On interrater reliability for Leonhard's classification of endogenous psychoses.
Pfuhlmann B, Franzek E, Stober G, Cetkovich-Bakmas M, Beckmann H
Twenty-two patients with a diagnosis of schizophrenia according to DSM-III-R and ICD-10 criteria, for whom the long-term courses of illness were all well documented, were classified by 4 independent investigators using Leonhard's classification of endogenous psychoses. With regard to the large nosological groups of cycloid psychoses (including the subtypes of anxiety-happiness psychosis, confusional psychosis and motility psychosis), of unsystematic schizophrenias (including the subtypes of affect-laden paraphrenia, cataphasia and periodic catatonia), and of systematic schizophrenias (divided into systematic catatonias, systematic paraphrenias, and hebephrenias), is was possible to reach a high level of agreement in the diagnosis, representing a Cohen kappa coefficient of 0.82 and 0.89, respectively. In only 2 out of 22 patients were discrepancies observed in the assignment to the above-mentioned groups. This clearly shows the high reliability of Leonhard's classification, which allows a differentiated diagnostic and prognostic judgement of schizophrenic psychoses according to the DSM-III-R and ICD-10.
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Encephale 1997 Jan;23 Spec No 1:12-19
[Emil Kraepelin and bipolar disorder: invention or over-extension]?
[Article in French]
Geraud M
From 1899 to 1913, Emil Kraepelin (1856-1926) creates and elaborates the nosographical group of the "manic-depressive insanity". In the 50-60s, Leonhard splits off this homogeneous group and describes unipolar psychosis, bipolar psychosis and cycloid psychosis (anxiety-elation psychosis, motility psychosis and confusion psychosis). Recent nosographical orientations seem to announce a come-back to Kraepelin's conception of "mood disorders". This paper presents the essential of Kraepelin's "manic-depressive insanity" theory-temperamental basis, integration of mixed states, epidemiological datas- and highlights its dialectical relations with today's theory of bipolarity.
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Eur Arch Psychiatry Clin Neurosci 1993;242(4):197-202
Incidence of cycloid psychosis. A clinical study of first-admission psychotic patients.
Lindvall M, Axelsson R, Ohman R
The concept of cycloid psychosis has gained increasing acceptance during recent decades. Using the diagnostic criteria of Perris and Brockington, an intelligible delineation of a group of patients has been obtained. Few epidemiological data on cycloid psychosis have been reported so far. The objective of the present study was to describe the one-year incidence of cycloid psychosis in a clinical sample. The diagnostic registers of all patients hospitalized for a functional or an organic psychosis and discharged in the year 1983, in Lund, Sweden were investigated. 514 patients were identified of whom 83 were admitted to hospital for the first time. 29 of these patients had a functional psychosis and were below the age of 50. In this age group 7 cases (4 women, 3 men) fulfilled the diagnostic criteria of cycloid psychosis and thus constituted almost one fourth of all first admissions of functional psychoses that year. The one-year incidence for first admission in cycloid psychosis was 5.0 per 100,000 inhabitants in women and 3.6 per 100,000 inhabitants in men within the age group 15-50 years in the catchment area of 163,175 persons. We conclude that cycloid psychosis constitutes a considerable proportion of functional psychoses in both sexes.
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Acta Psychiatr Scand 1992 Jan;85(1):23-29
Cycloid psychosis: regional cerebral blood flow correlates of a psychotic episode.
Warkentin S, Nilsson A, Karlson S, Risberg J, Franze'n G, Gustafson L
Eight patients meeting Leonhard's criteria for cycloid psychosis were investigated on repeated occasions during a psychotic episode, with regional cerebral blood flow measurements and clinical ratings. The results showed that, at admission to the hospital, when the patients were clinically exacerbated, the mean hemispheric blood flow was significantly elevated compared with values from a normal control group. The hemispheric blood flow level covaried significantly with the degree of clinical symptoms, such that the more elevated the cortical blood flow was, the more behaviorally disturbed was the patient. At discharge from the hospital, the patients had no residual symptoms and the cortical blood flow was normal. These findings differ distinctly from those commonly made in other psychoses, such as schizophrenia.
