Periodic Psychoses

PERIODIC PSYCHOSES, a concept that at the present time has only historical significance. By periodic psychoses was meant a group of mental diseases, extremely different in their clinical manifestations, but possessing one and the same common feature, consisting in the spontaneous repeatability of attacks of the disease at specific, often quite regular intervals of time. This spontaneous repeatability, the periodicity of the psychosis, was strictly distinguished from the simple recurrence of a non-periodic psychosis. Authors (Magnan, Kirn, Krafft-Ebing, Korsakov, Serbsky) list a whole series of signs by which, with a greater or lesser degree of probability, one can assume that one is dealing not with a simple, but with a periodic psychosis. These signs include similarity in the course of individual attacks, their rapid onset and termination, the presence in the intervals between attacks of certain pathological features of mental activity, the presence during attacks of accompanying vasomotor phenomena, etc. The scope of the concept of periodic psychoses varied among different psychiatrists and at different times. The main core of periodic psychoses remained the future manic-depressive psychosis of Kraepelin, which entered into it in the form of separate diseases, such as periodic mania, periodic melancholia, and circular or circular psychosis. In addition, most authors included in periodic psychoses periodically occurring forms of amentia and paranoia (periodic delusional insanity and periodic acute paranoia of Korsakov). Thus, the existence of simple mania, simple melancholia, simple amentia was recognized, and alongside them, having nothing in common with them, periodic mania, periodic melancholia, periodic amentia, etc. The differential diagnostic signs, important in the sense of prognosis, were considered to be precisely the features of periodic psychoses listed above; Krafft-Ebing also classified periodically arising pathological impulses (dipsomania, sexual pathological impulses) as periodic psychoses. Psychoses occurring periodically during menstruation were also referred to periodic psychoses, but not to their “idiopathic” group, but to the “sympathetic” one, i.e., caused by “peripheral processes of irritation.” Most authors considered the prognosis for each individual attack of periodic psychosis to be favorable, admitting in some cases a transition over the years into a state of mental weakness, understood as acquired due to mental exhaustion. There were disputes among authors regarding whether periodic psychoses should be classified as “degenerative” (i.e., arising on the basis of hereditary “degeneration”) psychoses or not. The majority inclined toward the first view. Kraepelin's manic-depressive psychosis absorbed periodic mania, periodic melancholia, and circular psychosis, as well as partially periodic amentia and periodic paranoia. The destruction of the entire group of periodic psychoses met with the same resistance as the introduction of “dementia praecox.” It is characteristic that even in a psychiatry textbook from 1912, Serbsky, defending the existence of periodic psychoses, subjects Kraepelin's teaching to sharp and caustic criticism, contrasting the unified, but vague manic-depressive psychosis with clear (in his opinion) and clinically verified individual diseases from the group of periodic psychoses. The concept of periodic psychoses as having a special, inherent course, as a special nosological unit, must be distinguished from the concept of periodicity as a symptom inherent in some both mental and somatic diseases due to the repeated return of the same physiological (resp. pathological) states; thus, emotional states in general are characterized by fluctuations in intensity, and the return of their pathological expressions is also inherent; periodically, epileptic clouding of consciousness, etc., can repeat, but this periodicity in itself does not determine the pathogenesis, as was assumed regarding periodic psychoses.