[An outline of the catatonia concept of the Wernicke-Kleist-Leonhard school of psychiatry]

Following Wernicke and Kleist's footsteps, Karl Leonhard developed a detailed nosology of psychomotor disturbances occurring in endogenous/functional psychoses. In Leonhard's classification the good prognosis cycloid motility psychosis is distinguished from the group of systemic and non-systemic catatonic schizophrenias. The diag - no sis of both types of catatonic schizophrenias is based on the recognition of a specific catatonic sign/symptom coupled with less specific, yet relatively stable other psychiatric symptoms forming unique Gestalts of psychiatric syndromes, or disease entities. These catatonic subtypes can be easily identified with practice and guidance by an experienced clinician. Apart from periodic catatonia, the other Leonhardian catatonia subtypes have never been subjected to syste - matic validation studies. The late Bertalan Petho refined the clinical description of catatonia in Leonhard's nosology and contributed to their clinical validation by conducting long-term follow-up studies.

[Chapters from the history of biological psychiatry: efforts made to increase the efficacy of electroconvulsive therapy]

Efforts to increase the efficacy of electroconvulsive therapy are reviewed from a historical perspective. The 'intensive' method, the 'regressive technique' and the 'de-patterning' method are discussed in more detail based on available publications. Side effects and complications of these methods are also dealt with in detail. Finally, an attempt is made to critically evaluate these methods in the context of contemporary ethical standards.

Atropine coma: a historical note

Insulin coma and various types of convulsive therapies were the major biologic treatment modalities in psychiatry before the psychopharmacological era. Except for electroconvulsive therapy (ECT), these methods disappeared from the psychiatric armamentarium after the introduction of psychotropic drugs. Atropine coma therapy (ACT) was one variety of nonconvulsive coma therapy used from the 1950s in a few state mental hospitals in the United States and in several Middle- and Eastern European countries until the late 1970s. In ACT, a coma of 6-10 hours' duration was induced with doses of parenteral atropine sulfate that were hundreds of times greater than the therapeutic dose administered in internal medicine. Although ACT was given to thousands of patients with a variety of diagnoses for nearly 3 decades, it is rarely mentioned, even in papers on the history of psychiatry. The method, indications, contraindications and adverse effects of ACT are summarized together with patients' personal accounts. Hypotheses concerning its mode of action are briefly mentioned. The reasons why ACT never gained wider acceptance are explored in the context of both contemporary psychiatric practice and the broader sociocultural climate of the era.

Pimozide treatment for delusion of infestation

Pimozide was tried in the treatment of delusion of parasitosis (a type of monosymptomatic hypochondriacal psychosis), a syndrome that is found with increasing frequency. Ten patients were selected on the basis of unambiguously defined psychopathological criteria. Pimozide therapy was assessed by means of placebo control and the double-blind method using a rating scale evolved for this particular therapy. The results have quite definitely proved the effect of small doses (two to eight mg per day) of pimozide compared to the administration of a placebo. The very few side-effects observed could easily be influenced. The dynamics of the regression of the psychopathological symptoms suggest that the efficacy of pimozide therapy is decisively linked to the central dopamine receptor blocking effect of the drug.

Comparative multiple threshold analysis: a possible new way for validating schizophrenia classifications

Activ. nerv. sup. (Praha) 28, 2. 1986. 350 carefully selected schizophrenic probands and their parents and siblings were diagnosed according to three different clinical classifications and a multiple-threshold analysis was carried out within the framework of the multifactorial model of inheritance. The results suggest that of the three classificatory systems studied, Leonard's and Sneshnevsky's nosological system delineate relatively homogeneous subtypes from the clinical and genetic point of view, pointing to the promise these nosological systems have for the planning of future research in psychiatric genetics.

[Some problems of genetic counseling in schizophrenic psychoses]

The authors sum up the most important basic principles of diagnostics and genetics of the schizophrenic psychoses from the viewpoint of genetic counseling for the practising psychiatrist and medical geneticist. Regarding genetic counselling strategy, in addition to nosological considerations, they stress the importance of socio-cultural and social psychological factors and of the emotional atmosphere in the family, which should all be taken into account together. Because of the special situation of schizophrenic (and in general, psychiatric) patients and their families, they regard it as advisable to set up a separate psychiatric genetic counselling service.

