Persistent discrepancy in international diagnostic practice since 1970

Saugstad, Letten F.; Ødegård, Ørnulv

doi:10.1111/j.1600-0447.1983.tb00958.x

Cited by 21 publications

(13 citation statements)

References 14 publications

(7 reference statements)

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“…However, as we all know, this is not the case for schizophre nia and manic-depressive psychosis [16]. The prevalence of reactive psychoses also varies widely in the official statistics of the countries which have a tradition with this concept [4], We therefore have a problem of cultural differences in the prevalence of reac tive psychoses. However, as demonstrated in Scandinavia, there are considerable differ ences in prevalence between neighboring countries, which are quite close in language and culture.…”

Section: Prevalencementioning

confidence: 99%

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Problems Concerning the Concept of Reactive Psychoses

Dahl¹

1987

Psychopathology

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The problems of reactive psychoses are discussed from the following perspectives: terminology, prevalence, psychogenesis and trauma, predisposition and vulnerability, as well as outcome. Four definitions of reactive psychoses, which are used in Scandinavia, are presented and discussed. Each of them is beset with problems. The authors argues that the term ‘reactive psychoses’ should be limited to those functional psychoses which are not typically schizophrenic, manic-depressive or paranoid.

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Section: Prevalencementioning

confidence: 99%

“…The term 'reactive psychosis' was strongly endorsed internationally by the Norwegian psychiatrist 0degard [4]. The term was meant by him to cover the functional psy choses which were not of clearly schizo phrenic, manic-depressive or paranoid type.…”

Section: Information and Terminologymentioning

confidence: 99%

Problems Concerning the Concept of Reactive Psychoses

Dahl¹

1987

Psychopathology

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“…On the other hand, when the reactive psychoses are taken as criterion diagnoses, it turns out that nearly half of these cases get a diagnosis within the schizophrenia spectrum in DSM-111. It has been shown that 35% of the Norwegian cases that get a diagnosis of reactive psychosis at first admission, will later get a diagnosis of schizophrenia (2). One can therefore assume that some of the cases with a diagnosis of reactive psychosis in ICD-8 that get a diagnosis within the schizophrenic/schizophreniform disorders in DSM-111, later will get a diagnosis of schizophrenic psychosis in ICD-8 too.…”

Section: Discussionmentioning

confidence: 99%

The DSM‐III classification of the functional psychoses and the Norwegian tradition

Dahl¹

1986

Acta Psychiatr Scand

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The relationship of the DSM-111 categories to the national diagnostic usage of ICD is of importance for communication between psychiatrists.Here the theoretical relationship between the DSM-111 categories and the Norwegian use of ICD-8 within the area of functional psychoses is discussed. An empirical investigation of these theoretical assumptions has been done on a hospital material diagnosed independently in the two classificatory systems. The empirical investigation gives support to the concordance of DSM-111 schizophreniform, schizoaffective, and bipolar disorder and the Norwegian ICD-8 counterparts. The concordance is less for schizophrenic disorders and major depression. It is also found that the Norwegian diagnoses of reactive psychoses spread over many DSM-111 diagnoses. In particular more of the reactive psychoses than predicted fall within the schizophrenic spectrum of DSM-111.In each country a collection of diagnostic concepts has developed or been adopted to span the range of psychopathology recognized by psychiatrists. In Norway psychiatric nosology has been strongly influenced by German traditions but modified by influence from the other Scandinavian countries. Leading Norwegian psychiatrists like Vogt, Langfeldt and 0degird also moulded the nosological development. The Eighth revision of the International Classification of Diseases (ICD-8) became the official Norwegian system for classification of psychiatric disorders from 1969 and replaced the national classification. However, as demonstrated in several studies ( 42) national traditions interpret the international classification quite differently.The international classification by its very nature of international cooperation and compromises is quite slow in absorbing methodological advancements in nosology. These advances are very important for progress in psychiatric research, and alternative systems of classification that incorporate such innovations have therefore been developed (3,4). The third edition of the classification of the American Psychiatric Association (DSM-111) (5) has received much attention recently because of its radical approach which includes several of these innovations. DSM-I11 takes a consistently atheoretical, descriptive approach to diagnosis. Diagnostic criteria are specified for all psychiatric disorders, and multiaxial evaluation is introduced.Many countries have translated and started to apply the DSM-I11 classification. In many scientific papers, patients' samples are described according to the DSM-111 diagnostic criteria. In this situation comparison of DSM-111 and national applications of the ICD becomes important for the understanding and communication between psychiatrists. In this paper the classification of functional psychoses according to DSM-I11 and the Norwegian application of ICD-8 will be compared. Norway, like the other Nordic countries, except Iceland, does not approve ICD-9 but still uses ICD-8 as its official classification of mental disorders. In the area of functional psychoses, however, the chang...

