15 years' activity of the Psychosomatic Disorders Section within the Psychiatric Association in the Czech Medical Society]

The author describes in detail the activities of the psychosomatic section of the Psychiatric Society of the Czech Medical Society since its foundation in 1975 from the theoretical, organizational, research and teaching aspects. The aim of this section is above all to enforce the psychosomatic approach and bio-psychosocial model of disease in the Czechoslovak health services. The society developed its activities according to interdisciplinary principles. The perspectives of development of psychosomatic care in Czechoslovakia in the next future are in particular: 1. further enforcement of the psychosomatic approach to patients and the bio-psychosocial model of disease in clinical practice and theory; 2. development of so-called consultation-liaison psychiatry according to the concept of Z. J. Lipowski on the basis of nonpsychiatric disciplines and creation of further psychosomatic in- and out-patient units and departments, in particularly at the primary health care level; 3. further development of postgraduate and initiation of undergraduate teaching of psychosomatic and behavioural medicine; 4. development of research, in particular by the method of controlled clinical trials and prospective studies; 5. extension of possibilities to publish work and of international collaboration.     

Neurological dysfunction, psychic conflict, and psychotherapy

Clinical experience of psychotherapists is getting more and more circumscribed by the boundaries of theoretical references. The Freudian "psychic treatment" for neurosis got its impetus from the friendship between Sigmund Freud and Ludwig Binswanger, the phenomenological psychiatrist. This relationship laid the foundation for the references of psychoanalytic psychotherapy in Europe. Then, the Freudian conception of actual neurosis led to a psychosomatic approach. Later, the study of narcissistic neurosis opened up to borderline patients. Today, scientific and medical progress greatly influence psychopathological research and the way we look at our patients and their requests. These changes come from the patients' sayings and their expectancy of well-being. At the same time psychotherapists have to take a new look at their theoretical references. On the one hand, a dynamic concept for psychotherapy is necessary for integrating the phenomenologic approach into psychoanalysis, and providing the understanding of situations emerging in neurological dysfunction. On the other hand, psychotherapists pay more attention to the different actors contributing to a pathology (Who is suffering? What about the life-partner or the relatives?). These changes lead to a new look into the processes of identification as well as the notion of identity. This article discusses these influences on psychotherapy and clinical research showing how clinical situations get ahead of theoretical references.     

The "war neurosis"-- an early model of a pluridimensional outlined trauma-theory in psychiatry

The war neurosis, mainly observed during the first World War, caused a lively debate on its origin and etiology. In psychiatric history this debate is often portrayed in a somewhat simplifying manner. Namely Oppenheim was considered as the leading exponent of the organic etiology of traumatic neurosis, while others, with growing interest in psychodynamic theories, were thought to favor exclusively psychogenesis of this condition. However, only discussing matters in this way would be too simple. Rather, the controversy was much more differentiated and led to important insights: First, it turned out to be impossible to explain any psychopathological syndrome exclusively in terms of neuropathological, i. e. structural alterations, in particular, a syndrome presenting with a sudden onset of dissociative and conversion symptoms. Secondly, the psychiatric theory of hysteria of Charcot and Freud was developed and extended further. And, last, the etiology of war neurosis was recognized to be multifactorial. Thus, the discourse on this issue was not one-dimensional and favoring a single explanation for a complex disorder, but revealed "pluridimensional" features. Subsequently psychotherapy, for the first time, was widely introduced into clinical practice with a clear indication and well-defined methodological approach. In summary, war neuroses can be addressed as an early model of traumatic stress disorder, such as acute stress disorder or post-traumatic stress disorder.     

Behavioral contagion in sibships.

A behavior is "contagious" if one person is more likely to exhibit it when a relevant other person has already done so. In this sense, behavioral contagion is commonly thought to contribute to many social problems, such as drug abuse and teenage promiscuity. In this paper we focus on behavioral contagion in sibships. Borrowing a model from the theory of contagious diseases, we show that contagion will cause prevalence to increase with sibship size. This model also allows us to estimate the magnitude of the contagious factor relative to non-contagious factors. Finally, we develop two statistical tests for the presence of contagion. Results are presented for participation in a skill-development program and four child-psychiatric conditions: neurosis, hyperactivity, somatization, and conduct disorder. Evidence is presented that program participation is probably contagious and conduct disorder possibly so. The other three child-psychiatric conditions are shown not to be contagious. Implications for research and practice are discussed.     

