How gender dysphoria and incongruence became medical diagnoses - a historical review.

This article is a historical review of the medical and psychiatric diagnoses associated with transgender people across epochs. Ancient Greek and Roman writings already mention gender change. Before a diagnosis even existed, historical documents described the lives of numerous people whom we would consider transgender today. The development of medical classifications took off in the nineteenth century, driven by the blooming of natural sciences. In the nineteenth century, most authors conflated questions of sexual orientation and gender. For example, the psychiatrist Krafft-Ebing reported cases of transgender people but understood them as paranoia, or as the extreme degree of severity in a dimension of sexual inversion. In the early 1900s, doctors such as Magnus Hirschfeld first distinguished homosexual and transgender behaviour. The usual term for transgender people was transvestite, before Harry Benjamin generalised the term transsexual in the mid-20th century. The term transgender became common in the 1970s. This article details the evolution of diagnoses for transgender people from DSM-III and ICD-10 to DSM-5 and ICD-11.

History of cannabis and the endocannabinoid system
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This article retraces the story of cannabis from the earliest contacts of humans with the plant to its subsequent global expansion, its medicinal uses, and the discovery of the endocannabinoid system in the 20th century. Cannabis was attested to around 12 000 years ago near the Altai Mountains in Central Asia, and since then, cannabis seeds have accompanied the migration of nomadic peoples. Records of the medicinal use of cannabis appear before the Common Era in China, Egypt, and Greece (Herodotus), and later in the Roman empire (Pliny the Elder, Dioscorides, Galen). In the 19th century, orientalists like Silvestre de Sacy, and Western physicians coming into contact with Muslim and Indian cultures, like O'Shaughnessy and Moreau de Tours, introduced the medicinal use of cannabis into Europe. The structure of the main psychoactive phytocannabinoid, tetrahydrocannabinol (THC), was determined in Israel by Mechoulam and Gaoni in 1964. This discovery opened the gate for many of the subsequent developments in the field of endocannabinoid system (ECS) research. The advances in the scientific knowledge of the ECS place the debate on cannabis liberalization in a new context.
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Este artículo describe la historia de la cannabis desde los primeros contactos de los humanos con la planta hasta su posterior expansión mundial, sus usos medicinales y el descubrimiento del sistema de endocannabinoides en el siglo XX. Hay testimonios de la cannabis desde hace unos 12,000 años, cerca de las montañas de Altai en Asia Central, y desde entonces las semillas de cannabis acompañaron la migración de los pueblos nómades. Los registros del uso medicinal de la cannabis aparecen antes de nuestra era en China, Egipto y Grecia (Herodoto), y más tarde en el imperio romano (Plinio el Viejo, Dioscórides, Galeno). En el siglo XIX, los orientalistas como Silvestre de Sacy y los médicos occidentales que entraron en contacto con las culturas musulmana e india, como O'Shaughnessy y Moreau de Tours, introdujeron el uso medicinal de la cannabis en Europa. La estructura del principal fitocannabinoide psicoactivo, el THC, fue identificada por Mechoulam y Gaoni en Israel en 1964. Este descubrimiento abrió la puerta para muchos de los desarrollos posteriores en el campo de la investigación del sistema de endocannabinoides (SEC). Los avances en el conocimiento científico del SEC colocan el debate acerca de la liberalización de la cannabis en un nuevo contexto.

Cet article décrit l'histoire du cannabis depuis les premiers contacts de l'espèce humaine avec la plante jusqu'à son expansion mondiale ultérieure, ses utilisations médicinales et la découverte du système endocannabinoïde au XXe siècle. La trace du cannabis a été retrouvée il y a environ 12 000 ans près des montagnes de l'Altaï en Asie centrale et depuis, les graines de cannabis ont suivi la migration des peuples nomades. Son usage médicinal apparaît avant notre ère en Chine, en Égypte et en Grèce (Hérodote), et plus tard dans l'empire romain (Pline l'Ancien, Dioscoride, Galien). Au XIXe siècle, des orientalistes comme Silvestre de Sacy et des médecins occidentaux en contact avec les cultures musulmanes et indiennes, comme O'Shaughnessy et Moreau de Tours, ont introduit son recours à des fins médicales en Europe. En 1964 en Israël, Mechoulam et Gaoni, en identifiant la structure du principal phytocannabinoïde psychoactif, le THC, ouvrent la voie à de nombreux développements dans le domaine de la recherche sur le système endocannabinoïde (SEC). Sur la base de ces progrès, le débat sur la libéralisation du cannabis se poursuit dans un nouveau contexte.

