Edward Shorter

Issues for DSM-5: Whither Melancholia? The Case for Its Classification as a Distinct Mood Disorder

Melancholia, a syndrome with a long history and distinctly specific psychopathological features, is inadequately differentiated from major depression by the DSM-IV specifier. It is neglected in clinical assessment (e.g., in STAR*D [1]) and treatment selection (e.g., in the Texas Medication Algorithm Project [2]). Nevertheless, it possesses a distinctive biological homogeneity in clinical experience and laboratory test markers, and it is differentially responsive to specific treatment interventions. It therefore deserves recognition as a separate identifiable mood disorder. Melancholia has been variously described as “endogenous,” “endogenomorphic,” “autonomous,” “type A,” “psychotic,” and “typical” depression (3–6). In contrast to the current DSM criteria for the melancholia specifier (features of which are often shared with major depression), it has characteristic clinical features (5–7).

Catatonia Is not Schizophrenia: Kraepelin's Error and the Need to Recognize Catatonia as an Independent Syndrome in Medical Nomenclature

Catatonia is a motor dysregulation syndrome described by Karl Kahlbaum in 1874. He understood catatonia as a disease of its own. Others quickly recognized it among diverse disorders, but Emil Kraepelin made it a linchpin of his concept of dementia praecox. Eugen Bleuler endorsed this singular association. During the 20th century, catatonia has been considered a type of schizophrenia. In the 1970s, American authors identified catatonia in patients with mania and depression, as a toxic response, and in general medical and neurologic illnesses. It was only occasionally found in patients with schizophrenia. When looked for, catatonia is found in 10% or more of acute psychiatric admissions. It is readily diagnosable, verifiable by a lorazepam challenge test, and rapidly treatable. Even in its most lethal forms, it responds to high doses of lorazepam or to electroconvulsive therapy. These treatments are not accepted for patients with schizophrenia. Prompt recognition and treatment saves lives. It is time to place catatonia into its own home in the psychiatric classification.

Bedside manners : the troubled history of doctors and patients

By reading, you can know the knowledge and things more, not only about what you get from people to people. Book will be more trusted. As this bedside manners the troubled history of doctors and patients, it will really give you the good idea to be successful. It is not only for you to be success in certain life you can be successful in everything. The success can be started by knowing the basic knowledge and do actions.

The doctrine of the two depressions in historical perspective

Objective:  To determine if the concept of two separate depressions – melancholia and non‐melancholia – has existed in writings of the main previous thinkers about mood disorders.

The Shape of Strikes in France, 1830–1960

Strikes became legal in France more than a century ago. Since their first partial legalization in 1864, the right to strike has waxed and waned, the great federations of labor have sprung from conflicts within Frances modern industries and bureaucracies, and the proportion of strikes leading to shootings, beatings, sabotage or imprisonment has diminished. The strike has appeared to modernize, to take on new sophistication as a means of regulating conflict, to go from savage to civilized. Some regard the transformation as a betrayal. On the walls of Nanterre, one of the graffitisti of May 1968 wrote this message: We are seeing an overturn of the proletariats struggle; workers are making decisions at the bottom, and unions are competing to hold on to a decision-making power which has until now always defused the revolutionary impulse.1

