Karl Koehler

Huber's basic symptoms: Another approach to negative psychopathology in schizophrenia

Abstract Starting in the 1950s, Gerd Huber, the major German pupil of Kurt Schneider, gradually evolved a concept of minus or negative symptoms in schizophrenia, which were not, like Bleulers, behavioral but experiential in kind. He called these phenomena the basic symptoms (HBS), regarding them as uncharacteristic because they also occurred in other psychiatric disorders. Nonetheless, Huber paradoxically considers the HBS essential for theoretically understanding the origin of schizophrenic illness. A few of his speculations in this direction are briefly given. However, the main emphasis in this paper is on the descriptive. Thus, the essential relationship of the HBS to the phenomenology of Hubers pure defect is highlighted. The latter concept states that there are many post-psychotic schizophrenic deterioration syndromes in which only prominent basic symptoms are present and no Bleulerian core or/and accessory features occur. Moreover, eight measures representing the central phenomenological areas covered by the HBS are then presented in some detail; three of these are shown to be the experiential mirror images of Andreasens negative symptoms as described in the SANS.

The dexamethasone suppression test and thyroid stimulating hormone response to TRH in RDC schizoaffective patients

SummaryThe dexamethasone suppression test (DST) brought to light significantly more non-suppression of cortisol secretion in RDC schizoaffectives of the depressed (89%) and of the manic type (67%) than in RDC schizophrenia (25%). However, only in the RDC endogenous depressives, whose pathological DST rate was 57%, was the thyroid stimulating hormone (TSH) response to thyrotrophin releasing hormone (TRH) found to be significantly “blunted”. It is suggested that the DST results can be interpreted as partially validating DSM-IIIs wide major affective disorder since this concept also encompasses all cases with mood-incongruent psychotic features. Furthermore, it is hypothesized that the coupling of DST non-suppression and TSH “blunting” may be important for defining a valid depressive subgroup within these extended clinical boundaries for affective illness.

Jaspers' sense of presence in the light of Huber's basic symptoms and DSM-III.

Abstract The present paper focuses on the primary phenomenological features of Jaspers sense of presence or the false proximate awareness (FPA) for purposes of setting up appropriate provisonal operational criteria. A case is also made for classifying the FPA experience among certain sensory/perceptual phenomena part of Hubers larger grouping of the basic symptoms (HBS), a concept currently enjoying great popularity in German research on schizophrenia. With the attention now paid to the FPA in DSM-III, it is hoped that this symptoms all too obvious neglect in the literature might finally come to an end.

Kraepelin-oriented research-diagnosable schizophrenia, mania, and depression in Schneider-negative schizophrenics.

SummaryThe rigorous neo-Kraepelinean research criteria of the St. Louis/ Iowa and Taylor groups were applied to case record data of 116 first admissions of Schneider-negative schizophrenics—that is, those without first-rank symptoms (FRSs)—hospitalized in a strongly Schneider-oriented German University Psychiatric Clinic from 1962 to 1971. This sample had a total of 45.7% (53 cases) of psychiatric illness diagnosable by research methods. Indeed, only 31% (36 cases) of Schneider-negative schizophrenics turned out to have research-positive Kraepelin-oriented schizophrenia; and of these, 21 fulfilled both sets of research criteria for schizophrenia. It is important that 14.6% (17 cases) of Schneider-negative schizophrenia consisted of research-diagnosable affective disorder, with mania making up 5.2% and depression 9.4% of this figure. The findings suggest that a sample of Schneider-oriented schizophrenia without FRSs as routinely diagnosed in Germany does not seem to represent a clear-cut homogeneous and ‘uncontaminated’ group of schizophrenics.ZusammenfassungIn der Kurt-Schneider-orientierten Klinik in Homburg/ Saar wurden die Daten von 116 schizophrenen Erstaufnahmen (1962–1971), die als Schneider-negativ galten, d. h. keine Symptome ersten Ranges zeigten, mittels den strengen Forschungskriterien der neo-kraepelinschen St. Louis/ Iowa- and Taylor-Gruppen untersucht. Insgesamt enthielt die Stichprobe 45,7% (53 Fälle) von forschungsdiagnostizierbaren psychiatrischen Erkrankungen. Allerdings waren nur 31% (36 Fälle) der Schneider-negativen Schizophrenen forschungs-positiv für eine Kraepelin-orientierte Schizophrenie-Diagnose, und 21 dieser letztgenannten Patienten erfüllten sogar beide Forschungssätze für die Schizophrenie. Wichtig war die Tatsache, daß 14,6% (17 Fälle) der gesamten Stichprobe aus Forschungsdiagnosen für eine affektive Erkrankung bestand, wobei die Manie 5,2% und die Depression 9,4% davon ausmachten. Diese Ergebnisse scheinen darauf hinzudeuten, daß die Schneider-negative Schizophrenie, wie sie routinemäßig in Westdeutschland diagnostiziert wird, nicht eine eindeutige homogene Gruppe von Schizophrenen darstellt.

