Conrads Model

The first stage model of the early course of schizophrenia was proposed by the Marburg-based psychiatrist Conrad [21], who studied 107 German soldiers admitted to a military hospital because of a mostly acute schizophrenic psychosis during World War II. On the basis of the symptoms and complaints reported by the patients, Conrad developed four - and a rarer fifth - stages of evolving and two stages of remitting schizophrenia.

Stage 1, called trema, could last for several years. Conrad described it as characterized by uncertainty, depression, anxiety, suspiciousness, first signs of attenuated delusions and social withdrawal. He likened what patients at this stage feel to the anxiety that takes possession of actors before entering the stage.

The next stage, apophany, brings forth strange experiences that the patients cannot explain, fully elaborated psychotic symptoms - hallucinations,

Table 1.1 Duration of the prephase of schizophrenia from onset (first sign, first psychotic symptom) until first contact or first admission (modified from Hafner et al. [10])

Duration from first Duration from first psychotic Study n sign (in years) symptom (in years)

Table 1.1 Duration of the prephase of schizophrenia from onset (first sign, first psychotic symptom) until first contact or first admission (modified from Hafner et al. [10])

Duration from first Duration from first psychotic Study n sign (in years) symptom (in years)

Gross [11]

290

3.5

Lindelius [12]

237

4.4

Huber et al. [13]

502

3.3

Loebel et al. [14]

70

2.9

1.0

Beiser et al. [15]

70

2.1

1.0

McGorry et al. [16]

200

2.1

1.4

Lewine [17]

97

1.9

Hafner et al. [18]

232

4.8

1.1

Johannessen et al. [19]

43

2.2

Ho et al. [20]

156

2.7

1.4

delusions, thought disorders etc. - and derealization. Insight and reality control are lost.

The third stage was called by Conrad anastrophae. It is characterized by formal thought disorder and a delusional-projective attribution of inexplicable experiences to external causes, which Conrad interpreted as secondary delusions in the manner of Bleuler. The fourth stage that the previous stage of increasing psychotic symptoms may lead to was called by Conrad apokalypse. It is identical to full-blown, severe psychosis associated with disorganization, severe anxiety, restlessness and catatonic symptoms.

Sometimes a fifth stage, catastrophae, follows, which shows increasingly severe psychotic symptoms, agitation, disorganization and concomitant physical phenomena. According to Conrad, catastrophae results in termínale, which usually ends in death. This final stage corresponds to the so-called pernicious or febrile catatonia. In those days, when antipsychotic treatment was lacking, it occurred fairly frequently as a consequence of desiccation, electrolyte imbalance, increased body temperature and protein catabolism in the muscles due to sustained and severe psychotic tension.

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