Objective: Schizoaffective disorders are well established. Nevertheless, the definition in the International Classification of Diseases (ICD)‐10 and the Diagnostic and Statistical Manual (DSM)‐IV ...are insufficient.
Method: Critical review of the literature from Kahlbaum (1863) to the 21st century.
Results: Many authors have described people suddenly developing a disorder with both ‘schizophrenic’ and ‘affective’ symptoms. In DSM‐IV and ICD‐10, the schizoaffective disorder is defined as the concurrent occurrence of schizophrenic symptoms with a major affective disorder. However, there is no reason for a chronological distinction regarding the co‐existence of schizophrenic and affective symptomatology. Moreover, longitudinal aspects are not included in the definitions.
Conclusion: Two types of schizoaffective disorder must be distinguished: the ‘concurrent’ and the ‘sequential’ type. The first includes people having only a coincidence of schizophrenic and affective symptoms. The ‘sequential’ type is defined as the schizoaffective disorder under a longitudinal aspect subsuming disorders with a symptom change between different episodes. Consequences for further research are discussed in detail.
Basement membrane molecules and fragments derived from them are regulators of biological activities such as cell growth, differentiation and migration. This review describes proteolytically derived ...fragments from the non-collagenous (NC1) domain at the C-terminus of the basement membrane collagens type IV, XV and XVIII, which have been implicated as regulators of angiogenesis. Endostatin is an endogenous collagen XVIII/NC1 derivative, inhibiting endothelial cell proliferation and migration in vitro and tumor-growth in vivo. A homologous NC1 domain fragment of type XV collagen has anti-angiogenic activity as well. Furthermore, NC1 domain fragments of the most abundant basement membrane collagen, type IV collagen, have been shown to inhibit induced vessel growth.
At the end of the 19th century Emil Kraepelin dichotomized the so-called “endogenous psychoses” into dementia praecox (later schizophrenia) and manic-depressive insanity (later mood disorders). ...According to Kraepelin there are significant differences between the two groups regarding age at onset, phenomenology, and prognosis. But some years later Kraepelin himself recognized that there was a domain between the two groups showing a lot of overlaps and thus making a distinction impossible. Modern research confirmed this observation and opinion of Kraepelin: There are psychopathological syndromes showing characteristics of both mood and schizophrenic spectra. The overlap of the spectra gives rise to syndromes like schizoaffective disorders or acute and transient psychotic disorders having their own characteristics which differ from core schizophrenia or core mood disorders. Obviously there is a genetic determination of the overlap. The characteristics of syndromes created by the overlap of the spectra and the therapeutic consequences will be discussed.
Brief and acute psychotic disorders with a short duration and a generally good prognosis have long intrigued psychiatrists. Although they are included in internationally accepted diagnostic systems, ...understanding of these disorders remains minimal. This book is the first comprehensive overview of the clinical features, biology, course and long-term outcome of brief and acute psychoses. The authors review the world literature on the topic and they also present data from their own longitudinal study - the most complete investigation of this group of disorders so far conducted. The book concludes with considerations of the nosological status of brief and acute psychoses and their impact on our understanding of the continuum of psychotic and affective disorders.
Two hundred years ago the term "psychiatry" (first named "psychiatery") was introduced by Johann Christian Reil in the city of Halle, Germany. With the word's composition Reil demonstrated that ...psychic disorders belong to the medical domain, which he justified in a long paper explaining why psychiatry must be one of the three major branches of medicine (the others being surgery and pharmacy). Further he emphasized that psychosomatics and medical psychology are part of the comprehensive new discipline psychiatry. He described psychotherapy as an essential treatment for mental and somatic diseases and having equivalence with pharmacological and surgical methods. Johann Christian Reil launched an antistigma campaign and a crusade towards humanization of psychiatric asylums. Two hundred years later psychiatry is well established as a medical discipline and has become self-confident through its self-determination, in spite of certain setbacks and some objectives that have not yet been achieved.
Mice lacking collagen XVIII and its proteolytically derived product endostatin show delayed regression of blood vessels in the vitreous along the surface of the retina after birth and lack of or ...abnormal outgrowth of retinal vessels. This suggests that collagen XVIII/endostatin is critical for normal blood vessel formation in the eye. All basement membranes in wild‐type eyes, except Descemet's membrane, showed immunogold labeling with antibodies against collagen XVIII. Labeling at sites where collagen fibrils in the vitreous are connected with the inner limiting membrane and separation of the vitreal matrix from the inner limiting membrane in mutant mice indicate that collagen XVIII is important for anchoring vitreal collagen fibrils to the inner limiting membrane. The findings provide an explanation for high myopia, vitreoretinal degeneration and retinal detachment seen in patients with Knobloch syndrome caused by loss‐of‐function mutations in collagen XVIII.
In this article we try to differentiate between impulsive crimes and crimes of passion. The former are all impulsively executed and unplanned aggressive acts where we can find no specific preceding ...events which can be derived from a relevant relationship between offender and victim. Crimes of passion on the other hand are also impulsive and aggressive acts executed in a highly stressful affective state, but they are directed towards another relevant person and characterized by specific preceding events derived from the relationship between offender and victim. Thus they result from a perceived threat to the offender's self-image. We outline features for assessing crimes of passion as well as some indications which could facilitate them. The above mentioned differentiation between impulsive crimes and crimes of passion is relevant in forensic practice. Assessment of the psychological and psychopathological processes and states described in this article allows forensic psychiatric experts to give more reliable and more distinct recommendations to a court regarding the offender's criminal responsibility.
The Kraepelin concept of "mixed states" has experienced a renaissance over the last two decades. This has been caused by clinical as well as theoretically relevant factors. Of particular clinical ...relevance is the fact that more than 40% of all patients with bipolar disorders show at least one mixed affective episode during the course of their illness. However, the correct assessment and the precise classification of the symptoms are very important. A diagnosis according to the tight criteria of ICD-10 or DSM-IV, or perhaps based on the moderate Pisa or Cincinnati criteria, is recommended, whereas the use of broader definitions cannot be advised. Mixed schizoaffective episodes are under-diagnosed in comparison to pure affective mixed episodes, although both are defined by ICD-10 as well as by DSM-IV, and the frequency of occurrence is almost the same. Mixed schizoaffective episodes appear to be one of the most severe forms of bipolar disorders. Their clinical relevance is mainly caused by their unfavourable prognosis and difficulty in treatment. Atypical neuroleptics combined with anticonvulsives have proved to be more effective than any other psychopharmacological substances. The occurrence of mixed depressive and manic symptoms during one and the same episode is theoretically important, especially in the sense of their nosological and etiological differentiation.
Age‐related macular degeneration (ARMD) with abnormal deposit formation under the retinal pigment epithelium (RPE) is the major cause of blindness in the Western world. basal laminar deposits are ...found in early ARMD and are composed of excess basement membrane material produced by the RPE. Here, we demonstrate that mice lacking the basement membrane component collagen XVIII/endostatin have massive accumulation of sub‐RPE deposits with striking similarities to basal laminar deposits, abnormal RPE, and age‐dependent loss of vision. The progressive attenuation of visual function results from decreased retinal rhodopsin content as a consequence of abnormal vitamin A metabolism in the RPE. In addition, aged mutant mice show photoreceptor abnormalities and increased expression of glial fibrillary acidic protein in the neural retina. Our data demonstrate that collagen XVIII/endostatin is essential for RPE function, and suggest an important role of this collagen in Bruch's membrane. Consistent with such a role, the ultrastructural organization of collagen XVIII/endostatin in basement membranes, including Bruch's membrane, shows that it is part of basement membrane molecular networks.
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