'Eccentricity', by DH Tuke (1892).

An astronomical concept up to the eighteenth century, 'eccentricity' started to be used to refer to behaviours considered as odd, strange, rare, extravagant, etc. Once reified into a personality trait, it gained explanatory power. This not only increased its popularity but also facilitated its links with psychopathology and neuropsychology, and, via the shared concept of madness, with the notions of genius and creativity. This Classic Text describes the process whereby Alienism (Psychiatry) medicalized eccentricity. To this day, the latter remains firmly attached to 'psychoticism' and to some personality disorders.

Reactive Psychosis: Discrepancy Between Nosological Concepts and Descriptive Categories.

ABSTRACT: Reactive psychosis (RP) is a trauma-induced category whose meaning has varied in relation to the role attributed to lived experiences or vulnerable personality. It has long been described in different countries, but seldom investigated under the influence of symptom-based psychiatric classifications. This article aims to examine the development of RP since the early 20th century, outline how it has been incorporated in modern diagnostic classifications, and set out empirical findings. It is likely that variations in terminology and diagnostic practice have affected estimates of the frequency and hampered the validity of RP in earlier studies. To enhance reliability, RP underwent several changes in successive Diagnostic and Statistical Manual of Mental Disorders and ICD versions and was eventually replaced with descriptive categories for short-lived psychotic disorders. Clinical observations during the COVID-19 pandemic attest the durability of RP, but the current categories prove unhelpful in identifying it and have failed to encourage research.

The predictive validity and outcome of ICD-10 and DSM-5 short-lived psychotic disorders: a review and meta-analysis.

The ICD-10 Classification of Mental and Behavioural Disorders introduced the category of 'acute and transient psychotic disorders' (ATPDs) encompassing polymorphic, schizophrenic and predominantly delusional subtypes, and the forthcoming ICD-11 revision has restricted it to polymorphic psychotic disorder, while the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) listed 'brief psychotic disorder' (BPD). To assess the predictive validity and outcome of ATPDs and BPD, relevant papers in English, French and German were searched in PubMed and Web of Science. Where possible meta-analysis of prognostic validators (diagnostic stability, course, outcome and response to treatment) was conducted. Fifty studies published between January 1993 and July 2019 were found. The clinical and functional outcome of ATPDs proved better than in schizophrenia and related disorders, but mortality risk is high, particularly suicide, and treatment trials provide little evidence. Meta-analysis of 25 studies (13,507 cases) revealed that 55% (95% CI 49-62) do not change diagnosis, 25% (95% CI 20-31) converted into schizophrenia and related disorders, and 12% (95% CI 7-16) into affective disorders on average over 6.3 years. Subgroup meta-analysis estimated prospective consistency of polymorphic psychotic disorder (55%; 95% CI 52-58) significantly greater than that of the ATPD subtypes with schizophrenic (OR 1.7; 95% CI 1.4-2.0) and predominantly delusional (OR 1.3; 95% CI 1.1-1.5) symptoms. Moreover, the diagnostic stability of BPD (13 studies; 294 cases) was 45% (95% CI 32-50) over a mean 4.2 years. Although these findings indicate that short-lived psychotic disorders have little predictive validity, significant differences among the ATPD subtypes support the revised ICD-11 ATPD category.

Conceptual Issues in Acute and Transient Psychotic Disorders.

Short-lived psychotic disorders as currently listed under "acute and transient psychotic disorder," ICD-11 Classification of Mental, Behavioural, and Neurodevelopmental Disorders, and "brief psychotic disorder," Diagnostic and Statistical Manual of Mental Disorders (DSM-5), constitute a point of divergence in the classification of psychotic disorders between the 2 diagnostic systems, which reveals the lack of knowledge about these conditions. Whether this is due to conceptual shortcomings inherent to the categories themselves and which spill over onto research or reflects a mismatch between the diagnostic criteria used and research techniques needs clarification. This study aimed to examine conceptual issues involved in the development of the above categories and shows that little continuity exists between earlier nosological concepts such as bouffée délirante, cycloid psychosis, and reactive psychosis and modern descriptive categories used to classify short-lived psychotic disorders. It seems likely that shortcomings in terms of symptom completeness, specificity, and heterogeneity, in addition to changes in definition and diagnostic criteria in successive DSM and ICD versions, have hampered empirical research, making it difficult to enhance the understanding of these conditions and achieve a closer concordance between the 2 classificatory systems.