Neurodevelopmental disorders-the history and future of a diagnostic concept
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This article describes the history of the diagnostic class of neurodevelopmental disorders (NDDs) up to DSM-5. We further analyze how the development of genetics will transform the classification and diagnosis of NDDs. In DSM-5, NDDs include intellectual disability (ID), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Physicians in German-, French- and English-speaking countries (eg, Weikard, Georget, Esquirol, Down, Asperger, and Kanner) contributed to the phenomenological definitions of these disorders throughout the 18th and 20th centuries. These diagnostic categories show considerable comorbidity and phenotypic overlap. NDDs are one of the chapters of psychiatric nosology most likely to benefit from the approach advocated by the National Institute of Mental Health's Research Domain Criteria project. Genetic research supports the hypothesis that ID, ASD, ADHD, schizophrenia, and bipolar disorder lie on a neurodevelopmental continuum. The identification of recurrently observed copy number variants and disruptive gene variants in ASD (eg, CDH8, 16p11.2, SCN2A) led to the adoption of the genotype-first approach to characterize individuals at the etiological level.
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Este artículo describe la historia de la clase diagnóstica de los trastornos del neurodesarrollo (TND) hasta el DSM-5. Además se analiza cómo el desarrollo de la genética transformará la clasificación y el diagnóstico de los TND. En el DSM-5, los TND incluyen la discapacidad intelectual (DI), los trastornos del espectro autista (TEA) y el trastorno por déficit de atención / hiperactividad (TDAH). Los médicos en países de habla alemana, francesa e inglesa (por ejemplo, Weikard, Georget, Esquirol, Down, Asperger y Kanner) contribuyeron a las definiciones fenomenológicas de estos trastornos a lo largo de los siglos XVIII y XX. Estas categorías diagnósticas muestran una importante comorbilidad y superposición fenotípica. Los TND constituyen uno de los capítulos de la nosología psiquiátrica que tienen más probabilidades de beneficiarse con el enfoque recomendado por el proyecto Research Domain Criteria (Criterios de Dominio de Investigación) del Instituto Nacional de Salud Mental. La investigación genética respalda la hipótesis de que la DI, el TEA, el TDAH, la esquizofrenia y el trastorno bipolar se encuentran en un continuo del neurodesarrollo. La identificación y observación repetida de variaciones en el número de copias y variaciones de genes disruptivos en el TEA (p. Ej., CDH8, 16p11.2, SCN2A) condujeron a la adopción de un enfoque primariamente genético para la caracterización etiológica de los sujetos.

Dans cet article qui décrit l'histoire de la classe diagnostique des troubles neurodéveloppementaux (TND) jusqu'au DSM-5, nous analyserons comment les progrès de la génétique vont transformer leur classification et leur diagnostic. Dans le DSM-5, les TND comprennent les handicaps intellectuels (HI), les troubles du spectre de l'autisme (TSA) et le déficit de l'attention/hyperactivité (TDAHA). Ce sont des médecins issus de pays germanophones, francophones et anglophones (comme Weikard, Georget, Esquirol, Down, Asperger et Kanner) qui ont participé à la définition phénoménologique de ces troubles, du XVIIIe au XXe siècle. On observe dans ces catégories diagnostiques une comorbidité et un chevauchement des phénotypes très importants. En termes de nosologie psychiatrique, les TND seraient les plus susceptibles de bénéficier de l'approche défendue par le NIMH (National Institute of Mental Health) : le projet Research Domain Criteria (Critères des domaines de recherche). Selon la recherche génétique, le HI, les TSA, le TDAHA, la schizophrénie et les troubles bipolaires appartiendraient à un continuum neurodéveloppemental. L'idée d'une caractérisation étiologique des individus en passant d'abord par la génétique est venue de l'observation répétée au sein des TSA de variations du nombre de copies et de variations génétiques perturbatrices (par exemple CDH8, 16p11.2, SCN2A).

Can psychopathology and neuroscience coexist in psychiatric classifications?

A crisis of confidence was triggered by the disappointment that diagnostic validity, an important goal, was not achieved with the publication of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The Research Domain Criteria (RDoC) project, which provides a framework for neuroscientific research, was initially conceptualized as an alternative to DSM. However, RDoC and DSM are complementary rather than mutually exclusive. From a historical perspective, this article argues that the debate opposing psychology and brain in psychiatric classification is not new and has an air of déjà vu. We go back to the first classifications based on a scientific taxonomy in the late 18th century with Boissier de Sauvages, which were supposed to describe diseases as they really existed in nature. Emil Kraepelin successfully associated psychopathology and brain research, prefiguring the interaction between DSM and RDoC. DSM symptoms remain valuable because they are the only data that are immediately and directly observable. Computational science is a promising instrument to interconnect psychopathological and neuroscientific data in the future.

