Cerebral systems in the pathogenesis of endogenous psychoses

Abstract

Mental process imply a harmonious functioning of psychic systems, assembled into larger units, psychic spheres (Table 1). Their neurophysiological representatives are brain systems of areas and pathways (Figs 1-4). Under functional and/or organic disturbances these systems originate the leading mental symptoms (Table 2) characterizing the diverse endogenous psychoses: hence, the latter's distinctive patterns. Accordingly, understanding and classification of psychoses should rest on the pathogenic dynamisms, not on clinical description. This is why Kleist's and Leonhard's conceptions of the endogenous psychoses surpass any other to exist. Kleist stands among the founders of psychiatry, by describing the "degeneration psychoses" and many single psychoses, as well as redefining, isolating and clarifying the progressive ones, later on renamed as schizophrenias (Table 3). Such pathogenic criterion may also be useul to define mental conditions other than psychoses, as hysteria, neuroses and psychopathic inferiority (Tables 4 and 5). One should consider here, besides the psychic systems and spheres involved, the way they were caught and the corresponding developmental phase. In Kleist's "degeneration psychoses"- cyclic or episodic (Table 6) the systems and spheres are disturbed by functional transient processes due to latent dispositions, while his and Leonhard's schizophrenias (Table 7) show a rather progressive, deteriorating course. The nature of the disorder is itself genetically determined, as is either its confinement to one sphere or its spreading out. The spread out pattern, while exceptional in schizophrenia, represents a rule for the "degeneration psychoses", in discussant's mind. Both groups may have symptoms alike by involvement of the same sphere (Table 8), but proper diagnosis is reached by taking pathogenesis into consideration.

Identifying the cutoff score for the PCL-R scale (psychopathy checklist-revised) in a Brazilian forensic population

“…Morana [8] in a study of forensic populations diagnosed with antisocial personality disorder, detected two subtypes of such disorder, which she named global personality disorder (GPD) and partial personality disorder (PPD), both characterized by differentiating criteria. These subtypes correspond to a previous classification by Silveira [9] who denominated them as psychopathy and abnormal character traits, respectively. Subtype GPD is close to Hare's definition for psychopathic personality [7], while subtype PPD corresponds to a less intense form of ASPD, with preservation of the integrity of some aspects of emotional resonance, enabling a better prognosis for rehabilitation programs.…”

Functional Neurologic Disorders, disorders to be managed by neurologists, or are neurologists wandering in a dangerous field with inadequate resources?

“…The idea that Conversion may be determined by an underlying brain disorder dates back to the first descriptions of the condition. Charcot believed that eredo-degeneration was the subtending mechanism (67, 69), Freud was aligned with the hypothesis by his mentor (70,71), several psychiatrists re-proposed the concept (72,73), by suggesting explanations that were based on neurophysiological knowledge of the time, i.e., cortical hyperexcitability and enhanced response to reticular system afferents was the hypothesized mechanism when the reticular system was the ultimate discovery of neurosciences (74). Studies on fMRI activation of cortical or subcortical areas during voluntary or involuntary movements (movement analysis protocols) are scarce (30,(75)(76)(77), which is in contrast with the many studies on resting state connectivity (77).…”

Análise patogenética dos distúrbios cognitivos em esquizofrênicos confusionais (Kleist) por meio da prova de Rorschach

“…Entretanto, no campo clínico esses estudos dão maior ênfase aos mecanismos bioquímicos empiricamente definidos a partir dos resultados obtidos pela ação de medicamentos que atenuam a expressão de Utilizaremos aqui o modelo sistêmico evolutivo concebido por Aníbal Silveira, pois é o único que abrange as relações do psiquismo com a atividade cerebral, tanto em condições normais como patológicas. A partir desse modelo, Silveira propôs um critério nosológico fundamentado nas concepções psiquiátricas de Kleist sobre as diferentes formas de esquizofrenia (Silveira, 1959(Silveira, , 1962 Neste trabalho apenas examinaremos alguns quadros clínicos das esquizofrenias confusionais, de modo a elucidar o procedimento que adotamos para o estudo patogenético por meio da prova de Rorschach ** . Utilizamos como referencial teórico o modelo de personalidade elaborado por Aníbal Silveira (Coelho, 1980).…”