Classic Text No. 128: Thomas Brown's comments on Erasmus Darwin's view on madness.

In his book Observations on the Zoonomia of Erasmus Darwin MD, Thomas Brown included a critical chapter on the analysis of madness proposed by Darwin in Zoonomia. Although neither Darwin nor Brown are ground-breaking in their views on madness, they illustrate the transitional accounts of madness that were being entertained at the end of the eighteenth century, particularly among writers who had studied at Edinburgh University.

Classic Text No. 126: 'Some main features in the history of the paranoid illness forms', by Aa. Thune Jacobsen (1921).

Since its construction in Classical times, the meaning of 'paranoia' has changed at least three times. Important gaps still interrupt its long chronology, and more studies of specific clinical and cultural usages are needed before its total history is put together.

'My insanity in the year 1783', by C.S. Andresen (1801).

The literature of the past has included self-reports by the mentally ill since before Roy Porter reminded us that their views and experiences constitute an important document for historians of psychiatry. The value of these self-reports can be enhanced if their potential biases and informational power are duly determined. This Classic Text concerns a self-report of a form of periodic madness written by an eighteenth-century Danish vicar. It shows how the same document can be presented in a more or less neutral fashion by a medical historian (Maar) or used as 'evidence' for some 'ontological' view of madness by a clinician (Rasmussen).

Assessing irritability in patients with stroke: psychometric properties of the Irritability Questionnaire.

Objective: Irritability is a very common symptom after stroke and a source of a great deal of distress to patients and caretakers. We evaluated the psychometric properties of the Irritability Questionnaire (IQ) in a sample of patients with stroke.Methods: we recruited 94 participants (47 stroke patients and 47 healthy controls) that participated in a 6-month longitudinal observational study. The IQ includes three dimensions in the assessment: emotion, cognition, and behavior. IQ has two subscales: The Irritability Questionnaire (IRQ) and the Carer's Irritability Questionnaire (CIRQ). Internal consistency, convergent validity, and sensitivity to change were evaluated for both IRQ and CIRQ.Results: Cronbach's alpha for the IRQ was 0.91 (95% CI: 0.76 to 0.87), whereas for the CIRQ was 0.92 (95% CI: 0.89 to 0.94). Convergent validity was good for both subscales. IRQ did not show sensitivity to change at 6 months (p-value = 0.99), while CIRQ showed moderate changes (-0.29, p-value = 0.124).Conclusions: IQ presented good psychometric properties to assess irritability in stroke. The tool detected significant differences between groups (stroke and healthy controls) and can be considered a valid instrument for clinical and research purposes.

'Insanity in Classical Antiquity', by JL Heiberg (1913).

Heiberg's 1913 text on psychopathological concepts and terms in classical times remains important because of its freshness and historiographical value. A philologist and classical scholar, he seemed puzzled by the assumption of nosological continuity between classical categories of madness and current ones that prevailed at the time among historians of medicine and psychiatry. Heiberg's text acts as a bridge or transition between the nosological antiquarianism of the 19th century and histories of psychiatry that later warned of the dangers of an anachronistic reading of earlier medical texts. It also shows how important has been the contribution of classical philologists to the study of the history of madness. To our knowledge, this is the first rendition into English of the complete Danish work.

From Evolutive Paranoia, by August Wimmer (1902).

Literature on the history of 'paranoia' (as a clinical concept) is large and confusing. This is partly explained by the fact that over the centuries the word 'paranoia' has been made to participate in several convergences (clinical constructs), and hence it has named different forms of behaviour and been linked to different explanatory concepts. The Classic Text that follows provides information on the internal clinical evolution of the last convergence in which 'paranoia' was made to participate. August Wimmer maps the historical changes of ' Verrücktheit' as it happened within the main European psychiatric traditions since the early 19th century. After World War II, that clinical profile was to become reified and renamed as 'delusional disorder'.

Acute Polymorphic Psychotic Disorder: Concepts, Empirical Findings, and Challenges for ICD-11.

