Insuficiencia de la identificación psicopatológica en un caso de esquizofrenia no procesual / Insufficiency of psychopathological identification in a case on non-processual schizophrenia

Se presenta un caso clínico de esquizofrenia no procesual y primariamente no productiva, pero cuyo desarrollo evolutivo y manifestaciones sintomáticas de alteraciones de la vivencia del «yo» resultan prototípicas del cuadro que representan, a pesar de lo cual el caso permaneció sin diagnóstico a lo largo de toda una década de observación. A través de la exposición de la paciente se ejemplifica cómo la práctica clínica disocia la teoría de la experiencia del enfermo. La consiguiente discusión, elaborada desde la historia conceptual y del self en la esquizofrenia, sugiere que los fenómenos subjetivos que se manifiestan en estos enfermos no son abarcables a través de los criterios operativos vigentes en la psiquiatría, pero tampoco desde un criterio unificador en torno a un enfoque nuclear exclusivo que pretenda dar cuenta de la causa última. Todo ello remite hacia la insuficiencia de la psicopatología como mera semiología y la necesidad de una práctica psicopatológica capaz de poner en activo los rendimientos de la teoría (AU)

A case of non-processual and primarily non-productive schizophrenia is presented. However, its evolutive development and clinical manifestations of «self» experiences alterations are prototypic of the picture they represent. Nevertheless, this case was not diagnosed during more than one decade of observation. The presentation of this patient's case history shows how clinical praxis dissociates the theory of schizophrenia from the patient's experience. The discussion elaborated from the conceptual history and the self in schizophrenia suggests that the subjective phenomena manifested in these patients cannot be approached by the present applicable operatives criteria in psychiatry nor from a unifying criterion based on an exclusive nuclear approach that aims to explain the final cause. All of this refers to the insufficiency of psychopathology as mere semiology and raises the need for a psychopathological praxis that can implement the results of the theory (AU)

Sobre el lugar del síndrome de Ganser en la nosotaxia: una muestra de la dificultad en la práctica psicopatológica / On the place of Ganser syndrome in nosology: an example of the difficulty of clinical practice in psychopathology

El texto que sigue trata de poner de manifiesto las limitaciones implícitas del proceder psicopatológico al uso, a través de la presentación de un caso clínico de síndrome de Ganser que resulta especialmente útil para dicha tarea. Nos referimos a este trastorno por lo controvertido de su naturaleza y porque el paciente en concreto evidenció, como tantos otros, las dificultades diarias con las que se enfrenta la psiquiatría, en especial cuando se salen de la norma o impiden un pensamiento simplista y estructurado en forma de las clasificaciones que empleamos habitualmente. El paciente con síndrome de Ganser es desconcertante y provoca en el médico observador diferentes reacciones y, sobre todo, la duda y la incertidumbre de lo incomprensible, en términos sintomáticamente determinantes. Para su enfoque se revisa la bibliografía concerniente, y se discuten las opiniones enfrentadas a lo largo de la historia del trastorno y, en especial, lo concerniente a la nosología y el origen psicótico, histérico u orgánico del cuadro, analizando la situación actual y extrapolando la problemática planteada al resto de patologías psiquiátricas conocidas

The present text aims to highlight the limitations implicit in currently used psychopathological procedures through a case report of Ganser's syndrome, which is especially suitable for revealing these limitations. This case is reported because of its controversial nature and because, like so many other patients, the patient illustrated the difficulties encountered daily in psychiatry, especially when patients are atypical and do not fit into commonly used classifications. Patients with Ganser syndrome are disconcerting and provoke different reactions in psychiatrists, especially doubt and uncertainty since these patients cannot be understood in terms of established symptomatology. As a focus, we review the relevant literature and discuss the various opinions held on this disorder throughout its history and, especially, that concerning nosology and whether the origin of the disorder is psychotic, hysterical or organic. The current situation is analyzed and the problems posed by Ganser's syndrome are extrapolated to all known psychiatric disorders

El delirio como metáfora psicopatológica / Delusion as psychopathological metaphor

