Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective.

The behavior patterns of hyperactivity, impulsivity and inattention that would ultimately become recognized as Attention-Deficit Hyperactivity Disorder (ADHD) have been described for centuries. Nevertheless, in the past 35 years, advances in diagnostic methods, identification of biomarkers, and treatments have advanced at an exponential rate. ADHD is now recognized as the most common behavioral disorder of childhood, with risks extending well into adulthood for both males and females, leading to its identification as a significant public health issue. This historical neuropsychological review of ADHD emphasizes scientific highlights in the past 35 years related to ADHD, including the evolution of the diagnosis (from Hyperkinetic Reaction of Childhood to ADHD), influential theories (executive functions, cognitive-energetic, delay aversion), landmark treatment studies (Multimodal Treatment of ADHD [MTA] and Preschool ADHD Treatment Study [PATS]), and advances in brain mapping techniques (anatomic, functional, and resting state magnetic resonance imaging, diffusion tensor imaging). The review concludes by highlighting the challenges of studying and treating a heterogeneous neurodevelopmental disorder like ADHD, with emphasis on associated disorders and conditions (learning disabilities, sluggish cognitive tempo), special populations (girls, preschoolers, adults), and recommendations for scientific inquiry in the next 35 years. Neuropsychologists are well positioned to address the clinical and research challenges of the next generation of studies, especially involving advances in understanding the sexual dimor.phism, full developmental course, and dynamic risks associated with ADHD. (JINS, 2017, 23, 916-929).

[Psychological events--organic interpretations: concepts of trauma in German psychiatry since 1889]. / Psychische Ereignisse--organische Interpretationen: Traumakonzepte in der deutschen Psychiatrie seit 1889.

This paper examines the debate on psychological trauma in German psychiatry since 1889. A content analysis of five leading German psychiatric journals between 1889 and 2005 is realised. An organic concept of psychological trauma has been prominent in the professional debate until today. Psychiatrists frequently referred to physical traumatisation, constitutional factors and genetic predisposition, exogenous reaction types according to Bonhoeffer, and to biological markers in the context of the PTSD concept. The biological tradition in German psychiatry resulted in a specific adoption of concepts on psychological trauma. However, integrating various models of psychological trauma into a psychiatric tradition focusing on a biological model proved to be difficult and inconsistent.

Síndromes postencefalíticos en la literatura médica española / Post-encephalitic syndromes in the Spanish medical literature

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Baudelaire's aphasia: from poetry to cursing.

At 45 years of age, Charles Baudelaire suffered a left hemispheric stroke that left him with a right hemiplegia and severe aphasia. In this chapter, we investigate the nature of his symptoms, drawing mostly on his own and his contemporaries' correspondence. Before specifically examining his aphasia, we put the poet's life, work, and health in context, notably his tormented mind, his probable syphilitic infection and the intellectual milieu of 19th century France. The time when Baudelaire was struck with aphasia coincides with early discoveries and debates that centered on the nature and implications of this neurological disorder. Many of the questions raised at that time still await definitive answers. Here, we compare Baudelaire's language disorder with recent research that has shed new light on the poet's disease. Most interestingly, we explore the nature of his dramatic use of the expletive Cré nom!, which was the only word he was able to express. Finally, we discuss the links between disease and creativity and dismiss the frequent notion that Baudelaire, in the end, paid the price of his genius.

Lundby revisited: first incidence of mental disorders 1947-1997.

OBJECTIVE: To investigate how first incidence of various mental disorders changed between the periods of 1947-1972 to 1972-1997 in the Lundby cohort. METHOD: First-incidence rates of mental disorders were calculated for two 25 year periods and ten 5 year periods. RESULTS: From 1947-1972 to 1972-1997 a decrease in almost all age- and sex-specific incidences of neurotic and organic brain disorders was observed, whereas incidence rates of psychotic disorders increased consistently in male subjects but decreased in most age intervals in female subjects. For both sexes the age-standardized 5 year period incidences of neurotic disorders decreased after 1972, fluctuated for psychotic disorders 1947-1997 and decreased steadily for organic disorders 1947-1997. CONCLUSIONS: The reduction in neurotic and organic brain disorder incidences may be linked to structural changes in society and medical advances.

