of 100 patients with schizophrenia a total of six patients was selected and described following a traditional psychopathological case approach. To expand this qualitative-casuistic method we included the results of standardized psychopathological assessments using the BPS and the positive and negative syndrome scale of schizophrenia (PANSS). RESULTS: Schizophrenic psychoses with affect-dominant symptoms could be characterized better using a system-specific approach than the positive-negative-concept. Ensuing from the cross-sectional psychopathological patterns only limited statements regarding the prospective course were possible. DISCUSSION: The concept of an affect-dominant subtype of schizophrenia was not entirely convincing with respect of the heterogeneous course of the patients described. Nevertheless, the system-specific approach may hold promise for the future regarding further neurobiological research.

[Psychiatric Day Clinics--Evidence for and Importance of Patient-Centered Care]. / Psychiatrische Tageskliniken--Evidenzlage und Stellenwert im Versorgungssystem.

OBJECTIVE: The aim of the study was to summarize and evaluate the recent literature on treatment in psychiatric day clinics, and to assess the importance of such clinics in the current healthcare system. METHOD: We conducted a systematic review of recent studies in order to compare the efficacy and cost effectiveness of day clinics in relation to in- and outpatient treatment. RESULTS: The evidence is still sparse and inconclusive. CONCLUSION: Psychiatric day clinics act as a link between inpatient and outpatient treatment in community mental healthcare. However, evidence in support of the efficacy and cost-effectiveness of day clinics is still sparse.

[Innovative patient-centered care systems: International perspectives]. / Innovative patientenzentrierte Versorgungssysteme : Internationale Perspektiven.

BACKGROUND: The "Psychiatrie-Enquete" (German Report on the State of Psychiatry) is 40 years old this year. It has always been inspirational; also internationally. OBJECTIVE: Which innovative elements of community mental health services can be found in an international perspective? MATERIALS AND METHODS: Narrative review. RESULTS: Community mental health care is a lively field with much research and innovative practice. With assertive community treatment (ACT) and home treatment (HT), internationally well-evaluated forms of community mental health care are available. CONCLUSION: Recovery-based and peer-to-peer approaches hold promise for the future. In terms of mid- and long-term perspectives, an increase in patient-centering via individualization of mental health care and a better implementation of community mental health interventions would be desirable in Germany.

[Schizophrenic Psychoses with Motor-Dominant Symptoms: Considerations for a System-Specific Approach]. / Schizophrene Psychosen mit motordominanter Symptomatik: Überlegungen zu einem systemspezifischen Ansatz.

In order to reduce heterogeneity in schizophrenia, a system-specific approach consisting of the domains "language", "affect" and "motor behavior" has been proposed. We examined this system-specific approach for its applicability to clinical practice in the motor behavior domain, using the methodological approach of case studies, and discuss here the differences to the positive/negative concept. We analyzed eight cases with stable motor-dominant symptoms, and also quantitatively assessed motor behavior by using the Bern Psychopathology Scale (BPS), a standardized psychopathological assessment instrument, as well as actigraphic data. Characterization of cases using the positive/negative approach was not helpful. We found an overlap of the motor behavior domain with the other two domains. This complicates the application of the system-specific approach in the sense of a typology. Furthermore, we found both relapsing courses with full remission and chronic courses with deterioration within the motor-dominant subtype. Nevertheless, the system-specific approach has heuristic utility for the future.

Subtyping schizophrenia: A comparison of positive/negative and system-specific approaches.

BACKGROUND: Schizophrenia is a heterogeneous disorder. Over the years, different approaches have been proposed to approach this heterogeneity by categorizing symptom patterns. The study aimed to compare positive/negative and system-specific approaches to subtyping. METHODS: We used the Positive and Negative Syndrome Scale (PANSS) and Bern Psychopathology Scale (BPS), which consists of subscales for three domains (language, affect and motor behavior) that are hypothesized to be related to specific brain circuits, to assess cross-sectional psychopathological characteristics in a sample of 100 inpatients with schizophrenia spectrum disorders. We then categorized participants into positive/negative and system-specific subgroups to allow comparisons of the two approaches. RESULTS: The analyses revealed correlations between the PANSS positive subscore and the BPS affective subscore (r=.446, p<.001) and between the PANSS negative subscore and the BPS motor behavior subscore (r=.227, p=.023). As regards the positive and negative subtype, more participants were classified as positive in the language-dominant subtype (30.3%) and affect-dominant subtype (30.3%), whereas more were classified as negative in the motor behavior-dominant subtype (44.4%). However, most patients met the criteria for the mixed subtype. CONCLUSIONS: The results suggest that the positive/negative and system-specific approaches can be regarded as complementary. Future studies should examine both approaches in a longitudinal assessment of psychopathological symptoms and link them with qualitative-phenomenological approaches.

