Search

Introduction: In his classic essay "The phenomenological approach to psychopathology", Karl Jaspers defended the irreducible reality of the "subjective" mental symptoms and stressed the pivotal role of empathy in their diagnostic assessment. However, Jaspers' account of the epistemological role of empathy in psychopathological diagnosis was far from clear: whereas at several places Jaspers claimed that empathy provides a direct access to patients' abnormal mental experiences, at other places he stressed that it did so only indirectly, through a whole battery of their observable clinical indicators. The aim of this paper is to reassess Jaspers' account of the epistemological role of empathy in psychopathological diagnosis. Methods: I examine thoroughly Jaspers' assertions on in the role of empathy in the diagnosis of "subjective" symptoms. Moreover, I explicate briefly the epistemological status of psychopathological diagnostic examination with the aid of the distinction between direct and indirect observation. Results: Diagnostic assessment of "subjective" mental symptoms involves necessarily indirect psychopathological observation. Jaspers' ambiguity is traced to his failure to distinguish clearly between direct and indirect psychopathological observation along with his excessive reliance on empathy. Relatedly, Jaspers' ambiguity is also traced to his conflation of the semantics with the epistemology of psychopathological concepts representing patients' "subjective" mental symptoms. These results apply also to contemporary phenomenological approaches to psychopathological diagnostic examination which maintain that patients' abnormal mental experiences are invariably expressed in their overt behavior. Conclusions: Jaspers was right in stressing that psychopathological concepts of subjective mental symptoms represent patients' genuine abnormal experiences irreducible to concepts representing their associated behavioral manifestations. Moreover, he was right in stressing the importance of the empathic 'second person' approach to patients' mental experiences. However, he failed to recognize unambiguously that the epistemological access to patients' mental symptoms, though enormously aided by empathy, remains mainly indirect and thus requires also a 'third person' approach to them. Overall then, clinical psychopathological examination requires both a 'second' and a 'third' person approach, as well as their judicious alternation during the diagnostic interview. Although focused on Jaspers' essay, my critical analysis is also highly relevant to contemporary psychopathological approaches aiming to overcome the serious limitations of currently prevailing systems of diagnostic criteria of mental disorders. [ABSTRACT FROM AUTHOR]

Background: Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky - especially for acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would have jeopardized a patient whose physical condition was already compromised by DM. Methods: We report the case of a 55-year-old female with a history of type-1 DM since the age of 11, and severe ocular and renal vascular complications thereof. While on the waiting list for pancreatic islet cell transplantation, she developed a manic episode that proved recalcitrant to a treatment with gabapentin, lorazepam and quetiapine. Moreover, her mental state affected adversely her already compromised glycemic control, requiring her psychiatric hospitalization. Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day for 10 days. Results: The patient's mental state improved steadily and on discharge, 3 weeks later, she showed an impressive improvement rate of over 70% on the YMRS. Moreover, she remains normothymic 6 months after discharge, with OXC at 1200 mg/day. Conclusion: Standard prescribing guidelines for acute mania recommend a combination of an antipsychotic with lithium or, alternatively, a combination of an antipsychotic with valproate or carbamazepine. However, in our case, administration of lithium was at least relatively contra-indicated because of patient's already compromised renal function. Furthermore, antipsychotics increase glucose levels and thus were also relatively contra-indicated. Moreover, the imminent post-transpantation immunosupressant treatment with immuno-modulating medicines also contra-indicated both valproate and carbamazepine. Despite the severe methodological limitations of case reports in general, the present one suggests that OXC as monotherapy might be both safe and efficacious in the treatment of acute mania in patients with early-onset type-1 DM, whose already compromised physical condition constitutes an absolute or relative contraindication for the administration of standard treatments, though there are no, as yet, randomized clinical trials attesting to its efficacy unambiguously. [ABSTRACT FROM AUTHOR]

Background Delusional Misidentification Syndromes (DMSs) have been observed in a variety of psychiatric and other medical conditions but they seem to be strongly associated with schizophrenia since they occur predominantly in the context of paranoid schizophrenia. Previous studies about a neuropsychological relationship between DMSs and schizophrenia have implicated cognitive functions performed by bilateral frontal and right hemisphere in both schizophrenia and DMS, but there are mainly case reports, lacking the appropriate controls. Aim of the present study was to investigate whether DMS in paranoid schizophrenia is mediated by a distinct neuropsychological substrate indicative of differential bilateral frontal and right hemisphere dysfunction. Materials and methods The sample of the study included 44 right-handed schizophrenic patients, 22 of them with DMSs and 22 without previous history of DMMs, matched for gender, age, education, severity and duration of illness. Both groups were on medication with comparable doses of atypical antipsychotics. The neuropsychological battery used was designed to assess cognitive functions mainly associated with right hemisphere and frontal lobe areas. DMMs were active and their counterparts were also deluded at the time of neuropsychological assessment. Results No statistically significant differences were found between the two groups in terms of their mean performance in all neuropsychological tests. Both groups showed evidence of dysfunction in frontal and right cerebral regions. Conclusions Our findings show evidence of right hemisphere and frontal lobe dysfunction of equal severity in both groups of paranoid schizophrenic patients with and without DMS and suggest that DMS and paranoid schizophrenia share the same neuropsychological substrate. [ABSTRACT FROM AUTHOR]