El que no se haya cumplido el importante objetivo de la validez diagnóstica con la publicación del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5), ha provocado decepción y una crisis de confianza. El proyecto Research Domain Criteria (RDoC), que pro-porciona un marco para la investigación neurocientífica, se conceptualizó inicialmente como una alternativa al DSM. Sin embargo, RDoC y DSM son complementarios en lugar de excluirse mutuamente. Este artículo argumenta, desde una perspectiva histórica, que el debate entre la psicología y el cerebro en la clasificación psiquiátrica no es nuevo y tiene un aire de déjà vu. Las primeras clasificaciones del siglo XVIII (de Boissier de Sauvages) basadas en la taxonomía científica debían describir las enfermedades tal cual existían en la naturaleza. Emil Kraepelin asoció con éxito la psicopatología y la investigación del cerebro, anticipando la interacción entre DSM y RDoC. Los síntomas del DSM siguen siendo valiosos porque son los únicos datos que se pueden observar de forma inmediata y directa. La ciencia computacional es un instrumento prometedor para interconectar, en el futuro, datos psicopatológicos y neurocientíficos.

Une crise de confiance a été déclenchée par la déception que la validité diagnostique, un objectif important, n'ait pas été atteinte avec la publication du DSM 5. Le projet des critères de domaines de recherche (RDoC), qui fournit un cadre pour la recherche neuroscientifique, a d'abord été conçu comme une alternative au DSM. Cependant, le RDoC et le DSM sont complémentaires plutôt que mutuellement exclusifs. D'un point de vue historique, cet article soutient que le débat opposant la psychologie et le cerveau dans la classification psychiatrique n'est pas nouveau et a un air de déjà-vu. Nous revenons aux premières classifications fondées sur une taxonomie scientifique à la fin du XVIIIe siècle avec Boissier de Sauvages, qui étaient censées décrire les maladies, telles qu'elles existaient réellement dans la nature. Emil Kraepelin a associé avec succès la psychopathologie et la recherche sur le cerveau, préfigurant l'interaction entre le DSM et le RDoC. Les symptômes du DSM restent valables parce qu'ils sont les seules données qui sont immédiatement et directement observables. La science computationnelle est un instrument prometteur pour interconnecter les données psychopathologiques et neuroscientifiques à l'avenir.

The history of generalized anxiety disorder as a diagnostic category.

From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included "pantophobia" and "anxiety neurosis." Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state). Also, generalized anxiety was considered one of numerous symptoms of neurasthenia, a vaguely defined illness. Generalized anxiety disorder (GAD) appeared as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, when anxiety neurosis was split into GAD and panic disorder. The distinct responses these two disorders had to imipramine therapy was one reason to distinguish between the two. Since the revised DSM-III (DSM-III-R), worry about a number of life circumstances has been gradually emphasized as the distinctive symptom of GAD. Thus, a cognitive aspect of anxiety has become the core criterion of GAD. The validity of GAD as an independent category has been questioned from DSM-III up to preparation of DSM-5. Areas of concern have included the difficulty to establish clear boundaries between GAD and (i) personality dimensions, (ii) other anxiety-spectrum disorders, and (iii) nonbipolar depression. The National Institute of Mental Health has recently proposed the Research Domain Criteria (RDoC), a framework destined to facilitate biological research into the etiology of mental symptoms. Within the RDoC framework, generalized anxiety might be studied as a dimension denominated "anxious apprehension" that would typically fit into the research domain called "negative valence systems" and the more specific construct termed "potential threat."

Desde el sigh XIX y hasta el siglo XX, los términos empleados para diagnosticar la ansiedad generalizada incluyeron la "pantofobia" y la "neurosis de ansiedad". Tales términos designaron manifestaciones paroxísticas (ataques de pánico) como también fenomenología interparoxística (el estado mental de aprensión). También la ansiedad generalizada fue considerada uno de Ios numerosos síntomas de la neurastenia, una enfermedad definida vagamente. El trastorno de ansiedad generalizada (TAG) apareció como una categoría diagnóstica en la tercera edición del Manual Diagnóstico y Estadístico de Ios Trastornos Mentales (DSM-III) en 1980, cuando la neurosis de ansiedad fue dividida entre el TAG y el trastorno de pánico. Una de las razones para distínguir estos dos trastornos fue la respuesta diferente que tuvieron a la terapia con imipramina. A partir de la edición revisada del DSM-III (DSM-III-R), la preocupación People Like Us - situaciones de vida se ha enfatizado gradualmente como el síntoma distintivo del TAG. En consecuencia, un aspecto cognitivo de la ansiedad ha llegado a ser el criterio central del TAG. La validez del TAG como una categoría independiente ha sido cuestionada desde el DSM-III hasta la preparación del DSM-5. Algunos aspectos tornados en cuenta han incluido la dificultad para establecer límites claros entre el TAG y 1) dimensiones de la personalidad, 2) otros trastornos del espectro ansioso y 3) la depresión no bipolar. Recientemente, el Instituto National de Salud Mental de EE.UU. propuso Ios Research Domain Criteria (RDoC), un sistema destinado a facilitar la investigación biológica acerca de la etiología de Ios síntomas mentales. Dentro del sistema RDoC, la ansiedad generalizada podría ser estudiada como una dimensión denominada "aprensión ansiosa", la cual podría ajustar típicamente con el dominio de investigación llamado "sistemas de valencía negativa" y más específicamente con el constructo llamado "amenaza potencial".

