Berrios History of Mental Symptoms - notes on positive psychotic symptoms

 

Hallucinations

Hallucinations moved away from understanding the semantic content towards differential classification from veridical perception, illusion and hallucination

Hallucinations/ illusions surveys of population in 19th century showed common in healthy population.

Definitions of pseudohallucinations unstable; vary from false perceptions with insight to false perceptions with limited "vivacity" or less convincing than veridical perception or in internal space.

Importance of Scottish philosophers of common sense on faculty psychology i.e. separate functions/ faculties

contrast with associationist models where simpler mental phenomena are building blocks of more complex phenomena and are interconnected

 

Thought disorder

Thought disorder originally not separated from language problems like expressive and receptive aphasia. Associated with dementia praecox as an important symptom. As it is dependent on theories of thinking it will be harder to find direct biological correlates

 

Delusions

Delusion regarded as hallmark of insanity . Often combined with delirium only separation that of Presence of fever.

18-19th C Aetiology involved somatic events of various types

Locke made parallel of arguing right from a wrong premise, he also had continuity psychosis description that erroneous thoughts/ beliefs also occur in general population

Often thought to be secondary to an internal event

Associationist thinking, defect of reason/judgement

Also separating into delusions caused by hallucinations and other delusions

Pinel only had 4 categories, delirium included hallucinations and delusions

Delusions thought often due to eg hallucinations or internal sensation, importance of affective response 

Disorder of intellect of reasoning and judgment due to organic brain disease e.g. Pinel thought attention

Delusions may be graded in severity

Often seen in context eg Falret who also thought lack of insight important

Early 19th C delusion and delirium thought to be same construct

Delirium split into with fever and without - the latter was insanity.

Early 19th C French psychiatry identified delusional disorder as separate, had continuity ideas of delusions; thought could be caused by emotional excitation

German 19thc insanity is chronic delire without fever but also partway between physical disease and mental illness as possible unidentified somatic disease

Griesinger unitary psychosis - melancholia to mania to dementia

Delusions are secondary eg to hallucinations or strong emotions; incorrigibility, contrary to previous ideas, different from normal strong beliefs, due to brain disease

English speaking 19th c Haslam impossibility of infallible definition of madness; all mental faculties involved eg judgment and memory

Mania at the time includes insanity not just elated moo

Pritchard - partial insanity with some  insight

Bucknill and Tuke - delusion in English errors without being corrected by reason

Mid 19th C French.

I use delirium a lot but often means delire

Cotard linked motor activity, thinking and mental content

Mid 19th C British

Hughlings Jackson includes positive and negative but in terms of evolution and dissolution of functions and not as we think of it

He thought delusions were the expression of healthy tissue released by abolition of function in diseased tissue

Late 19th to 20th C French psychiatry Magnan Serieux similar to Jaspers incubation, crystallisation, and 2 further stages

Targrowla and like Levy-Bruhl like Jaspers of intrusion of sudden complete judgment

Chaslin like Cotard and earlier regarded delusions and hallucinations as similar,

Delusions could occur in absence of defect of reasoning but also with defect

German 19thc insanity is chronic delire without fever but also partway between physical disease and mental illness as possible unidentified somatic disease

Griesinger unitary psychosis - melancholia to mania to dementia

Delusions are secondary eg to hallucinations or strong emotions; incorrigibility, contrary to previous ideas, different from normal strong beliefs, due to brain disease

English speaking 19th c Haslam impossibility of infallible definition of madness; all mental faculties involved eg judgment and memory

Mania at the time includes insanity not just elated moo

Pritchard - partial insanity with some  insight

Bucknill and Tuke - delusion in English errors without being corrected by reason

Mid 19th C French.

People use delirium a lot but in French often means delire

Cotard linked motor activity, thinking and mental content

Mid 19th C British

Hughlings Jackson includes positive and negative but in terms of evolution and dissolution of functions and not as we think of it

He thought delusions were the expression of healthy tissue released by abolition of function in diseased tissue

Late 19th to 20th C French psychiatry Magnan Serieux similar to Jaspers incubation, crystallisation, and 2 further stages

Targrowla and like Levy-Bruhl like Jaspers of intrusion of sudden complete judgment

Chaslin like Cotard and earlier regarded delusions and hallucinations as similar,

Delusions could occur in absence of defect of reasoning but also with defect

Delusions concept based on outdated concepts eg of epistemology

Eg based on concept of wrong belief that may or may have volitional content

Berrios states Jaspers actually regards delusions as having the form of beliefs but the content is morbid and false

Berrios states delusions do not meet Price criteria for beliefs

He states Bayesian models may not apply to delusions or normal beliefs

Delusions not real beliefs as not statements about the world (calls them empty speech acts) but Berrios ignored that they tell you something about the patient and their world

Talks about delusions being “enveloped” in “psychosocial noise”

Primary vs secondary delusions plus theories of psychological and biological causation

Even if can’t currently comprehend delusions on future may be able to

Up until early 19th C delusions considered sign of madness and little interest in their content

By 1850 interest in their form Then interest in the their content 1850s onward - hermeneutic rules driving content not succeeded

Pre delusional state PDS of moods, thought, connotation (consciousness) and motor action - existed before Jaspers including Hesnard in?France

Links between madness and dreaming again.

Ball & Ritti late 19th c linked sudden delusional formation with VEGETATIVE symptoms p116

Many before Jaspers had primary and secondary delusions including in France / Germany

De Clerembeault early 20th C thought delusions and hallucinations secondary to coenesthopathies - internal anamolous experiences

Pre Delusional State (PDS()  in relation to primary delusions what hallucinations or moods are to secondary delusions

PDS primordial soup out of which hallucinations/ delusions formed depending on coding rules

PDS not always observed by clinicians as occurred before contact as may function ok

Berrios says cognitive functioning during PDS impaired and delusion formation may not therefore provide adaptive / teleological / epistemological function

PDS descriptions important form various authors

Conrad Endogenous depression caused by SCZ but never other way round

Blondel and Llopis important ideas

In Continent PDS are disorders of consciousness - Continent disorders of consciousness is not just attention problems, disorientation and confusion but also dysphoria, irritability, subtle loss of grasp, situational disorientation and hypereasthetic states

Others also focussed on perplexity

Unclear if delusions different in SCZ from mania or organic disorders

May be mistaken believing same structure as normal beliefs

Dimensional measurements of aspects of delusions not v helpful and dimensional model does not clarify well from Normal beliefs according to experienced clinicians “figment of the researcher’s imagination” p. 125

Also wrong to have continuum between over-valued ideas, delusions and obsessions

20Th C saw sub typing of delusions eg jealousy as of separate diseases

19th C delusions “intimately linked to the notion of insanity itself” p. 126 and before 1800 both organic delirium and insanity depended on delusions, illusions and hallucinations (which were not considered as separate phenomena)