A contribution to the validity of Leonhard's classification of endogenous psychoses

The author made a clinical-genetical study of the schizophrenias and cycloid (schizoaffective) psychoses following the Leonhardian classification, using the traditional pedigree analysis and multiple threshold method. According to the latter method--on the basis of phenotypical correlations--the systematic schizophrenias could be clearly distinguished from the cycloid psychoses, while the non-systematic category presumably occupies a genetical position between the two former categories.

[Clinicogenetic studies within the scope of Leonhard taxonomy]

Using conventional genealogical methods and genetic correlation analysis, the author investigates Leonhard's classification of schizophrenias and cycloid psychoses. According to the second of these methods, the systematic schizophrenias and cycloid psychoses definitely diverge on account of the phenotypic correlations, whereas the unsystematic group presumably occupies a median genetic position between the two categories first mentioned.

[Comparative clinicogenetic study of schizophrenic psychoses]

The author diagnoses 350 carefully selected schizophrenic subjects, their parents and their siblings during parallel studies using three different clinical classification systems and analyzes the results by multiple threshold analysis and the multifactorial inheritance model. The results suggest that, of the three classifications the author studied, Leonhard's and Sneshnewski's system yield relatively homogeneous subgroups; this indicates the future significance of these nosological systems for the planning of biopsychiatric research.

[Treatment of a dermatozoon delusion with neuroleptics]

The author treated as inpatients or outpatients a total of 26 individuals with typical acarophobia syndrome, using neuroleptics, mainly Pimozid/Orap. His results have shown that neuroleptics are drugs with rapid and pronounced action in acarophobia and that they have a syndrome-specific profile. The author presents the theoretical and practical consequences of his experiences in connection with this mode of treatment.

Validity of the ICD-9 schizophrenia classification. A blind family history study

Within the framework of the multifactorial-polygenic model of inheritance, multiple threshold strategy was applied to a large set of pedigree data to examine the clinico-genetical position of some subtypes within the ICD-9 classification of schizophrenic psychoses. It appeared highly probable that the ICD-9 subtypes examined, based mainly on the classical Kraepelin-Bleulerian classification (simplex, hebephrenic, catatonic, paranoid, schizo-affective) are not homogeneous from the clinico-genetical point of view and genetical factors cannot be held primarily responsible for the clinical differences between the subtypes.

[The role of high-dosage neuroleptic therapy and electroshock in the treatment of the acute phase of schizophrenia]

The authors studied the effectiveness of neuroleptic high-dosage therapy in comparison to the electroshock treatment in the acute phase of systematic and unsystematic schizophrenia in a total of 75 patients. The results obtained show that the neuroleptic high-dosage therapy exceeds the effectiveness of the electroshock treatment mainly in the group of unsystematic schizophrenia.

[Neuroleptic large dose therapy of schizophrenias]

In recent years, the complex treatment of schizophrenia has been extended by the neuroleptic large-dose therapy. Our investigations carried out so far, which reflect the experiences gained in several years with this form of treatment, include 30 schizophrenic patients admitted in an acute psychotic condition. They were treated for six days running with 40 to 120 (average 65) mg of Haloperidol daily. The results of our studies show that the large-dose therapy with Haloperidol as an initial phase of a combined pharmaco-therapy represents a safe, rapid and effective method.

Clinical notes on the possible anticholinergic reversal of depressive syndromes

The authors report on the effects of acute confusional states and deliria (pharmacogenic confusional syndromes - PCS), occurring under the influence of psychotropic drugs on the depressive syndrome of three patients. The favourable influence of PCS on the depressive syndrome is considered to be largely linked to the anticholinergic effect of the drugs. The observations made in these three patients may give support to the hypothesis that cholinergic activity has pathogenic significance in depressive syndromes.

[Pathogenesis of the dermatoses delusion]

Discussing two cases, the authors describe their opinion on the etiopathogenicity of the dermatozoic delusion. They point to the necessity of a multidimensional examination of the syndrome, to its relative incidence, and to the advantageous possibilities of a therapy.

Reversal of neuroleptic-induced stupor by procyclidin. Two case reports and their theoretical implications

Two case reports and data from literature on the subject are used by the authors to describe characteristics of pathogenetic importance of neuroleptic induced stupor (NIS). The origin of NIS is outlined briefly and some fundamental clinical and experimental facts are presented, all of which stress the importance of the acute blockade of postsynaptic DA-ergic receptors. Emphasis is placed on the significance of the possible relationship and similarity between NIS and catatonic stupor, and on the theoretical possibilities which this offers.