Esquizofrenia

Pseudoneurotic schizophrenia revisited
Karen O. Connor, Barnaby Nelson, Mark Walterfang, Dennis Velakoulis, Andrew Thompson

Objectives: ‘Pseudoneurotic schizophrenia’ was a diagnostic term coined in the 1940s by Hoch and Polatin. It described a subgroup of patients who presented with prominent anxiety symptoms, which masked a latent psychotic disorder. Pseudoneurotic schizophrenia as adiagnostic entity has fallen out of clinical use. Methods: Described herein is a case that meets the Hoch and Polatin definition of pseudoneurotic schizophrenia. Results: The history of the concept is reviewed and a discussion is given of why it was forgotten. Conclusion: The concepts that underlie the diagnostic entity of pseudoneurotic schizophrenia remain relevant to current practice. Recent findingsin patients with an emerging psychotic disorder lend modern support to the idea that schizophrenia may present with significant neurotic symptoms Key words: anxiety, borderline, pseudoneurotic, psychosis, schizophrenia. Australian and New Zealand Journal of Psychiatry 2009; 43:873 876

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‘Pseudoneurotic schizophrenia’ was a diagnostic term described in the 1940s by Hoch and Polatin todescribe a subgroup of patients who presented with prominent anxiety symptoms, which masked a latent psychotic disorder [1]. Pseudoneurotic schizophrenia as a diagnostic entity, however, has fallen out of clinical use and is not part of current classification systems. We describe a case that meets the Hoch and Polatin definition of pseudoneurotic schizophrenia, review the history of the concept and whyit was forgotten. Significantly, recent findings in patients with an emerging psychotic disorder lend modern support to the idea that schizophrenia may present with significant neurotic symptoms.
Karen O. Connor, Psychiatry Registrar (Correspondence); Barnaby Nelson, Clinical Psychologist and Research Fellow; Andrew Thompson, Consultant Psychiatrist and Honorary Senior Research Fellow ORYGENYouth Health, Poplar Road, Parkville, Vic. 3052, Australia. Email: karenoconnor2@hotmail.com Mark Walterfang, Consultant Neuropsychiatrist and Research Fellow; Dennis Velakoulis, Consultant Neuropsychiatrist and Clinical Director Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia Received 29 April 2009; accepted 5 May 2009.

Case report The patient was a 22-year-oldunemployed man living with his brother. He was referred to the psychiatric crisis team via the emergency department, having presented with a panic attack. At assessment he described a 6 month history of worsening low mood, insomnia, anhedonia, anergia, poor concentration and memory. He reported a number of somatic concerns, including constant thirst, neck lumps, unsteadiness of gait and concerns thathe may have acquired immunodeficiency syndrome (AIDS) or cancer. He was preoccupied with the idea that he was dying. His first panic attack, which precipitated his referral, lasted 1 h and was characterized by a discrete episode of sudden-onset shortness of breath, increased heart rate, diaphoresis and perceived chest tightness. Pre-morbidly, the patient was reported to be a very bright student butthere had been a marked decline in his functioning since his final year of schooling. He had been employed full-time as a shift worker in a factory until 2 months prior to presentation but had

# 2009 The Royal Australian and New Zealand College of Psychiatrists

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PSEUDONEUROTIC SCHIZOPHRENIA REVISITED

resigned, reporting that the work was too stressful. His father had a diagnosisof schizophrenia. Mental state examination indicated a pleasant and cooperative young man who frequently appeared perplexed. His affect was flat. His speech was coherent but with increased latency of response, reduced rate and poverty of content. He was tangential with pessimistic thought content and overvalued almost delusional ideas of guilt, failure and physical ill health. There was no...