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Position of affective symptomatology in the course of delusional psychoses
Abstract:
The present study investigates the frequency, gender distribution, mode of appearance, and prognostic value of affective symptoms in a group of 90 patients with paranoid disorders of various etiologies (with the exception of marked organicity) who underwent a follow-up control. It appears that affective symptoms manifest more frequently than the brunt of delusional and hallucinatory ones, whereby the pronounced differences in gender (preponderance of females) that appear in acute states disappear in the course of the illnesses. Altogether, the frequency of affective symptoms diminishes just as that of delusions and hallucinations. Paranoic syndromes (simple delusional syndrome with a logically organized structure corresponding to the classical concept of paranoia) are characterized by a particularly frequent occurrence of dysphoric (irritable) mood, systematic and unsystematic paraphrenias by a depressive mood. Delusion subsided in all three delusional entities in about 50% of the cases; however, defect develops in unsystematic paraphrenias more often to a statistically highly significant degree than in the other two forms. Despite the expected low stability of affective symptoms over longer periods of time, the presence of affective syndromes has a high prognostic value, even in a population characterized primarily by the presence of a mood-incongruent delusion. The results of this investigation suggest that Jaspers' hierarchical principle, still important for many diagnostic systems, according to which the presence of delusions and hallucinations is considered to be pathognomonic for schizophrenia and takes priority over any affective ones, be abandoned. The consequence this would have for the theoretical basis of the diagnosis of endogenous psychoses is that apart from affective syndromes only schizophrenic nuclear symptoms would form the basis of nosological diagnosis, and so-called productive symptoms (delusions and hallucinations) would be construed as a superstructure.