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The utility of the "International Classification of Epilepsies, Epileptic Syndromes, and Related Seizure Disorders," proposed by ILAE in 1989, was investigated in a neuropsychiatric clinic with a patient population numbering 300. Two hundred and three patients (67.7%) had localization-related epilepsies (LRE), including one idiopathic case. Sixty-six patients (22%) had generalized epilepsies, 50 idiopathic, 2 Lennox-Gastaut syndrome, and 14 symptomatic. Thirty-one patients (10.3%) with generalized tonic-clonic seizures occurring only during sleep had the epilepsies undetermined whether they are focal or generalized. In the symptomatic LRE cases, 34 cases could not be classified, and 7 of the cases with frontal lobe epilepsies were difficult to subtype. Eleven of the symptomatic LRE cases had some independent seizures, multiple foci in surface EEGs and were intractable. These cases may be defined as "multifocal epilepsies."

Traditionally, apathy has been viewed as a symptom indicating loss of interest or emotions. This paper evaluates evidence that neuropsychiatric disorders also produce a syndrome of apathy. Both the symptom and the syndrome of apathy are of conceptual interest because they signify loss of motivation. An apathy syndrome is defined as a syndrome of primary motivational loss, that is, loss of motivation not attributable to emotional distress, intellectual impairment, or diminished level of consciousness. Loss of motivation due to disturbance of intellect, emotion, or level of consciousness defines the symptom of apathy. Neuropsychiatric literature dealing with apathy is reviewed within the framework of three approaches to defining the concept of a syndrome. Clinical and investigative approaches for evaluating apathy when it occurs in association with other syndromes are described.

To determine the validity of the DSM-IIIR category organic mood disorder, we compared 50 psychiatric consultations with this diagnosis to 50 psychiatric consultations diagnosed with major depression in the medically ill. Organic mood disorder patients were more likely to be in the index affective disorder episode and have a negative family history of depression. Despite similar pharmacologic treatment between groups, the organic mood disorder group was less likely to be completely recovered at 4 years follow-up. This study suggests organic mood disorder is a valid diagnosis in the psychiatry consultation service.

Increasing sophistication in the neurosciences has re-stimulated expectations that the underlying biological mechanisms involved in the psychoses might finally be clarified. These expectations however coexist with a sense of mounting frustration over the continuing failure of such progress to occur. One important factor in this failure is an enduring reliance upon obsolete nosological concepts and tools. The persistence of concepts such as schizophrenia and manic-depressive illness, which are substantially based upon unsustainable assumptions concerning the relationship between pathophysiology, symptoms and outcome, interferes with the appropriate deployment of new technologies and the interpretation of the resulting data. As many have suspected for some time, we are in a state of chronic paradigm failure, yet the lack of a superior alternative makes it difficult to dispense with traditional concepts. Following a review of the principal nosological paradigms, it is argued that the psychopathology of psychosis is more fluid than acknowledged by the dominant neo-Kraepelinian paradigm in particular. An alternative, which may be termed the loose linkage model, is proposed, which though it falls short of full paradigm status, does represent more accurately the true state of affairs in psychotic disorder, with fewer historical preconceptions. Its importance lies particularly in its significance for research strategy, and its capacity to minimise early iatrogenic sequelae of the diagnostic process and permit a more honest approach to clinical care.

This study presents frequency of organic depressive disorders in children and adolescents, their clinical manifestations and clinical course. The effects of coexisting organic brain lesion on clinical presentation and course of inorganic depressive disorders evaluated as well.

Given the variety of "organic" or "toxic" conditions that may produce, precipitate, or exacerbate psychotic disorders, it is important to attempt to clarify existing nosologies and to highlight the need for research strategies that may help to validate relevant distinctions. This review provides a brief discussion of some of those issues.

Altogether 126 patients with mental disorders of the non-psychotic nature, that occurred for the first time during menopause were examined. Different vegetative disorders (hot flush, hyperhidrosis, blood pressure fluctuations, asphyxia sensation, numbness of the limbs, skin burning, chill, pruritus) played the leading part in the clinical picture. The mental disorders manifested in the form of extensive age-related , asthenic, hysteric, phobic and depressive disorders. The long-term climacteric was likely to give rise to the formation of a pathological personality.

