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The evolution of psychosocial treatments for schizophrenia has tracked larger historical trends in psychology, behavioral science, and mental health policy over more than a century. At times, the communication of ideas and influences of science, practice and policy has been reciprocal and mutually beneficial. At other times, there is a lack of such reciprocity, sometimes with unfortunate consequences. This chapter reviews and summarizes those ideas and influences in our post-modern era, and identifies key landmarks in the progression toward contemporary psychosocial treatment of schizophrenia spectrum disorders.
Through a critical analysis of the peer-reviewed scholarly literature and reliance on primary and secondary historical sources, the current chapter will critically investigate three key aspects of the schizophrenia syndrome as they relate to outcome: 1. the emergence and metamorphosis of the diagnostic category over time beginning with Kraepelin’s and Bleuler’s seminal definitions at the turn of the twentieth century to DSM-5 formulations; 2. an analysis of large-scale, systematic, group studies of outcome beginning with the Iowa 500 study in the 1970s (Tsuang et al., 1979), through contemporary work, and how these findings have influenced thinking about patterns of recovery and disability in the disorder over recent history; and 3. the emergence and metamorphosis of psychosocial treatments for the disorder beginning in the 1890s through current practices. The chapter will seek to illuminate how changes in the ascendancy of conceptual models of schizophrenia in different historical epochs have influenced diagnostic formulations, treatment approaches, and understanding of outcome in the disorder.
When we talk about cycloid psychosis we have doubts about their nosological enclave; whether they should be considered as a subform of schizophrenia or as independent psychoses.Some solutions were proposed, such as the thesis of mixed psychoses (Kretschmer) or that of intermediate forms (Bleuler, Schneider). Cycloid psychoses and bouffée delirante are recognized in ICD-10 under the name of acute polymorphic disorder without symptoms of schizophrenia (F23.0) and with symptoms of schizophrenia (F23.1).
Objectives
Clinical case
Methods
We present the case of a 16-year-old patient with no psychiatric history, with medical background of epilepsy; she was in fllow-up by Neurology and in treatment with valproate.Neurology indicates to stop treatment; it is then whwn the patient begins to appear disoriented, confused, with significant anguish and lability and regressive behaviors.She has sudden mood swings (from laughing to crying); sudden changes in emotional reaction (from distress to anger) and sudden changes in behavior (from agitation to prostration); verbiage with pressure of speech and dysprosodia; delusional ideation and incongruous affect; visual, auditive and kinesthetic hallucinations with important repercussion. We request blood and urine tests, drug test, EEG, cranial MRI.
Results
She presents fluctuating, polymorphic and unstable affective and psychotic symptoms. What is the most appropriate diagnosis? We treat the patient with antipsychotic, mood stabilizer and anxiolytic treatment.
Conclusions
Psychopathology in early ages is not so clearly defined and it can take very different forms. The diagnosis of cycloid psychosis can be useful as well as necessary to describe certain patients with similar characteristics and different from other groups.
Disclosure
No significant relationships.
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