An analysis of Wernicke's original case records: his contribution to the concept of cycloid psychoses

Abstract

In order to compare Carl Wernicke's psychiatric system with his clinical practice we conducted an analysis of historical case notes. All 889 preserved records at Halle University Hospital from the time of Wernicke's directorship (1904-1905) were quantitatively evaluated, including diagnostic, demographic and clinical features. We focused on three diagnoses specific to Wernicke's nosology: 'motility psychosis'. 'anxiety psychosis' and 'expansive autopsychosis due to autochthonous ideas'. These three entities were further developed by Kleist and Leonhard into the concept of cycloid psychosis. We set out to ascertain whether the three 'Wernickean' diagnoses can justly be regarded as predecessors of cycloid psychosis. The findings show that motility psychosis and anxiety psychosis can be regarded as predecessors of cycloid psychosis only with reservations. The demographic features resemble those of cycloid psychosis, but there was considerable overlap with other disorders, especially between anxiety psychosis and organic disorders and between motility psychosis and deteriorating psychotic disorders. Expansive autopsychosis was mainly diagnosed in the context of neurosyphilis and shows little resemblance to cycloid psychoses.