[Operationalized diagnosis of schizoaffective and cycloid psychoses]

Case histories of 128 patients suffering from functional psychoses were evaluated. The operational definitions for schizoaffective psychoses (SAP) of Kendell, Welner, Spitzer (RDC) and Feighner were applied. Of the 30 cases of SAP based on ICD 8 (295.7), Kendell's criteria were fulfilled in 97% Welner's in 77%, Spitzer's in 70% and Feighner's in 30%. The highly sensitive criteria of Kendell are best qualified for delineating the schizoaffective (sa) syndroms, but have the disadvantage of not requiring a time limitation when examining the longitudinal course of the illness. In this respect, the Welner criteria which also demonstrate high sensitivity were found to be more appropriate for the disease concept of the ICD 8. When using the schizoaffective criteria, a striking overlap was found with catatonic schizophrenia (Kendell and Welner diagnosed 33% as sa), paranoid schizophrenia (Spitzer 39%, Kendell and Welner 28%) and mania (Kendell and Welner 50% sa diagnoses). Of the SAP only 30% satisfied Perris' criteria for cycloid psychoses. Except for catatonic schizophrenia (47% overlap), the cycloid psychoses could be well distinguished from the other psychoses. cycloid psychoses therefore should not form a subgroup of the SAP. Kendell's criteria were found to be best qualified for the determination of the schizoaffective group. A higher specificity of the disease concept SAP may be achieved if we use time limitations such as Welner's. To avoid placing cycloid psychoses in the SAP category, the Perris criteria should be applied. Because of their high specificity, the criteria of Feighner and Spitzer were found to be inappropriate. In DSM-III the definition of "psychotic disorders not elsewhere classified" is weak. It lacks an operational definition for SAP so that DSM-III was not used for this investigation. In order to obtain a more homogeneous population not only in the schizoaffective group, but also in both of the two major psychoses, we find it legitimate to maintain the schizoaffective group and, at the same time, recognize the exceptional position of cycloid psychoses as separate groups.