Silveira A
Faculty of Medicine, University of São Paulo, Brazil.
Arq Neuropsiquiatr. 1999 Dec;57(4):1046-56. doi: 10.1590/s0004-282x1999000600026.
Mental process imply a harmonious functioning of psychic systems, assembled into larger units, psychic spheres (Table 1). Their neurophysiological representatives are brain systems of areas and pathways (Figs 1-4). Under functional and/or organic disturbances these systems originate the leading mental symptoms (Table 2) characterizing the diverse endogenous psychoses: hence, the latter's distinctive patterns. Accordingly, understanding and classification of psychoses should rest on the pathogenic dynamisms, not on clinical description. This is why Kleist's and Leonhard's conceptions of the endogenous psychoses surpass any other to exist. Kleist stands among the founders of psychiatry, by describing the "degeneration psychoses" and many single psychoses, as well as redefining, isolating and clarifying the progressive ones, later on renamed as schizophrenias (Table 3). Such pathogenic criterion may also be useful to define mental conditions other than psychoses, as hysteria, neuroses and psychopathic inferiority (Tables 4 and 5). One should consider here, besides the psychic systems and spheres involved, the way they were caught and the corresponding developmental phase. In Kleist's "degeneration psychoses"--cyclic or episodic (Table 6) the systems and spheres are disturbed by functional transient processes due to latent dispositions, while his and Leonhard's schizophrenias (Table 7) show a rather progressive, deteriorating course. The nature of the disorder is itself genetically determined, as is either its confinement to one sphere or its spreading out. The spread out pattern, while exceptional in schizophrenia, represents a rule for the "degeneration psychoses", in discussant's mind. Both groups may have symptoms alike by involvement of the same sphere (Table 8), but proper diagnosis is reached by taking pathogenesis into consideration.
心理过程意味着心理系统的和谐运作，这些系统组合成更大的单元，即心理领域（表1）。它们的神经生理学代表是大脑的区域和通路系统（图1 - 4）。在功能和/或器质性障碍的情况下，这些系统产生了表征各种内源性精神病的主要精神症状（表2）；因此，后者具有独特的模式。相应地，精神病的理解和分类应基于致病动力，而非临床描述。这就是为什么克莱斯特（Kleist）和莱昂哈德（Leonhard）关于内源性精神病的概念超越了其他任何现存概念。克莱斯特是精神病学的奠基人之一，他描述了“退化性精神病”和许多单一的精神病，以及重新定义、分离和阐明了后来被重新命名为精神分裂症的进行性精神病（表3）。这样的致病标准也可能有助于定义除精神病之外的其他精神状况，如癔症、神经症和精神opathic劣势（表4和5）。在此，除了涉及的心理系统和领域外，还应考虑它们是如何被引发的以及相应的发展阶段。在克莱斯特的“退化性精神病”——循环性或发作性（表6）中，系统和领域受到由于潜在倾向导致的功能性短暂过程的干扰，而他和莱昂哈德的精神分裂症（表7）则呈现出相当进行性、恶化的病程。疾病的性质本身是由基因决定的，其局限于一个领域或扩散的情况也是如此。在讨论者看来，扩散模式在精神分裂症中虽然罕见，但却是“退化性精神病”的一个规律。两组可能因涉及相同领域而有相似症状（表8），但通过考虑发病机制才能做出正确诊断。
