[Schizophrenic psychoses with bipolar course--implications for nosology and treatment]

Based on a description of the psychopathological symptoms and clinical course of three patients, the diagnostic classification of schizophrenia, schizoaffective disorder and bipolar affective disorder is discussed. The reported cases are characterised by a rapid change of cognition, affect and psychomotor domain with fluctuations in two opposite directions and an incomplete remission of symptoms between acute episodes of illness. Such cases are not adequately represented in the current diagnostic systems ICD-10 and DSM-IV. This renders both the diagnostic classification and the development of evidence-based treatment guidelines more difficult. In accordance with the historical concepts of Emil Kraepelin and Kurt Schneider, the reported patients can be considered to suffer from a subtype of schizophrenia with bipolar course. The identification of such psychopathological course types could help to develop more concise and individualised treatment guidelines. In contrast, the characterisation of the reported cases using dimensional models seems doubtful.