DSM-III and its reception: a European view.

The author analyzes some elements in the reception of DSM-III in Europe. The worldwide success of a diagnostic classification originally presented as a purely American endeavor is associated with recurrent, albeit not often openly formulated, criticisms. In the history of psychiatric nosologies, the purely descriptive phase was succeeded by a period during which theories were dominant, as in the Kraepelinian system. DSM-III originated in recognition of the existence in the United States of contending psychodynamic and psychosocial orientations and problems of communication, which became even more evident with the growth of psychopharmacology and the influence of the biological school. Whereas ICD offered compromise solutions, DSM-III used a new paradigm based on diagnostic categories and a multiaxial format, which were on the whole easily accepted. Most criticisms involved three points. The first was the atheoretical syndromic approach, seen as a regression and an expression of an American preference for superficial facts and contempt for psychopathology, which was considered in Europe the source of future progress. The second was the introduction of quantification, which was rejected by some in the name of the clinical tradition, which emphasized understanding of the individual case. The third was DSM-III's adherence to alleged American values, such as pragmatism and novelty. The ambivalence of Europeans toward the world expansion of American culture was reinforced by use of English as the language of international scientific communication. The mostly irrational nature of the criticisms contrasts sharply with the general acceptance of DSM-III and its successors, which rests on their objective merits.

[Panic: attack and disorder. History of the word and concepts]. / Panique: attaque et trouble. Historique du mot et des concepts.

The history of the word panic, of the concepts of Panic attack and of Panic Disorder is a complex one. The adjective word panic, derived from the Greek, stressed initially the intensity of a feeling of unjustified, individual or collective, fear, similar to the reaction provoked, according to the mythology, by the intervention of the God Pan. In their present meanings, the concepts belong to the group of anxiety states, the Panic attack being a symptom characterized by a paroxysmal anxiety which may appear in various psychopathological states, whereas the Panic Disorder is a nosological category whose diagnostic criterium is the appearance, with a definite frequency, of Panic attacks. The disorder is frequently associated to agoraphobia considered, when it exists, as a complication. It is necessary to describe, in addition to the terms and concepts related to panic, the history of the terms angoisse and anxiété (and of the equivalent ones in English and German, since many studies dealing with the subject have been written in those languages) and the history of agoraphobia. The history of the word panic and of the psychiatric concepts to which it is applied today are partially different as are the current meanings of the adjective and the substantive (and today of the verb to panic) from their technical meanings. In the technical vocabulary the substantive word refers on the one side to an abnormal group behaviour whose mechanisms, when it appears in an army by also elsewhere, are studied by social psychopathology. On the other side it has been used until recently, but only in psychiatric texts written in English, for describing acute individual states of high anxiety, eventually associated with other symptoms, and considered as pertaining-in contrast to the Panic attack in its present meaning-to various psychiatric illnesses (melancholic panic, homosexual panic). A description of states similar in their aspects, including the association to agoraphobia, to the present Panic attack, may be found in the literature of the XIXth century. Essential in this respect is the description of anxiety neurosis which Freud isolated in 1895 from neurasthenia and defined by the coexistence of a state of moderate and permanent anxiety and of anxiety attacks, whose manifestations were identical to those of the present Panic attack. Under the influence of Klein's researches which, from 1962 on, demonstrated the differential reactivity to drug therapy of its two component parts, anxiety neurosis was divided in two distinct entities. The term Panic attack-for reasons given in detail by the paper-was proposed for the acute anxiety attack, whereas the state of moderate and permanent anxiety, considered as a completely independent disorder, received the name of Generalized Anxiety Disorder. The concept, with its corresponding nomenclature, was adopted initially in the United States by the RDC (1975), then by the DSM-III (1980). It is accepted today and has been the source of a large number of investigations about its semiological, nosological, epidemiological, etio-pathogenic and therapeutic aspects which fall outside of the scope of this paper.

[The future of the concept of depression]. / L'avenir du concept de Dépression.

The history of the concept of depression is briefly reviewed. First described under the name of melancholia as a delusional state, then, since Esquirol, as a primary mood disorder, it was subdivided by Kraepelin in diseases characterised by an hypothetical etiology and is considered, since 1980, as a syndrome with many sub-varieties. The nature of the three possible models is discussed. The first two, until now used, which considered depression either as a disease or as a syndrome, are categorical. The first has been provisorily abandoned, due to the insufficiency of scientific proofs about the etio-pathogeny; the second, despite its growing complexity, is obviously not satisfactory. The third model, dimensional, which attracts a growing attention in other field of psychiatric nosology, offers for the time being a possible alternative.