Entre le XIXe et le XXe siècle, plusieurs termes ont été utilisés pour dénommer l'anxiété généralisée, notamment la «pantophobie¼ et la «névrose d'angoisse¼. Ces termes désignaient à la fois des manifestations paroxystiques (les attaques de panique) ainsi que les symptômes intercritiques (l'état mental d'appréhension). D'autre part, l'anxiété généralisée était aussi considérée comme l'un des nombreux symptômes de neurasthénie, une maladie de définition imprécise. Le trouble anxieux généralisé (TAG) est apparu pour la première fois en tant que diagnostic dans la 3e édition du manuel statistique et diagnostique des troubles mentaux (DSM-III) en 1980 quand la névrose d'angoisse a été divisée en TAG et trouble panique. Ces deux troubles ont été distingués sur la base d'une réponse différente au traitement par imipramine. À partir de la révision du DSM-III (DSM-III-R), l'inquiétude face à un certain nombre de situations de la vie courante a été conceptualisée petit à petit comme le symptôme cardinal du TAG. Ainsi, un aspect cognitif de l'anxiété est devenu le critère primordial du TAG. La validité du TAG en tant que catégorie diagnostique indépendante a été mise en doute depuis le DSM-III jusqu'à la préparation du DSM-5. Les questionnements reposaient sur la difficulté à établir des frontières claires entre le TAG et (1) les dimensions de personnalité, (2) les autres troubles du spectre de l'anxiété et (3) la dépression non-bipolaire. L'institut national de la santé mentale aux États-Unis a récemment mis en place le Research Domain Criteria [RDoC], un cadre destiné à faciliter les recherches biologiques dans le domaine de l'étiologie des troubles mentaux. Dans le cadre du RDoC, l'anxiété généralisée pourrait être étudiée comme une dimension appelée «appréhension anxieuse¼, qui appartiendrait typiquement au domaine de recherche dénommé «systèmes de valences négatives¼ et plus spécifiquement au concept dit de «menace potentielle¼.

A history of anxiety: from Hippocrates to DSM.

This article describes the history of the nosology of anxiety disorders. Greek and Latin physicians and philosophers distinguished anxiety from other types of negative affect, and identified it as a medical disorder. Ancient Epicurean and Stoic philosophers suggested techniques to reach an anxiety-free state of mind that are reminiscent of modern cognitive psychology. Between classical antiquity and the late 19(th) century there was a long interval during which anxiety was not classified as a separate illness. However, typical cases of anxiety disorders kept being reported, even if under different names. In the 17(th) century, Robert Burton described anxiety in The Anatomy of Melancholy. Panic attacks and generalized anxiety disorder may be recognized in the "panophobias" in the nosology published by Boissier de Sauvages in the 18(th) century. Also, anxiety symptoms were an important component of new disease constructs, culminating in neurasthenia in the 19(th) century. Emil Kraepelin devoted much attention to the possible presence of severe anxiety in manic-depressive illness, thereby anticipating the "anxious distress" specifier of bipolar disorders in DSM-5. A pitfall to consider is that the meaning of common medical terms, such as melancholia, evolves according to places and epochs.

Este artículo describe la historia de la nosología de los trastornos de ansiedad. Los médicos y los filósofos griegos y latinos diferenciaban la ansiedad de otros tipos de afectos negativos y la identificaban como un trastorno médico. Los antiguos filósofos epicúreos y estoicos sugirieron técnicas para alcanzar un estado mental sin ansiedad que recuerdan a la psicología cognitiva moderna. Entre la Antigüedad Clásica y finales del siglo XIX hubo un largo intervalo durante el cual la ansiedad no se clasificó como una enfermedad independiente. Sin embargo, se reportaron casos típicos de trastornos de ansiedad aunque con diferentes nombres. En el siglo XVII, Robert Burton describió la ansiedad en el texte The Anatomy of Melancholy. Los ataques de pánico y el trastorno de ansiedad generalizada pueden ser reconocidos en las "panofobias" de la nosología publicada por Boissier de Sauvages en el siglo XVIII. Los síntomas ansiosos también fueron un componente importante de los nuevos constructos de enfermedad, culminando en la neurastenia en el siglo XIX. Emil Kraepelin puso mucha atención en la posible presencia de la ansiedad grave en la enfermedad maníaco depresiva, anticipando así el especificador "distrés ansioso" de los trastornos bipolares en el DSM-5. Una dificultad a tener en cuenta es que el significado de términos médicos comunes, como melancolia, evoluciona de acuerdo a lugares y épocas.