La equivocidad que posee el término delirio ha hecho que haya sido considerado un mero artefacto. En este trabajo se pretende considerar su significado como una metáfora psicopatológica para poder pensar las relaciones del hombre con la realidad distorsionadas. Para ello es menester comprender adecuadamente el significado del concepto de hombre y, desde ahí, observar las relaciones que el hombre establece con la realidad. Esta relación siempre es una pretensión de verdad, aunque no exclusivamente judicativa como se la entiende de forma habitual. Desde ese momento, una serie de fenómenos psicopatológicos aparentemente inconexos y extraños entre sí se pueden articular en vista de esa relación esencial veritativa. Dicha relación ha sido sometida a serias y profundas consideraciones filosóficas a lo largo del siglo XX, y no ha dejado de ofrecer su impronta en el concepto psicopatológico de delirio. Esa equivocidad del delirio, finalmente dependiente de una psicopatología que se entiende respecto a una idea de hombre insatisfactoria, puede ser aclarada en función de una mejor y más depurada práctica psicopatológica puesta al día, en lo que respecta a su idea de subjetividad y verdad

The equivocity of the term delusion has led to it being considered a mere artifact. In this study, its meaning is considered as a psychopathological metaphor to be able to consider the relationships of man with the distorted reality. To do so, the meaning of the concept of man must be adequately understood, and based on this, observe the relationships that man establishes with reality. This relationship is always an aspiration to truth, although not exclusively as judicative as is usually understood. From this time, a series of apparently unconnected and rare psychopathological phenomena can be joined in view of the essentially veritative relationship. This relationship has been subjected to serious and deep philosophical considerations during the XX century and has left its mark on the psychopathological concept of delusion. This equivocity of delusion, finally dependent on a psychopathology that is understood in regards to an unsatisfactory idea of man, may be explained based on a better and more purified psycholopathological practice that is up-dated in regards to concepts of subjectivity and truth

Delusion as psychopathological metaphor.

The equivocity of the term delusion has led to it being considered a mere artifact. In this study, its meaning is considered as a psychopathological metaphor to be able to consider the relationships of man with the distorted reality. To do so, the meaning of the concept of man must be adequately understood, and based on this, observe the relationships that man establishes with reality. This relationship is always an aspiration to truth, although not exclusively as judicative as is usually understood. From this time, a series of apparently unconnected and rare psychopathological phenomena can be joined in view of the essentially veritative relationship. This relationship has been subjected to serious and deep philosophical considerations during the XX century and has left its mark on the psychopathological concept of delusion. This equivocity of delusion, finally dependent on a psychopathology that is understood in regards to an unsatisfactory idea of man, may be explained based on a better and more purified psycholopathological practice that is up-dated in regards to concepts of subjectivity and truth.

[A crucial moment of psychopathology: Heidegger's review of Jaspers' Psychology of the conceptions of the world]. / Un momento crucial de la psicopatología: la revisión de Heidegger de la Psicología de las concepciones del mundo de Jaspers.

From the current status of psychopathology abolition, in behalf of a reductionist and non-satisfactory empiricism that has overwhelmed psychiatry in a sterile paralysis, we question its origin, discovering in Jaspers the methodological problems that made him unable to assume obstacles and led us to the present situation. Matching Heidegger's review on Psychology of the conceptions of the world, we are tracing the criticism to that methodology, in an attempt to approach the model of a new empiricism for psychopathology that solves the current situation. We use this occasion to pursue the tracks followed by one of the confronted attitudes or another that we consider a psychopathology crossroad. We are investigating the consequences and alternatives derived for that new task in present time, once these methodological positions have been assumed.