El trastorno orgánico de la personalidad: análisis conceptual y estrategias para la investigación / Organic personality disorder: conceptual review and research strategies

La revisión histórica del concepto de trastorno de la personalidad en psiquiatría pone de manifiesto que dicha categoría no converge ni da pie al concepto actual de trastorno orgánico de la personalidad (TOP); solamente el concepto de psicopatía sirve de viñeta fenomenológica que será utilizada para la descripción de algunos de los TOP como «seudopsicopáticos». Estos pacientes han sido descritos desde principios del siglo XX bajo el paraguas del síndrome del lóbulo frontal; a mediados del siglo XX, con el desarrollo de las nosologías psiquiátricas se adoptó el término trastorno orgánico de la personalidad para caracterizarlos. El fraccionamiento de la corteza prefrontal y el desarrollo de modelos neuropsicológicos que tratan de explicar la conducta social han abierto nuevas posibilidades de exploración y comprensión de esta patología. La distinción anatomofuncional entre corteza ventral y corteza dorsolateral señala a la primera como responsable de la modulación emocional y conductual. La evaluación del reconocimiento de emociones en voces y caras, de la empatía, del sentido del humor y de la «teoría de la mente» son algunas de las nuevas herramientas de que disponemos para explorar las funciones no cognitivas de la corteza prefrontal

The historical review of «psychiatric personality disorders » reveals the lack of convergence of those disorders with the organic personality disorder (OPD). Only the psychopathy concept has been used as a psychopathological phenotype for one of the groups of OPD, the socalled «pseudopsychopaths». These patients have been described from the beginning of the XXth century under the heading of «frontal lobe syndrome». It was only with the development of the psychiatric nosologies, towards the middle of the XXth century, that the term «organic personality disorder» started to be used. The accumulation of knowledge about the different prefrontal areas and the development of neuropsychological models that try to explain social behavior have opened new ways of understanding this syndrome. The orbitofrontal cortex has been identified as one of the key structures in behavioral and emotional regulation. Recognition of emotions in voices and faces, empathy, appreciation of humor, tasks that show «theory of mind» are some of the dimensions included in the examination of the non-cognitive functions of the prefrontal cortex

Surrealismo y locura (parte I) / Madness and surrealism (part I)

Nuestra pretensión en este trabajo ha consistido en abordar las relaciones entre surrealismo y psiquiatría. Tales relaciones son posibles dado que este grupo de artistas y literator: a) mostraron un gran interés por lo irracional y por la locura; b) algunos de ellos fueron psiquiatras (Breton, Huelsenbeck) o tenían importantes conocimientos de algunas patologías que se explican en nuestra especialidad; y c) adoptaron como matriz ideológica los postulados psicoanalíticos. Dentro de este movimiento, consideramos a Dalí no sólo como un pintor, sino también como un hombre cultivado y bastante versado en el tema de la paranoia. El encuentro que Lacan tuvo con el genio de Cadaqués fue fundamental para que el primero de ellos desarrollara un conocimiento distinto sobre este trastorno y, como consecuencia, defendiese brillantemente su tesis doctoral en 1932, que fue elogiada por la vanguardia artística y a partir de ese momento, fue considerado como el guía y maestro del futuro movimiento psicoanalítico francés

The purpose of this work is to study the relationship between surrealism and psychiatry. This is possible because these group of artist and arts men: a) took an interest in the irrational and madness; b) some of them were psychiatrist (Breton, Huelsenbeck) or had a through knowledge of some psychopathology; and c) they adopted psychoanalytical propositions as ideology. Within this movement we consider Dalí not only as a painter but also a cultured and expert man in th e theme of paranoia. The meeting between Lacan and the artist from Cadaqués was decisive for the first of them to develop a different concept to paranoia that in 1932 ended up a brilliant doctoral thesis which was praised by the ultra-modern artist, and from then on the future French psychoanalytical movement