Cet article relate l'histoire de la nosologie des troubles anxieux. Les philosophes et les médecins de l'antiquité gréco-romaine avaient déjà distingué l'anxiété des autres affects négatifs et l'avaient déjà identifiée comme un trouble médical. Les philosophes des écoles épicurienne et stoïcienne avaient proposé des techniques visant à atteindre un état d'esprit libre d'anxiété qui rappellent les enseignements actuels des thérapies cognitives. Il y a eu, entre l'antiquité classique et la fin du XIXe siècle un long intervalle durant lequel l'anxiété n'a plus été répertoriée comme une affection distincte. Cependant, des cas typiques de troubles anxieux ont continué à être décrits, même si cela se faisait sous des noms différents. Au XVIIe siècle, Robert Burton a décrit l'anxiété dans " L'anatomie de la mélancolie ". Des attaques de paniques et l'anxiété généralisée peuvent être identifiées dans les " panophobies " de la nosologie publiée par Boissier de Sauvages au XVIIIe siècle. De plus, les symptômes anxieux étaient une composante importante des nouvelles entités morbides conceptualisées au XIXe siècle, avec notamment la neurasthénie. Emil Kraepelin s'est beaucoup intéressé à la présence possible d'une anxiété sévère dans la maladie maniaco-dépressive, anticipant ainsi la spécification " détresse anxieuse " apparue pour les troubles bipolaires dans le DSM-5. Il faut se garder des anachronismes dans l'interprétation des textes historiques en psychiatrie et garder par exemple à l'esprit que des termes médicaux courants, comme la mélancolie, ont connu des sens divers selon les lieux et les époques.

French perspectives on psychiatric classification.

This article reviews the role of the French schools in the development of psychiatric nosology. Boissier de Sauvages published the first French treatise on medical nosology in 1763. Until the 1880s, French schools held a pre-eminent position in the development of psychiatric concepts. From the 1880s until World War I, German-speaking schools exerted the most influence, featuring the work of major figures such as Emil Kraepelin and Eugen Bleuler. French schools were probably hampered by excessive administrative and cultural centralization. Between the 1880s and the 1930s, French schools developed diagnostic categories that set them apart from international classifications. The main examples are Bouffée Délirante, and the complex set of chronic delusional psychoses (CDPs), including chronic hallucinatory psychosis. CDPs were distinguished from schizophrenia by the lack of cognitive deterioration during evolution. Modern French psychiatry is now coming into line with international classification, such as DSM-5 and the upcoming ICD-11.

Este artículo revisa el papel de las escuelas francesas en el desarrollo de la nosología psiquiátrica. Boissier de Sauvages publicó el primer tratado francés sobre nosología médica en 1763. Hasta los años 1380 las escuelas francesas mantuvieron una posición sobresaliente en el desarrollo de los conceptos psiquiátricos. Desde 1880 y hasta la Primera Guerra Mundial, las escuelas de habla alemana ejercieron la mayor influencia, con el trabajo de figuras muy destacadas como Emil Kraepelin y Eugen Bleuler. Probablemente las escuelas francesas fueron obstaculizadas por una excesiva centralización administrativa y cultural. Entre los años 1830 y 1930, las escuelas francesas desarrollaron categorías diagnósticas que las diferenciaron de las clasificaciones internacionales. Los principales ejemplos son la Bouffée Délirante y el complejo conjunto de psicosis delirantes crónicas (PDC) que incluye las psicosis alucinatorias crónicas. Las PDC se distinguieron de la esquizofrenia por la falta de deterioro cognitivo durante la evolución. La moderna psiquiatría francesa actualmente está alineada con la clasificación internacional, como son el DSM-5 y la próxima CIE-11.

