Course of Endogenous Affective Psychoses and its Modification by Prophylactic Administration of Imipramine and Lithium

Abstract

1. In spite of the wide-spread use of antidepressants during psychotic episodes, it is still true that the course of endogenous affective psychoses is characterized by a decrease of the average duration of the cycles with the increase in the number of episodes. In bipolar manic-depressive psychoses as well as in schizo-affective psychoses every subsequent cycle is shorter by 10 % than the previous one. The corresponding percentage for recurrent depression is 20 %. As schizo-affective and bipolar manic-depressive psychoses start with much shorter cycles, they definitely take a more malignant course than recurrent depression. 2. These courses can not be modified in severely depressed patients by long term Imipramine treatment. In spite of this medication the cycles get shorter and the rate of admissions to a hospital increases. 3. Lithium has genuine prophylactic properties. This result is based on 50 patients from Zurich and 41 patients from Prague. It increases the length of cycles significantly and decreases the rate of admissions by about a third when equal periods of time before and under Lithium medication are compared. It has prophylactic effects on the following diagnostic groups: schizo-affective psychoses, bipolar manic-depressive psychoses and endogenous recurrent depression. The results of Baastrup and Schou (1967) are thus confirmed by two other independent investigations.