[Visna of Egill Skallagrimsson].

Considering the changes in moral principles, human behavior and behavioral values through the ages, in Egill Skallagrimsson's Saga, Egill presents us with altered mental status. This is in terms of what at present is considered symptoms of an anti-social personality, and bipolar affective disorder. Egill Skallagrimsson is considered one of the most famous Vikings in the Icelandic Sagas. Archaeological findings mentioned in Egill's Saga indicate disfigurement of his skull, which has led many authors to suggest that Egill suffered from skeletal dysplasia. The primary assumption in the literature is that Egill Skallagrimsson was affected by Paget's disease of bone. This consideration is additionally based on the scholar's interpretation of the Saga text. The unique storytelling style in the Saga of Egill Skallagrimsson is evident; however, the question of the story's truthfulness remains open. In this article, we investigate Egill Skallagrimsson's assumed Paget's disease of bone, based on the physical and mental symptoms disclosed in the Saga of Egill Skallagrimsson. Associated with the assumption, the author's hermeneutics of Egill's Saga in the context of modern-day knowledge of Paget's disease of bone, brings forward the probability estimate to the range of permille. In Scandinavian folklore and mythology, a tale by Saxo Grammaticus of a notorious shield-maiden named Visna, reminds of Egill, as noted by Snorri Sturluson. Hence, in reference to Egill Skallagrimsson's mental status and physical appearance as listed in Egill's Saga, the authors recommend the name for his condition to be "Visna of Egill Skallagrimsson".

Virginia Woolf, neuroprogression, and bipolar disorder

Family history and traumatic experiences are factors linked to bipolar disorder. It is known that the lifetime risk of bipolar disorder in relatives of a bipolar proband are 5-10% for first degree relatives and 40-70% for monozygotic co-twins. It is also known that patients with early childhood trauma present earlier onset of bipolar disorder, increased number of manic episodes, and more suicide attempts. We have recently reported that childhood trauma partly mediates the effect of family history on bipolar disorder diagnosis. In light of these findings from the scientific literature, we reviewed the work of British writer Virginia Woolf, who allegedly suffered from bipolar disorder. Her disorder was strongly related to her family background. Moreover, Virginia Woolf was sexually molested by her half siblings for nine years. Her bipolar disorder symptoms presented a pernicious course, associated with hospitalizations, suicidal behavioral, and functional impairment. The concept of neuroprogression has been used to explain the clinical deterioration that takes places in a subgroup of bipolar disorder patients. The examination of Virgina Woolf’s biography and art can provide clinicians with important insights about the course of bipolar disorder.

Kraepelin's description of chronic mania: a clinical picture that meets the behavioral variant frontotemporal dementia phenotype.

Chronic mania is an under-investigated condition and few reports have associated this disorder with an organic background. The present work examines Kraepelin's reliable description of chronic mania from a current behavioral neurology viewpoint. Kraepelin had described a cluster of symptoms that are now recognized as core manifestations of the behavioral variant frontotemporal dementia (bvFTD) clinical phenotype. We also carried out additional reviews of original manuscripts from Kraepelin's peers, in order to find any case reports that might fulfill the current diagnostic proposal for bvFTD. Even though we failed to find an ideal case, we found some scholars who seemed to agree that chronic mania should be considered a special form of dementia. The present work highlights, through historical data, the possible overlapping features between primary psychiatric disorders and neuropsychiatric symptoms secondary to neurodegenerative conditions.

Kraepelin's description of chronic mania: a clinical picture that meets the behavioral variant frontotemporal dementia phenotype / A descrição de Kraepelin de mania crônica: um quadro clínico que corresponde ao fenótipo da variante comportamental da demência fronto-temporal

ABSTRACT Chronic mania is an under-investigated condition and few reports have associated this disorder with an organic background. The present work examines Kraepelin’s reliable description of chronic mania from a current behavioral neurology viewpoint. Kraepelin had described a cluster of symptoms that are now recognized as core manifestations of the behavioral variant frontotemporal dementia (bvFTD) clinical phenotype. We also carried out additional reviews of original manuscripts from Kraepelin’s peers, in order to find any case reports that might fulfill the current diagnostic proposal for bvFTD. Even though we failed to find an ideal case, we found some scholars who seemed to agree that chronic mania should be considered a special form of dementia. The present work highlights, through historical data, the possible overlapping features between primary psychiatric disorders and neuropsychiatric symptoms secondary to neurodegenerative conditions.