Cet article passe en revue le rôle des écoles françaises dans le développement de la nosologie psychiatrique. En 1763, Boissier de Sauvages publie le premier traité français de nosologie médicale. Jusqu'en 1880, les écoles françaises ont une position dominante dans le développement des concepts psychiatriques. De 1880 à la première guerre mondiale, les écoles germanophones sont les plus influentes, témoignant du travail de personnalités marquantes comme Émile Kraeplin et Eugène Bleuler. Les écoles françaises ont probablement été entravées par une centralisation administrative et culturelle excessive. Entre les années 1880 et 1930, les écoles françaises ont mis au point des catégories diagnostiques les séparant des classifications internationales. Les principaux exemples sont la Bouffée Délirante et l'ensemble complexe des psychoses délirantes chroniques (PDC), dont la psychose hallucinatoire chronique. Les PDC se distinguent de la schizophrénie par l'absence de détérioration cognitive pendant l'évolution. La psychiatrie française moderne s'aligne maintenant sur la classification internationale, comme le DSM-5 et l'ICD-11 à venir.

Milestones in the history of personality disorders.

This paper analyzes the major historical milestones in the study of normal and abnormal personality, from antiquity up until the 20th century. Special attention is paid to the interaction between dimensional and typological approaches, which was a major issue during the preparation of DSM-5. Theories of personality started with the humoral theory of Greek medicine. Pinel, and later Esquirol and Prichard, are credited with the first descriptions of abnormal personalities in textbooks of psychiatry. Between the late 19th and early 20th centuries, elaborate systems of normal and abnormal personality, associating to some degree types and dimensions, were devised by a succession of European psychologists, such as Ribot, Heymans, and Lazursky. Emil Kraepelin and Kurt Schneider proposed classifications of abnormal personality types. In parallel, psychoanalysts stressed the role of early life experiences. Towards the mid-20th century, statistical methods were applied to the scientific validation of personality dimensions with pioneers such as Cattell, anticipating the five-factor model.

Este artículo analiza los principales hitos históricos en el estudio de la personalidad normal y anormal, desde la Antigüedad hasta el siglo XX. Se pone especial atención a la interacción entre las aproximaciones dimensionales y tipológicas, tema que fue importante durante la preparación del DSM-5. Las teorías de la personalidad se iniciaron con la teoría humoral de la medicina griega. En los textos de psiquiatría se reconoce a Pinel, y luego a Esquirol y Prichard como los primeros autores en describir las personalidades anormales. Una sucesión de psicólogos europeos como Ribot, Heymans y Lazursky, entre finales del siglo XIX y comienzos del XX, idearon complejos sistemas de personalidad normal y anormal, asociando en algún grado tipos y dimensiones. Emil Krepelin y Kurt Schneider propusieron clasificaciones de tipos de personalidad anormal. Paralelamente, los psicoanalistas destacaron el papel de las experiencias tempranas de la vida. Hacia mediados del siglo XX se aplicaron métodos estadísticos para la validación científica de las dimensiones de la personalidad con pioneros como Cattell, anticipando el modelo de cinco factores.

Cet article passe en revue les étapes majeures de l'histoire de l'étude des personnalités normales et pathologiques, depuis l'antiquité jusqu'au XXe siècle. Cette perspective historique permet de comprendre certains débats qui ont animé la préparation du DSM-5, notamment le choix entre une approche faisant appel à des catégories diagnostiques distinctes, selon un modèle kraepelinien, par opposition à une description de la personnalité normale ou pathologique par des dimensions, dans la suite de travaux qui ont culminé dans le modèle de la personnalité à cinq facteurs (dit Big Five).

Law & psychiatry: the evolution of laws regulating psychiatric commitment in France.

This column reviews the evolution of French laws governing psychiatric commitment, culminating in the July 2011 Act, which was opposed by most professional organizations. The 2011 Act has maintained the two traditional French approaches to involuntary treatment: at the request of a third person and upon a decision by a prefect representing the government. However, the 2011 Act introduced major innovations into French practices: systematic review by a judge, a 72-hour observation period, and the possibility of compulsory community treatment.

What future for neuroendocrinology in psychiatry?

In psychiatry, neuroendocrine techniques were initially considered a potential "window into the brain" by indirectly marking central nervous system limbic dysfunction. At present this conception has evolved, owing to significant progress over the last decades demonstrating direct involvement of neuropeptides and neurohormones in psychiatric diseases. In a synchronic perspective, neuroendocrine investigations evaluate a functional status at a given moment in the evolution of the disease, which results from both etiopathogenic processes and compensatory homeostatic mechanisms. These vital physiological changes appear to be potential targets for novel hormonally based pharmacotherapies. However, in the past few years, the interest for the study of neuroendocrine dysregulations in psychiatric patients has declined. In order to better understand this relative disinterest, this article will attempt to shed light on strengths and limitations of the neuroendocrine approaches in psychiatry. It is necessary to bear in mind that the usefulness of these techniques in the clinical, pathophysiological and therapeutic fields depends largely on the selectivity of stimuli and the appropriateness of the methodologies used. Owing to the complexity of the clinical phenomena, multifactorial approaches (combining several neuroendocrine challenge tests to imaging, immunological, neurophysiological, neurochemical and/or genetic techniques) are to be privileged in psychiatric investigations. Despite the inherent limitations of these approaches, due to their technical and ethical constraints, the neuroendocrine strategy can inform modern clinical practice and lead to new breakthroughs in future science and practice.