[Convergent validity of SCID-II and TCI: categorical vs. dimensional diagnostics of personality disorders using the example of short-term prisoners]. / Konvergente Validität von SKID-II und TCI: Kategoriale vs. dimensionale Diagnostik von Persönlichkeitsstörungen am Beispiel von Gefangenen mit Kurzzeitstrafe.

In order to objectify the diagnostics of personality disorders, questionnaires and structured interviews are used. Nevertheless, due to different methodological approaches even those instruments arrive at different results very often. Therefore, this study aimed to check the convergent validity of two frequently used instruments - the Structured Clinical Interview for DSM IV Axis II Disorders (SCID-II) and the Temperament and Character Inventory (TCI) - the first one representing the categorical and the latter one the dimensional approach for diagnosing personality disorders. The diagnostic concordances were statistically described with Cohen's Kappa, Yule's Y, and correlations. The results indicate that there are striking differences in diagnoses and that the SCID-II rather tends to diagnose a personality disorder earlier than the TCI.

[Organic personality disorder: conceptual principles, clinical symptoms and treatment]. / Die organische Persönlichkeitsstörung: Konzeptuelle Grundlagen, Klinik und Therapie.

The organic personality disorder is primarily characterized by a change of premorbid behavior due to an organic impairment or disease of the central nervous system. German psychopathological preliminary work had a determining influence on the current diagnostic concepts in the international classification of diseases 10 (ICD-10) and the diagnostic and statistical manual of mental disorders 5 (DSM-5). An analysis of the literature in the MEDLINE database shows that most studies can be found for traumatic brain injury and epilepsy. The most common symptoms described were symptoms of depression, emotional instability, irritability and impulsive behavior. Psychopathological symptoms were not related to the etiopathogenesis but showed some relation to the neuroanatomical location of functional disorders or damages. Only few publications on treatment strategies were found. The empirical findings point to the necessity of multiaxial diagnostic measures to distinguish between the levels of etiology and symptomatology. Therapeutic interventions should be planned on the basis of psychopathological symptoms.

[Course typologies of schizophrenic psychoses]. / Verlaufstypologien schizophrener Psychosen.

The "group of schizophrenias" describes a heterogeneous nosological construct with a variable course of the illness. Against this background, several historical approaches to course typologies of schizophrenic psychoses have been described (Bleuler; Huber; Leonhard; Watt, Katz and Shepherd). These concepts, however, differ considerably from each other, in particular with respect to the definition of outcomes. This mainly results from the reference to different psychopathological traditions. The possible codings of subgroups and course types of schizophrenic psychoses in ICD-10 and DSM-5 are compromises in order to combine the different aspects. The empirical examination and the advancement of course typologies of schizophrenic disorders using modern instruments and analyses are important tasks for current psychiatric research. Such efforts should combine quantitative-statistical analyses with a casuistic approach.

[Psychopathological differentiation of depressive syndromes]. / Psychopathologische Differenzierung depressiver Syndrome.

The historical contributions of Kurt Schneider, Karl Leonhard, Hans-Jörg Weitbrecht and Hubertus Tellenbach provide different concepts for a psychopathological differentiation of depressive syndromes. The current diagnostic systems ICD-10 and DSM-5 also contain categories for a differentiated classification of depressive disorders that trace back to the above historical concepts. The extensive diagnostic concepts of "depressive episode" or "major depression", however, are mainly based on the severity of symptomatology in terms of the number of symptoms and on their temporal duration. This approach could result in a lack of psychopathological differentiation and the limitation to a more syndromal and dimensional view of depression. In contrast, a differentiated typology of depressive phenomenology based on traditional psychopathological concepts could be useful both for clinical treatment decisions and for neurobiological research.