RESUMO A mania crônica constitui uma condição subinvestigada e alguns trabalhos têm associado esta desordem a um substrato orgânico. O presente manuscrito analisa a descrição fidedigna de Kraepelin de mania crônica a partir de um ponto de vista atual da neurologia comportamental. Concebemos que ele havia descrito um conjunto de sintomas que atualmente é reconhecido como manifestações centrais do fenótipo clínico da variante comportamental da demência frontotemporal (bvFTD). Também realizamos uma revisão adicional de manuscritos originais de pares contemporâneos de Kraepelin, a fim de procurar por um único relato de caso que poderia preencher critério diagnóstico atual de bvFTD. Mesmo que não tenhamos conseguido encontrar um caso perfeitamente exemplar, identificamos que alguns estudiosos da época pareciam concordar que a mania crônica devesse ser considerada uma forma especial de demência. O presente trabalho destaca por meio de dados históricos a sobreposição entre transtornos psiquiátricos primários e sintomas neuropsiquiátricos secundários a doenças neurodegenerativas.

Sobre el diagnóstico de bipolaridad / Diagnosing bipolar disorder

Dado el aumento en el diagnostico de bipolaridad, las dificultades de establecer límites entre el ánimo normal y patológico y los riesgos derivados de la indicación de tratamientos inadecuados se presentan aquí antecedentes relativos a la historia y diagnóstico del Trastorno Bipolar así como las principales clasificaciones vigentes y las áreas de conflicto en cuanto a diagnóstico diferencial.

Given the increase diagnosis of bipolarity nowadays, the difficult to clarify the border between normal and pathological mood in this article the historical aspects and clinical features of Bipolar Disorder are reviewed as well as the differential diagnosis.

Melancolia e depressão durante o século XIX: uma história conceitual / Melancholia and depression during the 19th Century: a conceptual history / Mélancolie et dépression au cours du XIX siècle: une histoire conceptuelle / Melancolía y depresión durante el siglo XIX: uma historia conceptual

Este artigo analisa historicamente o background ideológico que tornou possível a transformação da noção de melancolia nos conceitos de depressão e transtorno bipolar, a partir das mudanças médicas e psicológicas ocorridas no decorrer do século XIX. A antiga noção de melancolia foi remodelada e sua transição para a doença depressiva foi facilitada pelo conceito de Iipemania de Esquirol, que, pela primeira vez, enfatizou a natureza afetiva primária da doença. Finalmente, uma vez obtidas as condições conceituais necessárias, a melancolia e a mania foram combinadas no conceito de insanidade alternante, periódica, circular, ou de forma dupla, seus rígidos padrões descritivos foram flexibilizados, tendo culminado este processo na sinopse de Kraepelin.

This article historically examines the ideological background that opened the way to the transformation of the notion of melancholia into the concepts of depression and bipolar disorder, based on changes in medicine and psychology during the 19th century. The older notion of melancholia was remodeled and its transition to the concept of depression disorder was facilitated by the concept of lipemania, introduced by Esquirol, who first emphasized the primarily affective nature of the disease. Finally, once the necessary conceptual conditions had been attained, melancholia and mania were merged into the concept of periodic, circular and alternating (or even simultaneous) insanity. Consequently, its strict descriptive standards were relaxed, culminating in Kraepelin's synopsis.

Cet article examine du point de vue historique le contexte idéologique qui a permit la transformation de la notion de mélancolie en concepts de dépression et de trouble bipolaire à partir de l'évolution médicale et psychologique qui a eu lieu au cours du XIX siècle. L'ancienne notion de mélancolie est révisée et sa transformation en notion de maladie dépressive s'opère entre autre grâce au concept de lypémanie d'Esquirol qui a été le premier à souligner le caractère affectif primaire de la maladie. Les conditions conceptuelles nécessaires établies, la mélancolie et la manie sont transformées en concept de la folie alternante, périodique, circulaire, ou double. Ses normes descriptives rigides sont assouplies, ce qui finalement abouti à la synthèse de Kraepelin.

