[Attention-deficit/hyperactivity disorder in adults in the clinical description and classification of Emil Kraepelin]. / Die Aufmerksamkeitsdefizit­/Hyperaktivitätsstörung bei Erwachsenen in der klinischen Beschreibung und der Klassifikation von Emil Kraepelin.

This study presents descriptions of symptoms specific to the adult form of attention-deficit/hyperactivity disorder (ADHD) in the 8th edition of the Textbook on Psychiatry by Emil Kraepelin (1856-1926). To identify whether ADHD is a new, fashionable phenomenon in adults or whether early psychiatrists also saw such patients and how they classified them, this textbook is an essential source. Published between 1905 and 1915, it can be perceived as the culmination and at the same time terminal point of Kraepelin's conceptual and nosological work, which in turn marked the beginning of present-day psychiatric classification. Kraepelin did not perceive ADHD as a psychiatric entity of its own, which is either due to the fact that he saw no necessity to do so or that he did not recognize this. If the latter, Kraepelin may have been misled by the manifold psychiatric comorbidities typical for ADHD, which may have masked ADHD. Kraepelin seems to have grouped patients obviously suffering from the adult form of ADHD into two groups: on the one hand into the so-called basic constitution (Grundzustand) of manic-depressive disorder, which he called manic disposition or constitutional excitement (manische Veranlagung oder konstitutionelle Erregung) and on the other hand into the so-called group of anchorless people (Haltlose), which he perceived as a special form of psychopathic personality. It seems that Kraepelin grouped milder grades of ADHD with predominantly ADHD-associated mood swings into the group of manic disposition while grouping more severe forms, which usually occur together with distinct personality disorders and addictive disorders, into that of anchorless people.

Medical diagnosis as a linguistic game.

BACKGROUND: We present a formalized medical knowledge system using a linguistic approach combined with a semantic net. METHOD: Diseases are defined and coded by natural linguistic terms and linked via a complex network of attributes, categories, classes, lists and other semantic conditions. RESULTS: We have isolated more than 4600 disease entities (termed pathosoms using a made-up word) with more than 100.000 attributes sets (termed pathophemes using a made-up word) and a semantic net with more than 140.000 links. All major-medical thesauri like ICD, ICD-O and OPS are included. CONCLUSIONS: Memem7 is a linguistic approach to medical knowledge approach. With the system, we performed a proof of concept and we conclude from our data that our or similar approaches provides reliable and feasible tools for physicians given a formalized history taking is available. Our approach can be considered as both a linguistic game and a third opinion to a set of patient's data.

Central neurocytoma: establishment of the disease entity.

The establishment and identification of central neurocytoma as a distinct disease entity are invaluable in catalyzing investigations of neuronal differentiation in central nervous system tumors. The discovery of neuronal differentiation in neuroepithelial tumors has been extended to extraventricular tumors and potentially to various glial tumors undergoing neuronal differentiation. Understanding the disease spectrum of neuronal and mixed neuronal-glial tumors is important for deciphering the mechanism of gliomagenesis.

"Disease entity" as the key theoretical concept of medicine.

Philosophical debates about the concept of disease, particularly of mental disease, might benefit from reconsideration and a closer look at the established terminology and conceptual structure of contemporary medical pathology and clinical nosology. The concepts and principles of medicine differ, to a considerable extent, from the ideas and notions of philosophical theories of disease. In medical theory, the concepts of disease entity and pathologicity are, besides the concept of disease itself, of fundamental importance, and they are essentially connected to the concepts cause of disease or etiological factor, natural course or natural history of disease, and pathological disposition. It is the concept of disease entity that is of key importance for understanding medical pathology and theory of disease. Its central role is shown by a short reconstruction of its main features and its intrinsic connection to the concept of pathologicity. The meaning of pathologicity is elucidated by explicating the underlying criteria.

Karl Jaspers on the disease entity: Kantian ideas and Weberian ideal types.