To study syndrome formation in the course of the development of neuropsychic disorders in oncological practice, a total systems approach including an original model of psychosomatic correlations was used. Two groups of patients, namely of those suffering from the cancerophobic syndrome without any real oncologic pathology and of those with neuropsychic diseases that developed because of an oncological disease are compared. Analysis is made of the hierarchy and mechanism of interaction of the three factors mainly responsible for the syndrome formation: ++somato-organic, constitutional typological and ++psycho-sociogenic depending on the character and stage of disease. The authors indicate areas where the approach may find practical application: diagnosis, the design of prognosis, and pathogenetic therapy of the neuropsychic disorders under consideration.

Through previous research, promising biological markers for schizophrenia have been identified. Abnormalities in eye movement, electrodermal activity, event-related brain potentials, attention and informational processing, and brain imaging have been reported. Studies of potential trait markers suffer from the lack of a standardized methodology, which makes comparisons of their results difficult. No one possible marker appears specific for schizophrenia. Additional studies in high-risk children and adults are needed using multiple measurements to define biologic similarities and differences between psychiatric syndromes in order to develop definitive trait markers for schizophrenia. Sufficient evidence does not exist to support the inclusion of biological markers among the DSM-IV criteria for schizophrenia, although some are sufficiently robust to merit mention among the associated features discussed in the text.

Although the usefulness of making a formal diagnosis in helping an individual deal with his/her 'problems' continues to be debated in all areas of medicine--"Il n'y a pas de maladies; il n'y a que des malades"--it is generally accepted that the initial interaction between doctor/healer/therapist and patient/client will consist of an attempt to fit the problem into one or more categories, to develop a diagnostic formulation. In the search for specificity and scientific accuracy increasingly sophisticated methods of selecting criteria have been developed to allow the assignment of a diagnosis. Examples will be given that even in the field of general medicine, a hierarchy of certainty versus uncertainty has to be accepted if potentially dangerous diagnostic errors are to be avoided. A similar approach has been proposed as a means of improving the decision making process in psychiatry. In the course of an epidemiological investigation into the prevalence of psychopathology among residents of longterm institutions, a simplified categorization into certain or suspected diagnoses is described. A semi-structured screening interview was developed for the study and will be discussed.

This article addresses the question: what is the most productive way to systematize abnormal behavior in order to study its biological roots? Though nosology still occupies the premier position in biological psychiatry, it is, in and by itself, a treacherous beacon. Syndromal organization of psychopathology is likewise seriously flawed. A functional organization of psychopathology is considered the most appropriate framework for biological research and a plea is made for a two-tier diagnostic system of psychiatric disorders. Tier one comprises the nosological diagnosis, and tier two a detailed depiction of the component psychological dysfunctions. Such a two-tier diagnostic system would bring psychopathology onto a true scientific footing.

The 1987 draft of ICD-10 presents many new aspects of the psychiatric diagnostic evaluation. Some were readily accepted by the participants of the field study, including: the purely descriptive approach with the abautonment of many theoretical concepts; the more operationalized descriptions of the diagnoses; similarity in structure and terms to DSM-III-R. Others proved controversial: extension of the term dementia to include even mild and moderately severe organic psychosyndromes; inclusion of all forms of depression in one chapter, and their subdivisioning only by severity; different time criteria for the diagnosis of schizophrenia in DSM-III-R (6 months) and ICD-10 (1 month). Considerable criticism was levelled at the overly long and often tediously formulated text, and the lack of didactic organisation. A number of examples of translation difficulties are given, and the differences between a too literal and a technically correct equivalent translation disu-used.

The natural history of classification systems for the organic mental disorders from ICD-8 through ICD-10 and DSM-III is presented. Out of a total of 31 cases the 6 with a main diagnosis of the F0-section of ICD-10 are described and field trial results analysed in terms of classification errors, goodness of fit, difficulty, and interrater-reliability. Specific categories (instead of "collective categories") were used more frequently and fewer classification errors made on the basis of ICD-10 as compared with ICD-9. The authors suggest that an operationalized differentiation of dementia as one of the core categories would further increase the reliability and clinical practicability of this section.

On the basis of the results of the field trial, the most important classificatory innovations of ICD-10, together with their advantages and disadvantages are described. The initial good acceptance of the new system could be further improved by structural modifications, such as a uniform and systematic description of the individual diagnostic categories. Criticism of content was focused on affective and neurotic disorders and adult personality disorders. When it is introduced, the psychiatric chapter of ICD-10 will surpass most of the hitherto existing psychiatric classification systems in size, differentiation and international testing.