Este artículo analiza históricamente el background ideológico que hizo posible la transformación de la noción de melancolía en los conceptos de depresión y trastorno bipolar, a partir de los cambios médicos y psicológicos ocurridos en el decorrer del siglo XIX. La noción antigua de melancolía fue remodelada y su transición para la enfermedad depresiva fue facilitada por el concepto de lipemania de Esquirol, quien, por primera vez, enfatizó la naturaleza afectiva primaria de la enfermedad. Finalmente, obtenidas las condiciones conceptuales necesarias, la melancolía y la manía fueron combinadas en el concepto de insanidad alternante, periódica, circular, o de forma dupla, sus patrones rígidos descriptivos fueron flexibilizados, culminando este proceso en la sinopsis de Kraepelin.

The madness of Dionysus -- six hypotheses on the illness of Nietzsche.

BACKGROUND: Friedrich Nietzsche (1844-1900) is considered as one of the most influential modern thinkers of the last two centuries. The great philosopher and poet developed a mental illness at the age of 44 and died at the age of 56. Pathological examination was not undertaken. At that time Nietzsche was diagnosed as having atypical paralysis progressiva, however recently five other probable diagnoses appeared in literature. METHOD: Literature search in MEDLINE and Web of Science on the illness of Nietzsche. RESULTS: Six hypotheses were identified: 1. Paralysis progressiva (General paralysis of the insane) 2. Bipolar affective disorder followed by vascular dementia 3. Hereditary form of frontotemporal dementia 4. Brain tumor 5. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) 6. Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome. CONCLUSION: Developments in neurology and molecular genetics give new perspectives to the secret of Nietzsche's illness and also there is a consensus on the questioning of the original paralysis progressiva concept. As there was no postmortem, the clinical speculations on the medical problems of the great philosopher remain a challenge.

A cena constituinte da psicose maníaco-depressiva no Brasil / The emergence of manic depressive psychosis as a diagnosis in Brazil

A intenção deste ensaio é esboçar a leitura da psicose maníaco-depressiva no Brasil, no começo do século XX. Destaca a transformação teórica ocorrida na psiquiatria brasileira, que se deslocou da tradição francesa para a alemã. Sublinha o modo como a problemática da histeria foi substituída pela da psicose maníaco-depressiva nesse contexto histórico.

This essay examines the early twentieth-century interpretation of manic depressive psychosis in Brazil, during a moment when Brazilian psychiatry witnessed a theoretical shift from the French to German traditions. It calls special attention to how the problem of hysteria was replaced by manic depressive psychosis within this historical context.

The blindness, deafness and madness of King George III: psychiatric interactions.

Recent research has thrown considerable doubt on the claim that King George III suffered from variegate porphyria, but indicates that he suffered recurrent attacks of mania as part of his bipolar disorder. George III's last episode of ill health occurred during the final decade of his life (1810-20). This has been diagnosed as chronic mania with an element of dementia. During this period the king was blind and possibly deaf, which may have contributed to his psychiatric condition. His blindness was due to bilateral cataracts; serious consideration was given at the time to surgery, but this was not carried out. The possible contribution of the king's blindness to his illness is discussed with respect to the roles of his medical attendants. It was also claimed that George III showed progressive deafness and this claim has been re-examined. However, the medical reports by the attending physicians and psychiatrists (mad doctors) do not support this claim.

A evolução histórica dos conceitos de transtorno de humor e transtorno de personalidade: problemas no diagnóstico diferencial: [revisão] / Historical evolution of mood disorders and personality disorders concepts: difficulties in the differential diagnostic: [review]

