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Without a proper definition, you do not see the phenomenon

Konferensbidrag (offentliggjort, men ej förlagsutgivet)
Författare Helge Malmgren
Publicerad i Consciousness and its pathologies. San Diego, CA, May 17-18, 1997
Publiceringsår 1997
Publicerad vid Filosofiska institutionen
Språk en
Länkar www.phil.gu.se/posters/ae.html
Ämnesord Diagnostic criteria, DSM, neurasthenia, fatigue, organic psychiatry, brain injury, astheno-emotional disorder
Ämneskategorier Neurologi, Psykiatri, Teoretisk filosofi


At the beginning of the century, pioneer psychiatrists in the classical German school (Kraepelin, Bonhoeffer) had established beyond reasonable doubt the existence of a certain organic mental syndrome or “reaction form”, variously named “Reizbare Schwäche” (irritable weakness) or “Emotionell-hyperaestetisches Schwächezustand” (emotional-hypersensitive weakness state). This reaction form is typically manifested by concentration difficulties, mental fatiguability, secondary memory disturbances, irritability and emotional lability. The term “astheno-emotional disorder” (AED) has recently been suggested. Patients showing this constellation of symptoms are very common in all parts of organic psychiatry, for example after moderate trauma to the brain, in chronic intoxications, in certain chronic infectious states, in endocrine disorders, as the initial manifestation of a brain tumour, after an intracranial bleeding, and so on. Mild forms of the same disorder are sometimes met with in which no organic cause can be found but where the patient has instead suffered great mental stress. The condition usually affects the patients’ ability to work and is often socially handicapping. In spite of the importance of AED, and in spite of its being well-known to most practitioners in each of the separate areas where it occurs, academic psychiatry has displayed very little interest in the condition during the last 40 years, and the major diagnostic systems of today do not allow for a unitary classification of these cases. For example, in DSM-IV a certain share of the mild cases would receive the diagnosis “mild cognitive disorder”, which would however fit neither mild cases with dominating emotional lability nor any of the (equally common) more severe cases. In this paper, I suggest the following causes of the present situation concerning the diagnosis of AED: (1) The astheno-emotional syndrome is often complicated by secondary, psychogenic reactions such as anxiety, feelings of tension and depressive mood, which can be difficult to disentangle from the primary symptoms. Many earlier classificatory attempts in this area (often in terms of “neurasthenia”) stumbled on a failure to distinguish the primary from the secondary symptoms. (2) The fact that the primary symptoms can themselves be psychogenic in nature, and the fact that the etiology cannot always be known for certain, entail that the disorder has to be delimited without recourse to causes. Many systems instead prefer seperate diagnoses for psychogenic cases. (3) Clinically, cases of AED form a continuum, ranging from very mild disturbances without clinical import to severe disturbances justifying a global diagnosis of dementia. Most diagnostic systems of today do not allow for such large-scale gradations of the severity of a disorder. (4) The conceptual apparatus which is used to describe symptoms is often too coarse to be able to distinguish typical symptoms of AED from similar symptoms which do not belong to this disorder. A clear examples of this is “memory difficulties”, which can refer either to a primary memory disturbance of the kind seen in Korsakov’s amnestic disorder or to secondary effects of concentration difficulties, as in mild AED. Another example is the term “emotional disturbance”, which does not differentiate between the emotional flattening typically seen in severe frontolimbic injuries and the emotional instability which is very common in AED. (5) The operationalistic bias in several recent systems of psychiatric classification prohibits hypothetical diagnoses based on knowledge of the interaction between different psychiatric disorders. From longitudinal studies of patients it is clear that the emotional lability and the manifest fatiguability of a patient with AED can both be completely neutralized if the same patient also suffers an emotional flattening. This means that the diagnosis of AED cannot be completely operationalized in terms of present symptoms. (6) The isolation of different parts of organic psychiatry from each other and from general psychiatry implies that few psychiatrists have a sufficiently broad experience to see the full spectrum of AED.

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