[Classification of endogenous psychoses. Predictive validity of initial diagnosis based on 5 and 21-33-years of follow-up in a long-term prospective study (Budapest 2000)]. / Az endogén pszichózisok osztályozása. A kiindulási diagnózisok prediktív validitása egy hosszú távú prospektív kutatás egymást követö 5 éves és 21-23 éves utávizsgálata alapján (Budapest 2000).

As regards the clinical psychopathological diagnostics, Leonhard's classification of endogenous psychoses published in 1957 contained description of a detailed nosology with claims that the diagnostic categories included in this classification system involve differentiated predictions of course and outcome of the illness. The principal investigator (BP) chose Leonhard's classification system to test these nosological hypotheses via a prospective study of psychotic patients based on their clinical and life history in 1966-67. Validity of the categorial diagnoses given at baseline (female patients n=222; healthy control persons n=54; 1968-1976) was proven by combination of assessments of psychopathological symptoms and personality types at the 5-year follow-up. Moreover, "pure defect" also proved to be valid (84,6%). At the time of the long-term follow-up in 1997-2002 (patients: n=125; healthy control persons: n=38) predictive validity of the nine categories was measured empirically and by using a stochastic (Markovian) model, thus combining validity and reliability. Hebephrenias, group of normal persons and of schizophrenias proved to be valid, with diagnostic stabilities of 0,93, 0,89, and 0,93, for the three groups, respectively. In addition, bipolar manic-depressive psychoses and cycloid psychoses were also valid (diagnostic stability of 0,76 in both cases). Unipolar depression was valid (diagnostic stability=0,84) only by forming a "nosological family" based on diagnostic stability and on current status and clinical presentation during the period preceeding the follow-up with regard to other moodcongruent disorders and outcome-diagnosis "healthy control". Validity of systematic paraphrenias (diagnostic stability =0,68) was also in the moderate range. Division of schizophrenias in "systematic vs. non-systematic" nosological categories was inconclusive; the categories of affect-laden paraphrenia, periodic catatonia and systematic catatonias could not be confirmed reliably in this study.

[Recent crisis of psychiatry in the context of modern and postmodern science]. / A pszichiátria mai krízise a modern és posztmodern tudomány kontextusában.

INTRODUCTION: We have investigated the recent crisis of psychiatry in perspective of the last two centuries of its history. First and longer part of this period belongs to the Modern era. The second part beginning in the sixties of the last century is the Postmodern era, the one we live in today. We have pointed out that the recent crisis has not come by accident but as one of the several changes characterising our transition into the era labelled "Postmodern". METHODS: The crisis of psychiatry was analysed in respect of the development of science and in social context. We focused on psychiatry and science and their interconnectedness in their historical articulations. A way out of the crisis of the current era can be found also with the use of historical methods. RESULTS: Science is changing both in respect of its quality and its role in our age. Taking into consideration normal and post-normal science, we differentiated two additional generations of science, pro-normal science and perato-scientia, in the most recent history. On the one hand, psychiatry serves as a paradigm for the conceptualisation of contemporary science. On the other hand, as an up-to-date science re-conceptualised partly according to its own paradigm it may find a way out of its own crisis. The many facets of the current crisis were demonstrated by analysing recent developments of the Hungarian health politics. Concerning this topic we adopted the term "economicity" elaborated by us earlier. We found that psychiatry operated by the hegemony of the rules of economicity might become a relay station for selecting patients to be thrown away as human garbage. CONCLUSIONS: This catastrophic outcome may occur if a political system is organized purely by economicity rules without either historical responsibility or local solidarity. However, up-to-date trends of scientificity as shown by pro-normal science and perato-scientia guarantee a radically different course for psychiatry. Following this course, which is consistent with the insight into the common lot of normal and abnormal people, psychiatry should be guided also in the future by the categorical imperative of therapy.

