Although the problem ofoptimal duration is always present in the mind of psychiatrists treating psychotic patients and is, in one or other of its various aspects, the subject ofmany publications, it is rarely considered as a whole.

Functional psychoses

It is generally accepted that functional psychoses consist of four main categories of psychotic disorders without any demonstrable organic aetiology: (a) affective psychoses, with manic-depressive psychosis as the main clinical entity; (b) schizophrenia, with its various clinical subcategories; (c) paranoid states of non-schizophrenic nature; and, (d) acute paranoid episodes frequently classified as acute schizophrenia. As conditions classified in the fourth category are by definition acute, they are not part of the question under discussion.

Long-term treatment

It is of course necessary to agree on the length of time implied by long-term. It can be suggested that it means at least 12-18 months.

Optimal duration

The notion of an optimal duration is itself closely linked to the objectives of psychiatric treatment. These objectives are the disappearance or alleviation of the symptoms and suffering of the patient, the correction of his pathological patterns of behaviour and the recovery of his best possible ability to function at the individual and social level.

The duration of treatment is considered optimal if these objectives are achieved in the shortest period of time. In practice, in the majority ofcases, they can only partially be attained and the results are only relatively good.

Modem psychiatry has at its disposal a wide spectrum of therapeutic means ranging from specific antidepressant, antimanic and antischizophrenic drugs on the one hand, to a wide range of psychotherapeutic, institutional and community-care possibilities on the other, whose development has paralleled that of modern biological treatments.

As a rule, in modem psychiatry, the combined use of all available methods (either simultaneously or in succession)leads to better results than the best results obtained from anyone of them alone. Despite this fairly well established fact, therapeutic creeds or preferences frequently lead to the misuse or abuse of one or other of these modern therapies.

Affective psychoses

The characteristic clinical feature of manic-depressive psychosis, the main clinical entity of this category of functional psychoses, is the occurrence at variable intervals of manic or depressive episodes in the bipolar type, or of depressive episodes alone in the unipolar type.