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Psychopathology 1992;25(3):154-160
Cycloid psychosis and affective disorder: borderland cases.
Jonsson SA
A subsample of untreated cycloid psychoses satisfying the requirements for major affective disorder according to DSM-III was compared with a subsample of cycloid psychoses getting other DSM-III diagnoses. The concept of cycloid psychosis applied thus was wider than permitted by the criteria stipulated by Perris and Brockington with respect to the prominence of the mood component. Since it could be demonstrated that no decisive differences prevailed with respect to frequencies of single features tested, a modified discriminant analytic procedure was applied. In this analysis, 76% of cases were correctly assigned. On average affective cases were more similar to the score profile derived from the nonaffective group than nonaffective cases were to the same profile, i.e. to themselves. Symptomatologically the affective cases had their main point in a distinctive confusion syndrome.
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Acta Psychiatr Scand 1991 Jul;84(1):22-25
The concept of cycloid psychosis: the discriminatory power of symptoms.
Jonsson SA, Jonsson H, Nyman GE
Records of all 154 psychotic patients first admitted to a psychiatric hospital in 1925 were rated according to a checklist of 33 dichotomous items expected to characterize cycloid and schizoaffective psychosis; 64 cases satisfied 5 or more items. Among them, 34 were globally judged as cycloid and showed a favourable outcome when followed up. The remaining 30 cases were used as a contrast sample, consisting of schizoaffective psychotics with an unfavourable outcome and schizophrenics and affective patients who shared some symptoms with the experiment group. Six symptoms significantly more frequent in the cycloid group were all characteristic for confusional and anxiety or happiness psychoses in the sense of Leonhard. Happiness-ecstacy and global altruism were exclusively recorded in cycloid psychosis. A discriminant analysis yielded a significant proportion of correct predictions. The result was thought to be relevant for differential therapeutic strategies.
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Psychopathology 1990;23(4-6):233-242
Cycloid psychoses and schizoaffective psychoses--a comparison of different diagnostic classification systems and criteria.
Zaudig M
In current psychopathological research there are at least two major groups of concepts in the field of psychoses with good prognosis: the more traditional concepts of 'bouffee delirante', cycloid psychoses and Kasanin's 'schizoaffectives'--on the other hand the modern idea of 'concurrent schizoaffective psychoses' like the operational criteria of Kendell, Welner, RDC, DSM-IIIR and ICD-10. Reviewing previous studies, 'bouffee delirante' and cycloid psychosis were found to form a homogeneous group which is very well delineated from affective and schizophrenic psychosis--to some extent also from the modern criteria of 'concurrent schizoaffective psychoses'.
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Psychopathology 1990;23(4-6):228-232
Epidemiology of cycloid psychosis.
Lindvall M, Hagnell O, Ohman R
The incidence and risk of cycloid psychosis were investigated in the 1947 cohort of the Lundby Study. No male cases were found. For women the incidence rate (per 100 observation years) was 0.016%. The cumulative probability, i.e. risk up to 60 years of age, was 0.7%. These figures are about half of those for schizophrenia in women in the same population. It is concluded that cycloid psychosis constitutes a substantial part of psychotic disorders among women.
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Psychopathology 1990;23(4-6):212-219
Relationship between cycloid psychosis and typical affective psychosis.
Cutting J
This article describes the clinical features and outcome of a series of 73 inpatients who fulfilled Perris' criteria for cycloid psychosis. It is argued that although the cases differ from either schizophrenia or affective psychosis in some ways, the condition of cycloid psychosis is best regarded as an atypical variety of affective psychosis.
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Psychopathology 1990;23(4-6):205-211
Prognostic validity of the cycloid psychoses. A prospective follow-up study.
Beckmann H, Fritze J, Lanczik M
In a prospective 4-year follow-up study, 26 out of 31 patients initially diagnosed as cycloid psychoses were investigated (anxiety-happiness psychosis n = 15; confusion psychosis n = 8; motility psychosis n = 3). Patients were independently interviewed by two clinical researchers. 61.5% showed one or several 'first-rank symptoms' according to Schneider. In addition, the SADS-LA was applied for RDC and DSM-IIIR diagnoses. According to these classification systems most of the patients were diagnosed as schizophrenic or schizoaffective. Personal interview as well as application of the Strauss-Carpenter Outcome Scale indicated a highly favorable clinical outcome, i.e. lack of affective or behavioral defective states in literally all patients of the study. These results justify the distinction of the cycloid psychoses as a nosological entity in general and--less convincingly--of the three subtypes of cycloid psychoses.
