Sigmund D, Mundt C
Department of Psychiatry, University of Heidelberg, Germany.
Compr Psychiatry. 1999 Jan-Feb;40(1):4-18. doi: 10.1016/s0010-440x(99)90070-6.
The heterogeneity within schizophrenia or the group of schizophrenias remains a vexing and limiting problem. An alternative to the "classic" explanatory construct of a schizophrenic unitary psychosis is the current concept of a positive/negative dichotomy with or without mixed type. However, the validation by findings from brain imaging, specificity, and prognostic validity of these multiple-entity approaches are still uncertain. Psychopathology is challenged to identify discrete types as homogenous as possible, providing closer relationship to distinct disease processes. Such types are to be defined by one or more axial syndromes, syndromes in an essential, not correlative, sense. One of these types is embraced by the term cycloid psychosis, implying a good prognosis. Using an integrative phenomenological methodology, the present study is able to show the specific quality of phenomena occurring in this type to pinpoint their "inner" relationships and to demonstrate cycloid syndromes as axial syndromes in the phenomenological sense. Thus, it is shown that positive symptoms in the cycloid type are different from those in core schizophrenia. In addition to the quality and inner coherence of the constituent elements, the absence of structural deformations of (1) emotional expression and affect, (2) thought, and (3) movement impulses and sequences is the decisive specificity feature that allows differentiation of the cycloid type from poor-prognosis core schizophrenia. These syndromes of structural deformations are the axial syndromes of core schizophrenia, occurring with or without "productive" (positive) phenomena. Its conceptualization makes a contribution to the actual negative-symptom discussion shifting the perspective from a low specific level (e.g., abulia) to phenomena of higher specificity. On the basis of a precise definition of cycloid axial syndromes, previous operationalization suggestions are reviewed and evaluated, and an alternative approach is outlined. Finally, it is hypothesized that the cycloid type may be a primary neurotransmitter disease, while core schizophrenia seems closer to the pathophysiological mechanisms described in Stevens' theory.
精神分裂症或精神分裂症群体内部的异质性仍然是一个棘手且具有局限性的问题。“经典”的精神分裂症单一精神病性障碍解释结构的替代方案是当前的阳性/阴性二分法概念，包括或不包括混合型。然而，这些多实体方法在脑成像结果、特异性和预后有效性方面的验证仍然不确定。精神病理学面临的挑战是尽可能确定离散的类型，使其具有同质性，从而与不同的疾病过程建立更紧密的关系。这些类型应由一种或多种轴心综合征来定义，这些综合征在本质而非相关意义上。其中一种类型被“循环性精神病”这一术语所涵盖，意味着预后良好。本研究采用综合现象学方法，能够展现出该类型中出现的现象的特殊性质，以确定它们的“内在”关系，并将循环性综合征证明为现象学意义上的轴心综合征。因此，研究表明循环性类型中的阳性症状与核心精神分裂症中的阳性症状不同。除了构成要素的性质和内在连贯性外，（1）情感表达和情感、（2）思维以及（3）运动冲动和序列不存在结构变形，是使循环性类型与预后不良的核心精神分裂症得以区分的决定性特异性特征。这些结构变形综合征是核心精神分裂症的轴心综合征，无论有无“生产性”（阳性）现象都会出现。其概念化为当前关于阴性症状的讨论做出了贡献，将视角从低特异性水平（如意志缺乏）转向更高特异性的现象。基于对循环性轴心综合征的精确定义，对先前的操作化建议进行了回顾和评估，并概述了一种替代方法。最后，推测循环性类型可能是一种原发性神经递质疾病，而核心精神分裂症似乎更接近史蒂文斯理论中描述的病理生理机制。