The birth of the bipolar disorder.

The history of the description by Jean-Pierre Falret of circular insanity, the origin of our present day bipolar disorder, is presented as well as the claims of priority raised by his colleague Jules Baillarger. A detailed account is given of the long-lasting controversy which has often given rise to biased judgments about the respective roles of the two psychiatrists. It is shown that the clinical concept was an expression of Falret's views about the nature of mental disorders and that, through the influence these views had on future nosological systems, the apparently purely picturesque episode corresponds to a landmark in the history of psychiatry.

[Neurasthenia, yesterday and today]. / La neurasthénie, hier et aujourd'hui.

Neurasthenia was described and explained in very mechanistic terms, at the end of the 19th century, by G.M. Beard to account for physical and mental exhaustion and for varied somatic troubles imputed to failure of too much solicited nervous resources. This concept was then universally adopted and gave rise to diverse interpretations, among which was the Freud's one. Later, in Occident, came a deterioration, the diagnostic of neurasthenia giving way to those of anxious or affective disorders. In the same time, at least for ideological and cultural reasons, the concept remained lively in Russia and in Asia. During the last decade the western psychiatry has been led to accept that there are clinical situations focussed on fatigue and fatigability, even if it coined for them new terminologies (post-infectious fatigue, chronic fatigue syndrome, etc.) and while DSMs keep on ignoring neurasthenia, the ICD 10 gives it an important place.

[Quantification in psychiatry: from psychometrics to quantitative psychiatry]. / La quantification en psychiatrie: de la psychométrie à la psychopathologie quantitative.

The development of quantitative techniques to analyse psychopathological states is reviewed from the XVIIIth Century till today. As far as back as the XIXth Century, Quetelet, Louis and Galton introduced and advocated the use of quantitative methods in medical and psychological sciences. The advent of psychometry dates back 1905, when Alfred Binet published his Intelligence Scale. The construction of instruments like Wechsler and MMPI scales in the forties starts using psychometry in psychiatry. At end of World War II, historical factors (selection and guidance of military recruits) in conjunction with technical advancements (beginning of psychopharmacology, multivariate statistics development and first computers arrival) favor the growth of quantitative psychopathology that further takes four great different courses: 1. Psychometry proper, 2. Symptom-quantifying assessment scales such as BPRS or Hamilton scales, 3. New nosological models constructed using quantified psychopathological data and mathematical procedures, 4. Diagnostic systems relying on operationalized criteria based on psychopathological quantification, such as DSM III.

[The history of German psychiatry from the viewpoint of French psychiatrists]. / Die Geschichte der deutschen Psychiatrie aus der Sicht der französischen Psychiater.

The reception of German psychiatry by the French psychiatrists has been influenced by material elements, such as the knowledge of the German language and/or the disposability of translations, but even more by factors of a general nature. The main reason has been the perception by the French psychiatrists of the progressive loss of influence of their own school, initially the leading one in the world, in favour of the German, a change which began with Griesinger and became evident at the time of Kraepelin. Around 1850, as demonstrated by many papers written by leading French psychiatrists, the interest both for the theoretical aspects of German psychiatry and for its care system was great. The judgements were extremely positive, although French authors tended to contrast the philosophical outlook of the Germans with their own concrete clinical approach. The war of 1870-71 produced no radical change. But the growing influence of German psychiatry induced negative reactions whose main target was the work of Kraepelin, and especially his synthesis of Dementia praecox which was in direct opposition with the then dominant concepts of Magnan. The French opinion was divided between defenders and adversaries of Kraepelin's ideas. In the years immediately preceding World War I the attacks increased. The alleged contrast between the descriptive clinical (and according to a German author like Jaspers literary and superficial) French psychiatry and the scientific theoretical (and for the most aggressive French authors valueless) German one was a recurrent theme. The nationalistic tone reached on the French side its apex during the war years, some faint traces remaining several years after 1920. But on the whole the influence of the concepts proposed by German speaking authors, not only Kraepelin, but also Bleuler, Kretschmer, Freud among others was then on the increase. After 1945, contrasting with the years after World War I, no hostility against German psychiatry can be detected, as testified by the choice of the main speakers by the French organizers of the First World Congress of Psychiatry in 1950. The creation in 1984 of the Association of European Psychiatrists, an initiative taken jointly by the French and German psychiatrists, can be considered as the symbolic conclusion of the relations between the two national schools.

