Nosology

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Nosology (from ancient Greek νόσος nosos , German 'disease' and -λογος -logos, -logie , German 'word' , 'doctrine'), also disease theory , is the study of the medical classification of diseases. Nosology was at times a branch of pathology . The adjective for nosology is nosological = relating to nosology; Systematically describing diseases.

A systematically proceeding nosology encompasses as many methods as possible of researching and recognizing disease processes ( diagnosis ) in order to contribute to the detailed scientific description of valid disease units.

criteria

The classification , naming and recognition ( diagnosis ) of a disease can be based on the following criteria:

The union of abstract categorization and concrete nosographic detail is a contradicting process and is therefore regarded as fiction. The delimitation and nomenclature of different disease units in the course of medical history, however, corresponds on a purely linguistic level to the process of concept formation, see semiology , etymology and epistemology .

Problems of the history of medicine

The basic doctrine of disease from antiquity to modern times was humoral pathology , which postulated a faulty composition or mixture of body fluids as the cause of diseases and classified diseases accordingly. Following the example of botanical naming , diseases were classified for the first time in the 18th century by the doctor and botanist Sauvages in Montpellier. However, these traditional medical views must be contrasted with those of psychopathology , as they are also represented by psychosomatics . In these sub-areas different theories of disease development are represented, which practically differ in their methodology and go back to the mind-body problem dealt with by philosophy . Both in pathology and in psychopathology , however, when illnesses develop , there is talk of a lack of adaptation or adaptation to requirements and stresses ( noxae , stressors , trauma ).

Different classification systems

Different ways of classifying individual manifestations are used simultaneously or in parallel.

The most common classification system is the ICD of the World Health Organization (WHO). The WHO definition of health as a “state of complete physical, emotional and social well-being” must be observed when defining the term disease as a disorder of health. This definition is also called the bio-psycho-social disease model for short , whereby the hierarchy of this ladder must be taken into account (see situation circle ). In its very own intention, the WHO instrument is more descriptive- pragmatic (symptomatological) when dealing with psychiatric issues and therefore has certain necessary disadvantages when considering other nosological aspects.

The triadic system of classical German psychiatry , relevant to the history of psychiatry, should be mentioned as a model for a classification according to etiological aspects . In contrast to a symptom-oriented classification (cross-sectional aspect), the course-oriented classification (longitudinal aspect) is to be understood as a classification based on the course of the disease . An example of this is the distinction between dementia praecox and other dementias and paraphrenias (see also the different concepts of schizophrenia ).

The so-called Nosologia Militaris is used in the Swiss Army .

criticism

In operationalized procedures, as the WHO inventories rightly suggest, a) the changeability of the theory and b) the time factor of the disease development must always be taken into account. It is this time factor in particular that poses a fundamental problem for so-called cross - sectional diagnoses. According to the operationalized procedure, findings collected at a specific point in time are more or less “automatically” combined into a diagnosis. This can - at least in medical records - falsely simulate a "permanent character". Especially when it comes to subject-dependent diagnostic assessments, operationalizing procedures pose a certain risk because they do not sufficiently take the developmental aspect into account.

This is particularly important in psychiatry . See in particular the discussion about the apparent relativization of the concept of neurosis in favor of overly pragmatic approaches and the psychosomatic objection of the machine paradigm . The all too strong focus on a descriptive-symptomatologically oriented disease diagnosis alone has led to the development of the multiaxial system. These axes are explained in the following list. This also takes account of fundamental epistemological reservations on the subject of the objectivity of the sciences. A motto by Karl R. Popper is also quoted here: “ Clinical observations like all other observations are interpretations in the light of theories. "(German:" Clinical observations, like all observations, are interpretations in the light of theories. ")

Multiaxial system according to ICD-10

  • Axis 1a: Psychiatric illnesses
  • Axis 1b: Somatic Diseases
  • Axis II: Social disabilities (impairment of psychosocial functioning)
  • Axis III: factors of the social environment and the individual coping with life according to Chapter XXI (Z) of the ICD-10 (stress factors)

In 1996 a new multiaxial system was developed. For criticism, please refer to the web links section . - The criticism of the concept of illness in classic German psychiatry has gained practical importance , since the criteria of axes II and III were not taken into account. Rather, a biological paradigm was practiced that led to the derailment of the hereditary hypothesis ( endogeneity ) and thus to the abandonment of therapeutic efforts, cf. also the concept of peripheralization .

Web links

Wiktionary: Nosology  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ a b Norbert Boss (Ed.): Roche Lexicon Medicine . 2nd Edition. Hoffmann-La Roche AG and Urban & Schwarzenberg, Munich 1987, ISBN 3-541-13191-8 ; P. 1250 on Lex.-Lemma "Nosology" and P. 1657 on Lex.-Lemma "Symptomatologie" ( Gesundheit.de/roche ).
  2. ↑ Nosology . In: PL Janssen et al. (Ed.): Guide to Psychosomatic Medicine and Psychotherapy . Deutscher Ärzte-Verlag, ISBN 3-7691-0452-8 , p. 102 ( limited preview in the Google book search).
  3. ^ Heinz Otremba: Rudolf Virchow. Founder of cellular pathology. A documentation. Echter-Verlag, Würzburg 1991, p. 43.
  4. ↑ Brigitte Hoppe : The origin of the diagnoses in the botanical and zoological systematics. In: Sudhoff's archive. Vol. 62, 1978, pp. 105-130.
  5. ^ Georg Fischer : Surgery 100 years ago. Verlag FCW Vogel, Leipzig 1876, p. 374.
  6. ↑ W. Böcker, H. Denk, Ph. U. Heitz: Pathology . 3. Edition. Urban & Fischer, 2004, ISBN 3-437-42381-9 , p. 5
  7. ↑ Otto Bach : About the subject dependence of the image of reality in psychiatric diagnosis and therapy . In: Psychiatrie today, aspects and perspectives, Festschrift for Rainer Tölle . Urban & Schwarzenberg, Munich 1994, ISBN 3-541-17181-2 , p. 1 to quote Popper after Bach.
  8. ↑ H. Dilling et al. (Ed.), World Health Organization: International Classification of Mental Disorders , ICD-10 Chapter V (F). 2nd Edition. Hans Huber Verlag, Göttingen 1993, ISBN 3-456-82424-6 , p. 7, point d).
  9. ↑ Dorothee Roer , Dieter Henkel: Psychiatry in Fascism. Hadamar Asylum. Psychiatrie-Verlag, Bonn 1986, ISBN 3-88414-079-5 . New foreword from 2nd edition 1996 and 6th unchanged edition, Mabuse Frankfurt 2019, ISBN 978-3-929106-20-6 ; Pp. 17, 19 to the head. "Biologization, biologic paradigm".