Schizo Affective Psychoses—are They Schixophrenic?

When Emil Kraeplin in .1899 gave the clinical description of the two psychoses 'Dementia Praccox" and 'Manic-Depressive Insanity,' he laid not only the foundation of our modern psychiatric taxonomy, but also the roots of our present diagnostic difficulties concerning the clinical forms which do not entirely meet the criteria required for inclusion in one or other of the two groups. Several workers have commented on the presence of such 'atypical' psychoses and suggested different names for them, such as Langfeldt suggested a subdivision within the group of schizop-hrenias—those with the classical piciure of dementia praecox wi h a chronic course and a poor prognosis be called 'irue' or process schizophrenias, while those with psychotic episodes of sudden onset, usually in response to a precipitating factor and with an ad-mixture of manic-depressive and confusional symptoms and a good prognosis be termed 'schizophreniform' psychoses. Similarly, in contrast to the 'nuclear' schizophrenia, Kasanin (1933) described an acute psychosis with marked affective symptoms, occurring in previously well integrated individuals, and in the presence of definite environmental stress—generally followed by remissions or full recovery. This relatively benign psy-chosis is obviously an atypical psychosis with a clinical course similar to the affective disorders, nevertheless, Kasanin does not hesitate to ascribe it to the schizophrenic group. In fact it has found its way into the official classifications as a subtype of schi-zophrenia (I.CD. 9-295. 7). Although Kraeplin had emphasised the course of illness as a major distinction between dementia praecox and M.D.I., subsequent writers starling with Bleuler and Schneider tended to focus more on symptoms which were thought to be characteristic of schizophrenia. The result was to encourage the frequent use of the diagnosis of schi-zophrenia even if a single symptom or a cluster of symptom presumed to be patho-gnomonic of schizophrenia was present. Pope and Lipinski (1978) in their review of the subject conclude that in the present stale of knowledge, there are no known pa'hognomonic sympoms of schizophrenia, nor even any clusters of sympoms, taken in cross section, as yet adequately demonstrated to be valid in diagnosing schizop-hrenia. Furthermoic, classical schizophrenic symptoms and Schneider's first rank symptoms arc reported in 20 per cent to 50 per cent of well validated cases of M.D.I., thus stressing the non-specificity of the so-called 'schizophrenic' symptoms. They suggest that any study of schizophrenia which does not make reference io prognostic, family history, and treatment response criteria must be considered …