Un momento crucial de la psicopatología: la revisión de Heidegger de la Psicología de las concepciones del mundo de Jaspers / A crucial moment of psychopathology: Heidegger’s review of Jaspers’ Psychology of the conceptions of the world

A partir de la constatación de la abolición de la psicopatología en la actualidad en favor de un empirismo reduccionista e insatisfactorio, que ha sumido a la psiquiatría en una parálisis estéril, nos interrogamos por el origen de tal situación y descubrimos en Jaspers las dificultades metodológicas que, en gran medida, nos han llevado a esta situación. Con ocasión de la revisión de Heidegger de su obra Psicología de las concepciones del mundo rastreamos la crítica a esa metodología en el intento de aproximarnos al bosquejo de un nuevo empirismo para la psicopatología que remedie la actual situación. Aprovechamos la ocasión para perseguir los caminos seguidos desde una u otra de las posturas enfrentadas en lo que consideramos una encrucijada de la psicopatología, y consideramos las consecuencias y las alternativas que se derivan para la nueva tarea en la actualidad una vez asumidas esas posiciones metodológicas

From the current status of psychopathology abolition, in behalf of a reductionist and non-satisfactory empiricism that has overwhelmed psychiatry in a sterile paralysis, we question its origin, discovering in Jaspers the methodological problems that made him unable to assume obstacles and led us to the present situation. Matching Heidegger’s review on Psychology of the conceptions of the world, we are tracing the criticism to that methodology, in an attempt to approach the model of a new empiricism for psychopathology that solves the current situation. We use this occasion to pursue the tracks followed by one of the confronted attitudes or another that we consider a psychopathology crossroad. We are investigating the consequences and alternatives derived for that new task in present time, once these methodological positions have been assumed

El lenguaje como problema nuclear de los trastornos generalizados del desarrollo: una contribución al problema del significado / Language as a central problem in pervasive developmental disorders: a contribution to the problem of meaning

Este trabajo nace al estudiar las estrategias para relacionar la sintomatología del autismo/trastornos generalizados del desarrollo (TGD) con el desarrollo de competencias lingüísticas. Este hecho ha tenido lugar desde el inicio de la definición del trastorno y, a nuestro entender, es del todo pertinente. La perspectiva dominante sobre la cuestión hace descansar la concepción del lenguaje en la tradición instrumental de éste. El propósito del trabajo es, en primer lugar, mostrar las restricciones a que aboca semejante punto de partida y las dificultades explicativas que, de cara a la clínica, comporta; y en segundo lugar, explorar las posibilidades de una concepción del lenguaje que no sea instrumental y que permita acercarnos al problema del lenguaje y su desarrollo (que consideramos núcleo patogénico de los TGD) desde su uso concreto en el habla cotidiana. Se apuntan algunas implicaciones para la psicopatología (AU)

[Symptoms of psychopathology. Identification and interpretation]. / Los síntomas de la psicopatología. Identificación e interpretación.

INTRODUCTION: Updating psychopathology is currently viewed as being dependent on a readjustment that fits the ever increasing knowledge of cerebral physiopathology. Nevertheless, this recalibration cannot elude the apories of a medical semiology based upon the identification of correlates and injury as the reference of symptoms. Experience is proposed as the true field of psychopathological research, the totality concept being one of them. MATERIAL AND METHODS: The publications of those authors who have dealt with the concept of totality are reviewed in addition to the basis of each approach and its ties with each author's contribution to psychopathology. RESULTS AND DISCUSSION: We observe that the totality concept has been subjected to determinant procedures that are not capable of abiding to the demand of totality as a structure of experience. CONCLUSIONS: Meaningful relationships between totality and symptoms are considered as a possible alternative to positivism-oriented processes of identification.

Los síntomas de la psicopatología. Identificación e interpretación / Symptoms of psychopathology. Identification and interpretation

Introducción. Se quiere hacer pasar la renovación de la psicopatología por su reajuste con respecto a los conocimientos sobre la fisiopatología cerebral. Sin embargo, esta renovación, solidaria de una semiología médica basada en la identificación de relatos, con la lesión como referente, no escapa de las aporías que denuncia. Se propone considerar la experiencia como ámbito propio de la investigación psicopatológica, y así remozarla partiendo de conceptos que piensen la experiencia. El concepto de totalidad es uno de ellos. Material y métodos. Se repasa la obra de los autores que han tratado el concepto de totalidad, se revisan los fundamentos del modo en que lo piensan y se revisa el papel dentro de la aportación de cada autor a la psicopatología. Resultados y discusión. Observamos cómo se ha ido sometiendo el concepto de totalidad a procedimientos determinantes incapaces de atenerse a lo que la totalidad como estructura de la experiencia demanda. Conclusiones. Se concluye presentando las relaciones de significación que se establecen entre síntoma y totalidad como vía alternativa a los procesos de identificación de significados de corte positivista (AU)

