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Monday, 01.05.2017

Per Bech’s comment

I started as a research assistant at Professor Ole Rafaelsen’s Psychochemical Research Unit at the University of Copenhagen in 1970. I was, therefore, too young to take part in the 7th CINP Congress in Prague, in 1970 with Heinz Lehmann as president. However, in 1972, I participated at the 8th CINP Congress in Copenhagen. Erik Jacobsen acted as president with Tom Ban as secretary. Some years later, I followed Jacobsen as a committee member of the Scandinavian College of Neuropsychopharmacology (SCNP).

My personal contact with Heinz Lehmann was established through Professor Paul Kielholz in Basel. Kielholz played a major role in encouraging, on the one hand, the WHO Department of Mental Health in Geneva to focus on the treatment of depression, and on the other hand, the drug companies in Basel to continue their development of antidepressants, e.g. Ciba-Geigy on imipramine and clomipramine, Roche on amitriptyline and isocarboxazide. At a meeting at Kielholz’ Department of Psychiatry at the University of Basel, I was introduced to Fritz Freyhan and Heinz Lehmann. Both were German emigrants to the United States or Canada after having studied medicine in Berlin. Like Kielholz (1974) himself, they were thoroughly versed in basic German psychiatry of Kraepelin and Jaspers and they were very interested in my study from 1975 on the six target symptoms in the Hamilton Depression Scale.

Later on, I contacted Heinz Lehmann about the Brief Psychiatric Rating Scale (BPRS) and was informed that in connection with the multicenter trials on clozapine he had produced a video-taped interview with schizophrenia patients in his Department of Psychiatry at McGill University in Montreal for Sandoz, a Basel based drug company. I received a copy of these BPRS interviews from Dr. Kurt A Fischer-Cornelssen of Sandoz’ Medical Research Division. However, after the 1990 CINP Congress in Kyoto, I realized that the Positive and Negative Symptom Scale (PANSS) which was based on the 18-item BPRS was enlarged into a 30 items scale and it was this 30-items scale that was used internationally in clinical trials with antipsychotics. Then I received the video-taped PANSS-30 interviews from Janssen Pharma, the major promotor of the PANSS-30. They were certainly not with Heinz Lehmann as interviewer.

We have recently made a clinimetric analysis of the PANSS-30, resulting in a “target symptoms” version with six items (PANSS-6) (Ostergaard, Lemming, Mors, Correll, Bech 2015).

These six items are quite concordant with the DSM-5 schizophrenia symptoms. These six items are included in the Heinz Lehmann interviews using the BPRS.  It is really a privilege to have access to these Heinz Lehmann dialogues with schizophrenia patients. His empathy (Gehör) and his flexibility in capturing the target symptoms of schizophrenia are based on his “Gemütlichkeit” which I myself felt from the very first moment when Paul Kielholz introduced me to him in Basel.

When I was asked to find a motto for my chapter on the assessment of positive mental health in the Clinical Handbook on Positive Psychiatry edited by Jeste and Palmer (2015), I recalled these words from Lehmann: “I don’t care whether it is mind or whether it is organic – it is clinical”!

I have never visited Heinz Lehmann’s clinical “garden” in Montreal but I have the video interviews and for many years I have been in close contact with Tom Ban, who still reminds me of this garden.

I would very much like to finish this Comment by referring to Heinz Lehmann’s retrospective view on his CINP Congress, in 1970, in Prague. He concluded with this very personal opinion quoted in a book edited by Ban and Hippius (1988), on pages 26 to 27:

 

Psychopharmacology had its start with clinical observations on associations between drugs and their clinical effects. Stimulated by these observations, research was then able to establish causal chains in neuropharmacological discourse. But we do not know – and possibly never will – a transducer from neural events to experiential effects. If we want to remain knowledgeable about the notorious psycho-physical parallelism on which psychopharmacology, after all, has to rely for its clinical pay-off, we must renew our clinical contact with individual patients – a contact that is in danger to be lost in the virtual onslaught of new, exciting and anti-intuitive neuroscientific data which research has produced in recent years. Most of these data are instrument-oriented and some of the many find clinical application only in a faraway Star Trek future. The psycho-social, even the idiosyncratic personal components of a psychiatric pharmacology will need to be re-integrated into neuropsychopharmacology. But perhaps time will take care of this in the never-ending dialectic of the insoluble mind-body problem.”

 

These considerations are very much in accord with the historical review of the SCNP made by Bech and Ban (2014).

Recently, when I made a follow-up study on patients with treatment-resistant depression, I found that the clinically most important paper in this respect was authored by Heinz Lehmann (1974).

 

References:

Ban TA, Hippius H, eds.. Thirty years CINP – A brief history of the Collegium Internationale Neuro-Psychopharmacologicum. Berlin: Springer-Verlag; 1988.

Bech P, Ban TA. A short historical review of SCNP with special reference to the UKU. Acta Neuropsychiatrica 2014; 26(1): 4.7.

Jeste DVP, Palmer B.W, eds. Positive Psychiatry. Washington D.C.: American Psychiatric Publishing; 2015, pp 127-143.

Kielholz P, ed. Depression in everyday practice. Bern: Hans Huber Publisher; 1974.

Lehmann HE. Therapy-resistant depression – a clinical classification. Pharmakopsychiatrie-Neuro-psychopharmakologie 1974; 7: 156-163

Ostergaard SD, Lemming OM, Mors O, Correll CU, Bech P. PANSS-6: a brief rating scale for the measurement of severity in schizophrenia. Acta Psychiatr Scand 2015. DOI: 10.1111/acps.12526.

 

Per Bech
February 4, 2016