CONTEXTO: Os conceitos de transtornos de humor e de personalidade sofreram diversas mudanças nas últimas décadas. Historicamente, esses conceitos foram construídos em paralelo, isto é, transtornos de humor e personalidade são considerados como transtornos independentes em relação ao diagnóstico, ao prognóstico e ao tratamento. Recentemente, entretanto, novas propostas na conceituação nosológica desses transtornos levantaram a questão de uma possível sobreposição dessas entidades, tornando o diagnóstico diferencial entre esses transtornos muitas vezes difícil. OBJETIVOS: Realizar uma revisão de literatura sobre a evolução dos conceitos de transtorno de humor e personalidade sob uma perspectiva histórica, focando em publicações relacionadas ao diagnóstico. MÉTODO: Revisão compreensiva da literatura utilizando o banco de dados MEDLINE (1990-2007). RESULTADOS: Ao contrário do conceito de transtorno de humor, que se apresenta estável e relativamente sem modificações desde suas primeiras descrições, o conceito de transtorno de personalidade mostra considerável variação ao longo dos diferentes achados de literatura. Assim, ambos os grupos de transtornos têm sido conceituados tanto categorial como dimensionalmente. Esta última abordagem pode ser, em parte, responsável pelas dificuldades algumas vezes encontradas no diagnóstico diferencial desses transtornos. CONCLUSÃO: O diagnóstico diferencial entre transtornos de humor e personalidade ainda representa um sério problema na prática clínica e não pode ser completamente esclarecido com base nas evidências disponíveis. O melhor entendimento da base fisiopatológica desses transtornos, bem como a identificação mais precisa de seus marcadores biológicos, pode ajudar a redefinir seus conceitos e seus status nosológicos atuais.

BACKGROUND: The concepts of mood and personality disorders have faced countless changes over the last decades. Historically, these concepts have been built in parallel, that is, mood and personality disorders have been considered as independent disorders with respect to diagnosis, prognosis and treatment. Recently, however, new proposes on the nosological conceptualization of these disorders have raised the question of a possible overlap between these nosological entities, making the differential diagnosis between these disorders difficult at times. OBJECTIVES: To carry out a literature review on the evolution of mood and personality disorders concepts under a historical perspective, focusing on diagnostic-related issues. METHOD: A comprehensive MEDLINE literature search (1990-2007) was conducted. RESULTS: Contrarily to the concept of mood disorder, which seems to be stable and relatively unchanged since its first description, the concept of personality disorder shows considerable variation over the different literature findings. Thus, both groups of disorders have been conceptualized not only in a categorical point of view but also according to a dimensional approach. The last one may be at least partially accountable for the difficulties sometimes observed in the differential diagnosis of these disorders. DISCUSSION: The differential diagnosis between mood and personality disorders may still represent a serious problem in clinical settings, and can not be completely clarified in light of available evidence. A better understanding of the pathophysiological basis of these disorders, as well as the more accurate identification of their biological markers can help redefining their concepts and their nosological current status.

[Deafness and mentality in Francisco Goya's paintings]. / Gluchota a psychika w malarstwie Franciszka Goi.

The famous painter Francisco Goya y Lucientes (1746-1828) suffered during his life one or several diseases, the nature of which has not been determined with certainty. At age of 46, Goya suffered from severe illness that lasted a few months. It caused loss of vision and hearing, tinnitus, dizziness, a right-sides paralysis, weakness and general malaise. Although he recovered from a cerebral stroke which accompanied it, the deafness remained unaltered. The illness divides Goya's artistic life into two great different periods. After in the painter produces his greatest works. The visual experience after the illness was heightened by the exclusion of acoustics stimuli and the artist's talent rose to the highest level. His character became more withdrawn and introspective and his entire vitality was direscted to his painting. Goya's painting became progressively more gloom and satirical during his long convalescence. The artist suffered a stroke at age 73 that again rendered him paralysed on the right side. The precise cause of his illness has long been debated. Ome medical writers have favored the diagnosis of syphilis, some consider the possibility of an exogenous psychosis, and other suggests that the symptoms of the illness are more congruent with heavy metal poisoning, particulary lead. It is interesting to speculate how the Goya's deafness influenced the artist's mentality and the changes of his painting. Interesting is also the problem of the sensory compensation in fact of disturbance of physiological function of one of the senses.

Relaciones entre el trastorno límite de personalidad y el espectro bipolar: [revisión] / Relationship between borderline personality disorder and bipolar spectrum: [review]

Existe una controversia respecto a la independencia nosológica del trastorno límite de personalidad. Algunos autores sostienen que es parte del trastorno bipolar, mientras otros afirman que es una entidad independiente. En este trabajo se analiza la evolución histórica de los conceptos de trastorno límite y trastorno bipolar. Se discuten los argumentos a favor y en contra de incluir el trastorno límite dentro del trastorno bipolar. Por último se proponen nuevas estrategias para abordar este problema.