La investigación cognitiva del síndrome esquizofrénico / Cognitive research on schizophrenia syndrome

Se revisan las anomalías cognitivas observadas en la esquizofrenia y, específicamente,los déficit encontrados en diversos procesos automáticos y controlados: el filtrado dela información, la atención y vigilancia, la formación de conceptos y la memoria. Sedescriben también diversos paradigmas experimentales utilizados para el estudio de losprocesos ejecutivos centrales; y, finalmente, se describe un modelo cognitivo para lasconductas anormales y los síntomas clínicos de la esquizofrenia (delirios, desorganización,alucinaciones y la pérdida del sentimiento de identidad personal) que sugiere quepueden estar ligados a un trastorno básico de la percepción holística o la interpretaciónde contextos

This review provides a perspective of cognitive disturbances found in schizophreniaand, particularly, of deficits found in several automatic and controlled processes:information filtering, attention and vigilance, concept formation and memory. Severalexperimental paradigms employed in the study of central executive processes are alsodescribed; and, finally, a cognitive model of abnormal behaviours and clinical symptomsof schizophrenia (delusions, disorganization, hallucinations, and the loss of a sense ofpersonal identity) are outlined suggesting that they may be linked to a basic disturbancein comprehensive knowledge or context perception

Teorías cognitivas de las creencias delirantes / Cognitive theories of delusional beliefs

Este trabajo presenta una revisión de las teorías cognitivas actuales sobre la formacióny mantenimiento de las creencias delirantes. Los estudios sobre el tema señalan la existenciade sesgos cognitivos subyacentes en la aparición y mantenimiento de este síntoma.Presentamos aquí los principales grupos de teorías propuestas en la actualidad, a saber:aquellas que proponen la existencia de sesgos y déficit de razonamiento, atencionales,atribucionales y de teoría de la mente en la formación y mantenimiento del delirio. Estosestudios han aportado una nueva visión de este síntoma sosteniendo que son los mismosprocesos de razonamiento que están en juego en las creencias normales los que influyenel la adquisición y mantenimiento del delirio. Se ofrece también una pequeña reseña dela concepción subyacente de este síntoma sobre las que se sustentan estas teorías

In this paper we present a review of current cognitive theories of delusion formation.Empirical research on delusions has shown that people with delusional beliefs doshow underlying cognitive biases in several tasks which are related to the severity oftheir pathological beliefs. The main theories discussed in this paper, in their relation tothe onset and maintenance of delusions, are related to the following domains: reasoningdeficits, attentional biases, causal attributions biases, and theory of mind deficits. Wedefend that these studies are providing a new view of that psychotic symptom as thereis an assumption that the reasoning processes implied in the formation of delusions aresimilar to those found in reasoning in normal people. The implications of this researchboth on the understanding of delusions and on innovative pathways to psychologicalintervention are discussed