Demencia y grandiosidad / Dementia and grandiosity

Exponemos a continuación un caso de un paciente con demencia sifilítica con una forma de presentación tradicional. Se trata de una forma hoy en día extraordinariamente infrecuente, tanto más porque la paciente no corresponde a un grupo de riesgo de esta patología. El caso pone de manifiesto la importancia de atender a los síntomas en el contexto en que adquieren peso diagnóstico. En este caso la demencia y la grandiosidad son los síntomas guía que sugieren la necesidad de estudios analíticos y técnicas de imagen para confirmar el diagnóstico. Recordamos que se trata de una de las pocas demencias que tiene tratamiento específico (AU)

[Persisting and late onset psychotic disorder due to consumption of ecstasy (MDMA)]. / Trastorno psicótico persistente inducido por consumo de éxtasis (MDMA).

Let us present a case of recurrent paranoid psychotic episodes in a patient with a history of abuse of <> (MDMA: 3, 4-methylenedioxymethamphetamine), that persisted after a long withdrawal time, that, in our opinion, after an exhaustive differential diagnosis, may be attributed to that consumption. The carachteristics of this case are formally and naturally equivalent to those referred to in other papers about paranoid psychosis after abuse of MDMA, in which the sudden appearance, and the symptomatolgy of an intense feeling of threat and physical violence outstands, accompanied by abnormal corporal perceptions. In the case hereby presented, the withdrawal time is longer than that described in other publications. Even though in some authors' opinion this should be considered as comorbility or dual diagnosis, in our opinion enough facts exist suggesting that this is not a case of functional mental disorder but an organic disorder secondary to the neurotoxic effect of MDMA.

Trastorno psicótico persistente inducido por consumo de éxtasis (MDMA) / Persisting and late onset psychotic disorder due to consumption of ecstasy (MDMA)

Presentamos un caso de episodios psicóticos paranoides recurrentes en un paciente con antecedentes de abuso de éxtasis (MDMA: 3,4-metilendioximetanfetamina), persistente tras largo tiempo de abstinencia, que, en nuestra opinión, tras un diagnóstico diferencial exhaustivo, puede ser atribuible a dicho consumo. Las características del cuadro son equivalentes, formal y naturalmente, a las referidas en otras comunicaciones sobre psicosis paranoide por abuso de MDMA, en las que se destaca la brusquedad de aparición y la clínica de una intensa vivencia de amenaza y violencia física, acompañado de percepciones corporales anormales. En el caso que presentamos es más largo el tiempo de abstinencia que lo descrito en otras publicaciones. Aunque para algunos autores esto debería ser considerado como comorbilidad o diagnóstico dual, en nuestra opinión hay suficientes datos que sugieren que no se trata de un trastorno mental funcional sino de un cuadro orgánico secundario al efecto neurotóxico de MDMA. (AU)

[Personality and endogeneity in psychopathology]. / Personalidad y endogenidad en psicopatología.

Personality and endogenity built the background of available concept necessary to understand the different manifestations of mental illness. In spite of coming from different tradition, now a days both of them have converged. The object this study is ti reconstruct of genesis of these two concepts in a way there convergence could be understood. This convergence is not obvious but full of consequences. The concept of personality has had along way beginning with the origin of occidental thought. During the last century this concept has been drastically reduced according to the necessity of using it in a predetermined way. On the other way the concept of endogenity comes from the degenerationist theory and has deep roots in positivism. The convergence between personality and endogenity is produced understanding personality as biological conditioned and endogenity as vulnerability. This solution is clearly unsatisfactory leading to aporias and important difficulties as the nosological crisis we live now a days. One way to overcome this difficulty it is showed in Tellenbach work. Another solution as a future task should be based on changing the concept of mental illness creating the categories to think about it.

