Disease unit

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The term disease unit according to Karl Jaspers (1883–1969) represents a nosological concept of psychiatry . It was first used by Karl Ludwig Kahlbaum (1828–1899). With this concept, the forms of mental illness proposed in various classifications can be critically assessed. They should be made easier to understand by creating subgroups, expanded if necessary and separated from one another. The differentiations first made in the field of psychiatry have, however, also generally proven to be useful in medicine or for the concept of disease in general.

According to the method proposed by Jaspers, this differentiation is carried out according to the phenomenological method by observing a large number of comparable cases of illness and conceptual formation of individual, specific, irreducible and relatively constant or constant structural elements that can be recognized in these comparison cases. They can be described as typical symptoms of illness. In this way, new forms of special disorders can be described in the case of unclear or differently shaped clinical pictures. Through these differentiations, previously applicable classifications must be further developed.

Example schizophrenia

Emil Kraepelin (1856–1926) described dementia praecox in 1898 , but left it open whether it was a single disease or a group of diseases. Eugen Bleuler (1857–1939) took the view that this disease was a matter of different groups of diseases or different disease units and introduced the disease term schizophrenia in 1911 , as Kraepelin himself had found that not all of the cases he described ended with defects . As paradigm was and prototype of a course of observation so far mainly progressive paralysis been considered. It was the first disease that was described not only on the basis of symptoms , but also on a pathological-anatomical basis and also with a clinical course. This description was made in 1822 by Antoine Laurent Jessé Bayle (1799-1858). The syphilis was u Bayle as the cause. a. suspected for the chronic inflammation of the meninges in the form of arachnitis that he found. His dissertation was based on six cases with psychological symptoms and increasing paralysis. As a result, the representatives of classical German psychiatry assumed a physical or organic damage pattern as probable or hypothetical for schizophrenia (see triadic system ).

Research methods from the point of view of the disease unit

In addition to the already mentioned progress monitoring , Jaspers emphasizes the etiological differentiation as further research methods . For example, the methods and teachings of heredity and hereditary factors tried to find out one's own disease units. Kraepelin called these “ natural disease units ” because they corresponded to a scientific approach. The French Valentin Magnan (1835–1916) and Bénédict Augustin Morel (1809–1873) in particular represented this view before Kraepelin.

In addition, various psychiatric symptoms were summarized as symptom complexes. For example, rage and confusion were combined with one another, since a correlation between the frequency of individual cases of illness was assumed. In this way, new disease units should also be recognized. From this point of view, illness appeared as a theory of symptoms (see also chapter History of Psychiatry ).

The anatomical findings were also viewed as a comparable criterion of the disease unit in different cases of illness. In this connection, reference can sometimes be made to organic findings that are consistent in law, such as occur, for example, in progressive paralysis.

The comparative psychiatry has also raised the question of the disease entity and demanded therefore ethnological, cultural and sociological methods as indispensable sources of diagnostic assessment.

Opposite concept

The contradicting psychiatric illness concept to the model of the illness unit represents the conception of the unit psychosis . Here one does not start from individual units that are specifically distinguishable from one another, but assumes fluid transitions between the individual mental illness symptoms.

This makes it clear that these terms are theories that serve to advance scientific knowledge. However, the knowledge gained in this way must not be made absolute, since diseases are ultimately not about recognizable objects, but about human facts that correspond to the point of view of a diagnostic scheme and therefore have to be regarded as idealizations .

History of Psychiatry

Originally, the symptoms , which are now considered symptoms, were accepted as diseases in their own right, such as kleptomania , pyromania , poriomania . Such designations as they were introduced and used in particular by Jean-Étienne Esquirol (1772-1840), often represent a series of registrations that can be expanded at will and all too easily (compare monomania ). Already Wilhelm Griesinger (1817-1868) called it "conglomeration of symptoms".