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Psychopathology 1990;23(4-6):196-204
Cycloid psychotic disorder: validation of the concept by means of a follow-up and a family study.
Maj M
A 3-year prospective follow-up investigation and a family study were carried out in patients fulfilling the diagnostic criteria for cycloid psychotic disorder proposed by Perris and Brockington in 1981. The results show that cycloid psychosis differs in several respects from schizoaffective disorders as defined by current diagnostic criteria used in the United States. Furthermore, they seem to suggest that most cases of cycloid psychosis are not variants of either schizophrenia or major affective disorders.
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Psychopathology 1990;23(4-6):193-195
An evaluation of the concept of cycloid psychosis.
Brockington I, Roper A
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Psychiatr Dev 1988;6(1):37-56
The concept of cycloid psychotic disorder.
Perris C
The concept of cycloid psychosis or cycloid psychotic disorder has been used in the European psychiatric literature for almost half a century. However, it has now for the first time been comprised into the 10th revision of the World Health Organization's International Classification of Diseases (ICD-10) that is currently in the phase of field trials. In this article evidence is presented that supports the independence of cycloid psychotic disorder from other major psychotic disorders. In particular, evidence is presented in favour of the clinical and predictive validity of the cycloid psychosis construct. Issues related to treatment are discussed and suggestions for future research are given.
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Psychopathology 1984;17(4):158-167
The evolution of some European diagnostic concepts relevant to the category of schizoaffective psychoses.
Maj M
The evolution of the German-Scandinavian concept of cycloid psychosis and of the French concept of 'bouffee delirante' is analyzed. It is stressed that they probably correspond to the same clinical entity, not overlapping with any of the American nosological categories, although sharing a number of features with the original Kasanin's picture of schizoaffective psychosis. Moreover, a survey is given of the evidence supporting the construct and predictive validity of the concept of cycloid psychosis.
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Psychol Med 1982 Feb;12(1):97-105
The course and outcome of cycloid psychosis. Brockington IF, Perris C, Kendell RE, Hillier VE, Wainwright S
Thirty patients with cycloid psychosis were found among 244 general psychotic and schizo-affective patients studied in London. The main clues to the diagnosis were the presence of "confusion', a pleomorphic clinical picture or an acute onset. Most of the patients were classified as schizophrenic by British psychiatrists and the Catego system, and as schizo-affective or mood-incongruent affective psychotics by the American Research Diagnostic Criteria and DSM-III. There was little overlap between the cycloids and any Anglo-American category, and cycloid psychosis is not synonymous with schizo-affective psychosis. The outcome of the cycloids was better than that of psychotic patients as a whole, and much better than schizophrenia as defined by Catego, Schneider's, Langfeldt's or Carpenter's rules, or by the guidelines set by the International Classification of Diseases. Compared with manic-depressive patients (defined by the presence of mania at some stage), cycloids had more schizophrenic and fewer depressive and manic symptoms. There was a negligible concordance between the diagnosis of cycloid psychosis and the final diagnosis of manic-depressive disease. It is concluded that these patients should not be diagnosed as schizophrenic, but that the relation of cycloid psychosis to manic-depressive disease is not yet resolved.
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Psychol Med 1978 Nov;8(4):637-648
Cycloid psychosis: an investigation of the diagnostic concept.
Cutting JC, Clare AW, Mann AH
Seventy-three patients with the features of 'cycloid psychosis', adopted from Perris and Leonhard, were identified from case records. Information concerning background, presenting illness and follow-up was compared with that from the case-records of patients with schizophrenic, affective and schizoaffective psychoses. The characteristic features of 'cycloid psychosis' were a female predominance and a remittent course. The 'cycloid' group resembled the conventional groups in some respects, but differences from schizophrenic, affective and, to a lesser extent, schizoaffective groups were also striking. The factors which might account for the apparent independence of the 'cycloid' group from other diagnostic categories are discussed.