New RAB3GAP1 mutations in patients with Warburg Micro Syndrome from different ethnic backgrounds and a possible founder effect in the Danish.

Warburg Micro Syndrome is a rare, autosomal recessive syndrome characterized by microcephaly, microphthalmia, microcornia, congenital cataracts, optic atrophy, cortical dysplasia, in particular corpus callosum hypoplasia, severe mental retardation, spastic diplegia, and hypogonadism. We have found five new mutations in the RAB3GAP1 gene in seven patients with suspected Micro Syndrome from families with Turkish, Palestinian, Danish, and Guatemalan backgrounds. A thorough clinical investigation of the patients has allowed the delineation of symptoms that are consistently present in the patients and may aid the differential diagnosis of Micro Syndrome for patients in the future. All patients had postnatal microcephaly, micropthalmia, microcornia, bilateral congenital cataracts, short palpebral fissures, optic atrophy, severe mental retardation, and congenital hypotonia with subsequent spasticity. Only one patient had microcephaly at birth, highlighting the fact that congenital microcephaly is not a consistent feature of Micro syndrome. Analysis of the brain magnetic resonance imagings (MRIs) revealed a consistent pattern of polymicrogyria in the frontal and parietal lobes, wide sylvian fissures, a thin hypoplastic corpus callosum, and increased subdural spaces. All patients were homozygous for the mutations detected and all mutations were predicted to result in a truncated RAB3GAP1 protein. The analysis of nine polymorphic markers flanking the RAB3GAP1 gene showed that the mutation c.1410C>A (p.Tyr470X), for which a Danish patient was homozygous, occurred on a haplotype that is shared by the unrelated heterozygous parents of the patient. This suggests a possible founder effect for this mutation in the Danish population.

Relationship between prolactin secretion, and plasma risperidone and 9-hydroxyrisperidone concentrations in adolescents with schizophreniform disorder.

BACKGROUND: Treatment with the atypical antipsychotic risperidone can result in elevated prolactin levels. To date, the relationships between plasma concentrations of prolactin, risperidone and its active 9-hydroxy-metabolite have been little investigated in adolescents with psychosis. METHODS: Prolactin levels were determined at baseline in 16 hospitalized drug-naïve adolescents meeting DSM-IV criteria for schizophreniform disorder. Prolactin, risperidone, 9-hydroxyrisperidone levels were subsequently determined after 3 weeks of oral risperidone treatment. RESULTS: Compared with pretreatment values, prolactin levels at endpoint were significantly increased (p<0.00001) and correlated with risperidone doses (r=0.58, N=16, p<0.02), and plasma levels of risperidone (r=0.60, N=16, p<0.02) and 9-hydroxyrisperidone (r=0.54, N=16, p=0.03). CONCLUSIONS: These data suggest that risperidone's effect on prolactin release is dose-dependent in adolescents and is linked to both plasma risperidone and 9-hydroxyrisperidone concentrations.

Orally disintegrating olanzapine induces less weight gain in adolescents than standard oral tablets.

We compared the changes in weight (kg) and body mass index (BMI) (kg/m(2)) in 52 hospitalized adolescents between baseline and after 12 weeks of monotherapy with either (i) olanzapine (OLZ) orally disintegrating tablets (ODT) (N=16; 16.6 mg/day+/-4.4 [SD]), or (ii) OLZ standard oral tablets (SOT) (N=10; 18.0 mg/day+/-4.2), or (iii) risperidone (N=26; 2.8 mg/day+/-1.2). Significantly greater increases in mean weight and BMI were observed in the patients treated with OLZ SOT (8.9+/-5.1 [SD] kg; 1.9+/-0.6 kg/m(2), respectively) than in those with ODT (3.0+/-2.1 kg; 1.1+/-0.8 kg/m(2)). Similarly, OLZ ODT treatment was associated with significantly greater increases in weight and BMI than risperidone (1.0+/-1.8 kg; 0.4+/-0.7 kg/m(2)). These findings suggest that adolescents gain less weight with OLZ ODT than OLZ SOT, possibly because the former formulation shortens the time of interaction with digestive serotonin receptors mediating satiety.

Historical and cultural aspects of man's relationship with addictive drugs.