The ICD-11 International Classification of Diseases and Related Health Problems will move toward a narrower concept of "acute and transient psychotic disorders" (ATPD) characterized by the remnant "polymorphic psychotic disorder" (APPD) of the current ICD-10 category, also including schizophrenic and predominantly delusional subtypes. To assess the validity of APPD, relevant articles published between January 1993 and September 2017 were found through searches in PubMed and Web of Science. APPD is a rare mental disorder and affects significantly more women than men in early-middle adulthood. Its diagnostic reliability is relatively low, and its consistency reaches just 53.8% on average over 8.8 years, but is significantly greater than either of ATPD subtypes, which are more likely to progress to schizophrenia and related disorders. Although APPD has distinctive features and higher predictive power, its rarity and the fleeting and polymorphic nature of its symptoms could reduce its usefulness in clinical practice and discourage research.

Historical epistemology of the body-mind interaction in psychiatry.

This paper deals with the history of the relationship between the mind-body dualism and the epistemology of madness. Earlier versions of such dualism posed little problem in regard to the manner of their communication. The Cartesian view that mind and body did, in fact, name different substances introduced a problem of incommunicability that is yet to be resolved. Earlier views that madness may be related to changes in the brain began gaining empirical support during the 17th century. Writers on madness chose to resolve the mind-body problem differently Some stated that such communication was not needed; others, that mind was a redundant concept, as madness could be fully explained by structural changes in the brain; and yet others described psychological spaces for madness to inhabit as a symbolic conflict. The epistemology of the neurosciences bypasses the conundrum, as it processes all together the variables representing the brain, subjectivity, and behavior and bridges the "philosophical" gap by means of correlational structures.

Este artículo aborda la historia de la relación entre el dualismo mente-cuerpo y la epistemología de la locura. Las primeras versiones de dicho dualismo plantearon poco problema en relación a la manera en que ellas se comunicaban. La perspectiva cartesiana de que el cuerpo y la mente designan, de hecho, diferentes contenidos introdujo un problema de incomunicabilidad que aún no se ha resuelto. Durante el siglo XVII comenzaron a aparecer los datos empíricos que dieron sustento a los primeros planteamientos acerca de la relación entre la locura y los cambios cerebrales. Autores interesados en la locura decidieron resolver de diferente manera el problema mente-cuerpo. Algunos plantearon que dicha comunicación no era necesaria; otros, que la mente era un concepto redundante, ya que la locura podría explicarse totalmente por cambios estructurales del cerebro. Incluso, otros autores describieron espacios psicológicos para que la locura habitara como un conflicto simbólico. La epistemología de las neurociencias evita el enigma, al procesar juntas todas las variables que representan el cerebro, la subjetividad y las conductas, y une el hiato "filosófico" por medio de estructuras que se correlacionan.

Cet article traite de l'histoire des relations entre la dualité corps-esprit et l'épistémologie de la folie. Les versions antérieures d'une telle dualité ne posent guère de problème quant à leur façon de communiquer. L'idée cartésienne que le corps et l'esprit désignent, en fait, différents contenus, a mis en place un problème d'incommunicabilité qui n'est pas encore résolu. Au XVIIe siècle, des données empiriques ont soutenu l'existence d'un lien entre les maladies mentales et des modifications du cerveau. Des auteurs s'intéressant à la folie ont choisi de résoudre différemment le problème corps-esprit. Certains ont trouvé qu'une telle communication n'était pas nécessaire ; d'autres, que l'esprit est un concept redondant, les troubles mentaux pouvant être complètement expliqués par des changements structurels du cerveau ; et d'autres encore ont décrit l'espace psychologique de la folie comme un conflit symbolique. L'épistémologie des neurosciences contourne le dilemme en traitant ensemble toutes les variables représentant le cerveau, la subjectivité et le comportement et comble le vide « philosophique ¼ par des structures en corrélation.

