Alexander Nikolaevich Scriabin (1872-1915): Enlightenment or illness?

The similarity between psychotic symptoms and aspects of mystical experiences is well known. It has long been recognized that there are similarities between mystical and spiritual and psychotic experiences. The content of an experience alone usually does not determine whether an individual is psychotic. The Russian composer Scriabin (1872-1915) was among the most famous artists of his time. Scriabin infused his music with mysticism, evolving a modernistic idiom through which he created a musical counterpart to the Symbolist literature of that period. In this paper, we discuss the question that arises from perusing Scriabin's life is whether the composer was a mystic genius or whether he suffered from affective psychopathology with psychotic features.

En los orígenes, lo arcaico / In the beginning, the archaic

Estamos permanentemente confrontados, por la clínica y por nuestra necesidad de saber, a manejar una teoría de lo originario que nos permita pensar, metapsicológicamente, nuestra praxis. Todos los autores psicoanalíticos aquí reseñados comparten la necesidad de responderse a los cuestionamientos teóricos a los que les confronta su práctica. Todos señalan las incoherencias de las teorías en las que han crecido y con las que han ido a sus consultas llenos de entusiasmo clínico encontrándose con la desilusión de los desencuentros. Dichas propuestas modifican singularmente nuestra concepción del trabajo psicoanalítico, como Freud lo presentó, y abren otro frente en el seno del proceso de las curas. Un frente que plantea el problema de los fundamentos de aquello que manda en la instauración y el despliegue del aparato psíquico y de su funcionamiento. Este trabajo concierne al estatuto de los vestigios de los acontecimientos arcaicos, tanto en cuanto a su conservación intrapsíquica como a la fuente de la energía que pueda reactivarlos. Y lo más importante para nosotros, las condiciones para su captación y puesta en sentido en el seno de nuestra matriz epigenética: nuestro encuadre interno y el que compartimos y nos acoge, el encuadre psicoanalítico (AU)

We are continually challenged, by our clinical work and by our need to know, to wield a theory of “the originary” Which would enable us to consider, metapsychologically, our praxis. All of the authors summarized here share the need to respond to the theoretical questions thrown up by their practice. All point out the inconsistencies in the theories they have grown up with and with which they have gone to their consulting rooms, full of clinical zeal, finding themselves face to face with the disillusionment of the failed encounter. These proposals singularly modify our conception of the work of psychoanalysis, as advanced by Freud, opening up another front within the process of the cures. This is a front that raises the issue of the fundaments of that which commands in the establishment and deployment of the psychic apparatus and its functioning. This work concerns the status of the traces of archaic events, both in terms of their intrapsychic conservation and the source of the energy able to reactivate them. Most importantly for us, the conditions for their apprehension and meaning-making within our epigenetic matrix: our internal setting and that which we share and which takes us in, the psychoanalytic setting (AU)

Melancholia: past and present.

OBJECTIVE: To investigate commonalities in the clinical presentation of melancholia over time. METHOD: I conducted a comparative study to 2 epidemiologically complete databases from 1875-1924 and 1995-2005. RESULTS: Patients in the historical period (1875-1924, compared with 1995-2005) with a diagnosis of melancholia show a classic profile of endogenous onset, with remission after 6 months, neurovegetative features, and, commonly, psychosis. The incidence of psychotic presentations appears to have fallen in recent decades. Patients in the contemporary period (1995-2010, compared with 1875-1924) at first admission for severe depressive disorders are more likely at an older age, more likely to go on to die by suicide, and will have much more frequent admissions. CONCLUSIONS: The data from this study support classical perceptions of melancholia. The poor outcomes in contemporary cases of severe depressive disorders support arguments for distinguishing between melancholia and other depressive disorders.

