Thomas A. Ban
Neuropsychopharmacology in Historical Perspective
Psychopharmacology and the Classification of Functional Psychoses
Neuropsychopharmacology in Historical Perspective
4. Classification of Mental Disorders and Psychopharmacology – Diagnostic Criteria for Research
In addition to the consensus-based diagnostic criteria of ICD-9 and DSM-III, introduced primarily for clinical use, several other diagnostic criteria relevant to the population of functional psychoses were developed primarily for research purposes. They include the St. Louis Criteria (Feighner, Robins, Guze et al. 1972); the Research Diagnostic Criteria (RDC) (Spitzer, Endicott and Robins 1978a,b); Taylor and Abrams Criteria (Taylor and Abrams 1978; Taylor, Redfield and Abrams 1981) and the Vienna Research Criteria (VRC) (Berner and Katschnig 1983).
St. Louis Criteria
The St. Louis Criteria for the diagnosis of schizophrenia and affective disorders are based on considerations by Robins and Guze (1970) to improve both reliability and validity of essentially Kraepelinian diagnoses. In its diagnostic criteria of affective disorders the concepts of “primary” and “secondary” affective disorders developed by Robins, Munoz, Martin and Gentry (1972) are adopted. The St. Louis Criteria are frequently referred to as Feighner's Criteria because they were first presented in an operationalized format in a paper published by Feighner, Robins, Guze and Woodruff (1972)
Research Diagnostic Criteria
The RDC is an elaboration, expansion and modification of the St. Louis Criteria by Spitzer, Endicott and Robins (1978a,b). It was developed as part of a collaborative project on the psychobiology of depressive disorders sponsored by the Clinical Research Branch of the United States National Institute of Mental Health (Maas, Koslow, Davis et al. 1980). The RDC is more inclusive than the St. Louis Criteria. By subtyping schizophrenic psychoses on the basis of their course and manifest psychopathological symptoms and by subdividing major affective disorders into several different types, it allows for the testing of many hypotheses relevant to schizophrenic and affective illnesses.
Taylor and Abrams Criteria
Taylor and Abrams' criteria for schizophrenia (Abrams, Taylor and Gaztanaga 1974; Taylor and Abrams 1978; Taylor, Gaztanaga and Abrams 1974; Taylor, Redfield and Abrams 1981) were developed in the course of a dialogue between Abrams and Taylor and the St. Louis group (Taylor and Abrams 1970). The criteria of mania and endogenous depression were derived from Mayer-Gross, Slater and Roth's (1969) descriptions.
Vienna Research Criteria
Development of the VRC for schizophrenic psychoses, referred to as the endogenomorphic-schizophrenic axial syndrome, and affective disorders, referred to as the endogenomorphic - affective axial syndrome can be traced to Peter Berner's (1965, 1969) follow-up study on paranoiac patients and his recognition that a considerable proportion of these patients suffer from a schizophrenic or an affective (referred to as cyclothymic) disorder. With consideration that these syndromes were derived from a follow-up study of paranoiac patients a “catamnestic” study was designed to test the hypothesis that paranoiac patients can be assigned a diagnosis of schizophrenia or affective disorder on the basis of operationally defined criteria at the time of their first (index) admission (Muller 1981). The operationally defined criteria were referred to as “axial syndromes," a term first used by Hoche (1912). The adjective “endogenomorphic” was added for distinguishing axial syndromes from definitive diagnoses.
The VRC consists of six endogenomorphic axial syndromes, one schizophrenic and five affective. In the formulation of the six axial syndromes, Janzarik’s (1948, 1959) concept of "structural dynamic coherency” played an important role.
The five “endogenomorphic” axial affective syndromes are referred to as depressive, manic, dysphoric, unstable mixed and stable mixed. Common characteristics of these axial syndromes are disturbance of biorhythm manifest in diurnal variation of symptoms and sleep disturbance. Differential characteristics are based on the different types of dynamic derailments described by Janzarik (1948, 1959), e.g., dynamic expansion (seen in the manic axial syndrome), dynamic restriction (seen in the depressive axial syndrome) and dynamic instability characterized by rapid fluctuation or swings between the first two (seen in the unstable mixed axial syndrome.
References:
Abrams R, Taylor MA, Gaztanaga P. Manic-depressive illness and paranoid schizophrenia. A phenomenological, family history and treatment-response study. Arch Gen Psychiatry, 1974;31:640-2.
Berner P. Der Lebensabend der Paranoiker. Wien Z Nerv Heilk, 1969;27:115-61.
Berner P. Das paranoische Syndrom. Springer, Bern; 1965.
Berner P, Katschnig H. Principles of "multiaxial" classification in psychiatry as a basis of modern methodology. In: Helgason T, editor. Methods in Evaluation of Psychiatric Treatment. Cambridge University Press, Cambridge; 1983.
Hoche A. Die Bedeutung der Symptomkomplexe in der Psychiatrie. Z ges Neural Psychiatr, 1912;12:540-51.
Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry, 1972;26:57-63.
Janzarik W. Dynamische Grundkonstel lationen in endogenen Psychosen. Springer, Berlin, Gottingen, Heidelberg; 1948, 1959.
Maas JW, Koslow SH, Davis JM, Katz MM, Mendels J, Robins E, Stokes PE, Bowden CL. Biological component of the NIMH clinical research branch collaborative program on the psychobiology of depression: I. Background and theoretical considerations. Psychol Med, 1980;10(4):759-76.
Muller C. Psychische Erkrankungen und ihr Verlauf Sowie ihre Beeinflussung durch das Alter. Hans Huber, Bern, Stuttgart, Wien; 1981.
Robins E, Guze S. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry, 1970;126:983-7.
Robins E, Munoz RA, Martin S, Gentry KA. Primary and secondary affective disorders. In: Zubin J, Freyhan F, editors. Disorders of Mood. The Johns Hopkins Press, Baltimore and London; 1972.
Spitzer RL, Endicott J, Robins E. Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders. 3rd Edition. New York Psychiatric Institute, New York; 1978a.
Spitzer RL, Endicott J, Robins E. Research Diagnostic Criteria: Rationale and Reliability. Arch Gen Psychiatry, 1978b;35:773-82.
Taylor MA, Gaztanaga P, Abrams R. Manic-depressive illness and acute schizophrenia: a clinical, family history and treatment response study. Am J Psychiatry, 1974;131:678-82.
Taylor MA, Abrams R. The prevalence of schizophrenia: a reassessment using modern diagnostic criteria. Am J Psychiatry, 1978;135:945-8.
Taylor MA, Redfield J, Abrams R. Neuropsychological dysfunction in schizophrenia and affective disease. Biol Psychiatry, 1981;16:467-78.
April 29, 2021