SUCKER-PUNCHED AGAIN! PHYSICIANS MEET THE DISEASE-OF-THE-MONTH SYNDROME

Physicians are continuously getting sucker-punched. Every new diagnosis that floats through the media seems to catch the medical profession off guard. Out of the blue arrive bizarre new illness attributions, held as articles of faith by the patients but supported neither by scientific evidence nor the patina of plausibility. You as a patient have typed too long at the computer? You’ve got repetition strain injury, or RX, necessitating that you go on disability. The carpeting in your building contains formaldehyde? You’ve got Sick Building Syndrome, a disorder now rapidly spreading in the North American workplace as employees stagger from their desks dizzy and nauseated. Feeling perpetually weary and unable to concentrate? You’ve got ME, or Chronic Fatigue Syndrome, the result of a mystery virus that seems to affect mainly middle-class females. Thus the patients troop to the doctor, ailing with the kinds of non-specific symptoms-pain and fatigue, vertigo and dysphoria-that have afflicted humankind since the dawn of time. And since the ancient Greeks and Romans physicians have been treating these symptoms as best they know how. But nothing in doctors’ medical training has prepared them for patients who bring to the consultation not just symptoms but ready-made disease labels: “Doctor, I know I’ve got ME.” This is historically unprecedented: an efflorescence of fervently-held disease attributions in patients who are not merely symptomatic but morally certain that they know what they have, usually a pseudo-disease that does not exist [l]. It is this fixity of belief, not the process of illness attribution itself, that is new [2]. Patients have always tended to attribute their problems to some circumstance beyond themselves. Yet in the past they were open to medical counter-suggestion. Today the physician’s reasoning tone is drowned out by voices that clamor beyond the consultation room. Among non-medical sources there is complete agreement, “You must have ME.” Several decades ago some observers saw this gathering storm of media-driven illness attribution on the horizon. “Undoubtedly,” wrote Joel Yager and Roy Young in 1974, “many patients are veritable textbooks of non-disease, harboring many incorrect notions about the causes and implications of their symptoms.” [3]. Now in the mid-1990s the storm has burst upon us with full force. In Britain, organizations of sufferers march in protest outside of conferences on ME, demanding that the medical profession concede an organic cause to their sufferings. The head

Melancholia: restoration in psychiatric classification recommended

The classification of depressive disorders has varied considerably over the last 80 years, with quite contrasting models. Present-day DSM and ICD guidelines are based on a categorical model, using symptom check list criteria and weighting severity. The resulting heterogeneity of clinical and research populations has proved to be detrimental to effective clinical care and research. Concerns about the utility of the criteria for the diagnosis of major depression led to a three-day conference in Copenhagen in May 2006. Eighteen researchers and clinicians from Australia, Canada, Italy, Scandinavia, Switzerland, the United Kingdom and the United States considered problems intrinsic to the concept of ‘major depression.’ Their reports and a summary of the discussions are published in the ‘Melancholia: Beyond DSM, Beyond Neurotransmitters’ supplement to Acta Psychiatrica Scandinavica.

Childhood catatonia, autism and psychosis past and present: Is there an 'iron triangle'?

To explore the possibility that autism, catatonia and psychoses in children are different manifestations of a single underlying form of brain pathology – a kind of ‘Iron Triangle’ of symptomatology – rather than three separate illnesses.

Women's talk? : a social history of "gossip" in working-class neighbourhoods, 1880-1960

Part One: the whisper of devilish tongues - womens words corrupted. Part two: talk at the street door - the gossip exchange in working class neighbourhoods. Part three: the knowable community - the limits of mental and social space. Part four: blood thicker than water? Family and street tensions. Part five: no coats hanging on the door - neighbourhood networks in decline. Conclusion: women on the washtub.

The failure of the schizophrenia concept and the argument for its replacement by hebephrenia: applying the medical model for disease recognition.

The present DSM and ICD delineations of schizophrenia do not identify homogeneous populations, and patients with different presentations satisfy the official criteria. Treatment response, illness course, and biological findings vary widely, indicating heterogeneity and not a common pathophysiology. The DSM ⁄ ICD construct of schizophrenia does not meet the standard of the medical model. This model for disease recognition delineates syndromes and then attempts to validate them by course and prognosis, response to treatment, and laboratory tests that ultimately lead to a clear picture of the pathophysiology and its etiology. This model has been successfully employed for centuries (1). We examine the historical record and empirical data for schizophrenia from this perspective and find that hebephrenia is a more homogeneous construct with distinctive and reliably identified clinical features and better fits the application of the medical model.