Hourglass model of psychiatric diseases: the endogenous psychoses.

On the basis of Jaspers' conception, a continuum of disease entities was earlier proposed. According to this linear disease model, a psychopathological syndrome, expanded with course of illness over a specified period of time (small disease entity) and with the etiopathogenesis (etiopathogenetical-syndromatological disease entity), can progress to the full disease entity. In empirical studies, variables indicating psychopathological disorders, on the one hand, and social maladjustment, on the other, form a relatively antagonistic open system in the outcome. Based on this finding and on the conceptions of multi-axial classifications, an hourglass model is proposed as a further development of the linear disease model. The proposed model reflects the intertwining of life history and case history, and offers the opportunity for both the elaboration of hypotheses that lend themselves to testing, and a synthesis of the biological and social psychiatric approaches.