社区神经症的临床特征与亚型分类探讨

目的为进一步修订我国精神病诊断分类标准提供基础资料.方法使用<精神状况评定和分类>中有关神经症条目内容54项,社会功能评定量表(SDSS)等评定量表符合CCMD-2-R及ICD-10诊断的365例神经症患者,对其临床特征分类诊断和社会功能进行比较分析.结果①95%左右的患者以神经症性症状群为主,焦虑性神经症、抑郁性神经症、躯体化障碍、神经衰弱为最多见类型,有32.26%的抑郁性神经症婚姻状况不良.②症状严重度以抑郁性神经症和癔症排前2位,神经衰弱最后,社会功能受累也有类似趋势.结论建议再修订CCMD时,注意以下两点①保留神经衰弱及躯体化障碍分类诊断;②在亚型的等级梯度上抑郁性神经症放在癔症之前.     

Place de l’hystérie dans les nosographies psychopathologiques et les approches psychodynamiques contemporaines

AimThe aim of this study is to focus on the place of hysteria in psychiatric nosographies and the psychoanalytic conceptions of the 21st century, across the different classification models: the diagnostic criteria are very heterogeneous, and this does not facilitate pluridisciplinary teamwork.MethodA literature review to analyse place and evolution of hysterical neurosis in national and international psychiatric nosographies (DSM, ICD10, CFTM) and in psychoanalytic conceptualizations (PDM, the structural approaches of Bergeret and Lacan, the processual approaches of Roussillon and Benedetti).ResultsWe note a gradual disappearance of hysteria and neurosis in successive versions of the DSM, from DSM-3 to DSM-5. Hysteria is broken down into several disorders in the ICD10. This makes it more difficult to reach a consensual diagnosis in a clinical team. Conversely, hysteria has retained its founding and fundamental place in all psychoanalytical nosographies.DiscussionThe divide between the American DSM-5 psychiatric nosography and psychoanalytical nosographies seems increasingly marked in the field of neuroses, despite the beginnings of an integration of a dimensional perspective. We can also note the plurality of views of hysteria within the psychoanalytic field. Authors present hysteria either as a neurosis or as a personality structure that is able to function on an adaptive or decompensated mode (Bergeret). The plurality of theoretical models constructed to understand hysteria has resulted in a transnographic extension of hysteria, since several authors (Roussillon, Benedetti) postulate that it is possible to find hysterical elements in the most severe narcissistic disorders.ConclusionWhile it seems difficult to construct an integrative model including the anthropological, psychodynamic and biological dimensions of hysteria, making it possible to reach a consensual diagnosis in a clinical team, the numerous theoretical models in the psychodynamic field provide each clinician with useful benchmarks to understand and to manage hysteria.     

Obsessional thinking as "paradoxical action"

Obsessive-compulsive neurosis has long intrigued psychoanalysts. Although they may disagree about the underlying etiological mechanisms, analysts generally agree that obsessive individuals are often difficult to engage in the psychoanalytic process and are therefore difficult to treat psychoanalytically. The author offers a selective integration of theoretical approaches to this disorder and elaborates on Schafer's theory of obsessional thinking as paradoxical or conflictual action as a way to understand the resistance frequently encountered in these patients. A case report illustrates this psychoanalytic approach to obsessional neurosis.     

Nosography of the neuroses. 5. Aspects and problems of the neurotic reaction as an adaptive disorder

The term "neurosis", although is no longer used in the recent American classification, is still considered valid and firmly established in our learning even with its etymological and semantic inexactitudes. So in this 5th coordinated and systematical study on the nosography of neurosis the Authors observe its less known and less described aspects in literature, such as short-dated neurosis forms with acute course. These situations of acute neurosis can be explained as unspecific answers to stress situations, that is to say as reactions to conscious or removed biological and psychological events. They are disorders of adaptation with a single pathogenetical mechanism and their aspect suggests the approach to alarm-reactions for unspecific stressors. This neurotic reaction of adaptation, conditioned by the subject's cognitive interpretation, has the characteristics of an exaggerated and disorderly alarm-reaction with particular polymorphism of its symptomatology. The Authors elaborate a model of the symptomatology and they examine the differential diagnosis of these reactions. Regarding the evolution and the course of this disorders they assert that the prognosis is good, but in some cases there may be the passage to a form of structured neurosis or the evolution to a depressive syndrome; they interpret this as a decompensation due to the exhaustion of fitting mechanisms. At the end of the study the authors illustrate the therapy.     

