Search

A disease concept should be broad enough to provide social protection for all subjects suffering from this malady but at the same time it needs to be narrow enough to avoid pathologization of behavior that is merely socially undesirable. From a medical perspective a"disease" is present if functions are impaired that are relevant for individual survival. In the field of psychiatry and psychotherapy, such medically relevant functions include the ability to be alert and fully oriented, to ascribe one's own intentions to oneself and to modulate affects according to the situation. Beyond such medically relevant symptoms of a disease, any clinically relevant dysfunction should also be harmful for the individual if a mental malady is to be diagnosed. One such harmful consequence of a disease can be that the person feels ill and suffers from this state, another negative consequence for the individual can be due to an impairment of activities of daily living and social participation. These harmful consequences of a disease are usually discussed under the heading of the"illness experience" and the"sickness aspect" of any disorder. Beyond mental maladies characterized by disease symptoms that are accompanied either by an illness experience or impaired activities of daily living and social participation (sickness), there are many states of human suffering which can be objectified and classified but do not constitute a disease in the medical sense and should more aptly be named a disorder.

Background: The article defends an interpretation of mental illness as mental dysfunction. It develops a concept in line with the naturalistic viewpoint in the philosophy of medicine., Methods: The concept of mental function is scrutinized. Functions are regarded as effects of traits that enable an organism to live independently. The significance of this theoretical perspective for the psychiatric practice is discussed. Finally, the developed conceptualization is compared to the current edition of the diagnostic and statistical manual of mental disorders (DSM)., Results and Discussion: It is emphasized that the theoretical conceptualization of mental disorder determines what may justifiably and in a scientifically valid way be deemed a disease entity. Nevertheless, the practical perspective needs an additional element of individual well-being as not every mental dysfunction involves impairment in this respect. It is claimed that the DSM takes a perspective similar to the one defended in this article.

For the first time, the present study assessed the achievable predictive value of early self-experienced neuropsychological deficits for the fater development of schizophrenia. Ninety-six patients with DSM-III-R diagnoses mainly of the formerly neurotic or personality disordered field, of whom 81% had shown such basic disorders at the time of the index examination and therefore were classified as persons at high risk of developing schizophrenia, were re-examined for schizophrenia. After an average follow-up period of about 8 years, more than half of the re-examined sample had developed a schizophrenic disorder according to DSM-III-R. The outcome of schizophrenia versus no schizophrenia was predicted correctly in 77% of cases by the presence or absence of self-experienced disturbances of perception, thought, speech or action.

This paper evaluates the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of psychiatric disorders according to the "International Classification of Diseases" (ICD-10). Indications for CT/MRI can be derived from ICD-10 for the identification or exclusion of defined cerebral lesions resp. for the etiology in organic disorders. Due to the lack of specific morphological findings, CT/MRI do not contribute to the classification of all other diagnoses. CT/ MRI can only exclude causal organic factors. However, ICD-10 provides only few guidelines for ruling out cerebral pathology (e.g. tumors in bulimic anorexia). Therefore, recommendations for routine CT/MRI-investigations for the exclusion of organic disorders are required and might be developed by the quality assurance. Application of CT or MRI: CT plays an important role in diagnostic imaging in routine as well as in emergency situations (haemorraghe, hamatoma, infaction, head injury, tumour, vascular malformation). MRI on the other hand, is more sensitive in the diagnosis of inflammatory diseases, skull base lesions, degenerative changes of the white matter and in the imaging of hydrocephalus and epilepsy.

A high prevalence of obsessions and compulsions is recognized in patients with Gilles-de-la-Tourette syndrome. Comparison of a group of patients with Gilles-de-la-Tourette syndrome with a group with obsessive-compulsive disorder, using the diagnostic criteria of the DSM-III-R, showed significantly higher scores in both groups of patients in the Hamburg obsessive-compulsive inventory (short version) than in a control group. When selected items from this Inventory were entered in a discriminant analysis, it was shown that there were specific differences in the obsessive-compulsive symptoms in the Gilles-de-la-Tourette syndrome compared to an obsessive-compulsive disorder. Eighty-eight percent of the patients were correctly classified with respect to their diagnosis with eight items of the Hamburg obsessive-compulsive inventory. This result leads to the conclusion that differential observation of the psychopathology of obsessions and compulsions can contribute to the differential diagnosis in obsessive-compulsive disorder and Gilles-de-la-Tourette syndrome, which is still underdiagnosed in Germany compared to epidemiological data in the USA. Moreover, the different psychopathology may reflect differences between a neurotic and an organic basis for obsessions and compulsions.

The aim of the study was to find whether the c.I. test is useful for the exclusion and the demonstration of acquired cognitive deficits. In all, 195 patients with brain damage and 68 neurotic patients were examined with the c.I. test and with a comprehensive number of neuropsychological tests. The hit rate of the c.I.-test for the whole group was 67% and lay lower than the base rate of 74% brain damaged patients respectively only unessentially higher than the base rate of 64% patients with unambiguous acquired cognitive deficits. There were very low hit rates especially in patients with absent (46%) or low-grade cognitive deficit (54%) and with low (55%) or with high premorbid mental abilities (55%). Both the low correlations between the c.I. test and the validity criterion as well as the considerable overlapping of the c.I. test raw score distributions, grouped by grades of cognitive deficits, indicate serious deficiencies in the test. The extremely brief c.I. test possesses an inadequate grade of difficulty and cannot detect low- and medium-grade acquired cognitive deficits, and its orientation to ability-related global syndromes means that partial, multifactorial and general cognitive deficits are neglected. The c.I. test is therefore not useful as a screening method for the diagnosis of acquired cognitive deficits.

According to an influential trend within contemporary neurology, psychiatry should abandon terms like "organic brain syndrome" or "dementia", which are regarded as out-dated. Such terms which imply the questionable possibility of global disturbances of the psychic apparatus, should be replaced by a classification based on detailed neuropsychological analysis. The response of psychiatry to this challenge is essentially lacking. An examination of the reasons leads us to the methodological contradiction between categorical and global models. We consider that we here are not confronted by a decision between mutually exclusive alternatives but that the two models necessarily complement each other. From this it follows that only a biperspectivistic view is adequate to the matter under consideration. This is equally requisite both for psychiatry and neurology, though an accentuation of the one or the other perspective may be expedient for each individual syndrome.