L. Madeira

Distimia, Unipolar and Bipolar Depression: Are Modern Nosology Making Us Crazy?

Present day Psychiatric nosology allows for three syndromes of psychopathological sadness segregated by intensity and stability of symptoms as well as vegetative and premorbid particularities. Yet it is mostly a matter of seeing the advancement of the disorder (duration and presence of polarity) rather the particularity of the episode that roots the possibility of a diagnosis. We propose an exegesis of the various psychopathological studies contributions that might help segregating phenomenological particularities of each episode. Ultimately we aim shed light on the differences that were ground to the nosology so that increased clarity is reached for diagnosis and research.

EPA-0563 – Treatment and diagnosis of anomalous self experiences

There has been recent appraisal of anomalous self-experiences Sass and Parnas, 2003 as relevant for an early approach Schizophrenia Spectrum disorders (Nelson, 2012) and perhaps other psychiatric categories (Sass 2013). There is lack of research on their nosology and treatment. Critical appraisal of (1) the psychopathological descriptions of anomalous self experiences (2) diagnostic assessment and (3) psychopharmacological and psychotherapeutic treatment choices. We provide data analysis of 3 years psychiatric and psychotherapeutic followup, including (1) psychopathology, nosological assessment and psychopharmacological choices of 50 clinical sessions (2) a total of 500 emails to psychiatrists; (3) 58 psychotherapeutic sessions records and 10 taped psychotherapy sessions. All together showing that this patient symptomatic arrangement and his defiance to standard treatment approaches shows further research is needed on these topics of anomalous self-experiences. We now possess interviews as the EASE (Examination of Anomalous Self Experiences) and appraising such experiences has greatly improved. Yet treatment research on this area is lagging behind and any approach to these patients requires that they simultaneously fit other nosological categories. This case demonstrates how bewildering can be the treatment choices of such patients.

AS09-04 - Depressive episode phenomenological consistency and neuroscience evidence

Under current taxonomy clinical research in neuroscience is trying to identify brain differences in psychiatric groups. Current research is top-down, meaning the use of phenomena to identify structural and chemical changes. Emphasis has been made that psychiatry needs a stronger phenomenology before real neuroscientific inquiry can begin and that the phenomena currently used have frail consistency. Others insist that this attempt to correlate mental symptoms and diseases with brain changes would provide different epistemic ground for Psychiatry and new means to diagnose diseases. In fact there is a third problem - disorders in Psychiatry can have a different coherence in each epistemological paradigm and we need to show why is the neuro-scientific paradigm so important. We’ll discuss this topics under current conceptualization of mental symptoms as hybrid objects some are cultural while others biological objects (some seem pervasive to current taxonomy). We hope to show that even these last ones are subject to cultural changes and we might be tracing these cultural changes rather then real symptoms Mood episodes have a complex taxonomy and DSM-IV and ICD-10 listings show apparently correlated polymorphic symptoms and features. The attempt to be objective could be considered frail in these disturbances as most criteria refer to subjective experience and some rely in common-sense vocabulary (e.g. feelings of emptiness). This presentation will also show how our current classification scheme sometimes does not respect phenomenological boundaries (e.g. Masked depression and Borderline Personality Disorder). We’ll also mark how this category isn’t well defined and how that might be a necessary requirement for any coherent reductionism. We hope to present difficulties and merits of current mood disorders psychopathology and taxonomy in relation with neuroscience research.

AS39-01 - Experience of time: from psychosis to affective disorders

Time conceptualization is tricky and influential concepts of time and timing seem to help in a competent discussion of this topic. The distinction between time and temporality is key to the debate of time disturbances in psychiatric disorders. This presentation will discuss these concepts and clarify what authors as Kant, Fink, Schelling, Husserl, Heidegger, Fuchs and others have offered. In this process we’ll differentiate possible changes in personal and interpersonal time and notions of synchronization. Although unaccounted in DSM-IV and ICD-10 time experience and temporality are clearly altered during depressive and manic episodes. There seems to be a dialectical relation of mood to these experiences. Moreover, patients’ descriptions of lived time are enlightening of seminal accounts of these disorders and seem pervasive to other experiences in these patients. This presentation will further illustrate the phenomenology of time in depression and mania. It will propose to acknowledge time as a feeling, sharing phenomenological features with this type of experiences. We hope additionally to present through it relevant epistemology of fundamental experiences in depression (e.g. experience of inhibition, loss of vital contact with the world).

P-958 - The self: psychiatry, philosophy and neuroscience

The concept of Self has brought about major interdisciplinary interaction as Neuroscientific, Philosophic and psychological paradigms clash. The psychiatric epistemic paradigm of insight, depersonalization, dissociation, passivity experience and even schizophrenia reveals clear links to some important concepts that depend on this one. First we aim to present in a clear flowchart a short conceptual history of the Self from Aristotle’ till today. We’ll present Stoics, Descartes, Locke and Hume contributions to the clarification of this concept. As will be shown, this vast theoretical background was ground not only to its pervasiveness in psychopathology and psychiatric nosology but also to conceptual blur. Also we’ll present which different terms in psychiatry were influenced by the foundation and development of different theories of Self. Some concepts have weakened and were dropped (e.g. Multiple Personality) while others have received a greater prominence (e.g. insight). A special focus will be given to the intersection of the neuro-scientific and philosophical paradigm. It seems rather than destroying and weaken each other they can support each ones. We believe a clearer understanding of the Self will offer psychiatrists a clearer understanding in their clinical practice.