[Therapy of subclinical (subdiagnostic) syndromes of schizophrenia spectrum]

Since 1911, when E. Bleuler thought of the so-called latent schizophrenia as the most frequent type of schizophrenia, but most seldom diagnosed as such, the question, whether there exist abortive forms of schizophrenia, was discussed again and again; so in 1932 by Mayer-Gross, who devoted to the uncharacteristic onset of schizophrenia a special chapter, in 1938 by Stern (so-called borderline neuroses) und in 1949 by Hoch and Polatin (pseudoneurotic schizophrenias). Since the 50s Huber had described by means of follow-up studies the uncharacteristic basic stages occurring long before the onset and after remission of the florid symptomatology, in 1957 the cenesthetic schizophrenia and in 1961 and 1966 the asthenic or pure defect of schizophrenia, which he also counts to the subclinical syndromes or formes frustes of endogenous psychoses just as the endogenous juvenile-asthenic failure syndromes, the larvate schizophrenia, the endogenous obsessive-compulsive disorder and the circumscribed cenesthopathy. The recognition of these subthreshold stages and types of the schizophrenia spectrum, which cannot be diagnosed by valid diagnostic criteria for schizophrenia, is the presupposition for an adequate therapy. The patients complain about subjectively experienced mainly dynamic, affective, cognitive (thought, perception and action disturbances), cenesthetic and vegetative basic symptoms, can be registered and documented by the Bonn Scale BSABS. We will deal with symptomatology, course and therapy of the mentioned sublinical syndromes. The psychopharmacological treatment is chosen according to the psychopathological cross-section picture and will be continued until improvement or remission of the symptomatology and after stepwise reduction stopped. If dynamic and affective basic symptoms predominate, we prefer antidepressants (e. g. amitriptyline-type or the newer SSRIs), in case of prevailing cognitive and cenethetic basic symptoms neuroleptics, today mainly atypical ones. In the past also classical neuroleptics, e. g. haloperidol, fluphenazine or pimozide in low dosage of or low potent drugs as thioridazine or perazine have proved to be worthwhile.