Agoraphobia and depression: Relationships and severity in hospitalized women

Abstract The temporal links between life-time episodes of agoraphobia and different chronic forms of depressive states, including various types of “double depression,” found in hospitalized women were compared with the chronological connections between life-time episodes of panic disorder and the same kinds of affective illness occurring in female inpatients without agoraphobia. The associations coming to light were similar in both groups; in particular, no differences existed with respect to the amount of chronic primary depression detected. In contrast to some other work in this area, a rather high proportion (60%) of probands with a chronic form of primary depressive disorder sooner or later presented with the “complication” of agoraphobia. The descriptive data are discussed in terms of further supporting the hypothesis that agoraphobia and panic disorder only represet subcategories of a core endogenous anxiety illness.

The relationship of panic attacks to autonomically labile generalized anxiety.

Abstract Some data show that probands suffering from a mixed or panicking form of generalized anxiety disorder (GAD) tend to manifest more cross-sectional somatic anxiety than patients who have the pure or nonpanicking form. This has generated the hypothesis that mixed and pure GAD represent autonomically labile and stable subgroups of generalized anxiety disorder respectively. A corollary might be that patients with mixed GAD also have higher lifetime rates of autonomically labile episodes of GAD. The present findings, derived using criteria disregarding the current exclusionary system on which DSM-III is based, failed to support this hypothesis, though a trend in the expected direction emerged.

Schneider-oriented psychiatric diagnosis in Germany compared with New York and London

Abstract It has long been known 1–3 that there were considerable differences in diagnostic rates generated by mental hospitals in America and Britain. However, Kramer 4 was the first to systematically calculate the rates of various psychiatric diagnostic categories for the two countries. He found that the frequency in England and Wales for schizophrenia was one third lower, and for manic-depressive illness nine times higher, than the rates in the United States. At this point the U.S.-U.K. Diagnostic Project 5 was designed to discover why such discrepancies existed. The main question posed by the U.S.-U.K. Study 5 had been: are the reported differences in the diagnostic percentages for mental hospitals in the United States and Great Britain brought about by actual symptomatologic differences in the patients admitted in the two areas, or can diagnostic differences between countries by mainly responsible? The basic conclusion of this study was that the reported differences are largely, though not entirely, due to differences in diagnostic criteria used in New York and London. Another study 6 indicated that the diagnostic criteria used in London did not differ appreciably from those applied in other English centers. However, it seemed that the broad New York concept of schizophrenia did not extend to Illinois or California, 7 nor did it reach North Carolina. 8 There appeared to be a gradient across the United States from east to west, though in California the prevailing concept of schizophrenia was considerably wider than that used in Great Britain. 9

100 years of DSM-III paranoia

SummaryModified stricter criteria for DSM-III paranoia were fulfilled by 63 (37%) of 169 Heidelberg probands given a diagnosis of “Case Record Paranoia” (CRP) during a 100-year period (1878–1977). Clinical findings were chiefly interpreted in light of the controversial issues of age, illness duration and type of delusional content pertinent to the formulation of a present-day valid definition for this disorder. With respect to diagnostic consistency over time, 56% of DSM-III paranoia cases with at least one further Heidelberg admission proved to be non-stable, non-consistency being overwhelmingly due to a change in a DSM-III schizophrenic direction.

Season of birth and Schneider-oriented diagnosis of schizophrenia, "neurosis" and psychopathy.

SummaryMost earlier studies and all studies on national samples in Scandinavia and in England and Wales have shown that schizophrenics have a significant excess of births in the winter or early months of the year when compared with the expected distribution of the normal population. The present German study, carried out on schizophrenic patients diagnosed in a strongly Kurt Schneider-oriented clinic, in contrast to almost all other authors, demonstrated no such significant overrepresentation of births in the winter months. Thus, the findings of Danneels (1973) German report, also utilizing Schneider-diagnosed schizophrenics, seem, at least for the present, to be confirmed.ZusammenfassungDie meisten früheren, wie auch alle anderen nationalen Studien in Skandinavien, England und Wales zeigten, daß Schizophrene in den Wintermonaten eine signifikant höhere Geburtenfrequenz in Vergleich mit der erwarteten Häufigkeit der Normalpopulation aufweisen. In der jetzigen Studie, durchgeführt an Schizophrenen, die an einer stark K. Schneider-orientierten deutschen Klinik diagnostiziert wurden, fand man — in Gegensatz zu fast allen anderen Autoren — keine solche signifikant erhöhte Geburtenfrequenz in den Wintermonaten. Dadurch wurden die Ergebnisse der vor kurzem erschienenen deutschen Stichprobe von Danneel (1973) vorläufig bestätigt.

Prognostic Prediction in RDC Schizo-Affective Disorder on the Basis of First-Rank Symptoms Weighted in Terms of Outcome

Most recent research has failed to demonstrate that first-rank symptoms (FRS), globally or individually, have any ability to predict outcome. yet, some findings have suggested that misidentification of person (Personenverkennung) and/or thought insertion and/or made impulses on the one hand, and voices commenting on the other, might be associated with a good and a poor prognosis, respectively, in schizophrenia. In the present study, FRS, weighted with respect to prognosis on the basis of this hypothesis, were used to arbitrarily set up subsamples of RDC schizo-affective disorders in terms of several predicted outcome categories. However, no differences came to light between various RDC schizo-affective groupings defined in this way with respect to total outcome mean scores. In contrast, however, a significant difference on this prognostic measure was found when RDC schizo-affective probands with any type of FRS were compared with those lacking FRS, the latter group having the lower or better outcome score.