The independent nosological status of borderline personality disorder is a controversial issue. Some authors consider borderline as part of bipolar spectrum, but other sustain that is a independent entity. The historical evolution of borderline personality disorder and bipolar disorder is analyzed in this work. The arguments for include, or not include, borderline personality disorder in bipolar disorder is discussed. Finally, new strategies for study this problem are proposed.

Impacto funcional de los trastornos bipolares: altibajos históricos frente a un problema clave / Bipolar disorders functional impact. historical ups and downs in relation to a key problem

The way that the sanitary concept impacted the bipolar disorders has oscillated noticeably in the last years. At the beginning of the XX century they were considered a fundamental part of the structure of clinical psychiatry, disabling and more frequent then schizophrenias. Concomitantly to the insertion of the use of the antiseptics in the fifties they start to enter the shadows of the interest of clinicians and investigators at the same time that the concept of them is changed understanding that in the majority of cases they are benign and with little functional impact. In the last twenty years this situation changes yet again getting more attention and rediscovering that more then half of the people affected by it suffer a strong functional impact. None the less, in this conceptual back and forth, the enormous heterogeneity that these cases have has been lost which permit that an appreciable percentage of affected people have an optimal performance or even above average. In this article we explore the conceptual alternatives and also some models that take into account this heterogenety.

El modo en que se conceptuó el impacto sanitario de los Trastornos Bipolares ha oscilado llamativamente en los últimos años. A principio del siglo XX eran considerados parte fundamental de la estructura clínica psiquiátrica, disabilitantes y más frecuentes que las esquizofrenias. Concomitantemente a la inserción del uso de los antipsicóticos en la década del 50 comienzan a entrar en un cono de sombra en el interés de clínicos e investigadores al mismo tiempo que se cambia el concepto sobre ellos al entenderse de que en la mayoría de los casos se trata de cuadros benignos y con poco impacto funcional. En los últimos 20 años esta situación vuelve a cambiar al prestársele más atención a estos cuadros y redescubrir el hecho de que más de la mitad de las personas afectadas por ellos sufren un fuerte impacto funcional. Sin embargo, en este vaivén conceptual se ha ido perdiendo de vista la enorme heterogeneidad que tienen estos cuadros la cual permite que un porcentaje nada despreciable de personas afectadas tengan un rendimiento óptimo o incluso mayor al de la media. En este artículo se revisan estas alternancias conceptuales y se revisan algunos modelos que tienen en cuenta esta heterogeneidad.

The delphic oracle and the ethylene-intoxication hypothesis.

An interdisciplinary team of scientists--including an archeologist, a geologist, a chemist, and a toxicologist--has argued that ethylene intoxication was the probable cause of the High Priestess of Delphi's divinatory (mantic) trances. The claim that the High Priestess of Delphi entered a mantic state because of ethylene intoxication enjoyed widespread reception in specialist academic journals, science magazines, and newspapers. This article uses a similar interdisciplinary approach to show that this hypothesis is implausible since it is based on problematic scientific and textual evidence, as well as a fallacious argument. The main issue raised by this counterargument is not that a particular scientific hypothesis or conjecture turned out to be false. (This is expected in scientific investigation.) Rather, the main issue is that it was a positivist disposition that originally led readers to associate the evidence presented in such a way that it seemed to point to the conclusion, even when the evidence did not support the conclusion. We conclude by observing that positivist dispositions can lead to the acceptance of claims because they have a scientific form, not because they are grounded in robust evidence and sound argument.

Virginia Woolf: enfermedad mental y creatividad artística / Virginia Woolf as an example of a mental disorder and artistic creativity

This is an attempt to evaluate the mental disorder that the novelist Virginia Woolf suffered, and to determine the relatioship between her creativity and her insanity. What mostly characterizes her illness is the presence of typical phases of severely impairing depression and significant hypomania, culminating in suicide at the age of 59. This is a convincing life history of a bipolar II disorder, although the «broad bipolar spectrum¼ is less easy to define operational than bipolar disorder I. She was moderately stable as well as exceptionally productive from 1915 until she committed suicide in 1941. Virginia Woolf created little or nothing while she was unwell, and was productive between attacks. A detailed analysis of her own creativity over the years shows that her illnesses were the source of material for her novels.