[Operationalized diagnosis of schizoaffective and cycloid psychoses]

Cycloid psychoses revisited: case reports, literature review, and commentary

Emil Kraepelin proposed to separate psychiatric disorders with psychotic features into two major categories, dementia praecox (later schizophrenia) and manic-depressive insanity (later bipolar disorder and major depression). Over the past century, there have been many efforts to categorize conditions that do not fit readily in either group. These conditions include many cases of acute psychotic illnesses of limited duration, with recovery between recurrences. For some of these conditions, Karl Kleist proposed the term cycloid psychosis: acute features were psychotic, as in schizophrenia, but the course was episodic, as in manic-depression. His concept was later elaborated by Karl Leonhard and Carlo Perris, and validated by modern studies. Leonhard described three overlapping cycloid subtypes (anxiety-beatific, excited-inhibited confusional, and hyperkinetic-akinetic motility dysfunction forms); Perris proposed a more unitary syndrome with operational diagnostic criteria; and recent investigators have considered relatively affective versus thought-disordered subtypes. The cycloid concept is not explicitly included in standard international diagnostic schemes, but both DSM-IV and ICD-10 have broad categories for acute, recurrent psychotic disorders, whose validity remains insecure. We present two cases of probable cycloid psychosis, review the history of the concept, and propose that it be reconsidered as a clinically useful category whose validity and utility for prognosis and treatment can be further tested.

Is computerized tomography ventricular abnormality related to cycloid psychosis?

Twenty-eight psychiatric patients with computerized tomography (CT) findings of ventricular abnormality most likely to result from prenatal/perinatal lesions (VA group) were compared to 28 sex- and age-matched psychiatric patients with normal neuroradiological findings (NCT group). The neuroradiological rater was blind to clinical psychiatric diagnoses and, vice versa, clinical diagnoses were established without knowledge of neuroradiological findings. A polydiagnostic approach (DSM-III-R, ICD-10, Leonhard Classification) was used for psychiatric diagnostic workup. Significantly more patients with cycloid psychoses (according to Leonhard's original description) were found in VA as compared to NCT patients. According to DSM-III-R and ICD-10, VA and NCT groups did not differ significantly regarding diagnostic distribution. Ventricular abnormalities that may reflect sequels of birth complications and/or adverse events during pregnancy may constitute one of the risk factors for developing cycloid psychosis as originally described by Leonhard.

Incidence of cycloid psychosis. A clinical study of first-admission psychotic patients

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.

Psychopathological and social outcome in schizophrenia versus affective/schizoaffective psychoses and prediction of poor outcome in schizophrenia. Results from a 5-8 year follow-up

Forty-six patients with the ICD diagnosis of schizophrenic or similar paranoid psychosis, 35 patients with the ICD diagnosis of affective psychosis, 22 patients with the ICD diagnosis of schizoaffective psychosis, and a large sample of control probands from the general population were followed up using standardized assessment procedures 5-8 years after index hospital treatment. A comparison of respective psychopathological or social outcome measures among the diagnostic groups and between patients and matched non-patients from the general population survey confirms the hypothesis that patients with the diagnosis of schizophrenia have, as a group, the poorest degree of psychopathological disturbances and social maladjustment. However, there is a large subgroup with a favourable outcome. Some predictors for poor outcome, described in the literature and in a former follow-up study of ours, could be confirmed. Under the aspect of invariance under different sample conditions, the predictive power of some prognostic scales, such as the Stephens Scale, the Vaillant Scale, and the Strauss-Carpenter Scale, was substantiated.

Epidemiology of cycloid psychosis. A prospective longitudinal study of incidence and risk in the 1947 cohort of the Lundby Study

The objective of the present study on cycloid psychosis was to describe the incidence and risk in a defined population sample. We therefore re-evaluated specific diagnostic groups in the 1947 cohort of the Lundby Study. Three female cases were identified as cycloid psychosis according to the diagnostic criteria of Leonhard, Perris and Brockington. No men were found. The incidence rate (per 100 observation years) was found to be 0.016% for women. The cumulative probability i.e. risk, up to 60 years of age was calculated to be 0.7%. Incidence rate and risk for cycloid psychosis in women was thus about half of the corresponding values for schizophrenia as described for the same population in a parallel study. We conclude that cases of cycloid psychosis constitute a substantial proportion of female psychotic patients.

An approach to the diagnosis and classification of schizoaffective disorders for research purposes

A classification of schizoaffective disorders for research purposes is presented. Two main categories are preliminarily singled out: 1) that characterized by the consecutive appearance of an affective and a schizophrenic syndrome (type I), 2) that marked by the concurrent appearance of a full schizophrenic and a full affective syndrome (type II). Within type I, two subtypes are distinguished: 1) that beginning as a typical schizophrenic disorder and shifting later on into a recurrent affective syndrome (affective subtype), 2) that beginning as an affective disorder and showing in its further course a progressive schizophrenic development towards deterioration (schizophrenic subtype). For type II, a multiaxial classification is proposed. Axis 1 should be used to describe the cross-sectional symptomatology, axis 2 to define the course, and axis 3 to note the presence of associated factors. On axis 1, schizoaffective disorder type II can be divided into a manic and a depressive subtype. Operational diagnostic criteria for each are provided. On axis 2, an affective (recurrent) and a schizophrenic (continuous with exacerbations) subtype can be distinguished.