The fragmentation of dementia
- Jun 20, 2011
During the second half of the nineteenth century, and based on the clinical observations and reconceptualization carried out by the French, German and English writers mentioned above, dementia starts to be considered as a syndrome and hence could be attached to a variety of disorders. The primary classification was to be between primary and secondary, the latter including all the vesanic dementias, i.e. states of defect that could follow any severe form of insanity. An increased use of light microscopy during the second half of the century led to the view that primary forms of dementia could be caused by degenerations of cerebral parenchyma or by arteriosclerosis. By 1900, senile, arteriosclerotic, infectious and traumatic forms of dementia had been reported (Berrios and Freeman, 1991). ‘Mixed forms’, such as ‘dementia praecox’ were also suggested reflecting Kahlbaum’s view that mental disorders appeared during specific biological transitions. The list of parenchymal forms became longer after the inclusion of states of degeneration from alcoholism, epilepsy, myxoedema and lead poisoning. The history of some of these forms will be discussed presently.
1.5.1 General paralysis of the insane
Bayle (1822) described under the name arachnitis chronique cases of what later was to be called ‘general paralysis of the insane’. Whether this ‘new phenomenon’ resulted from ‘a mutation in the syphilitic virus towards the end of the eighteenth century’ is unclear (p. 623) (Hare, 1959). Equally dubious is the claim that its discovery reinforced the belief of alienists in the anatomoclinical view of mental disease (Zilboorg, 1941).
In fact, it took more than 30 years for general paralysis to gain acceptance as a ‘separate’ disease. Bayle’s ‘discovery’ was more important in another way, namely that it challenged the ‘cross-sectional’ view of disease; in the words of Bercherie (1980): ‘for the first time in the history of psychiatry there was a morbid entity which presented itself as a sequential process unfolding itself into successive clinical syndromes’ (p. 75).
By the 1850s, no agreement had yet been reached as to how symptoms were caused by the periencephalite chronique diffuse (as general paralysis was known at the time). Three clinical types were recognized: manic-ambitious, melancholichypochondriac, and dementia; according to the ‘unitary view’, all three constituted stages of a single disease, the order of their appearance depending on the progress of the cerebral lesions. Baillarger (1883), however, sponsored a ‘dualist’ view: ‘paralytic insanity and paralytic dementia are different conditions’. It is clear that the debate had less to do with the nature of the brain lesions than with how mental symptoms and their contents were produced in general: how could the ‘typical’ content of paralytic delusions (grandiosity) be explained?
Since the same mental symptoms could be seen in all manner of conditions, Baillarger believed that chronic periencephalitis could account only for the motor signs - mental symptoms ‘therefore, having a different origin’ (p. 389). The absence of a link between lesion and symptom also explained why some patients recovered.
AMOXICILLIN is one of the most commonly used antibiotics in the world. It belongs to the spectrum of β-lactam antibiotics, and is the drug of choice when it comes to treating bacterial infections, as it is well absorbed even when given orally. Hence, it is used to treat a variety of infections, including infections of the ear, nose throat, skin infections, urinary tract infections, lower respiratory tract infections, gonorrhea and other sexually transmitted infections etc. AMOXICILLIN for sinus infection treatment is also a very well-known use of this drug. Thus, its multipurpose use makes this drug a very popular one among medical practitioners. However, amoxicillin side effects are something that doctors need to be well aware of, so as to prevent them from occurring, as they can be life-threatening at times.
One of the most serious and dangerous of all side effects is anaphylactic reaction. An anaphylactic reaction is defined as a life-threatening type 1 hypersensitivity reaction to a drug which is given internally or orally. Around 1500 patients die yearly due to an anaphylactic reaction in the United States. However, this serious allergic response of the body only occurs in those patients that have a true allergy to penicillin and its derivatives, as opposed to people who present with pseudo-anaphylaxis or an anaphylactoid reaction. An anaphylactic reaction is characterized by the following signs and symptoms:
- Normally, a true anaphylactic reaction with systemic signs and symptoms begin showing within 72 hours of exposure to the allergen, without the need of further exposure. Skin involvement is one of the first signs seen. This includes generalized hives, skin rashes, itchiness, flushing. Fever is often experienced by people, along with the skin rashes.
- Swelling of lips, tongue and/or throat is also seen, as this is the body’s way of responding and fighting the inflammation.
- Respiratory distress, in the form of difficulty in breathing, shortness of breath, wheezing etc. may also be seen.
- Some patients may also complain of gastrointestinal problems like severe abdominal cramps, stomach pain, diarrhea etc.
- Other serious effects that may occur if immediate action is not taken to deal with the symptoms includes Coronary artery spasms, which may lead to myocardial infarction. Consequently, there may also be a sudden drop in blood pressure, which may lead to lightheadedness and fatigue, along with loss of consciousness.
The view that general paralysis might be related to syphilis (put forward by Fournier, 1875) was resisted. Indeed, the term ‘pseudogeneral paralysis’ was coined to refer to cases of infections causing psychotic symptoms (Baillarger, 1889). In general, there is little evidence that alienists considered general paralysis as a ‘paradigm-disease’, i.e. a model for all other mental diseases. It can even be said that the new ‘disease’ created more problems than it solved (for a discussion of this issue see Berrios, 1985a).
Alistair Burns MPhil, MD, FRCP, FRCPsych
Professor of Old Age Psychiatry,
John O’Brien MA, DM, FRCPsych
Professor of Old Age Psychiatry,
Institute for Ageing and Health,
University of Newcastle upon Tyne,
Newcastle upon Tyne, UK
David Ames BA, MD, FRCPsych, FRANZCP
Professor of Psychiatry of Old Age,
University of Melbourne, St George’s Hospital, Melbourne,
German Berrios BA (OXFORD), MD, DM H.C. HEIDELBERG, FRCPsych, FBPSS
University of Cambridge Department of Psychiatry,
- Alzheimer A. (1907) Uber eine eigenartige Erkrankung der Hirnrinde.
- Allgemeine Zeitschrift fur Psychiatrie und Psychisch-Gerichtlich Medizine 64: 146-148
- Alzheimer A. (1911) Uber eigenartige Krankheitsfalle des spateren Alters. Zeitschrift fur die gesamte Neurologie und Psychiatrie 4: 356-385
- Anderson EW, Threthowan WH, Kenna JC. (1959) An experimental investigation of simulation and pseudodementia. Acta Psychiatrica et Neurologica Scandinavica 34 (Suppl. 132)
- Anonymous (1832) An exposure of the unphilosophical and unchristian expedients adopted by antiphrenologists, for the purpose of obstructing the moral tendencies of phrenology. A review of John Wayte’s book. The Phrenological Journal and Miscellany 7: 615-622
- Baillarger J. (1883) Sur la theorie de la paralysie generale. Annales Medico-Psychologiques 35: 18-52; 191-218
- Baillarger J. (1889) Doit-on dans la classification des maladies mentales assigner une place a part aux pseudo-paralysies generales? Annales Medico-Psychologiques 41: 521-525
- Ball B and Chambard E. (1881) Demence. In: A. Dechambre and L. Lereboullet (eds), Dictionnaire Encyclopedique des Sciences Medicales. Paris, Masson, pp. 559-605
- Barrett AM. (1913) Presenile, arteriosclerotic and senile disorders of the brain and cord. In: WA White and SA Jelliffe (eds), The Modern Treatment of Nervous and Mental Diseases. London, Kimpton, pp. 675-709
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