[Autism and inter-subjectivity]. / Autismo e intersubjetividad.

The concept of autism as a fundamental symptom of schizophrenia has been lacking of psychiatric eminence in the course of time, just because of its absence of univocal sense, and its extraordinary richness, hardly to be apprehended by deterministic procedures. However, the experience which it refers to, is still present in the daily clinical practice. In its attempt of apprehend this reference, the psychopathology has developed several concepts, as diverse and unspecific as "Praecoxfeeling", "self disorders", or "contact disturbances". In this paper, we start from "Intersubjectivity" as the viewpoint from which we try to comprehend the immediate experience of the Other as a whole. Finally, our purpose would be to offer an interpretation of autism that could serve as a comprehensive substrate for many of the manifestations of the schizophrenic condition.

[The understanding of psychopathology and the role of phenomenology. Contribution to a controversy]. / El sentido de la psicopatología y el papel de la fenomenología. Contribución a una controversia.

The sense of psychopathology is interpreted as the development of a descriptive language, that allowed the approach to the psychiatric disease in the context of natural sciences. The phenomenology was introduced as a methodological tool for the improvement of this language. Since then this topic has been present in the foundations problems of psychiatry. In this paper the discussion is set towards the influence of phenomenology in psychopathology, as a controversy between two opposite points of view. The authors establish their own arguments about the limits of psychopathological knowledge and psychiatric experience.

[Psychopathologic manifestations in the sphere of subjectivity: disorders of self]. / Manifestaciones psicopatológicas de la esfera de la subjetividad: los trastornos del yo.

As much as it strives to be "scientific" psychiatry can not obviate its necessary bonds to the subjectivity of the subject. The attempt has been made to reflect the richness of manifestation of subjectivity by means of a formalization process based on the traditional concept of it. This has led to the concept of disorders of self (Ichstörungen). They are of central importance in clinical psychiatry and psychopathology, as can be seen in the attempts to conceptualize schizophrenia. However, the presumed degree of precisión reached runs parallel to the apartness of the fidelity to the effective vivification of the patient. This discord is interpreted as a fault in the conceptualization of the disorders of self and the possibilities originates by corporality point to the need to redefine, once again and in depth, the concept of subjectivity which is the foundation of psychiatry.

[Status of child psychiatry]. / Situación de la psiquiatría infantil.

This paper is a revision of the present situation of child psychiatry showing its confluence with general psychiatry through the epistemological unification as a biopsycho-social model. The psychopathological limitations of this process as empiricism are taken into account as well as its identity, which did not really exist till now. At the same time this identity supposes an orientation for the clinical, teaching and research action.

[Secondary effects of lithium. Their evaluation]. / Efectos secundarios del litio. Su valoración.

A groupe of 52 patients in long-term lithium treatment were questioned about side effects. The K. Ghose questionnaire was used which contained 36 items. The most frequent complaints were hand-tremor, dry mouth, poor memory, polyuria, diarrhoea, weight gain. We hypothesize that apart from symptoms clearly demonstrated to be caused by lithium treatment (polyuria, hand-tremor, weight gain diarrhoea). Other complaints such as dry mouth, poor memory or skin eruptions occur frequently and they are also related to lithium.

[The tasks of psychiatry: the psychiatric experience]. / Las tareas de la Psiquiatría: intentos sobre la experiencia psiquiátrica.

This work pretends to show the necessity of psychiatry of knowing its grounds as medical knowledge in order to do justice to its history and to the concepts that have been traditionally used in the west way of thinking. By the idea of experience it is tried to search in psychopathology the motives of the transformation of psychiatry under the operative concept of 'life world'. The psychiatry tasks shall be those in connection with the development and appropriation of the ontological and methodological implications that the concept of 'life world' involves, always across a psychopathological theory.