[Etiological and therapeutic aspects of schizoid and schizotypal personality disorder]

[The advantage of a modern operational approach to the diagnosis of mental disorders. The case of the Bavarian King Ludwig II--an example from biographical research]

Worldwide discrepancies in the classification, terminology and diagnosis of mental disorders have induced efforts for unification after World War II. This led to the introduction of an operational diagnostic approach according to strict criteria, at the same time taking into account the comorbidity of disorders. However, this approach is still not routinely used. The consequences of this deficiency are demonstrated here by an example from biographical research referring to the Bavarian King Ludwig II. The study is based on an extensive search of the relevant literature. Although the pathography of this Bavarian king is well documented, the diagnoses published between 1910 and 2010 by altogether 21 specialists, are distributed rather chaotically over 24 diagnostic categories of the ICD-10. Merely in the (probably wrong) diagnosis of a schizophrenic psychosis is there agreement among half of the authors. This is concordant with the expert diagnosis of paranoia by von Gudden and his colleagues (1886) when considering the then contemporary concept of the disorder. According to modern diagnostic principles almost half of the 24 diagnoses can be confirmed. The others have to be regarded as false diagnoses. The conclusion is that modern principles of the diagnosis of mental disorders should be applied according to internationally accepted diagnostic manuals. This approach should be used in, but is not exclusive to, biographical research. Precondition is, of course, the exact knowledge and careful application of these principles.

[Autism and autistic disorders. Historical and current aspects]

Since its first use in medical literature the meaning of the term autism has constantly changed. An historical overview indicates that in both adult and child psychiatry autism was first used to refer to a symptom of schizophrenia. Later on the use of the term in child psychiatry took a different independent course, which led to present-day conceptualization of autism, mainly due to the work of Leo Kanner and Hans Asperger. Currently autism and autistic disorders are regarded as severe developmental disorders and, due to their stable nature, have gained considerable attention in adult psychiatry. In order to better understand this development, the path from onset to reception is traced via Kanner and Asperger. In the search for central characteristics of autism, one finds restrictions in social communication and interaction, which can be explained by fundamental deficits in social cognition. These restrictions in social cognition can be considered the central characteristic of autism - one which has been a constant since the phenomenon was first described. Our historical review considers to what extent experimental psychopathological research can deepen our understanding of the disorder.

Die Erfassung von Wahn und Halluzinationen in der Normalbevölkerung

Zusammenfassung. Die hohe Prävalenz wahnähnlicher Überzeugungen und halluzinatorischen Erlebens in der Bevölkerung erfordert spezifische Selbstbeurteilungsskalen, die diese subklinischen Phänomene abbilden. In der vorliegenden Untersuchung werden Reliabilität und Validität deutschsprachiger Adaptationen des Peters et al. Delusions Inventory ( Peters, Joseph & Garety, 1999b ) sowie der Launay-Slade Hallucination Scale ( Launay & Slade, 1981 ) an einer in Bezug auf Alter, Geschlecht und Bildungsstand annähernd repräsentativen Stichprobe aus der Normalbevölkerung (n = 359) und einer Stichprobe von Personen mit Schizophrenie (n = 54) untersucht. Beide Skalen weisen eine gute interne Konsistenz sowie hinreichende Kriteriums- und Konstruktvalidität auf. Trotz der Eignung der Skalen zur Differenzierung zwischen Personen mit und Personen ohne Schizophrenie zeigte sich, dass die Items zu wahnähnlichen Überzeugungen und halluzinatorischem Erleben auch in der Bevölkerungsstichprobe in relevanten Ausmaßen bejaht wurden. Weiterhin zeigte sich, dass halluzinatorische Erlebnisse und wahnähnliche Überzeugungen in der Bevölkerung mit erhöhtem psychischen Leidensdruck einhergehen.