Albert Lemoine and the epistemology in psychiatry / Albert Lemoine e a epistemologia da psiquiatria / Albert Lemoine et l'épistémologie de la psychiatrie / Albert Lemoine y la epistemología de la psiquiatria

Abstract In 1862, the French philosopher Albert Lemoine (1824-1874) published one of the earliest books on the philosophy of psychiatry and psychopathology. Although brought up as a Spiritualist thinker in the mould of Maine de Biran and Royer-Collard, he attempted to reconcile the speculative neurobiological account of madness predominant in his time (particularly amongst alienists interested in its medicalization) with a broader approach that conceived of the mind as a psychological space populated by dynamic forces and elements also relevant to the causality and meaning of madness. In the ongoing debate on whether Psychology or Physiology was the most appropriate science for the study of Madness he rightly stood in the middle. His views remain important for the issues that he dealt with have not yet been resolved.

Em 1862, o filósofo francês Albert Lemoine (1824-1874) publicou um dos primeiros trabalhos sobre a filosofia da psiquiatria e da psicopatologia. Embora criado como um pensador espiritualista nos moldes de Maine de Biran e Royer-Collard, ele tentou reconciliar o relato neurobiológico especulativo da loucura predominante em seu tempo (particularmente entre alienistas interessados em sua medicalização) com uma abordagem mais ampla, que concebeu a mente como um espaço psicológico povoado por forças dinâmicas e elementos também relevantes para a causalidade e o significado da loucura. No debate em curso sobre se a ciência mais apropriada para o estudo da loucura seria a psicologia ou a fisiologia, ele corretamente ficou no meio. Suas opiniões continuam importantes, pois as questões de que ele tratou ainda não foram resolvidas.

En 1862, le philosophe français Albert Lemoine (1824-1874) a publié l'un des premiers ouvrages sur la philosophie de la psychiatrie et de la psychopathologie. Malgré le fait d'avoir reçu une formation de penseur spiritualiste selon Maine de Biran et Royer-Collard, il tenta de réconcilier le récit neurobiologique spéculatif de la folie prédominant à son époque (en particulier chez les aliénistes intéressés par sa médicalisation) avec une approche plus large qui conçoit l'esprit en tant qu'espace psychologique peuplé de forces dynamiques et d'éléments qui sont tout aussi pertinents pour la causalité et le sens de la folie. Dans le débat en cours qui essayait de décider si la science la plus appropriée pour l'étude de la folie serait la psychologie ou la physiologie, il se tenait à juste titre au milieu. Ses opinions restent d'ailleurs pertinentes, car les questions abordées par ce philosophe n'ont toujours pas été résolues.

En 1862, el filósofo francés Albert Lemoine (1824-1874) publicó uno de los primeros libros sobre la filosofía de la psiquiatría y de la psicopatologia. A pesar de haber sido criado como un pensador de la corriente espiritualista, en los moldes de Maine de Biran y de Royer-Collard, intentó reconciliar el relato neurobiológico especulativo de la locura predominante en su tiempo (particularmente entre alienistas interesados en su medicalización) con un enfoque más amplio, que concibió la mente como un espacio psicológico poblado por fuerzas dinámicas y elementos también relevantes para la causalidad y el significado de la locura. En el debate en curso sobre si la psicología o la fisiología eran las ciencias más apropiadas para el estudio de la locura, se mantuvo en la mitad. Sus puntos de vista siguen siendo importantes porque los problemas que abordó aún no se han resuelto.

Im Jahr 1862 veröffentlichte der französische Philosoph Albert Lemoine (1824-1874) eines der ersten Bücher zur Philosophie der Psychiatrie und Psychopathologie. Obwohl er ein spiritistischer Denker im Sinne von Maine de Biran und Royer-Collard war, versuchte er, die spekulative neurobiologische Darstellung des Wahnsinns, welche in seiner Zeit vorherrschte (insbesondere unter den Nervenärzten, die an seiner Medikalisierung interessiert waren) mit einem großzügigeren Ansatz zu verbinden. Dieser konzipierte den Verstand als psychologischen Raum, der von dynamischen Kräften und Elementen besetzt ist, die auch für die Kausalität und Bedeutung des Wahnsinns relevant sind. In der anhaltenden Debatte darüber, ob die Psychologie oder die Physiologie die am besten geeignete Wissenschaft für das Studium des Wahnsinns sei, stand er richtigerweise in der Mitte. Seine Ansichten sind bis heute relevant, da die Fragen, die er anging bis heute noch nicht gelöst sind.