Twenty-eight patients with erotomanic delusions were compared with 80 patients with other delusions to clarify questions about diagnosis and course of illness in erotomania. The erotomanic patients were a heterogeneous group with respect to both diagnosis and course. They had significantly more manic symptoms than the comparison group and more affective diagnoses than would be expected from the literature; 25% (N = 7) had schizoaffective disorder and 7% (N = 2) had bipolar disorder. A subgroup of monodelusional erotomanic patients was identified who met the DSM-III-R criteria for delusional disorder, thus supporting the decision to include erotomanic delusions in this diagnostic category in the revision of DSM-III.

The authors review recent literature on four medical conditions that constitute important examples of organic mental disorders: AIDS dementia complex, cocaine abuse, cerebrovascular accident, and traumatic brain injury. These disorders are of particular interest because they are frequently the result of high-risk behaviors and the patients are often young adults. Progress in classification and diagnosis, along with greater understanding of pathophysiological mechanisms, has facilitated therapies to ameliorate some symptoms. More specific classification of organic mental disorders should facilitate the examination of biological factors believed responsible for functional psychiatric disturbances.

DSM-III-R requires the exclusion of causal organic factors to permit a diagnosis of major depression. This exclusion criterion may be unreliable because (1) neither the biomedical nor the historical data base for determining organic causation is operationally specified, (2) rules for weighting various causes of depression are not specified, and (3) the distinction between causal and contributory organic factors often is arbitrary. The exclusion criterion may not be valid because (1) it is unstable with time and (2) clinical criteria for CNS involvement may correlate poorly with neurodiagnostic tests. Both reliability and validity of diagnosis would be improved by keeping Axis I strictly phenomenological and identifying relevant organic factors on Axis III.

Leonhard conceived a hierarchical classification system for endogenous psychoses consisting of a small number of vast, clinically heterogenous main categories. These are subdivided into more homogenous and narrower subcategories: Bipolar affective psychoses, cycloid psychoses and unsystematic schizophrenias are subcategories of a main category of psychopathologically polymorphic, episodic bipolar psychoses. Common features of these related forms of psychoses are syndrome lability, bipolarity and switching. Rapid cycling is a course complication in bipolar affective psychoses as well as in cycloid psychoses and in nonsystematic schizophrenias. Empirically established ideal types of idiopathic psychoses are the foundation of psychiatric classification systems, not only in Leonhard's classification, but also in others. In the description of the features of diagnostic categories based on psychotic ideal types, Leonhard accounted for the low degree of diagnostic specificity of isolated symptoms in so far as he recognised that in bipolar affective psychoses, in cycloid psychoses and in unsystematic schizophrenias intra-episodic syndrome-dynamical features are of greater diagnostic importance. The phenomenon of intra- and interepisodic syndrome lability as a dynamic feature finds its strongest expression in the switch processes.

The authors defend the proposition that the simple division of schizophrenia into family history positive versus family history negative in the hope of uncovering etiological heterogeneity is too naive for a multifactorial disorder as contrasted with rare, mendelizing genetic conditions. Dalén is correct to forecast that a monolithic homogeneity view about the origins of schizophrenia is likely to be refuted and that it is important to pursue such a strategy. Using computed tomographic brain scan results and the simple dichotomy of family history positive versus family history negative as an illustration, we show the weakness (lack of statistical power) of the strategy. The problem arises from the fact that a negative family history for schizophrenia characterizes the vast majority of schizophrenic patients just as it does for insulin-dependent diabetes, another genetically influenced multifactorial disorder. A continuum from more genetic to less genetic variation in the etiology of schizophrenia fits the available familial patterns of risk.

On the basis of 30 years of cowork with Leonhard it is attempted to enlighten the theoretical background of his classification of endogenous psychoses. Inspired by the conceptions of Wernicke and Kleist he explained the differentiation of symptomatology by the model of system diseases applying this in completing and improving the psychopathological classification. His ideas about the origin of a differentiated vulnerability of brain structures are very similar to the doctrine of pathoclisis of Vogt, although Leonhard did not use this term.

Based on clinicopsychopathological and paraclinical examinations of 150 patients afflicted with organic diseases of the brain of infectious, traumatic and alcoholic nature, the clinical picture and formation of hypochondriac conditions were traced depending on the type of exogeny and the stage of cerebral sufferings. It is shown that hypochondriac conditions develop by stages, namely from hypochondriac fixation to hypochondriac reaction and to the hypochondriac syndrome and that psychasthenic, vasovegetative and CSF dynamic disorders play the leading part in their establishment. Seven varieties of the hypochondriac syndrome are distinguished.

