Psychiatric Semiology Research Articles

En terre étrangère. Proposition d’une cartographie minimale de la psychiatrie pour l’étudiant en médecine

When a medical student is learning psychiatric semiology and nosology, he is sometimes like a stranger in a strange land. Heterogeneous use of references in the symptomatic description of the disorder and in the nosographic classifications is problematic from a pedagogical point of view because it can be confusing for the student. This article proposes a minimal nosography of mental disorders in adults for a medical student. Nosological diagnostic approach in psychiatry will be presented to then be adapted to the principal mental disorders in adults. Synthetic support cards with decision trees will be proposed.

Psychopathology beyond semiology. An essay on the inner workings of psychopathology

This text develops three interwoven issues: first, a succinct comparative analysis of medical and psychiatric semiology, which proposes that the lack of referring relations between psychiatric symptoms and brain/psychic dysfunction is a fundamental distinction between medical and psychiatric semiology. Second, the multiple features of psychiatric semiology are reviewed. Third, a new approach to psychopathology is introduced, proposing three different ways to shape symptoms (perception, linguistic structure, praxis); highlighting its role as a cognitive activity that creates intelligibility from undifferentiated experiences; and distinguishing psychopathology and semiology on an activity/product relation basis.

Philippe Chaslin (1857–1923). À propos du centenaire des Éléments de sémiologie et de la discordance (1912)

Belonging to the last generation of the alienists of Paris hospitals, Philippe Chaslin begins his career in 1887 as physician of the lunatic sections at the hospital of Bicêtre. He is then (1910) physician in chief at the Salpêtrière hospital and becomes president of the Société Medico-Psychologique in 1917. His service is closed in 1921, one year before his retreat. He has published about 40 papers and three books on the “mental confusion” (1895), the psychiatric semiology (1912) and the psychology of mathematics (posthumous, 1926). Partisan of an empirical and descriptive approach of the mental pathology, opposite to the theoretical classifications, he criticizes the paradigm of “mental illness” and promotes the concepts of mental disorder, “clinical type” and syndrome in psychiatry. He rigorously separates the symptomatology from the etiology, operates a dichotomy between mental disorders of recognized (organic) and of unknown origin. His description of the “mental confusion” has leaded to the organic disorder named Delirium in the DSM. He introduced the concept of discordance, as an alternative to Bleuler's Spaltung (dissociation), in the symptomatology of the schizophrenia. He also published studies about the psychiatric terminology, about the reformation of the hospitals at the beginning of the 20th century and about the psychoanalysis, while Freud was still alive. His approach of the mental symptomatology has been very influential until the present time, especially on the DSM.

A Case of Crying Seizures

A Case of Crying Seizures

Neurophysiological mechanisms of psychotic symptoms

Psychotic symptoms are supposed to be expression of highest order brain functions such as symbolic thinking, language, planning, empathy or complex emotional reactions. However, due to its historical roots, current psychiatric symptomatology is based on descriptions of disturbed behavior, which refer to metaphysic concepts rather than to brain function. Therefore, modern biological research suffers from an important gap between psychiatric semiology and contemporary knowledge in systems neurophysiology. The authors argue for a redefinition of psychiatric symptoms in a neurobiologically meaningful way. Based on recent empirical studies, this strategy is exemplified for auditory verbal hallucinations and formal thought disorder. In these examples, characteristic psychiatric symptoms can be related to circumscribed structural and functional alterations in the language system, allowing the description of clinical phenomena in terms of neurobiological events. This strategy is also applicable to other psychotic symptoms like emotional dysregulation and catatonia, where disturbances of the functional circuits of mood and motor regulation, respectively, are predicted. This approach to psychiatric symptoms is based on contemporary evidence concerning systems neurophysiology and is expected to provide meaningful and testable hypotheses for future research aimed to a better understanding of the pathogenesis of psychiatric disorders, to more accurate prognosis and to better targeted therapeutic strategies.