Estudio psicológico del trastorno distímico en la mujer / Psychological study of the dysthymic disorder in the woman

En este artículo estudiamos a dos mujeres distímicas a quiénes tratamos mediante psicoterapia y, a partir de ahí, se pusieron de manifiesto aquellos componentes “internos” que sustentan los síntomas depresivos. Estos mismos hallazgos se confirmaron en otras pacientes con idéntico diagnóstico. El resultado consistió en descubrir una desinserción sentimental respecto a sus parejas, permaneciendo con ellos sin separarse, al tiempo que van apareciendo insidiosamente las manifestaciones depresivas. Este desarrollo las lleva a la caída del “ideal de amor” al que aspiraban, que sostenía sus vidas y funcionaba como una “agarradera de la personalidad”. Tales apreciaciones ponen en cuestión las nociones clásicas acerca del “duelo” (AU)

In this article, we study two dysthymic women who we are treating with psychotherapy in order to reveal the inner components that maintain depressive symptoms. The same findings have been confirmed in other dysthymic patients. The result of the study consisted in discovering a sentimental separation from their love object, while the woman still lives with her partner and while the depressive symptoms are appearing insidiously. This development leads them to the deterioration in the “ideal of love” they sought, that supported their lives and served as an “anchor of their personality”. This point of view places classic notion about mourning into doubt (AU)

[Mixed affective states in the juvenile age (historical aspects, current state of the problem, psychopathology)].

The author analyzed the problem in historical, diagnostic and psychopathological aspects and presented the results of his own study. The aim was to study the structure and dynamics of endogenous juvenile mixed states in order to work out the psychopathological typology and to clarify the criteria of diagnosis, differential treatment and clinical-social prognosis. The study included 174 patients, 118 men and 56 women, aged from 17 to 25 years (mean age 20, 4 years). Depressive states were found in 65%, mania in 16% and mixed in 19% of patients. The clinical differentiation of mixed states was carried out basing on the dominating pole of affective disorders and the following types were singled out and described: mania type (dysphoria-like mania)--34%, depressive type (association-driven depression)--38%; alternating type of mixed states--28%. The preference of the formation of alternating and atypical variants of mixed states in the juvenile age demonstrated in the study may reflect the pathogenetic and pathoplastic effect of biological features characteristic of this age--lability and polymorphism of clinical presentations as well as immaturity of emotional and cognitive spheres.

Wimmer's concept of psychogenic psychosis revisited.

In the early twentieth century the Danish psychiatrist August Wimmer (1872-1937) developed the concept of psychogenic psychosis (PP) as a category of mental disorders separate from schizophrenia and manic depression. It subsumed a variety of clinical conditions with affective, confusional and paranoid features typically triggered by a psychical trauma.Wimmer's work has established itself as one of the classic texts in Scandinavian psychiatry but, for linguistic reasons, long remained almost unknown in other European countries.Translated into English in 2003, it is now available for historical and psychopathological analyses. This paper describes the original meaning of PP and sets it in context, then discusses the implications arising from the usage of the diagnostic categories introduced to replace PP in modern international classifications.

The work of Emil Kraepelin and his research group in München.

Emil Kraepelin is well known due to his development of the psychiatric classification. The ICD-10 and DSM-IV classification is based on the dichotomy of endogenous psychoses into affective psychoses and schizophrenia as early as 1899. Moreover, beside his classification system he put enormous impact on the development of psychiatry to an empirical field of science. The research activities of Kraepelin and his coworkers show that he was not only the most active researcher in the field of psychiatry in his time but also that his research activities included a lot of clinical and experimental work in different disciplines of psychiatry, including psychology, pharmacology and natural sciences as 'Hilfswissenschaften'. Due to his extraordinary position also in his time he brought together important researchers of this time, in particular after the foundation of a psychiatric research institute. Alois Alzheimer, Franz Nissl, Robert Gaupp, or Korbinian Brodman are only a few of his well known coworkers. Kraepelin tried to bring foreward the empirical knowledge in psychiatry, he did not want to have cessation in psychiatry in general and in the classification of psychiatric disorders in particular. He discussed and partly revisted his view and his theoretical approach in the different editions of his textbook according to the state of his empirical knowledge. This is also true for the dichotomy. More than twenty years after the 6th edition of his textbook, he wrote in an essay 'Die Erscheinungsformen des Irreseins' ('The manifestations of insanity') regarding the dichotomy: "No experienced diagnostician would deny that cases where it seems impossible to arrive to a clear decision, despite extremely careful observation, are unpleasantly frequent." and "....therefore, the increasingly obvious impossibility to separate the two respective illnesses satisfactorily should raise the suspicion that our question is wrong". This contribution shows that Kraepelin himself questioned his dichotomy of dementia praecox and manic depressive insanity, a discussion which is lively still today--more than 80 years later.