[Changes of hallucination and delusion: the results of the 21-33 year follow-up of "Budapest 2000"]. / A téveszme és a hallucináció változásai: a "Budapest 2000" 21-33 éves follow-up eredményei.

UNLABELLED: In view of the fact that there are only a few longitudinal follow-up examinations in patients with major mental illness, data on the changes of hallucination and delusion over the lifetime of the patient are extremely limited. AIM: The purpose of this study was to investigate the long-term course of delusions and hallucinations in patients with psychotic disorders. METHOD: 221 patients were evaluated in this study. The subjects were classified according to Leonhardian nosological system into affective, cycloid and schizophrenic groups and were assessed at three different times (index, and 5- and 21-33 year follow-up). All subjects received pharmacotherapy during the study. The psychopathological assessment of patients was performed by two trained raters. The Rockland Pollin Rating Scale was obtained at each time-point in the study. RESULTS: The initially low severity of hallucinations and delusions showed a tendency for full recovery across the course of the illness in the affective group. The high initial severity of both symptoms displayed a full resolution in the cycloid group. By contrast, at each follow-up time-point in all groups with schizophrenia, persistence of both symptoms was observable with some fluctuation, i.e., with the worsening of hallucination between the second and third follow-up time-points. Certain schizophrenia subgroups were distinguishable based on the correlation of the two symptoms. The severity of these symptoms did not show a significant association with the severity of psychosis observed at a particular time. DISCUSSION: The main productive symptoms with some fluctuations persist through course of the illness.

The predictive validity of the Leonhardean classification of endogenous psychoses: a 21-33-year follow-up of a prospective study ("BUDAPEST 2000").

To our knowledge, no previous long-term studies of the Leonhardean classification in the whole spectrum of endogenous psychoses have been conducted. This prospective study (n = 276; female patients n = 222; normal control persons n = 54) started in 1967-1976. The same population was followed-up by participation of a "blinded control" psychiatrist in 1997-2002 [patients available at follow-up = 125 (56.3%); available controls = 38 (70.4%)]. Patients for this investigation were selected by two independent diagnosticians from eight nosological groups based on full diagnostic agreement. Diagnostic agreement at follow-up (weighted-kappa) was 0.87. Predictive validity of the diagnostic categories was measured empirically and using a stochastic (Markovian) model, thus combining validity and reliability. Hebephrenias, group of normal persons and of schizophrenias proved to be valid categories, with diagnostic stabilities of 0.94, 0.91, and 0.93, for the three groups, respectively. In addition, bipolar manic-depressive psychoses and cycloid psychoses were also valid (diagnostic stability of 0.77 and 0.76, respectively). Unipolar depression was valid (diagnostic stability = 0.84) only by forming a "nosological family" based on diagnostic stability and on current status and clinical presentation during the period preceding the follow-up with regard to other mood-congruent disorders and outcome-diagnosis "normal control". Validity of systematic paraphrenias (diagnostic stability = 0.69) was in the moderate range. Division of schizophrenias in "systematic versus non-systematic" nosological categories was inconclusive; the categories of affect-laden paraphrenia, periodic catatonia and systematic catatonias could not be confirmed reliably in this study.

Validity of reliability: comparison of interrater reliabilities of psychopathological symptoms.

We have tested the stability of interrater reliability of psychiatric symptoms over a quarter of century using 2 rating scales. Interrater reliabilities of items of 2 psychiatric rating scales employed by 2 consecutive follow-ups were compared. Interrater reliabilites proved to be by and large stable. Interrater reliability depends on the standard deviation of the items scores. In addition to the traditional approach, a new statistical method for unifying the assessments from multiple raters is also presented. Using this method, we demonstrated that probabilities of correct ratings are higher in the absence of manifest symptoms, or in the presence of symptoms, as compared with cases characterized by middle scores. To interpret the relationships revealed in the setting of the experiment, we introduce for its theoretical designation the term "validity of reliability." It is recommended for evaluation of results of rating scales in the context of psychiatric nosology.