Psychopathological long-term outcome of schizophrenia -- a review.

OBJECTIVE: In the past, the comparability of empirical studies that examined the course and outcome of schizophrenia was limited by their use of different diagnostic systems. Focussing on the psychopathological long-term outcome, the present article aims to review follow-up studies that used modern operationalized diagnostic criteria for schizophrenia (DSM-III, DSM-III-R, DSM-IV and ICD-10). METHOD: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO and PSYNDEX for relevant studies up to the year 2011. Twenty-one studies were included in the final analysis. RESULTS: The long-term outcome of schizophrenia was heterogeneous and included full remissions as well as severe chronic states. Schizophrenia, however, showed a considerably more unfavourable outcome than other diagnostic groups such as schizoaffective or affective disorders. Psychopathological symptoms remained relatively stable in the course of illness. Several predictors for a poor outcome were identified, such as male gender or pronounced negative symptoms. CONCLUSION: Recent studies using modern diagnostic systems largely confirm the results of earlier studies. Current diagnostic criteria for schizophrenia identify a heterogeneous sample of patients. The influence of therapeutic interventions on long-term outcome remains unclear.

[Schizophrenic psychoses with bipolar course--implications for nosology and treatment]. / Schizophrene Psychosen mit bipolarem Verlauf - Implikationen für Nosologie und Therapie.

Based on a description of the psychopathological symptoms and clinical course of three patients, the diagnostic classification of schizophrenia, schizoaffective disorder and bipolar affective disorder is discussed. The reported cases are characterised by a rapid change of cognition, affect and psychomotor domain with fluctuations in two opposite directions and an incomplete remission of symptoms between acute episodes of illness. Such cases are not adequately represented in the current diagnostic systems ICD-10 and DSM-IV. This renders both the diagnostic classification and the development of evidence-based treatment guidelines more difficult. In accordance with the historical concepts of Emil Kraepelin and Kurt Schneider, the reported patients can be considered to suffer from a subtype of schizophrenia with bipolar course. The identification of such psychopathological course types could help to develop more concise and individualised treatment guidelines. In contrast, the characterisation of the reported cases using dimensional models seems doubtful.

[Deconstructing schizophrenia. Dimensional models or division into subtypes?]. / Auflösung des Schizophreniebegriffes. Dimensionale Modelle oder Aufteilung in Subtypen?

Against the background of the arrangements of ICD-11 and DSM-V, future approaches in order to diagnose schizophrenic psychoses are currently being discussed. In this context, the current concepts of schizophrenia are questioned because attempts at neurobiological validation and validation based on family and follow-up studies have not succeeded. Therefore, dimensional diagnostic models or a division into subtypes are suggested. Both of these proposals would imply a deconstruction of the current concept of schizophrenia. A historical review shows that the psychopathological roots of the current discussion can be traced back to Kurt Schneider's nominalistic concept of schizophrenia which is based upon the so-called first-rank symptoms. In contrast, the psychopathological foundation of dimensional concepts and a division into several subtypes date from contributions of Klaus Conrad and Karl Leonhard. A triaxial diagnostic system with the axes of syndromes, course types and aetiology could provide a bridge between the different approaches.

[Obstructive sleep apnoea syndrome as the cause of atypical depression]. / Obstruktives Schlaf-Apnoe-Syndrom als Ursache einer atypischen Depression.

Sleep apnoea is a common disorder presenting with somatic comorbidities and psychiatric symptoms. This case report describes a 43-year-old man with an organic depressive disorder due to obstructive sleep apnoea. Initially, an atypical depressive episode or schizophrenic residual syndrome had been considered likely diagnoses; subsequent polysomnography results, however, suggested obstructive sleep apnoea instead. Upon nasal continuous positive airway pressure (nCPAP), the respiratory distress symptoms improved. The case report highlights the association between sleep disturbances and depressive symptoms. In patients presenting with symptoms of atypical depression and excess body weight sleep apnoea should be considered.