Unit psychosis

The term unit psychosis represents a nosological concept of psychiatry , according to which the most diverse forms of mental illness are only successive stages of a continuous illness process and thus represent a psychotic continuum . A differentiated differentiation into various independent clinical pictures (psychiatric disease units ) such as schizophrenia and endogenous depression ( Emil Kraepelin's “dichotomy” ) is therefore not mandatory. In principle, transitions from one form to the other are always possible. The variety of psychiatric manifestations can therefore also be described by subdivision and classification into individual disease units - not more clearly and without contradictions. Rather, one must start from the idea of ​​a "unitary psychosis" in which all forms of illness are included. According to a definition given by Albert Zeller and Heinrich Neumann around 1860, psychiatric clinical pictures mainly differ in their more or less favorable course. The unfavorable final states are characterized by complete mental decay or by the formation of defects .

Progress stages or continuum?

• Jean Étienne Dominique Esquirol (1772–1840) has dealt extensively with the concept of the disease process in psychiatry. He differentiated between four stages of the disease in terms of the process-like disease process: melancholy → monomania → mania → dementia . He assumed that a functional-psychological impairment leads in the long term to structural-physical damage, unless the temporary course is influenced by a "healing crisis" or a "passion" that halts this process, cf. the problem of endogenous psychosis . Esquirol also saw the aging process in this context. Esquirol took over the historically comparative method from Philippe Pinel (1745–1826). He also has also the law of three stages of Auguste Comte (1798-1857) on the suicide applied. The problem of suicide fell first under religious, then under civil law, and finally it must now come under medical law. The suicide should now be viewed as a disease. However, the moral treatment advocated by Esquirol, conversely, transfers a considerable moral responsibility to the doctor-patient relationship and to the responsibility of society.

• After Klaus Dörner, Joseph Guislain (1797–1860) introduced the concept of unitary psychosis into the European discussion and used it e.g. B. passed on to Ernst Albert Zeller and Wilhelm Griesinger, cf. also Bodam Cape. Literature .

• Albert Zeller (1804–1877) also distinguished four stages of illness: melancholy → mania (madness) → madness → nonsense in the sense of a uniform course of mental illnesses. Ackerknecht sees especially an emotional and intellectual disturbed Stadium. Zeller did not recognize special disease processes for individual mental illness units. He is therefore counted among the representatives of the theory of unit psychosis, which was only founded later by Heinrich Neumann. He passed on Guislain's idea of ​​unit psychosis to his student Wilhelm Griesinger (1817–1868). He quotes Guislain on the assumption that melancholy and the psychological pain associated with it represent the basic form of all other mental illnesses as follows: “ Originally, madness is a state of malaise, fear, suffering, pain, but a moral, intellectual one , more cerebral. “The new clinical spirit of Griesinger made him follow the thesis of the disease process and not that of a“ conglomerate of symptoms ”. According to Ackerknecht, this saved him “empty classification exercises”.

• Heinrich Neumann (1814–1884) differentiated between three stages of the disease: productive pathological mental products → loosening of the conceptual contexts → mental decay.

The number of assumed stages appears here without any deeper meaning. It only serves to describe the “uniform chronological sequence” of mental illness in general. The name of the psychotic continuum takes this into account better.

History of Psychiatry

The concept of unitary psychosis did not correspond to that of classical German psychiatry . It considered four different principles to be appropriate for the differentiation and classification of mental illness:

1. Cause ( causal relationship , etiology )
2. Appearances ( symptoms and symptom coupling, so-called symptom complexes)
3. Brain findings ( anatomy , histology )
4. Course and outcome of the disease

Above all, Emil Kraepelin and Kurt Schneider each tried to describe typical symptoms that allowed the prognosis to be made in advance on the basis of psychopathological findings and not just by observing the course of the disease. Kurt Schneider therefore described z. B. Symptoms of the first order in schizophrenia. Nevertheless, Emil Kraepelin also referred indirectly to Heinrich Neumann's description of the course, namely via Karl Ludwig Kahlbaum .

The meaning of different nosological concepts

Different nosological concepts may lead to less productive arguments about the correctness of mutually contradicting views. They only make sense if there is sufficient willingness to compromise on all sides of the discourse. The point is therefore in the understanding between the conversation participants and not in the argument about the truth, since the essence of illness is ultimately unknown.

Individual evidence

1. ↑ ^{a b} Andreas Marneros : Schizoaffective psychoses . Diagnosis, therapy and prophylaxis. Springer, Berlin 1989, ISBN 3-540-51243-8 ; P. 4 f., 53.
2. ↑ GE Berrios and D. Beer (1994) The notion of Unitary Psychosis: a conceptual history. History of Psychiatry 5: 13-36.
3. ↑ ^{a b} Uwe Henrik Peters : Lexicon of Psychiatry, Psychotherapy, Medical Psychology . Urban & Fischer, Munich ⁶ 2007; ISBN 978-3-437-15061-6 ; Pp. 153, 222, 360, 618.
4. ↑ ^{a b c} Klaus Dörner : Citizens and Irre . On the social history and sociology of science in psychiatry (1969). Fischer Taschenbuch, Bücher des Wissens, Frankfurt / M 1975, ISBN 3-436-02101-6 ; (a) pp. 165, 174 ff. on head. “Disease process in French psychiatry”; (b) pp. 178, 297, 315, 318 on stw. “Unit psychosis in the European discussion”; (c) P. 297 to Stw. "Thoughts of the unit psychosis from Guislain to Zeller and Griesinger".
5. ↑ ^{a b c} Rudolf Degkwitz et al. (Ed.): Mentally ill . Introduction to Psychiatry for Clinical Study. Urban & Schwarzenberg, Munich 1982, ISBN 3-541-09911-9 ; Columns indicated below with ~: - (a) p. 448 ~ 1 on Stw. “Staging according to Zeller”; (b) p. 448 ~ 1 to Stw. “Staging according to Neumann”; (c) p. 51 ~ 1 to Stw. “The meaning of different nosological concepts”.
6. ↑ ^{a b} Erwin H. Ackerknecht : Brief history of psychiatry . Enke, Stuttgart ³ 1985, ISBN 3-432-80043-6 ; P. 70.
7. ^ Wilhelm Griesinger : About psychological reflexions . P. 37.
8. ^ ^{A b} Karl Jaspers : General Psychopathology . Springer, Berlin ⁹ 1973, ISBN 3-540-03340-8 ; (a) Re. “Principles of Differentiation”: Part 4: The conception of the totality of mental life - Chapter 1: The synthesis of the clinical pictures (nosology) - § 1: Research under the idea of ​​the disease unit - unitary psychosis or series of definable disease units p 471ff., (B) p. 513: - § 4 to the district “mixed psychosis”: the classification of diseases (diagnosis scheme) - combination of psychoses (mixed psychoses); (c) p. 472 on stw. "Debate and Understanding".
9. ↑ Kurt Schneider : Clinical Psychopathology . 11th edition, Georg Thieme Verlag Stuttgart 1976, ISBN 3-13-398211-7 ; P. 135 f.
10. ↑ Oswald Bumke : Textbook of mental illnesses . Verlag JF Bergmann, Munich, ⁶ 1944; Regarding Stw. "Kahlbaums progress observation": p. 1 f.

literature

• J. Bodamer: On the phenomenology of the historical spirit in psychiatry. In: Neurologist. 19, 1948, pp. 299-310.
• J. Bodamer: On the emergence of psychiatry as a science in the 19th century. In: Fortschr. Neurol. Psychiatry. 21, 1953, pp. 511-535.