Delirium: uma perspectiva histórica / Delirium a historical perspective

O delirium corresponde a uma das primeiras doenças mentais descritas na literatura médica, há mais de 2.500 anos. Nas classificações psiquiátricas, permaneceu como categoria nosológica independente até o final do século XIX, quando foi redefinida com base nos seus aspectos fenomenológicos e etiológicos, precipitando a reclassificação das insanidades funcionais em psicoses. os estados confusionais passaram a se referir a uma síndrome mais ampla que incluía o delirium, enfatizando a desorganização dos processos cognitivos e do pensamento, e tendo no turvamento da consciência e na desorientação temporoespacial a condição de base. Com o objetivo de descrever a evolução histórica do conceito de delirium, foram realizados levantamentos da literatura médica através do sistema Medline, além da pesquisa em publicações literárias específicas sobre os temas história da medicina e história da psiquiatria. Partiu-se de algumas observações dogmáticas praticadas na Antigüidade e Idade Média, para atingir as definições e práticas atuais, oferecendo uma análise crítica dos critérios diagnósticos vigentes (DSM-III, DSM-IIIR, DSM-IV e CID-10). Não obstante a evolução conceitual, o delirium continua sendo mal compreendido, do ponto de vista fisiopatológico e são poucas as opções terapêuticas. o diagnóstico de delirium é ato eminentemente clínico: baseia-se na observação cautelosa das manifestações psíquicas e comportamentais dos pacientes acometidos, além da análise dos fatores predisponentes e precipitantes. É freqüente o seu subdiagnóstico em contextos clínicos e cirúrgicos. o diagnóstico do delirium é estabelecido em apenas 30 por cento a 50 por cento dos pacientes, sendo a omissão diagnóstica menos freqüente em serviços que contam com a interconsulta psiquiátrica. o delirium é uma das complicações mais comuns entre pacientes idosos hospitalizados e está associado a maior morbimortalidade. Isso sustenta a importância do seu pronto reconhecimento e manejo.

Open psychiatric services in interwar France.

The open psychiatric service established in Paris by Edoward Toulouse was meant to provide early, active psychiatric treatment to mildly afflicted individuals without subjecting them to legal commitment. Psychiatric reformers also hoped that the service would help to raise the status of psychiatry by typing their specialty's fate to laboratory science and hospital medicine. This article traces the genesis of open psychiatric services in interwar France and survey the debates they engendered within the French psychiatric community. It highlights the role of World War I in the implementation of open services and in the creation of a pool of patients who required assistance.

Status epilepticus, the grim reaper of the mental health system in early Victoria.

In an era when patients with refractory epilepsy were managed in mental asylums in the colonial days of Victoria, Australia, the opinion of the administration was that such patients seemed to have a benign prognosis. However the decision to collect all female epileptics in the colony and manage them in the Ballarat Mental Hospital, effected in 1901, allowed scrutiny of the progress of a cohort of 96 patients over the first seventeen years of the twentieth century, thereby revealing that under asylum conditions no less than a third of their number died as the result of status epilepticus. The results of this survey and the reasons for such an outcome are discussed.

Aproximación al tema del delirio: una posibilidad humana / Introduction to the subject of delusion a human possibility

Es frecuente que en psiquiatría y psicopatología se empleen palabras con un claro sentido peyorativo, como "psicópata", "loco", "demente", "histérico", "defectual", etc. Incluso en orientaciones menos médicas y más antropológicas, como la de L. Binswanger, por ejemplo, nos encontramos con el uso frecuente de expresiones como "fracaso" (existencial), "estancamiento", "descarrilamiento", etc. La progresiva psiquiatrización de la vida moderna ha acentuado aún más la tendencia a calificar negativamente aquellos rasgos del vivenciar o del comportamiento que en algún sentido se alejan del término medio. Desde el punto de vista histórico, la exageración de esta actitud ha llevado al menos a dos casos de abusos masivos de los que la comunidad tendría que avergonzarse: "la higiene racial" nazi (que, como es sabido, también se aplicó a los enfermos mentales) y el uso político de la psiquiatría en la ex Unión Soviética. El autor se propone en este trabajo sobre el delirio no buscar en él ni la deficiencia ni la alteración, sino más bien lo que hay en él de proceso transformador lleno de sentido. Con el objeto de profundizar en el concepto de "transformación", recurre a un soneto de R. M. Rilke, y para comprender las semejanzas y diferencias entre la experiencia religiosa psicótica y la normal, se apoya en ejemplos clínicos y en algunos textos religiosos y mitológicos. De lo anterior se desprende -entre otras características positivas del proceso psicótico- que estos enfermos tienen una capacidad de tolerar la proximidad de lo divino que los normales han perdido ya hace mucho tiempo (AU)