This contribution to a symposium on our ability to affect the course of psychiatric illnesses deals with psychopathology and uses a syndrome-oriented approach. The core of the idiopathic syndromes consists of the bipolar affective psychoses, including the predominantly affective-psychotic psychoses of the schizoaffective borderland. The underlying dynamic constellation is determined by restriction and expansion, whereas schizophrenic phenomena arise when the dynamic becomes unstable. One can differentiate between the central affect-psychotic type, the purely depressive dysphorias, and the schizophrenic syndromes which are complicated by a dynamic insufficiency and a structural change and which are normally no longer completely reversible. The real psychotic core of the idiopathic syndromes on which the thymotropic drugs act, lies in the derailments of the psychic dynamic of the three types: restriction, expansion and instability. Within the structural-dynamic framework the psychotic derailments and personality with its biographi cal and situational background are closely linked. The cope and limitations of the treatment of the idiopathic syndromes are discussed from a structural-dynamic viewpoint.

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© 1980 S. Karger AG, Basel
1980
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