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Thomas A. Ban: Diagnostic end points for research based on Leonhard’s classification covered up by Kraepelin’s manic-depressive psychosis

 

The DCR Budapest-Nashville, developed by Petho and Ban with their associates in the mid-1980’s, is a diagnostic instrument hat provides algorithms for diagnosing  “bipolar psychoses” and “unipolar psychoses” in Leonhard’s (1957) classification covered up by Kraepelin’s (1899, 1913) diagnostic concept of “manic-depressive psychosis” (Petho and Ban 1988).

In the DCR “unipolar psychoses” are defined as psychoses characterized by a “monomorphous clinical picture” and “bipolar psychoses” as psychoses characterized by a “polymorphous clinical picture” or a “polymorphous fluctuating clinical picture”. Yet, the only guide for the differentiation between these “clinical pictures” is in the “glossary” of the instrument in which “monomorphous clinical picture” is defined as “pure, distinct disease picture which remains unchanged  during the illness or at least within a single episode of the illness”; “polymorphous clinical picture, as “variable disease picture in which different symptoms or syndromes prevail at different times”; and “polymorphous fluctuating clinical picture” as “multiform variable disease picture in which different symptoms and/or syndromes prevail a different time and behavior is characterized by its rapid and frequent variations alternating between extreme (opposite) poles”.

To qualify for a phasic or a cycloid “bipolar illness” subjects must qualify for one of the four diagnoses in addition to displaying a “polymorphous” or “polymorphous fluctuating” clinical picture. The four diagnoses with qualifying criteria are:

Manic-depressive psychosis: At least three of the following five functional areas must be disordered: mood, drive, sex drive, sleep, psychomotility.

Anxiety-happiness psychosis: At least three of four from either one or the other sets of symptoms must be present: marked anxiety, marked tension, delusional perceptions and delusions of reference, or feelings of happiness, desire to make others happy, exaggerated self-esteem and misperceptions.

Excited–inhibited confusion psychosis: Incoherence must be present and at least three of four from either one or the other sets of symptoms: decreased talkativeness, decreased activity, reactive stupor and misperceptions, or increased talkativeness, increased activity, misperceptions and fragmentary hallucinations.

Hyperkinetic-akinetic motility psychosis: One of three from the following three symptoms must be present: akinesia, hypokinesia, hyperkinesia, as well as at least three of four from either one or the other sets of symptoms: confused stupor, absence of purposeful activities, diminished reactive movements and diminished expressive movements, or increased reactive movements, increased expressive movements, agitation and speech characterized by short phrases and long pauses with occasional emotionally charged outbursts.

To qualify for a phasic “unipolar illness” subjects must qualify for one of 12 diagnoses in addition to displaying a “monomorphous” clinical picture. The 12 diagnoses with qualifying criteria are:

Pure mania: At least three of the following five symptoms must be present: hyperthymic mood, psychomotor agitation, flight of ideas, premature decisions and exaggerated self-esteem.

Pure melancholia:   At least three of the following five symptoms must be present: dysthymic mood, psychomotor retardation, retarded thinking, indecisiveness and feelings of inadequacy.

Harried depression: At least three of the following five symptoms must be present: momomorphous clinical picture, motor restlessness, marked anxiety driven complaintiveness and poor thematization.

Hypochondriacal depression: At least three of the following five symptoms must be present: monomorphous clinical picture, hypochondriasis, homonome bodily hallucinations, hopeless complaintiveness and corporization.

Self-torturing depression: At least three of the following five symptoms must be present: monomorphous clinical picture, feelings of guilt, loss of self-esteem, lamentiveness and self-incrimination. 

Suspicious depression: At least three of the following five symptoms must be present: monomorphous clinical picture, suspiciousness, ideas of reference, paranoid ideation and lack of hostility.    

Nonparticipatory depression: At least three of the following five symptoms must be present: monomorphous clinical picture, lack of affective participation, abulia, anhedonia and feelings of alienation.

Unproductive euphoria: At least three of the following four symptoms must be present: monomorphous clinical picture, motiveless feeling of happiness, radiant facial expression and poor thematization.  

Hypochondriacal euphoria: At last three of the following four symptoms must be present: monomorphous clinical picture, hypochondriasis, homonome bodily hallucinations and cheerful complaintiveness.  

Enthusiastic euphoria: At least three of the following four symptoms must be present: monomorphous clinical picture, exaggerated self-esteem, happily enthused when talking about self-related topics and happily enthused when talking about topics related to others.

Confabulatory euphoria: At least three of the four following symptoms must be present: monomorphous clinical picture, confabulations with grandiose ideas, recounting happy experiences and lively talkativeness.  

References:

Kraepelin E. Psychiatrie. Leipzig: Barth; 1899.

Kraepelin E. Psychiatrie. Leipzig: Barth; 1913.

Leonhard K. Aufteilung der Endogenen Psychosen. Berlin: Akademie Verlag; 1957.

Petho B, Ban TA.  In collaboration with Kelemen A, Ungvari G, Katczag I, Bitter I, Tolna J (Budapest), Jarema M, Ferrero F, Aguglia E, Zurria GL, Fjetland O. (Nashville). DCR Budapest-Nashville in the Diagnosis and Classification of Functional Psychoses. Psychopathology 1988; 21: 153-240. 

 

Thomas A. Ban

December 10, 2015