[Noise, sleep and behavior]. / Bruit, sommeil et comportement.

The negative effects of noise on sleep and behaviour have been related to three mechanisms: a physiological arousal (above a certain threshold of noise), an aversive reaction and an interference with non auditive neurophysiological and mental processes. The perturbation of verbal communication and the effects of sleep are the directly observable consequences. The negative effects of noise above a certain threshold on sleep have been demonstrated both in experimental conditions and in real life. They concern length, EEG pattern, and subjective quality and produce an increase of irritability and tiredness. There is no habituation. In all populations studied, strong discomfort is expressed by 50% of the subjects living in an area with an Ldn of 75 dB in the case of air traffic noise, the same results being obtained with ground traffic for a 5-15 dB higher level. Objective expressions of discomfort: use of aural protections, closing the windows, staying indoor, changing residence, increase linearly with the intensity of noise. Noise influences the incidence of stress-related disorders: hypertension, related cardio-vascular diseases, psychosomatic and psychological disorders. It has been shown by the use of different techniques (epidemiological studies based on the frequency of medical contacts, on the diagnoses made by general practitioners, on the use of specific drugs, and on the examination of the whole population) that the prevalence increases in relation with the level of noise in the vicinity of airports.(ABSTRACT TRUNCATED AT 250 WORDS)

[Current developments in psychiatry: current interest of works by A. Quételet and J. Guislain]. / Les développements récents de la Psychiatrie: actualité des oeuvres de A. Quételet et de J. Guislain.

The influence of Adolphe Quételet and Joseph Guislain, born respectively in 1796 and 1797 in Gent, on the most recent developments of Psychiatry has a paradoxical character. Quételet was a mathematician and astronomer, but his interest in statistics led him to organize the standardized collection on data on an international basis and to initiate the measurement of social and pathological behaviours, two trends which dominate present day epidemiological, nosological and clinical research in Psychiatry. Although Guislain is rightly honoured as the organizer of a human system of treatment for the mentally ill in Belgium, his theoretical ideas about the nature of mental disorders, he considered as reactions to a basic disturbance, whose aspects were determined by the physical and psychological peculiarities of the individual, have been practically forgotten. But they provide an alternative to the now prevalent tendency towards a strictly categorical nosology, whose shortcomings are more and more apparent in empirical biological and clinico-epidemiological research.

Measuring the severity of depression through a self-report inventory. A comparison of logistic, factorial and implicit models.

The present study investigates the psychometric adequacy of a self-report inventory of depression (the QD2) with respect to the severity of depressive symptoms, within the framework of a unidimensional model of depressive states. Responses to the 52 QD2 items, by 481 subjects divided into four groups (depressed, psychiatric, somatic and control), were subjected to a Rasch analysis. Results show that 15 items (QSD(R1] display a satisfactory goodness of fit for both items and persons, as defined by the Rasch model. This set of items, solely related to 'pure' depression, gives a measure of the severity of depression, free from anxiety symptoms. The discussion focuses upon the advantages of the Rasch model as compared to traditional tests. The Rasch 15-item solution should provide a parsimonious tool for future studies on the classification of depressive disorders.

[Epidemiology of depression]. / Epidemiologiia depressii.

According to epidemiological data, 5-6% of the general population are suffering from some kind of depressive disorders. Only a small proportion of them are seen by psychiatrist; others are seen by general practitioners, and many more do not seek medical advice. In a study carried out in France on 400 non-selected patients consulting general practitioners 8% of the patients have a depressive disorder and further 9% anxiety disorders.

The historical roots of behavior therapy.

This paper reviews lines of thought that are historically relevant to the emergence of behavior therapy. First consideration is given to animal magnetism, and the reaction against it. Then the influence of German psychiatry is surveyed, followed by various views of disorders of the nervous system. These in different ways affected the Freudian mode of thinking and also Pavlovian theory, and more indirectly experimental psychology.