Discussions on the nosological position of delusional parasitosis (DP) have resulted in a wide range of opinions. In the present study in 34 patients with DP, the various and contradictory opinions concerning DP positioning in psychiatric nosology were examined through clinical, psychopathological, and polydiagnostic analyses using VRC, DSM-III, DSM-III-R and ICD-9. The psychopathological analyses with VRC as well as the polydiagnostic comparisons with other classification systems indicated that DP is neither a nosological entity nor due to a specific psychiatric illness. As our results showed, DP is a nosologically unspecific syndrome, which may occur superimposed on all psychiatric disorders.

Numerous terms commonly used in psychiatry show a lack of preciseness and logical consistency. This results in an obscuration of the objects under observation and generates fictitious problems which function as a source of permanent confusion. The reasons for this are analyzed and exemplified with respect to organic psychoses.

The authors found that all but 3 of 80 randomly chosen patients in a Veterans Administration hospital who had been given a primary nonspecific neuropsychiatric diagnosis (organic brain syndrome, organic psychosis, chronic brain syndrome, etc.) could be assigned to specific diagnostic categories. Diagnosis was based on chart review and thorough neurological and clinical evaluation. Senile and alcoholic dementia and Korsakoff's syndrome were seen most often, and 15% of the patients were diagnosed as having functional disorders of the mental state. The authors review the organic brain syndrome diagnosis in light of this and other evidence. They believe that fractionation into more specific diagnoses is essential to further understanding of this group of diseases. Use of the general term can result in inappropriate or no treatment; further, it hampers essential psychological, pharmacological, and biomedical research on these disorders.

The psychopathology of acute organic psychosis was investigated by interviewing 74 patients using the Present State Examination (PSE). Their delusions, perceptual disturbance, thought disorder, and emotional disorder were categorised and then compared with those seen in 74 acute schizophrenics. In acute organic psychosis there was a particular pattern to the delusions, perceptual disturbance, and thought disorder, which was quite unlike that seen in acute schizophrenia. These results have implications for theories claiming that schizophrenia is an organic psychosis. It is suggested that the psychopathology in acute organic psychosis has very different origins from that seen in schizophrenia.

The shortcomings of the DSM-II classification of organic brain syndrome are described, including the limitation of the concept to the global brain disorders; the idiosyncratic use of the terms acute and chronic; and the unsatisfactory categories psychotic and nonpsychotic. Organic brain syndrome is defined according to DSM-III and the 10 separate brain syndrome categories are outlined. The diagnostic criteria for each category are listed and the general principles underlying the criteria are described. Finally, the goals of the authors' of DSM-III to enhance diagnostic reliability and validity are discussed and the impact of the new nomenclature is assessed.

It was supposed by clinical impressions that disturbances of orientation do not appear only in severe degrees of a transit-syndrome, but also in the light stadium of such a physically founded psychosis. In order to verify these impressions, a questionnaire was developed which permitted an objective scoring. This Q-Test consists of 37 questions (items), which measure the orientations of time, space, situation, and person. On the base of this questionnaire two samples were tested, the one consisting of 50 patients with functional psychoses (reversible physically founded psychoses), the other consisting of 50 patients with only neurological disturbances. The degree of the functional psychoses was determined by the "Syndrome-Test" (F. Bocker, 1959). The range of the scores corresponded with the clinical categories from a low degree of the transit-syndrome to a medium degree of disturbances of consciousness. The scoring was based on an standard system derived from the results of the control group (patients with only neurological disturbances). The clinical impressions could be verified by empirical and statistical methods. According to the test results, disturbances of orientation already appear during the light stadium of the transit-syndrome. Furthermore there is a high significant correlation (p. less than 001) between the degree of the functional psychoses and the degree of the disturbances of orientation. This applies to all categories of orientation. The orientation concerning time, space and situation proved to be more susceptible to disturbances than the orientation concerning the person. The very close correlation between the degrees of the functional psychoses and the degrees of the disturbances of orientation make it possible to determine the stadium of the functional psychoses promptly. The complete and very handy "short-time-test" will be published in a special paper.

The concept, definitions and classification of organic mental disorders have been radically revised in DSM-III, the new American classification. Seven organic brain syndromes have been included and their diagnostic criteria explicitly formulated. The boundary between so-called functional and organic mental disorders has been blurred. The author discusses these changes in the light of growing importance of organic psychiatry due to aging of the population and the high incidence and prevalence of organic mental disorders in the elderly.