Ethnicity as a variable in mental health research: a systematic review of articles published 1990-2004

The objective of the study was to investigate how the ethnic variable has been used in mental health research, in theory, in measurement and classification criteria. Journal articles published 1990-2004 that address original research on psychopathology, treatment and mental health services and with "ethnic" or "ethnicity" in their title or abstract were selected. The papers were examined for their theoretical definition of ethnicity, how the ethnic data were collected and the criteria used to identify ethnic groups. The use of comparison groups and country of the studies were recorded. A total of 421 papers were identified. An explicit theoretical definition was found in 33 (7.8%) papers. Data collection procedure was mentioned in 248 (58.9%) and 104 (24.7%) papers described how data was converted into ethnic groups. The operationalizations of ethnicity have remained almost unchanged during the 15-year review period. Generally, the ethnic variable was incompletely reported. Confusion regarding which individual or social characteristics ethnicity refers to makes the research findings of limited value in clinical settings, and may continue to create misunderstanding about the effect of ethnicity in clinical contexts.     

Some Nosological Considerations on "Borderline Case"

Abstract: The so-called "borderline cases" are classified nowadays into Borderline Personality Disorder (BPD) or Schizotypal Personality Disorder (SPD) according to DSM-III-R. We discussed them as follows: The common pathology to them is their imaginary relationship to the object of identification. The difference between them is the distance from patients to their object. After presenting a case who is situated midway between the borderline case and neurosis, the pathology of borderline case can be described as a failure of repression. After classifying borderline cases in Japan into hysterical borderline or obsessional borderline, their relationship to hysterical neurosis and to obsessional neurosis are respectively discussed.     

Histoire du concept d’anxiété : de la théorie des humeurs à la biologie moléculaire

If the study of the anxiety seems to have known an eclipse during years 1930–1960, the works of D. Klein [32] (1964) [32] have labeled a renewal of interest in the study of the anxiety at the same time on the experimental, pharmacological, epidemiological but also clinical plan. From the 1970s, the modification of the classification of anxiety disorders at the instigation of the criteria of the DSM in a purpose of clinical researches and pharmacological allowed to distinguish various forms of anxiety the biological origins of which seem better established today at the price of a dismemberment of the classification of the neurosis's. If the anxiety neurosis as the specific entity was separated in generalized anxiety disorder and panic disorder, the phobic disorder was fragmented in social phobia, agoraphobia and simple phobia. The neurosis of constraint is a part from now on obsessive compulsive disorders and the hysteria became a somatoform disorder. The place of the central anxiety in the mental illness and which formerly rolled out in the form of anxiety of castration, separation or division in the psychodynamic model became otherwise a secondary phenomenon, the sign of an adjustment disorder. The development of the pharmacological treatments of the anxiety since the discovery of the benzodiazepines (1957) but also the antidepressants shows us that we changed gradually paradigm and it seems from now on that through a better knowledge of the neurobiological mechanisms of the anxiety we can relieve patients’ largest number even if at the same time we attend an overconsumption of anxiolytics. The paradox of the human being seems to know better its fear to master her (it) and its research for the property–to be seems often short-lived.     

Civilization, culture and neurotic depression: In view of the Freudian theory

Abstract Our discussion is based on the psychoanalytic theory of Freud. We, however, discuss a case of neurotic depression which is not considered a subtype in Freud's concept of neurosis. We discuss the difference between culture and civilization, referring to what Freud discussed in Totem and Taboo and Moses and Monotheism. We then discuss two matters specific to Japanese culture; the assimilation of foreign cultures, and the sexual differences found in Japanese culture. On the basis of these discussions, we attempt to link these with the problem of structure of the neurotic depression. We conclude with Confucianism which we can consider as relative to the East-Asian world.     

Le signe du miroir : reflets cliniques et théoriques

Paul Abely (1927-1930) and then Delmas (1929) described in three articles published in French what came to be called the miiror sign. Sadly psychiatry sold out to'management and “stastical gibberish” so that essential clinical discoveries fell by the wayside… In this article - the sythesis of a longer piece of research - we try to show that the mirror sign is the clinical and theoretical validation of the mirror phase (or stage) as theorised by H. Wallon, J. Lacan and others. We have called upon the history of art to show that the mirror sign is the key to understanding what seperates neurosis from psychosis. G. Rodenbach and his “freind from the mirror” will accompany us and explain the very experience of “the mirror sign…”.     