Historical and conceptual aspects of motor disorders in the psychoses.

Historical epistemology is a useful method to understand the longitudinal construction of the movement disorders in psychiatry. Four periods can be identified in such a process. The first, extending from Classical times to the work of Griesinger, included disorders such as catalepsy, crocidism, epilepsy and paralysis. The second period, stretching from Griesinger to Kahlbaum, concentrated on the study of melancholia attonita, stupor and catatonia. The third period, covering the time from Kahlbaum to WWI, witnessed important conceptual shifts such as: the transformation of madness into psychoses; the redefinition of movement and motility in psychiatry; the appearance of self-contained syndromes as dyskinesias, tics, akathisia, complex disorders like the cases of encephalitis lethargica, etc.; the advent of functional and psychodynamic explanations; and the description by Wernicke, Kleist and others of the motility psychoses. The fourth period stretches from WWI to the present and since it corresponds to the views and work reported in the rest of this Special issue it has not been touched upon in this paper. In spite of an increasing methodological refinement, empirical research is yet to clarify what is the clinical meaning of the movement disorders in the context of the psychoses and to explain whether such disorders are primary (i.e. issuing directly from the brain and parallel to the rest of psychotic symptomatology) or secondary (i.e. mediated by cognitive and emotional phenomena characteristic of the psychoses).

[Psychogenesis: Central concept of the disciplines of the mind?] / Psicogénesis: ¿concepto central de las disciplinas de la mente?

To contemporary neuroscience the concept of psychogenesis and all psychogenetic explanations are nonsense. Work on psychogenesis undertaken by the Cambridge group disagrees with the concept of mental disorder proposed by neuroscientific reductionism because it: 1) offers too narrow a view of the concept of mental disorder; and 2) does not do justice to its cultural complexity as shown by epistemological, historical and clinical research. The study of psychogenesis will help with the understanding and ethical management of many mental disorders. In due course, psychiatrists will have to decide whether these are to be considered as mere brain diseases or as complex hybrid phenomena combining brain localization, symbolic conflict and cultural configuration (psychogenesis). It seems clear that in the future therapy will only be defined as ethical when it is made to target the primary source of the disorder (which can be brain pathology or semantic conflict).

'Motility Psychoses', by Erik Strömgren (1940).

The motility psychoses are a group of acute psychiatric conditions characterized by salient disorders of movement (increased, decreased and disorganized), psychotic experiences, confusion and good prognosis. The debate on whether they are just atypical forms of schizophrenia or manic-depressive insanity or constitute an independent group of psychoses has not yet been settled. Erik Strömgren's classical chapter deals with the history and clinical aspects of the motility psychoses. Based on a historical analysis and an empirical study of a patient cohort, the author draws conclusions on the nature of this clinical group that has stood the test of time well.

Research in Psychiatry: Concepts and Conceptual Analysis.

Current research in psychiatry is increasingly focused on empirical studies with methods and technologies adopted from medicine. This paper argues that psychiatry has a different epistemological basis from medicine, and it is on account of this that research in psychiatry demands a different approach, one that perforce focuses on the clarification of concepts central to psychiatric practice. This means undertaking conceptual analysis and conceptual history and only then moving on to empirical study. This paper highlights the crucial epistemological differences between the practice of medicine and psychiatry, showing that the latter is enacted at the level of language and communication. Consequently, the structures of psychiatric objects, namely, mental disorders and mental symptoms, are complexes of meaning derived from heterogeneous sources - both organic and semantic. Conceptual analysis of such structures is essential as ultimately the validity of empirical research is directly dependent on the conceptual clarification of its objects of inquiry.

The construction of anosognosia: history and implications.

The construction of anosognosia as a clinical 'disorder' resulted from the convergence (in the work of various writers and culminating in Babinski) of a name, a concept, and a clinical phenomenon. During the early stages of this convergence, unawareness of neurological dysfunction was not considered as an independent clinical phenomenon. Started in the work of Anton, the process of separating it as a differentiable clinical state is completed by Babinski who reaffirmed the semiological independence of 'unawareness'. The history of the construction of 'anosognosia' parallels the late 19th century debate on the nature and brain inscription of the concept of 'consciousness'.