La introducción clínica de la iproniazida y la imipramina: medio siglo de terapéutica antidepresiva / The clinical introduction of iproniazid and imipramine: half a century of antidepresant therapy

Los primeros fármacos antidepresivos, imipraminae iproniazida, fueron introducidos en clínica en 1957.El origen de la iproniazida, un isopropil derivado dela isoniazida, se encuentra en los agentes antituberculososque se venían utilizando desde principios de ladécada de 1950.Los primeros datos sobre los efectos de la iproniazidaen pacientes depresivos no tuberculosos fueroncomunicados por Kline y cols. en 1957, quienes valoraronsu eficacia en pacientes con depresión psicóticacrónica, abriendo las puertas al primer grupo de fármacosespecíficamente antidepresivos (los inhibidoresde la monoamino-oxidasa, IMAO). Simultaneamente,tuvo lugar otro gran avance histórico en elmanejo de la depresión: el descubrimiento de los antidepresivostricíclicos, cuyo primer exponente y prototipofue la imipramina. La historia de estos antidepresivoscomenzó en los primeros años de la década de1950, gracias al desarrollo de sustancias iminodibenzólicasestudiadas en ese momento como posiblesagentes antihistamínicos, y a la perspicacia del psiquiatrasuizo Kuhn, quien ensayó un hipotético agenteantipsicótico de la compañía farmacéutica suiza J.R.Geigy (G-22355), en 300 pacientes esquizofrénicos.Aunque su eficacia antipsicótica fue inferior a la dela clorpromazina, su actividad antidepresiva fue superiora la de cualquier sustancia conocida hasta lafecha. El nuevo fármaco, denominado imipramina,se comercializó en la primavera de 1958, y sigue siendoun agente de referencia, sobre todo en investigaciónclínica. Sin embargo, la vida comercial de laiproniazida fue corta, pues se retiró del mercadoamericano en 1961 por problemas de seguridad (ictericiay nefrotoxicidad).En cualquier caso, la importancia en la historia dela psiquiatría de estos dos agentes ha sido capital,pues abrió las puertas a un evidente fenómeno de desestigmatización de la asistencia psiquiátrica y a laincorporación de la Atención Primaria al tratamientode los problemas de salud mental

In 1957, the first antidepressant drugs introducedinto clinic were imipramine and iproniazid. Iproniazid’sorigin, an isopropyl derivative of isoniazid, was includedin anti-tuberculosis agents that were used frombeginning of the 1950 decade. The first data about iproniazideffects in depressive patients without tuberculosiswere presented by Kline’s team in 1957, whichassessed the efficacy in patients with chronic psychoticdepression,opening the door to the first group of specificallyantidepressant drug (monoamine oxidaseinhibitors, MAOI). At the same time, there was anotherhistoric advance in the management of depression: thediscovery of tricyclic antidepressants, whichimipramine was its first agent and prototype.Imipramine’s history began in the first years of thedecade of 1950, thanks to development of iminodibenzolicsubstances, studied like possible anti-hystaminergicagents in that moment, and the perceptiveness of theSwiss psychiatrist Kuhn, who tested a hypotheticantipsychotic agent of Swiss Pharmaceutical CompanyJ.R. Geigy (G-22355) in 300 schizophrenic patients.Despite its antipsychotic efficacy was lower than chlorpromazine,its antidepressant’s activity was higher thanany other substance known at this moment. New drug,called imipramine, was launched in the spring of 1958,and it continues being an agent of reference, especiallyin clinical research. Nevertheless, the commercial lifeof iproniazide was short, because it was withdrawnfrom the American market in 1961 due to safety problems(jaundice and nephrotoxicity). In any case, thesetwo agents have a great significance in psychiatric history,like that opening the door at the phenomenon ofdestigmatization of psychiatric assistance and the incorporationto primary care to treatment of mental healthproblems

Episodio de una interna de La Castañeda - ciudad del México 1924 / Episode of an intern woman of La Castañeda - City of México 1924

Tiene por objeto poner de relieve algunas aristas del dispositivo de control instaurado entre el personal médico y la familia de una interna del Manicomio General de la Ciudad de México, con el seguinte diagnóstico médico: '...Excitación maníaca, caraterizada especialmente por 'Ninphomania', de origen histérico'. A través de fragmentos de tres cartas reconstruye un episodio epistolar, que tuvo lugar en 1924 y cuya repercusión se dejó sentir hasta 1925 en la vida de la interna [AU]