État maniaque et état d'agitation : une étude diachronique

The following work is a retrospective review of medical files dealing with manic and agitation (breaking behaviour) crises in the last century. The work resulted from empirical findings that classical cases of manic episodes are rarely described in practice but simultaneously more and more cases are reported of agitation allying hostility or violence and psychic acceleration. Moreover, whereas conceptions evolve and become more precise, the classical semiology of manic episodes remains preponderant and is revealed via normative tools such as DSM or CIM. The study reviews files of a psychiatric sector over 80 years and analyses the clinical descriptions. The variability of the diagnoses and the semantic sliding of terms are also studied. These elements lead to questioning the possibility of a social variability in psychiatric semiology.

Introduction générale

This article is the completed introduction of a book that Lantéri-Laura was writing at the moment of his untimely death in 2004. The book was to be called “Psychiatric semiology: historical research and a critique of its foundations”. The long introduction breaks down into two parts. In the first part, the author deals with the historical development of medical clinic from ancient Greece to the modern day, he insists on the importance of the role played by “l'École de Paris” (end of the eighteenth century to the beginning of the nineteenth century) for the birth of a medical semiology. The consequent organisation of neurological semiology (second half of nineteenth century) is also sketched out as is the question of secondary medical examinations. In the second part the author explains his choices of linguistic structural tools (Saussure and Hjelmslev) for his project of analysis of medical, neurological and psychiatric semiologies. He underlines the inanity of the idea of a complete examination and defines a concept that will be useful for the future: that of regional espistemology.

Séméiotique de l'aliénation mentale

The origins of psychiatric semiology can be traced to the publication of A.-J. Landré-Beauvais “Séméiotique ou traité des signes des maladies” 1809, which was also the year of publication for the second edition of “Traité médico-philosophique sur l'aliénation mentale” by Philippe Pinel, wich included clinical observations of lunatics written up by Pinel in collaboration with A.-J. Landré-Beauvais, his second in command at the Sapétrière.

A fala e o pharmakon

A partir da generalização crescente do uso dos psicotrópicos, o autor se propõe a pensar o tratamento psíquico pelo químico. Supõe, então, a existência de um psicotropismo que eliminaria aquilo que do psíquico faz sintoma na tentativa de curar-se. Como conseqüência,não mais seria necessário, nestas condições, falar de sintoma, não apenas pela assintomatização da vida psíquica, mas por uma menor necessidade de conceber uma “demanda subjetiva” – transferencial – que leve ao trabalho necessário de rearranjo das representações e afetos. Enquanto a psicofarmacologia era bastante solidária com uma psicopatologia, a neurofarmacologia se tomaria por mais científica, a ponto de se emancipar de qualquer conhecimento dos disfuncionamentos psicopatológicos do indivíduo, já não lhe sendo mais necessário regular-se por uma clínica dos processos. Como ficariam, então, a semiologia psiquiátrica e o espírito nosográfico? Como ficaria a psicopatologia? E, em última análise, como ficaria a psicanálise até então protegida, de alguma forma, pela psiquiatria? O que se procura então, é, antes de tudo, esclarecer o enigmático “tratamento psíquico pelo psíquico” e determinar as condições segundo as quais a fala, como um pharmakon, propicia ou não para si os meios de interiorizar uma ação medicamentosa.

On the reason, why psychiatry in 80 years could not integrate schizo-affective psychoses. Can it now?

Schizo-affective psychoses are neither schizophrenias nor affective psychoses. What makes them particular are the pathological changes in emotions. As has already been pointed out by Wernicke in 1900, virtually all changes in the patient's psychopathology are dependent on the actual degree of anxiety or other pathological emotions. But neither emotion nor even anxiety has ever been part of any psychiatric semiology. Although emotional psychoses--a term we would prefer instead of schizo-affective psychoses--are easy to diagnose, if the psychiatrist takes into consideration the pathology of emotions which we outline here, it seems unlikely that psychiatry is now more able to integrate these psychoses than it was 80 years ago. This can be put down to language problems, but there are also historical, symptomatical, methodological, and systematic reasons for it.