Cambridge University Press 978-0-521-85858-8 - The Overlap of Affective and Schizophrenic Spectra Andreas Marneros and Hagop S. Akiskal Frontmatter More information
The Overlap of Affective and Schizophrenic Spectra
An increasing number of clinicians and researchers are now favoring an overlap between affective and schizophrenic spectra. In this book, an international team of experts discuss aspects of comorbidity, genetic models, clinical course, phenomenology and therapies. This is the first comprehensive overview of this area of overlap. Challenging cases presenting clinical and paraclinical features of both spectra are surprisingly numerous. Not only the phenomenology but also the course, outcome and treatment of such cases have their own characteristics. Recent research shows that the overlap also involves genetics and biological processes related to psychotic disorders. Within the overlap of affective and schizophrenic spectra it is possible to identify some groups of disorders having similar clinical and non-clinical features: the “Schizoaffective” group, “Acute and Transient Psychotic Disorder” or “Brief Psychosis,” and other groups found in so-called “Atypical Forms.” Andreas Marneros is Professor of Psychiatry in the Department of Psychiatry and
Psychotherapy at the Martin Luther University in Halle-Wittenberg, Germany. He won the Kraeplin Research Prize in 2002 for his work on psychoses, especially schizoaffective and acute brief psychoses. Hagop Akiskal is Professor of Psychiatry and Director of the International Mood Center at the
University of California at San Diego. Among his awards are the Anna Monika Prize for research on the depressive spectrum, and the World Psychiatric Association’s Jean Delay Prize for bridging clinical and research perspectives in the bipolar spectrum.
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Cambridge University Press 978-0-521-85858-8 - The Overlap of Affective and Schizophrenic Spectra Andreas Marneros and Hagop S. Akiskal Frontmatter More information
The Overlap of Affective and Schizophrenic Spectra Andreas Marneros Department of Psychiatry and Psychotherapy, Martin Luther University, Halle-Wittenberg, Germany
Hagop S. Akiskal International Mood Center, University of California at San Diego, USA
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Cambridge University Press 978-0-521-85858-8 - The Overlap of Affective and Schizophrenic Spectra Andreas Marneros and Hagop S. Akiskal Frontmatter More information
cambridge university press Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 2RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521858588 © Cambridge University Press 2007 This book is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2007 Printed in the United Kingdom at the University Press, Cambridge A catalog record for this publication is available from the British Library ISBN-13 978-0-521-85858-8 hardback ISBN-10 0-521-85858-5 hardback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.
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Cambridge University Press 978-0-521-85858-8 - The Overlap of Affective and Schizophrenic Spectra Andreas Marneros and Hagop S. Akiskal Frontmatter More information
Contents
1
List of contributors
page vii
Preface
page xi
The paradigma of overlapping affective and schizophrenic spectra: schizoaffective conditions
1
Andreas Marneros
2
The overlapping of the spectra: overlapping genes and genetic models
25
John R. Kelsoe
3
The continuum of psychosis and its genetic basis
43
T. J. Crow
4
Functional psychoses: molecular-genetic evidence for a continuum
55
Hans H. Stassen, Christian Scharfetter and Jules Angst
5
State- and trait-related deficits in sustained attention in bipolar disorder: are there any overlaps with schizophrenia?
79
Luke Clark
6
The concept of schizoaffective disorder: utility versus validity and reliability – a transcultural perspective
104
Ahmed Okasha
7
Phenomenological approaches to the schizoaffective spectrum
133
William Coryell
8
Clinical course of schizoaffective disorders
145
Maria Reinares, Eduard Vieta, Antoni Benabarre and Andreas Marneros
9
Depressive syndromes in schizophrenia
156
Wolfgang Gaebel, Ellen Bittner and Wolfgang Wölwer
v
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Cambridge University Press 978-0-521-85858-8 - The Overlap of Affective and Schizophrenic Spectra Andreas Marneros and Hagop S. Akiskal Frontmatter More information
vi
Contents
10
The overlapping of the spectra: brief and acute psychoses
182
Frank Pillmann and Andreas Marneros
11
Overlapping of the spectra: physical comorbidity between schizophrenia and affective disorders
207
William S. Stone, Andrea H. Roe and Ming T. Tsuang
12
The overlapping of the spectra suicide
224
Simavi Vahip
13
Biological treatment of schizoaffective disorders
248
Christopher Baethge
14
Psychological therapies and schizoaffective disorders
264
Jan Scott
Epilogue: The interface of affective and schizophrenic disorders: a cross between two spectra?