Contribución de la iproniazida y la imipramina al desarrollo de la psiquiatría biológica: primeras hipótesis etiopatogénicas de los trastornos afectivos / The contribution of iproniazid and imipramine to the development of biological psychiatry: the first etiopathogenic hypotheses of affective disorders

En 1957 se introdujeron en la clínica los dos primeros antidepresivos, imipramina e iproniazida, agentes de dos familias farmacológicas distintas; los antidepresivos tricíclicos y los inhibidores de la monoaminooxidasa (IMAO), respectivamente. Estos fármacos revolucionaron la práctica clínica en la asistencia psiquiátrica de la época. Pero, además, el desarrollo de la imipramina y la iproniazida supuso la introducción de nuevos métodos para la evaluación de la actividad antidepresiva de distintas sustancias y permitió avanzar en el conocimiento de la etiopatogenia de los trastornos afectivos, al posibilitar el postulado de las hipótesis monoaminérgicas de las depresiones durante la década los sesenta, que planteaban una deficiencia funcional de la neurotransmisión noradrenérgica y/o serotoninérgica, con base en el efecto bloqueador de la recaptación sináptica de estas aminas por parte de la imipramina, o la inhibición de la monoaminooxidasa, en el caso de la iproniazida. Sobre estas primeras hipótesis neurobiológicas del origen de las enfermedades mentales, se fue construyendo paulatinamente lo que hoy conocemos como psiquiatría biológica (AU)

In 1957, the 2 first antidepressants introduced into clinical practice were imipramine and iproniazid. These agents belong to 2 different pharmacologic families: tricyclic antidepressants and monoamine oxidase inhibitors (MAOI), respectively. These drugs revolutionized clinical practice in psychiatry at that time. Moreover, the development of iproniazid and imipramine required the introduction of new methods to evaluate the antidepressant activity of different substances and led to advances in the knowledge of the etiopathogenesis of affective disorders. This allowed the monoaminergic hypothesis of depression to be postulated in the 1960s, which proposed a functional deficiency in noradrenergic and serotonergic neurotransmission, based on synaptic reuptake blocking of theses amines by imipramine or monoamine oxidase inhibition by iproniazid. On the basis of these first neurobiological hypotheses on the origin of mental illness, what is currently known as "biological psychiatry" gradually developed (AU)

Medicalizing melancholia: exploring profiles of psychiatric professionalization.

The nineteenth century was the site of radical changes in understanding mental illness. The professionalization of psychiatry consisted primarily of the discipline's aspiration to the status of an expert medical subspecialty. While all forms of insanity were eventually reframed in medical terms, melancholia--for moral and nosological reasons--assumed a special role that made it an ideal diagnosis for conceptual reframing. Our analysis of the journal literature of the nineteenth and early twentieth centuries in North America and Germany traces several ways in which melancholia was medicalized. As the care for the insane shifted into the professional realm of physicians and medical terminology came to replace prior descriptors of mental illness, melancholia was replaced by depression. In addition, the process of delineating affective pathology assumed a distinctly medical flavor. Finally, melancholia was firmly medicalized when its boundaries blurred with neurasthenia. Differences in how ordinary affective terms became medicalized in German and North American psychiatry illustrate the importance of local historical approaches.

Síntomas psicóticos incongruentes con el humor en la manía: una revisión / Psychotic symtoms incongruent with mood in mania: a review

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Programa de Ansiedade e Depressäo-UFRJ. Série Psicofarmacologia: 2. Personalidade e transtornos do humor / Personality and mood disorders

Personalidade e transtornos do humor apresentam vários tipos de relaçäo: 1) traços pré-mórbidos ou pós-depressivos de personalidade; 2) traços ou transtornos de personalidade coexistindo com depressäo; 3) personalidade como um modificador dos episódios depressivos (patoplastia); e 4) traços depressivos normais. Embora o transtorno de personsalidade depressiva nunca tenha sido reconhecido pelo DSM, as depressöes caracterológicas de inìcio precoce säo diferentes das depressöes crônicas de inìcio tardio, e complicam a evoluçäo da Depressäo Unipolar e de outras doenças. O programa de Ansiedade e Depressäo do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro tem estudado as caracterìsticas fenomenológicas, clìnicas e farmacológicas das relaçöes entre Personalidade e Transtorno do Humor