Abstract
The introduction of potent physical and pharmacological therapies for psychotic conditions has increased the need for accurate diagnosis, not only in terms of assigning a patient to the diagnostic category but of assessing the various trends which may result in a very mixed symptomatology. Therapy, be it physical, pharmacological, or psychotherapeutic directed against one or the other of these components may frequently intensify other symptomatology. A suitable combination of anti-depressant and anti-psychotic drugs plus the use of E.C.T. when indicated is necessary in the management of such cases. In the author's judgment this mixed symptomatology frequently results from the influence of personality trends and conflicts and particularly in these mixed states psychotherapeutic aid must also be included. In the words of Jules Masserman: “Even frankly psychotic behaviour patterns, whether depressive or schizoid, are not as sometimes inferred-merely shapeless fragments from a personality shattered by some hypothetical ‘mental disease’. On the contrary, the psychosis itself is an integrated syndrome which however socially deviant is adaptively operated at all levels from the physiologic to the most abstrusely symbolic.” (3)