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Original Paper

Towards an Empirically Based Validation of Intuitive Diagnostic: Rümke’s ‘Praecox Feeling’ across the Schizophrenia Spectrum: Preliminary Results

Grube M.

Author affiliations

Klink für Psychiatrie und Psychotherapie, Städtische Kliniken Frankfurt a. M., Akademisches Lehrkrankenhaus der Universität Frankfurt, Frankfurt a.M., Germany

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Psychopathology 2006;39:209–217

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 09, 2004
Accepted: July 14, 2005
Published online: August 15, 2006
Issue release date: August 2006

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 6

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: http://www.karger.com/PSP

Abstract

Background: The early identification of schizophrenia is important in establishing an adequate therapeutic intervention, especially in emergency situations. Intuitive reasoning is often necessary because a standardized classification according to ICD-10 or DSM-IV criteria is not suitable in these complex, and often changing, settings. The process of recognizing the specific schizophrenic structure in an intuitive way by an experienced psychiatrist was named ‘praecox feeling’ by the Dutch psychiatrist Rümke in 1941. Sampling and Methods: To evaluate the diagnostic quality of this kind of intuitive clinical approach we investigated 67 previously unknown patients. All patients displayed acute psychotic symptoms like paranoid delusions and hallucinations belonging to the schizophrenic spectrum. The first interview by an experienced psychiatrist included only the present state psychopathology. Data referring to the course of the illness or medication or family history of schizophrenia were explored later by other independent staff members who were blind to the aim of the investigation. The intensity of the ‘praecox feeling’ was rated in four degrees: not present – mild – moderate – high. At the end of the inpatient period a standardized diagnostic classification according to ICD-10 and DSM-IV classification was carried out by independent raters. Results: Compared to the standardized diagnostic classification the precision of the intuitive reasoning was remarkably high with a sensitivity of about 0.85, a specificity of about 0.80, a positive predictive power of about 0.90, and a negative predictive power of about 0.65 depending on the standardized system used. Cognitive impairment, affective disturbances, disturbed self-perception, and reduced communication skills all correlated with intensity of ‘praecox feeling’. The single variable ‘affective disturbances’ had the highest impact on the intensity of ‘praecox feeling’ in an ordinal regression analysis. Furthermore a high intensity of ‘praecox feeling’ strongly correlated with a hereditary predisposition to schizophrenia. Neither the severity of the mental illness nor extrapyramidal side effects of the medication correlated with the intensity of ‘praecox feeling’. Conclusion: Our work can possibly help in contributing to reflection on our diagnostic practices and help to make the various factors involved in establishing diagnoses apparent.

© 2006 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 09, 2004
Accepted: July 14, 2005
Published online: August 15, 2006
Issue release date: August 2006

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 6

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: http://www.karger.com/PSP


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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