Our taste for addictive psychoactive substances is attested to in the earliest human records. Historically, psychoactive substances have been used by (i) priests in religious ceremonies (eg, amanita muscaria); (ii) healers for medicinal purposes (eg, opium); or (iii) the general population in a socially approved way (eg, alcohol, nicotine, and caffeine). Our forebears refined more potent compounds and devised faster routes of administration, which contributed to abuse. Pathological use was described as early as classical Antiquity. The issue of loss of control of the substance, heralding today's concept of addiction, was already being discussed in the 17th century. The complex etiology of addiction is reflected in the frequent pendulum swings between opposing attitudes on issues that are still currently being debated, such as: is addiction a sin or a disease; should treatment be moral or medical; is addiction caused by the substance; the individual's vulnerability and psychology, or social factors; should substances be regulated or freely available.

Nicotine dependence and self-esteem in adolescents with mental disorders.

Recent studies in adolescents have found a weak association between lower self-esteem and smoking. However, this association has not been investigated in a psychiatric setting. In 223 inpatient adolescents [140 girls (16.5 years) and 83 boys (16.4 years)], self-esteem was measured with Coopersmith's self-esteem inventory (SEI), and smoking dependence with the Fagerström Test for Nicotine Dependence (FTND). DSM-IV categories included major depression (n=35), anxiety disorders (n=35), psychotic disorders (n=31), eating disorders (n=9), and conduct disorders (n=113). There were 101 smokers and 122 nonsmokers. Self-esteem scores were lower in smokers than in nonsmokers (p=0.039). Self-esteem scores were very significantly lower in smokers showing moderate or high nicotine dependence (i.e., FTND score>or=4) when compared with nonsmokers (p=0.002). Smoking with moderate or high nicotine dependence was associated with lower self-esteem in both girls and boys, whereas smoking with no or low nicotine dependence was associated with lower self-esteem only in girls. Smoking was associated with lower self-esteem in all diagnostic categories, except in eating disorders. Interventions targeted on self-esteem might be used to prevent smoking in adolescents with mental disorders.

Suicide attempts and family history of suicide in three psychiatric populations.

The influence of a family history of suicide on suicide attempt rate and characteristics in depression, schizophrenia, and opioid dependence was examined. One hundred sixty inpatients with unipolar depression, 160 inpatients with schizophrenia, and 160 opioid-dependent patients were interviewed. Overall, a family history of suicide was associated with a higher risk for suicide attempt, with high-lethality method, with repeated attempts, and with number of attempts, while the interaction between family history and diagnostic group was not significant. Thus, a positive family history of suicide was a risk factor for several suicide attempt characteristics independent of psychiatric diagnosis.

Increased adrenocorticotropin suppression following dexamethasone administration in sexually abused adolescents with posttraumatic stress disorder.

Evidence suggests that individuals with posttraumatic stress disorder (PTSD) have an enhanced sensitization of the hypothalamic--pituitary--adrenocortical (HPA) axis. However, few studies in adolescents have been performed. Fourteen sexually abused adolescent inpatients with DSM-IV PTSD (12 female, two male; mean +/- SD age, 16.2 +/- 1.9 years) were compared with 14 adolescent hospitalized controls (11 female, three male; mean age, 15.7 +/- 2.0 years). All subjects underwent a standard dexamethasone suppression test (DST, 1 mg given orally at 2300 h) five days after admission. Baseline blood samples were obtained at 0800 h, and the following day, adrenocorticotropin (ACTH) and cortisol levels were measured at 0800, 1600, and 2300 h. Clinical assessment included the Impact of Event Scale, Stanford Acute Stress Reaction Questionnaire, Beck Depression Inventory, and Coping Inventory for Stressful Situations. Post-DST ACTH levels were significantly lower in PTSD than in control adolescents (at 0800 h: P < 0.005; at 1600 h: P < 0.001; at 2300 h: P < 0.05). In patients, post-DST cortisol levels were reduced but not significantly. No correlations were found between ACTH and cortisol levels and time elapsed since trauma. These results demonstrate that sexually abused adolescents with PTSD show ACTH hypersuppression to DST suggesting enhanced glucocorticoid receptor sensitivity in the pituitary.

Treatment goals: response and nonresponse.

Psychiatric symptomatology is often subjective, but it can be partly made more objective for the purposes of evaluation. Esquirol was the first modern psychiatrist to stress the need for a scientific approach to treatment evaluation. The kinetics of treatment is complex because different components of the clinical picture improve at a different pace. Assessment of treatment requires prior definition of end point, response, and nonresponse. Response is influenced by several factors, such as placebo effect, diagnostic category and subtypes, and patient heterogeneity. Treatment response may be predicted from clinical and biological parameters. This article lists the main causes of nonresponse, and suggests how to remedy them.