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“…The concept is similar in all countries. There was a 50% increase in first admissions classified as manic depression in Norway during 1926Á65 (Saugstad and Ødegård 1980(Saugstad and Ødegård , 1983(Saugstad and Ødegård , 1987. This increase occurred almost entirely after 1955, when a growing proportion was classified as ''non-psychotic'', while a great number of these non-psychotic depressions were involuntarily admitted as being considered psychotic.…”

Section: High Familial Loading Low Standard Of Living and Schizophreniamentioning

confidence: 95%

“…This became the most used psychiatric diagnosis in subsequent years (Ødegård 1971, 40% in 1965). Denmark also introduced a third category of functional psychosis: psychogenic psychosis, which became a similarly popular diagnosis (Saugstad and Ødegård 1980(Saugstad and Ødegård , 1983(Saugstad and Ødegård , 1985.…”

Section: Warning Signs and Symptomsmentioning

confidence: 99%

Kraepelin's dichotomy is true: contrasting brain dysfunction at the extremes of human growth and maturation. Excitability, the fundamental property of nervous tissue, is affected

Saugstad¹

2009

The World Journal of Biological Psychiatry

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The distribution of Kraepelin's ubiquitous dichotomy varies with standard of living and pubertal age: when one rises, the other declines. The universal similar clinical picture--mortality risk, manic depressive psychosis, episodic dysfunction of brainstem control systems (sleep-wake cycle, food, mood control mechanism)--is caused by abridged pubertal pruning of excitatory synapses, which is treated with anti-epileptics, as opposed to convulsant neuroleptics in dementia praecox, where the clinical variation reflects varying degrees of excessive pruning and deficit in excitability. Localization of cortical breakdown of circuitry, silent spots and persistent dysfunction due to insufficient fill-in mechanisms, determine the clinical picture. This ranges from dementia praecox in late puberty and poor living standards, to cognitive dysfunction (mainly with higher standards of living) with earlier puberty. This variation is the most likely explanation why the acceptance of dementia praecox as a disease entity was complicated. Kraepelin's dichotomy, episodic dysfunction against a clinical deterioration, is at the extremes of brain maturation; the fundamental property of nervous tissue, excitability, is affected. To reduce the risk of psychotic episodes, omega-3 might also be given, as it normalizes excitation at all levels. The neo-Kraepelinian atheoretical quantitative scoring systems have eliminated disease entities and neglected endogeneity in psychiatry. We are back to a pre-Kraepelinian state, without his systematic observations. What is psychiatry without Kraepelin's dichotomy? Mood stability is a fundamental personality trait with a normal distribution; what is considered within or outside normal variation is arbitrary. Given the mood-stabilizing effect of anti-epileptics and omega-3, these will increasingly dominate psychiatric treatment.

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Persistent discrepancy in international diagnostic practice since 1970

Cited by 21 publications

References 14 publications

Problems Concerning the Concept of Reactive Psychoses

Problems Concerning the Concept of Reactive Psychoses

The DSM‐III classification of the functional psychoses and the Norwegian tradition

Kraepelin's dichotomy is true: contrasting brain dysfunction at the extremes of human growth and maturation. Excitability, the fundamental property of nervous tissue, is affected

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