Abstract
Before an outline of the process of diagnosis and differential diagnosis in infectious and/or inflammatory psy-chosyndromes is given, a more general overview onto the approach to organic psychosyndromes seems useful, because in both entities similar principles of causality conclusion are applied. Correlation does not demonstrate causality. Therefore the principles and consensus recommendations, and limitations of causal inference to categorize psychosyndromes as be-ing ‘organic’, is to be discussed in detail.
Highlights
In some chronic psychosyndromes the improvement after therapeutic intervention might mark the point for causality inference, as we recently demonstrated in cases with arachnoid cysts associated with organic psychosyndromes in the form of minor personality disorder, which were reversible resp. improved after neurosurgery [1]
A similar description of organic psychosyndromes like the ICD-10 is found in DSM-VI, a major difference is, that the term ‘organic’ is eliminated
The term ‘delirium’ is much more broadly understood and a major criterion to assume a causal relationship between a ‘medical disease factor’ and the various psychosyndromes, is the presence of a relevant or seemingly relevant time relationship between both
Summary
Well defined criteria are available for the diagnosis of delirium in both systems, i.e. DSM-IV 293.0, ICD10 F05 Both international classification systems lack clear operational criteria for most of what is traditionally termed organic psychosyndromes with less severe or moderate symptoms. In this broad spectrum of psychosyndromes mainly the experienced clinician’s opinion based on the evaluation of findings observations and examinations, is the clue for causality inference. Huber according to Kurt Schneider staged into three severity levels, i.e. pseudoneurasthenia (mild), organic personality disorder (medium), and dementia (severe) This staging is not internationally accepted but in my view a very useful clinical categorization, because giving an evaluated information about the strength of causality or relevance of the respective organic factor for the observed respective psychopathology. Huber is a clearly organic syndrome whereas functional syndromes according to Fish’s clinical psychopathology [4], means psychogenic syndromes in the old triadic system
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