https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20001

Secondary psychoses: an update

The Royal Park Multidiagnostic Instrument for Psychosis (RPMIP) is a validity-oriented assessment procedure developed for the acute psychotic episode using serial interviews and multiple information sources to construct a data base of clinical information. A number of sets of operational criteria, including 11 definitions of schizophrenia and several concepts of atypical, schizoaffective, and affective psychoses, are simultaneously applied to the data base to produce a diagnostic profile for each patient that can be linked to other variables. This article describes the rationale for the development of the RPMIP and contrasts it with other assessment and diagnostic procedures. A companion article (Part II) presents data on interrater reliability and procedural validity, together with an account of the structure and development of the instrument.

/pdf/royal-park-multidiagnostic-instrument-for-psychosis-part-i-19jwt13ha7.pdf

Royal Park Multidiagnostic Instrument for Psychosis: Part I. Rationale and review.

The hypothesis that schizophrenia is a recent disease can explain why descriptions of schizophrenia-like disorders were rare before 1800, why the prevalence of insanity in the Western world increased during the 19th but remained low in the non-Western world until the 20th century, and why schizophrenia has become milder in the West during recent decades. It also explains why schizophrenia has 'persisted' in spite of its associated low fertility. The evidence for the hypothesis is somewhat frail, but perhaps not more so than that for alternative hypotheses.

Schizophrenia as a recent disease.

The authors present a literature review and a scientific commentary. The prevalence of depressive disorders in the elderly and their association with significant morbidity and mortality are discussed in relation to study of clinical heterogeneity, which may provide useful insights into etiologic and pathophysiologic variability. The authors summarize findings regarding clinical and associated features of late-life depression, explore the limitations of current factual knowledge and conceptual approaches, and propose directions for future research. They argue that current sample selection procedures minimize the variability of the very phenomena under study; therefore, few phenomenologic differences or risk factors for long-term outcome have been noted consistently. Factors such as medical illness account for much of the observed heterogeneity in presentation and outcome. Future studies must include a broader range of subjects and carefully examine in a multidimensional fashion a wider range of "comorbid" conditions, personality and social assessments, and neuropsychologic and neurobiologic measures. Such approaches will enhance our understanding of the pathophysiologic mechanisms of depression in the elderly and across the lifespan.

Reconsidering Depression in the Elderly.

Nineteenth century views on the interaction between dementia, depressive illness, general paralysis and brain localisation are discussed in the context of a book by A Mairet entitled: Melancholic Dementia. It is shown that by 1883 there was already awareness of the fact that severe affective disorder could lead to cognitive impairment. General paralysis was the commonest diagnosis put forward to account for patients with depression who went on to develop dementia. Patients so diagnosed, however, often recovered and clinical and statistical analysis of Mairet's case histories suggests that some were in fact suffering from depressive pseudodementia. Evidence is marshalled to show that during the 19th century there was wide disagreement concerning the clinical domain, course and even histopathology of general paralysis. This casts doubt on the traditional view that this condition served as "a paradigm" for other psychiatric diseases during this period. It is shown that by the turn of the century these difficulties led to a redefinition of the concept of dementia and to a marked narrowing of the clinical bounds of general paralysis.

https://jnnp.bmj.com/content/jnnp/48/5/393.full.pdf

"Depressive pseudodementia" or "Melancholic dementia": a 19th century view.

Dementia paralytica is a declining disease. Deaths due to it in England and Wales were first recorded by the Registrar General in 1901 and since that year, when the number was 2,272, the annual figure has fallen steadily until in 1957 it was only 68. Moreover, there is evidence (adduced below) that not more than a small part of this decline can be attributed to improvements in medical treatment. The fear that there might be a recrudescence of dementia paralytica as a result of the spread of syphilis during the second world war has not so far been realized and it seems likely that what is now, in Great Britain at all events, an obsolescent disease will soon become a rarity. Yet there are many unsolved problems in its history. We do not know, for example, why the alleged references to this striking disease were so few and so inadequate until the third decade of the nineteenth century. We do not know why its recognition in many countries was so tardy in spite of the clear description given by the French alienists. Nor do we know why the disease, which at the start of the nineteenth century seems to have been predominantly one of males, has gradually—and at different rates in different countries—become much more evenly distributed between the sexes.

E. H. Hare

Papers

The Origin and Spread of Dementia Paralytica