Neurosis from the Viewpoint of DIS (Diagnostic Interview Schedule)

Abstract: We examined the relationship between clinical and DIS-Lifetime diagnoses given independently on 106 psychiatric patients clinically diagnosed as suffering from neurosis. They had many coexisting DIS diagnoses, and some of them had no DIS diagnosis. The key to the coexistence relationships in DIS diagnosis was a major depressive episode, and the subjects were classified into four types by the DIS coexistence relationships; Type I: 28 cases (26.4%) had coexisting diagnoses belonging to anxiety disorders or somatoform disorders, in addition to a major depressive episode. They were suffering from clinically severe neurosis accompanied by borderline personality disorder. Type II: 30 cases (28.3%) belonged to anxiety disorders or somatoform disorders without a major depressive episode, and had clinically symptomatic neurosis. Type III: 18 cases (17.0%) had a major depressive episode without anxiety disorders or somatoform disorders, and had clinically depressive neurosis or depressive episode with less distortion of the personality. Type IV: 30 cases (28.3%) were other than Type I-III, and were clinically similar to symptomatic neurosis.     

Obsessive-compulsive disorder: its conceptual history in France during the 19th century

Until the 1850s, obsessive-compulsive phenomena were considered to be a variant of the old notion of insanity. Around this time they became a separate disease: first, as a member of the old class of the neuroses; then, briefly, as a variant of the newly formed notion of psychosis; and finally, as a neurosis proper (in the post-1880s sense). These changes reflected theoretical shifts in the definition of the grand psychiatric categories. After 1860, organic causal hypotheses for OCD included dysfunctions of the autonomic nervous system and cortical blood supply. Psychological hypotheses suggested the OCD might result from volitional, intellectual, or emotional impairment, the last of which predominated after 1890. Issues relating OCD to personality types and hereditability were dealt with in terms of the degeneration theory. By the late 1880s, OCD achieved full clinical and nosological definition.     

Precocious ego development and obsessive compulsive neurosis

Precocious ego development is frequently mentioned in psychoanalytic theory as an important determinant of obsessive-compulsive neurosis. Writers such as Anna Freud suggest that an imbalance in the development of ego over drive may lead to obsessional neurosis. However, further examination of the psychoanalytic literature reveals that the nature of this supposed link is not clear. Explanations couched in economic language or in terms of an early hypersensitivity to stimulation are open to theoretical criticism or are unsatisfying. The author suggests that we focus on the effect of precocious ego development on developing object relations. It is suggested that precocity may lead to early disappointment in parental objects. The inter-relationships of disappointment with early identifications, premature sense of autonomy and anal problems are discussed. A case of an obsessive-compulsive adolescent girl is presented to illustrate the role of precocious ego development and superior intelligence in the formation of the symptoms.     

Controlled encoding strategies in memory tests in lithium patients

The "levels of processing" theory (Craik and Lockhart) and "dual coding" theory (Paivio) provide new aspects for clinical memory research work. Therefore, an incidental learning paradigm on the basis of these two theoretical approaches was chosen to test aspects of memory performances with lithium therapy. Results of two experiments, with controlled non-semantic processing (rating experiment "comparison of size") and additive semantic processing (rating "living--non-living") indicate a slight reduction in recall (Fig. 1) and recognition performance (Fig. 2) in lithium patients. Effects on encoding strategies are of equal quality in patients and healthy subjects (Tab. 1, 2) but performance differs between both groups: poorer systematic benefit from within code repetitions ("word-word" items, "picture-picture" items) and dual coding (repeated variable item presentation "picture-word") is obtained. The less efficient encoding strategies in the speeded task are discussed with respect to cognitive rigidity and slowing of performance by emotional states. This investigation of so-called "memory deficits" with lithium is an attempt to explore impairments at an early stage of processing; the characterization of the perceptual cognitive analysis seems useful for further clinical research work on this topic.     

Neurosis from the viewpoint of DIS (Diagnostic Interview Schedule)

We examined the relationship between clinical and DIS-Lifetime diagnoses given independently on 106 psychiatric patients clinically diagnosed as suffering from neurosis. They had many coexisting DIS diagnoses, and some of them had no DIS diagnosis. The key to the coexistence relationships in DIS diagnosis was a major depressive episode, and the subjects were classified into four types by the DIS coexistence relationships; Type I: 28 cases (26.4%) had coexisting diagnoses belonging to anxiety disorders or somatoform disorders, in addition to a major depressive episode. They were suffering from clinically severe neurosis accompanied by borderline personality disorder. Type II: 30 cases (28.3%) belonged to anxiety disorders or somatoform disorders without a major depressive episode without anxiety disorders or somatoform disorders, and had clinically depressive neurosis or depressive episode with less distortion of the personality. Type IV: 30 cases (28.3%) were other than Type I-III, and were clinically similar to symptomatic neurosis.