Jaspers' nosology is indebted to Immanuel Kant's theory of knowledge. He drew the distinction of form and content from the Transcendental Analytic of Kant's Critique of Pure Reason. The distinction is universal to all knowledge, including psychopathology. Individual experience is constituted by a form or category of the Understanding to give a determinate or knowable object classified into the generic type of a real disease entity. The application of form and content is limited by the boundaries of experience. Beyond this boundary are wholes whose conception requires Ideas of reason drawn from the Transcendental Dialectic. Wholes are regulated by Ideas of reason to give an object or schema of the Idea collected into ideal types of an ideal typical disease entity. Jaspers drew ideal types from Max Weber's social theory. He anticipated that, as knowledge advanced, ideal typical disease entities would become real disease entities. By 1920, this had been the destiny of general paralysis as knowledge of its neuropathology, serology and microbiology emerged. As he presented the final edition of General Psychopathology in 1946, Jaspers was anticipating the transition of schizophrenia from ideal typical to real disease entity. Almost 70 years later, with knowledge of its aetiology still unclear, schizophrenia remains marooned as an ideal typical disease entity - still awaiting that crucial advance!

Stabilizing autism: A Fleckian account of the rise of a neurodevelopmental spectrum disorder.

Using the conceptual tools of philosopher of science Ludwik Fleck, I argue that the reframing of autism as a neurodevelopmental spectrum disorder is constrained by two governing 'styles of thought' of contemporary psychiatry. The first is the historically conditioned 'readiness for directed perception' of, and thinking in terms of, ontologically distinct diseases. The clinical gaze of mental health professionals, the bureaucratic needs of health administration, the clinical and scientific utility of disease categories, and the practices of autism-oriented advocacy groups all imply a bias toward thinking about autism and related disorders as ontologically distinct psychiatric and scientific entities. Second, within the 'neuromolecular style of thought', mental disorders are more and more located at the neurobiological levels of the brain. In autism research, one of the biggest challenges is the identification of autism's neurobiological singularity. However, at a moment when biological and categorical approaches toward autism face serious empirical difficulties, a balance is established that holds together these two styles of thought. With a need to account for some of the most persistent uncertainties and conflicts in autism research, namely ubiquitous heterogeneity and a failure to identify disease specific biomarkers, the reframing of autism as a neurodevelopmental spectrum disorder satisfies the scientific, institutional and socio-political needs for stability and homogenization.

Application of Single-disease Entity Quality Control in Children with Community Acquired Pneumonia of Our Hospital / 中国药房

OBJECTIVE:To promote the application of single-disease entity quality control in children with community acquired pneumonia.METHODS:According to the requirements of "Single-disease Entity Quality Control Index" issued by Ministry of Public Health,280 children with community acquired pneumonia in our hospital were analyzed retrospectively in respect of admission standard,pathogen inspection,selection of antibiotics,medication time,treatment course,health education,clinical efficacy and cost of hospitalization.RESULTS & CONCLUSION:The diagnosis and treatment of children community acquired pneumonia in our hospital are in line with "Single-disease Entity of Pneumonia Quality Control Index" while detection rate of bacterial cultivation and the level of sensitivity test should be improved.

Analysis of disease entities and medical costs in the Pediatric Department of a hospital / 医学研究生学报

Objective: To learn the disease entities and medical costs of the patients admitted in the Pediatric Department of a general hospital.Methods: We collected from the Hospital Information System(HIS) the related data of the patients admitted in the Department of Pediatrics from October 2001 to October 2007 and analyzed the patients' main types of diseases and medical expenditure.Results: Among the total number of 8 062 patients,diseases of the genitourinary,respiratory and digestive systems and of blood and hematogenic organs accounted for 47.82%,36.78%,4.22% and 3.16%,ranking as the first 4 disease entities.The per patient medical costs in the first 4 places were those of the diseases of the musculoskeletal system and connective tissues($6 368),tumors($5 845),diseases of the genitourinary system($5 818) and congenial anomalies($5 469).Conclusion: The largest number of patients were those with genitourinary system diseases,and the highest medical costs per patient were those of the diseases of the musculoskeletal system and connective tissues in the Department of Pediatrics.

Using the first page data of medical record to analyze medical service quality of different disease entities / 第二军医大学学报

Objective:To search for a method for analyzing medical service quality of different disease entities using the first page data of medical records.Methods: Based on documents review and real data analysis,the basic principles,methods and steps of disease entity dividing and selecting,evaluation index selecting,and calculating were introduced.Special attention was paid to certain problems in the discussion.Results: When the inpatients of selected disease entities covered 60% of total hospitalized patients,the medical quality information included exceeded 80% of the total information.For 97.66% disease entities,their inpatient cost and length of hospital stay were logarithmic-normally distributed.Conclusion: Dividing disease entities by fixed digits of ICD-9 code is easily performable.This method should be used when the disease entities include about 60% of total inpatients,and geometric mean should be used in calculating average length of hospital stay and average cost.