277
Hagop S. Akiskal
Index
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Cambridge University Press 978-0-521-85858-8 - The Overlap of Affective and Schizophrenic Spectra Andreas Marneros and Hagop S. Akiskal Frontmatter More information
Contributors
Hagop S. Akiskal International Mood Center University of California at San Diego VA Psychiatry Service 116A 3350 La Jolla Village Drive San Diego, CA 92161 USA
Ellen Bittner Department of Psychiatry Heinrich-Heine-Universität Düsseldorf Bergische Landstrasse 2 Postbox 12 05 10 D-40605 Düsseldorf Germany
Jules Angst Psychiatrische Universitätsklinik Zürich Postfach 68 CH_8029 Zürich Switzerland
Luke Clark Department of Experimental Psychology University of Cambridge Downing Street Cambridge CB2 3EB UK
Christopher Baethge Department of Psychiatry and Psychotherapy University of Cologne Medical School Kerpener Str. 69 50 924 Cologne Germany Antoni Benabarre Bipolar Disorders Program Institute of Neuroscience Hospital Clinic University of Barcelona Spain
William Coryell University of Iowa Department of Psychiatry 500 Newton Rd Iowa City IA 52242 USA T. J. Crow SANE Prince of Wales International Centre Warneford Hospital Oxford OX3 7JX UK
vii
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Cambridge University Press 978-0-521-85858-8 - The Overlap of Affective and Schizophrenic Spectra Andreas Marneros and Hagop S. Akiskal Frontmatter More information
viii
List of contributors
Wolfgang Gaebel Department of Psychiatry Heinrich-Heine-Universität Düsseldort Bergische Landstrasse 2 Postbox 12 05 10 D-40605 Düsseldorf Germany
Maria Reinares Bipolar Disorders Program Institute of Neuroscience Hospital Clinic University of Barcelona Spain Andrea H. Roe
John R. Kelsoe Department of Psychiatry, 0603 University of California, San Diego 9500 Gilman Drive La Jolla, CA 92093 USA
Christian Scharfetter Psychiatrische Universitätsklinik Zürich Postfach 68 CH-8029 Zürich Switzerland
Andreas Marneros Klinik und Poliklinik für Psychiatrie und Psychotherapie Martin Luther Universität Julius-Kühn-Strasse 7 06097 Halle/Saale Germany
Jan Scott P. O. Box 96 Department of Psychological Medicine Institute of Psychiatry Denmark Hill London, SE5 9AF UK
Ahmed Okasha Director, WHO Collaborating Center for Training and Research in Mental Health Institute of Psychiatry Ain Shams University Cairo Egypt
Hans H. Stassen Psychiatrische Universitätsklinik Zürich Postfach 68 CH-8029 Zürich Switzerland
Frank Pillmann Department of Psychiatry and Psychotherapy Martin Luther Universität Julius-Kühn-Strasse 7 06097 Halle/Saale Germany
Ming T. Tsuang Massachusetts Mental Health Center Division of Public Sector Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School Departments of Psychiatry Boston, MA USA
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William S. Stone
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ix
List of contributors
Simavi Vahip Affective Disorders Unit Ege University Medicine Faculty Department of Psychiatry Izmir Turkey
Wolfgang Wölwer Heinrich-Heine-Universität Düsseldorf Bergische Landstrasse 2 Postbox 12 05 10 D-40605 Düsseldorf Germany
Eduard Vieta Bipolar Disorders Program Institute of Neuroscience Hospital Clinic University of Barcelona Spain
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Cambridge University Press 978-0-521-85858-8 - The Overlap of Affective and Schizophrenic Spectra Andreas Marneros and Hagop S. Akiskal Frontmatter More information
Preface
Affective and schizophrenic disorders are not monolithic concepts. The idea of groups of disorders has proved to be useful. Today the concept of a spectrum of affective disorders and a spectrum of psychotic disorders is based on clinical and research findings. It has also been proposed that a kind of continuity exists between the two spectra. There are clinical bridges joining them, or perhaps some nosologic islands filling the gaps in-between. Possibly what is “in-between” represents a cross of the underlying dimensions of the two “voluminous” spectra, or a superposition of some of the contributory factors of one or that of the other. Psyche is like Physis – Nature. She does not take any leaps, even when she is ill. Emil Kraepelin himself realized the indistinct boundaries of the dichotomy of the manic-depressive and schizophrenic psychoses he had proposed at the turn of the nineteenth century. He thought that it was only partially true. One can read it in his paper published in 1920: “Die Erscheinungsformen des Irreseins”, which means “The manifestation types of insanity”. Among other relevant observations, he noted: No experienced psychiatrist will deny that there is an alarmingly large number of cases in which, despite the most careful observation, it seems impossible to arrive at a reliable diagnosis . . . We therefore will have to get used to the fact that the symptoms we have used so far are not sufficient to always reliably distinguish between manic-depressive insanity and schizophrenia, but that there are overlaps based on the origin of these symptoms from given preconditions.
Developments in psychiatry in the last century have actually confirmed the doubts of Emil Kraepelin, and have shown that the so-called Kraepelinian dichotomy is not the philosopher’s stone. Many scientists in various countries of the world have attempted to fill the gap with different concepts: in Germany with the “cycloid psychoses”, in France with the “bouffée délirante”, in Scandinavia with the “psychogenic” and “reactive psychoses”, in Japan with the “atypical psychoses”, in the United States with the “schizoaffective disorders” or with “remitting schizophrenia”. The major diagnostic systems of DSM xi
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xii
Preface
and ICD accept the existence of an intermediate area called “schizoaffective”. Nevertheless the uncertainties in diagnosis and nosology remain. One of the reasons for these uncertainties is the inconsistent definition of schizoaffective psychopathology. To better understand the overlap between the affective and schizophrenic spectra it is necessary, among others, to consider the space in-between in a diachronic continuity. Psychiatric symptoms have to be considered in their evolution from fundamental structures such as temperament and personality. Modern dimensional models deliver both clinical and theoretical aspects for syndromes to depict the spectrum. In the contemporaneous evolution of psychiatry, the concept of a domain based on the overlap of the spectra is, to a varying degree, supported by genetic, biological, psychological, clinical, therapeutic and longitudinal findings. The purpose of this book is to present such findings, theories, and methods and to highlight their relevance and limitations regarding the interface of affective and schizophrenic disorders.
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