Probleme und Konzepte der Lithium-Forschung aus psychologischer Sicht

 

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Abstract

In psychological lithium research one is not only confronted with diverging findings, very heterogenous objects and methods, but also completely different theoretical frames of reference. Three concepts can be distinguished: lithium is considered as a chemical substance leading to biochemical changes which are responsible 1) for the disappearance or non-manifestation of the affective psychosis, 2) for physiological changes, and 3) for changes of so-called normal psychological functions. Within the context of lithium induced effects on normal psychological functions different scientific aims can be distinguished: either the relevance of psychic effects for the performance of daily activities is considered; or special indications such as aggressiveness are searched for; or normal psychic functions are examined as a model for psychotic processes. Most authors have investigated psychic effects of lithium as single phenomena not related to each other, nor to unchanged normal psychological functions. It is, however, rather unlikely that psychotropic drug effects would not develop their own dynamics, influencing other psychic functions. From a psychological point of view three conceptual possibilities may be distinguished: 1) Lithium induced direct effects on psychotic symptoms interfere with other psychotic symptoms or with non-psychotic processes. 2) Lithium-induced direct effects on normal psychic functions during the free interval of patients or in normal volunteers interfere with other psychic functions. 3) Lithium-induced effects on normal psychic functions are related to the prophylactic response (prophylactic relationship). The prophylactic relationship can be interpreted in three ways according to the chosen protocol: 1) Predictors can be obtained for the prophylactic response. 2) Psychological changes acting as condition for lithium prophylaxis may be found. 3) Factors relevant for the etiology of the psychosis may be elucidated. Such etiological factors might be found for instance within the concept of the "typus melancholicus" of Tellenbach. Independent of the actual findings of empirical studies a theoretical question always arises, i.e. whether psychotic phenomena should be conceived as something categorically different from normal psychological phenomena. This question cannot be answered empirically, because in every description this question is always implicitly decided. And this decision determines the possible methodological approaches towards single phenomena or complex models. If psychopathological phenomena are conceived as something which is not categorically different from normal psychic processes, then, these phenomena can only be specifications of phenomena known within general psychology. It must, then, be possible to describe them by general psychological theories, though with those specifications distinguishing the psychopathological from the non-pathological phenomena. Thus, the typus melancholicus and the depression would then be conceived as specifications of normal psychic processes. A conditional relationship between primary personality and psychosis would, then, be possible from a theoretical point of view, because a conditional relationship requires a general substantial concept connecting condition and what is conditioned.

Zusammenfassung

In der gegenwärtigen psychologisch interpretier baren Lithium-Forschung sind unthematisierte heterogene Inhalte, Methoden und theoretische Bezugsrahmen erkennbar. Es werden die aus den theoretischen Bezugsrahmen entspringenden Forschungskonzepte und bestehende und neu entwickelte Interpretationsmöglichkeiten aufgeführt und klassifiziert. Zudem wird die Abhängigkeit der psychologischen Theorien der Lithium-Prophylaxe und der psychologischen Ätiogenese der Psychosen von der Begriffsmethodik und dem sachlogischen Verhältnis der Primärpersönlichkeit zur Psychose dargestellt.