Kraepelin, suggested by Karl Ludwig Kahlbaum (1828–1899), began to differentiate between dementias , which can not only be viewed as age-related gradual development of defect states ( senile dementia ), but rather develop in adolescence ( hebephrenia ) and often develop in bursts (negative symptoms of schizophrenia ). Kraepelin helped Kahlbaum's principles of classification, which were originally neglected, to become very well established. On Kahlbaum, however, go from him u. a. forms of hebephrenia and catatonia described as schizophrenic disease units on the basis of progress criteria to this day. Kraepelin, however, deserves the additional credit for having differentiated manic-depressive insanity (MDI) from dementia praecox. This disease unit is known today as the manic-depressive illness or as cyclothymia or bipolar disorder . Kraepelin also named many other individual forms of disease units, some of which are still common today. In eight editions of his "Textbook of Psychiatry" he repeatedly classified the variety of mental illnesses in a new system. This constantly modified system established itself internationally.

Demands on a teaching of the units of illness

Ideally, the following prerequisites and conditions should be met:

  1. An established and generally recognized classification system is required.
  2. Each case finds its appropriate place in the classification system.
  3. Each case is only classified in a single place in the classification system.
  4. The classification criteria ( symptomatology , pathogenesis , pathology etc.) are known and always constant.
  5. Different observers come to the same conclusion when classifying a case.

Since these are "ideal" requirements, it must appear self-evident that established classification systems such as the ICD-10 diagnostic code always contain compromises. The compromise in the case of the ICD is in favor of the symptomatological orientation and description of disorders and at the expense of the precise conceptual traditional delimitation of diseases . The increase in the description of disorders does not necessarily go hand in hand with a corresponding increase in specific therapeutic skills. For this, the concept of illness is essential, such as psychogenetic differentiation or the synopsis of neurosis and psychosis .

Individual evidence

  1. ↑ a b c d e f g Karl Jaspers : General Psychopathology . Springer, Berlin 9 1973, ISBN 3-540-03340-8 ; Pp. 464 ff., 471 ff .; 506 ff., 513.
  2. ↑ a b c d e Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology . 3. Edition. Urban & Schwarzenberg, Munich 1984:
    (a) p. 409 f. to Wb.-Lemma: “Phenomenology”;
    (b) p. 493 to Wb.-Lemma: “Schizophrenia”;
    (c) p. 317 to Wb.-Lemma: "Disease unit";
    (d) p. 289 to Wb.-Lemma: “Kahlbaum”;
    (e) S. 315 to Wb.-Lemma: "Kraepelin".
  3. ^ Karl Leonhard : Forms and courses of schizophrenia . Lecture given at the meeting of German neurologists and psychiatrists in Göttingen in 1949. Mschr. Psychiat. Neurol. 1952; 124: 169-191 ( doi : 10.1159 / 000139968 ) online
  4. ↑ a b Erwin H. Ackerknecht : Brief history of psychiatry . 3rd edition, Enke, Stuttgart, 1985, ISBN 3-432-80043-6 :
    (a) p. 51 on Stw. "Progressive paralysis";
    (b) p. 2 to stw. "comparative psychiatry".
  5. ^ Klaus Dörner : Citizens and Irre . On the social history and sociology of science in psychiatry. (1969) Fischer Taschenbuch, Bücher des Wissens, Frankfurt / M 1975, ISBN 3-436-02101-6 ; Pp. 171, 183-186 on St. "Bayle, ALJ".
  6. ^ Stefan Müller : Antoine Laurent Bayle . Zurich 1965.
  7. ↑ a b Rudolf Degkwitz et al. (Ed.): Mentally ill . Introduction to Psychiatry for Clinical Study. Urban & Schwarzenberg, Munich 1982, ISBN 3-541-09911-9 ; Column indicated below with ~: (a) p. 50 ~ 2 on stw. "Natural disease patterns (Kraepelin)"; (b) p. 50 ~ 1 on stw. “Indispensable requirements”; P. 251 ff. On tax. “ICD problems, chap. V ".

  8. ^ Wilhelm Griesinger : About psychological reflexions . P. 37.
  9. ↑ Rolf Adler (Ed.): Psychosomatic Medicine. Models of medical thought and action. Founded by Thure von Uexküll. Urban & Schwarzenberg, Munich 2003, 1564 pages, chap. 24 - ICD-10 and DSM-IV - a critical opinion on the use of the international diagnostic codes. Pp. 389–395, in particular pp. 389–391 on Stw. “Increase in diagnostic classifications”.