Combined Psychoses

COMBINED PSYCHOSES, combinations of different mental diseases in one person and at the same time. If we do not count complications of schizophrenia, manic-depressive psychosis, epilepsy and other psychoses with alcoholism, drug addictions, cerebral arteriosclerosis, hysterical symptoms and so on, then combined psychoses represent a very rare phenomenon. Such are, for example, the still questionable and extremely rare cases of progressive paralysis in circular patients* or lethargic encephalitis with its mental changes in schizophrenics and so on. The greatest interest lies in the question of whether diseases such as schizophrenia and manic-depressive psychosis can be combined. Modern psychiatry considers these two diseases as mutually exclusive, since one is characterized by progression, while the other represents a series of fluctuations around the same level; however, here the matter is more about the logical incompatibility of concepts than about the actual state of affairs. Clinically, the undoubtedly existing cases in which the features of both diseases are so mixed with each other that it is extremely difficult to make a diagnosis of either of them (Gaupp's and Mauz's 'mixed psychoses'). Their diversity is usually explained by the combination of two constitutional bases. In recent times, the term combined psychoses is used less and less frequently, as this formal-mechanistic concept is increasingly being replaced by the idea of the complex structure of any mental disease, the picture of which represents an indivisible whole (see Psychoses).