Obsession in the Strict Sense: A Helpful Psychopathological Phenomenon in the Differential Diagnosis between Obsessive-Compulsive Disorder and Schizophrenia

Background: Psychopathological concepts of the 19th and early 20th century postulated an antagonism between psychotic and obsessive-compulsive disorders, assuming obsessions and compulsions to have protective effects on psychotic disintegration. Although both disorders have been subject to intense multimodal research, their pathogeneses are yet to be fully understood. Methods: Here, we discuss recent neurobiological findings pointing towards opposite directions which are strongly reminiscent of the historical psychopathological antagonism. Results: Obsessive-compulsive syndromes (OCS) are efficiently treated with serotonergic substances, while on the other hand modern antipsychotic drugs exert antiserotonergic effects. Especially these atypical antipsychotic substances, however, were found to involve the risk of inducing second-onset OCS. Dopamine antagonists are potent antipsychotic substances, whereas the partial dopamine agonist aripiprazole has been associated with an antiobsessive potency. Within the glutamatergic system, reduced NMDA-dependent glutamatergic neurotransmission is discussed to be one major pathomechanism of psychotic disorders, whilst NMDA antagonists have proven to be effective in improving treatment-resistant OCS. While neurogenetic findings seem to separate the populations in heterogeneous samples, detailed neuroimaging studies suggest that both disorders affect similar neurocircuits in different manners. Conclusions: With regard to these findings, future research on schizo-obsessive syndromes will have to be multimodal, integrating psychopathology, neuropsychology, functional imaging, neurogenetics and psychopharmacology. Prospective trials involving these methods might be able to elucidate the dysbalances of neurotransmission and to locate the neuroanatomical and neuropsychological correlates. In particular, this might contribute to defining schizophrenic patients at risk for developing second-onset OCS and to evaluating new treatment strategies in patients suffering from both psychosis and OCS.

Section: Historical Perspective On Psychopathologymentioning

confidence: 99%

Section: Recent Neurobiological Evidence In Favor Of An Antagonistic mentioning

confidence: 99%

Neurobiology Confirms Psychopathology

Zink

Englisch²,

Dreßing³

2008

“…The phenomenological method is an expression of the anthropological orientation towards the specified modification of mental experience [23][24][25] . I have, for example, elsewhere attempted to adopt a phenomenological approach to the core syndrome of obsessive-compulsive disorder [26,27] .…”

Section: Methods and Proceduresmentioning

confidence: 99%

Phenomenological Investigation of Despair in Depression

Bürgy¹

2008

In current psychopathological literature, the concept of despair is almost redundant. At most, the term is applied in a behavioral biological context as a synonym for helplessness and hopelessness. In light of the fact that the subjective experience of despair is neglected, the present paper adopts a phenomenological approach. The selection and hermeneutic investigation of philosophical concepts serve as tools for an initial delineation of the core structure of despair. On the basis of a growing deviation between desire and reality, target and actual status, an alternating development is initiated which increasingly constricts and leads to hopelessness and suicide. This phenomenological core structure is identified from a number of integral characteristics of depression and further developed. Despair, thus, becomes a psychopathological key term through which access can be gained to the subjective experience of the depressive individual and which can provide the basis for promoting understanding and communication as well as developing successful therapeutic interventions.

“…– Several authors have highlighted the unclear limits of the concept of ‘delusion’, particularly as opposed to ‘obsession’ [44,45]. …”

Section: The Unstable Structure Of Descriptive Psychopathologymentioning

confidence: 99%

Misunderstanding Psychopathology as Medical Semiology: An Epistemological Enquiry

Gorostiza

Manes²

2011

In our everyday clinical experience we encounter significant problems directly related to the instability of psychopathological concepts. In order to trace the origin of this inconsistency, the nature of these concepts will be explored in their historical development. They will be compared to those pertaining to medical semiology, paying special attention to the specific nature of the ‘object’ each of them refers to. While concepts belonging to medical semiology refer to natural objects and retain their meaning independently of the patient’s context, psychopathological concepts refer to fragments of experience, which lose their significance if detached from their contextual horizon. The instability of psychopathological concepts is a consequence of the misunderstanding of psychopathology as medical semiology. As an alternative to this view, it will be argued that psychopathology represents an active and never-ending process aimed at the creation of intelligibility.