Hector Warnes’ comment
Ernst J. Franzek: From the dichotomy to a three-part grouping of endogenous psychoses
Beginning in 1957 with Karl Leonhard and continuing, particularly since the 1990s, a distinguished group of researchers has attempted to differentiate the Bipolar Disorders from the Cycloid Psychosis and the Systematic schizophrenias from the Unsystematic schizophrenias. Among them areFranzek (2017) andBeckmann (2000), Perris(1986) and Ban (1990); several from England; and Alberto Monchablon Espinoza from Argentina (2005).
Judging from Ernst Franzek’s latest essay (2017), these authors’efforts over several decades have succeeded and now the Cycloid Psychosis have been incorporated as a separate entity to the Clasificación de trastornos mentales(CIE 10) – ICD-10.
This newly established nosological entity has its historical foundations in the Bouffées delirantes ofMagnan (cited by Henry Ey  and P. Pichot );Wernicke’s (1990) Cyclic Psychosis of motility, along with Angst Psychosis, Confusional Psychosis, etc.; Kleist’s 1928 Randpsychosen (Marginal meaning: on the border of Bipolar Disorders), which included the Cycloid, Paranoid and Epileptoid Psychosis;E. Bleuler’s (1911) Acute Schizophrenia with good prognosis;the Periodic Catatonia of Kahlbaum; and Leonhard’s (1957) Cycloid Psychosis, at times difficult to distinguish from the Faegerman´s (1963) Psychogenic psychosis, Atypical Psychosis, Reactive Psychosis, Stress induced Schizophrenia and so on.
For Franzek, the issue of reliability of psychiatricdiagnosis was in general well established, whereas the issue of validity, long-term course, prognosis and outcome measures “has failed to materialize.” Franzek hasshown that between 10 and 20 % of all first admissions to a psychiatric hospital are Cycloid Psychosis or “Bouffée delirante.”Further, Morinigo Escalante (2003) showed a resemblance of the clinical state between the cycloid psychosis and the epileptic psychosis (already shown by Kleist), insofar as both have a sudden onset, with a fluctuating state or clouding of consciousness, frequent visual hallucinations, partial amnesia for the episode and restitutio ad integrum. Leonhard (1979) described three subtypes of the Cycloid Psychosis: Anxiety-Euphoria, the Confusional and the Motility type (perplexity, pananxiety, ecstatic feelings, amnesia, hyperkinesia, hallucinations and mood incongruent delusions).
Morinigo Escalante (2003) hasshown focal dysrhythmias in the EEG of these patients with increased slowing of electrical activity, frequent theta waves and isolated delta waves mostly from the brain stem and thalamo-cortical projections. In contrast with Bipolar and core Schizophrenia, the vertical genetic loading for cycloid psychosis was found to be low.
Genetic studies carried out by the research team of C.R.Cloniger at the Washington University School of Medicine in San Louis, MO (Arnedo et al. 2015), have shown single nucleotide polymorphism in 4,200 patients with schizophrenia compared with 3,800 healthy controls. Individual genetic variations interact with each other to determine eight qualitatively distinct disorders based on the underlying genetic condition. Since the diagnosis of Cycloid Psychosis has not been included in the DSM 10 it is likely that the diagnosis of schizophrenia includes the diagnosis of Cycloid Psychosis, at least in the USA.
From Wernicke’s(Miller and Denison 2015)search for cerebral localization, specific pathways, dysfunctional circuitry and focal brain lesions, we are reaching the point of constructing another portion of the spectrum disorders with an indeterministic, epigenetic or multifactorial model of mental disorders and an unrelenting shift to the underlying neural and developmental factors.
Arnedo J, Svrakic DM, Del Val C, Romero-Zaliz R, Hernández-Cuervo H; Molecular Genetics of Schizophrenia Consortium, Fanous AH, Pato MT, Pato CN, de Erausquin GA, Cloninger CR, Zwir I. Uncovering the hidden risk architecture of the schizophrenias: confirmation in three independent genome-wide association studies.Am J Psychiatry. 2015 Feb 1;172(2):139-53.
Ban T A. Clinical pharmacology and Leonhard's classification of endogenous psychoses. Psychopathology 1990; 23:331-338.
Beckmann H, Franzek E. Das Konzept der zykloiden Psychosen und ihre Abgrenzung von affektiven und schizophrenen Psychosen. In: Helmchen H, Henn F, Lauter H, Sartorius N (Hrsg). Psychiatrie der Gegenwart. Berlin Heidelberg New York u.a., Springer, 2000.
Ey, H. Les bouffées délirantes et les psychoses hallucinatoires aiguës. Ëtude no. 23. In Études Psychiatriques vol. 3, 1954. Paris, Desclée de Brouwer, pp. 203-224.
Faegeman P. Psychogenic Psychoses, a description and follow up of Psychoses following psychological stress. London, Butterworths, 1963.
Franzek, E. From the dichotomy to a three-part grouping of endogenous psychoses. INHN.org.12.21.2017.
Kleist K. Über cycloid, paranoid und epileptoid psychosen und über die frage der degeneration psychosen. Schweizer Archive für Neurologie und Psychiatrie 23; 1-35, 1928.
Leonhard K. The classification of endogenous psychoses. 5th edition. New York, Irvington Publisher, 1979.
Monchablon Espinoza A, Derito MNC, Martinez Rodriguez, G. Las Psicosis cicloides según Karl Leonhard—Tratado de Psiquiatría Vol. 1. Chapter 40 (Eds) Néstor Marchant- Alberto Monchablon Espinoza. Grupo Guía, Buenos Aires, 2005.
Morinigo Escalante, J. Compendio de Psiquiatría. Imprenta Salesiana, 2003.
Perris C. The Case for the Independence of Cycloid Psychotic Disorder from the Schizoaffective Disorders. In: Marneros A, Tsuang M T (Hrsg). Schizo-affektive Psychoses. Berlin Heidelberg, Springer, 1986.
Strömgren E. Psychogenic Psychoses. In: Hirsch S. and Shepherd M.: Themes and variations in European Psychiatry. Bristol, John Wright and Sons, 1974.
Wernicke C. (editors and translators Robert Miller and John Denison). An Outline of Psychiatry in Clinical Lectures. The Lectures of Carl Wernicke. (1stedition) Springer International Publishing, 2015.