Aretaeus the Cappadocian on mental illness

The role of microbes and autoimmunity in the pathogenesis of neuropsychiatric illness

PURPOSE OF REVIEW

To illustrate how microbes might participate in the pathogenesis of neuropsychiatric illness by triggering the production of autoantibodies that bind to brain targets.

RECENT FINDINGS

Some studies link exposure to infectious agents to development of brain disorders; others have identified autoantibodies in individuals with these conditions without finding evidence of pathogens. Neither line of work demonstrates consistent associations between a specific neuropsychiatric disease and a particular environmental trigger or immune marker. Growing evidence suggests that the microbiome conditions host immunity to microbes and xenobiotics, and regulates autoimmune responses that can affect the central nervous system (CNS). The presence of CNS receptors for cytokines and other immune molecules underscores the importance of brain-immune crosstalk in maintaining normal function. An increased prevalence of familial autoimmunity, exposure to pathogens prenatally and postnatally, and findings of antibrain antibodies is common in disorders as diverse as schizophrenia, obsessive-compulsive disorder and autism, and suggests that differences in exposure timing and genetic vulnerability toward autoimmunity are important determinants of neuropsychiatric outcomes.

SUMMARY

Microbes, both pathogenic and commensal, can induce autoantibodies that bind to brain and affect behavior in susceptible hosts. Interventions that correct the microbial balance or diminish autoantibody binding may be effective in diverse neuropsychiatric conditions mediated by autoimmunity.

Melancolia e depressão durante o século XIX: uma história conceitual

Este artigo analisa historicamente o background ideológico que tornou possível a transformação da noção de melancolia nos conceitos de depressão e transtorno bipolar, a partir das mudanças médicas e psicológicas ocorridas no decorrer do século XIX. A antiga noção de melancolia foi remodelada e sua transição para a doença depressiva foi facilitada pelo conceito de Iipemania de Esquirol, que, pela primeira vez, enfatizou a natureza afetiva primária da doença. Finalmente, uma vez obtidas as condições conceituais necessárias, a melancolia e a mania foram combinadas no conceito de insanidade alternante, periódica, circular, ou de forma dupla, seus rígidos padrões descritivos foram flexibilizados, tendo culminado este processo na sinopse de Kraepelin.

Is SAD Lost to SAD?

Since 1984, 447 articles have been published using the acronym “SAD” for seasonal affective disorder in the heading of the publication, and since 1992, 59 articles have used “SAD” in the heading of the publication as an acronym for social anxiety disorder, according to MEDLINE. Using the acronym SAD for social anxiety disorder has been used with more frequency in recent scientific publications—interestingly, mostly in connection with newer antidepressants that have been found to be of therapeutic potential for this indication. To avoid possible confusions in research, the acronym “SOAD” was proposed for social anxiety disorder by Kasper and Winkler and “SAnD” by Nutt (D.J. Nutt, MD, PhD, unpublished data, 2004)—seemingly without success since these abbreviations are not seen in the literature. This month, CNS Spectrums focuses on the existing literature on the original acronym for SAD—seasonal affective disorder and its worldwide recognition.

In the early 1980s, Rosenthal and colleagues at the National Institute of Mental Health (NIMH) set out to describe a syndrome called SAD, not to be confused with the other, more recent SAD, social anxiety disorder. The original has been known to physicians since ancient times, dating back to Aretaeus the Cappadocian. However, the NIMH researchers for the first time systematically described the clinical symptomatology, compared it with healthy controls, and differentiated SAD from nonseasonal depression. Their work in tandem with emerging technology led to the discovery of the underlying pathophysiology of SAD and treatment approaches. The most important of these approaches were light therapy and pharmacotherapeutic options.

Of Mania: introduction (Classic text no. 57)

Classic Text no. 57 is meant to illustrate the way in which the old, pre-1800 clinical notion of mania was transformed into its current counterpart. In Classical times, the term 'mania' had been used to refer to three orders of objects: medical (as featured in this introduction and in the Classic text), theological (two Greek deities) (Smith, 1870) and epistemological. In regard to the last, a mania of 'divine'origin is mentioned by Plato in the Phaedrus, as a way to gain full knowledge, i.e., to journey from the sensible world to the ideal or intelligible world.By the end of the nineteenth century, however, the clinical category 'mania' had changed its referent completely: it now named a different symptom-cluster, was inscribed in a novel nosological frame, and was explained by new mechanisms. This metamorphosis took about sixty years to complete, and the extract reprinted below instances the way in which such a process took place within English alienism.

A historical inquiry into the appropriateness of the term "panic disorder"

Panic disorder was introduced in the standard psychiatric nosology with the publication of the DSM-III in 1980. The myriad of earlier medical and psychiatric names describing anxiety attacks and related conditions were all abandoned, being housed under the term "panic attack and panic disorder". In this paper, the rationale and the appropriateness of this term are critically examined from a historical perspective. First, a brief historical account of anxiety that comes in the episodic form, and the medical and psychiatric terminology that emerged during the last two centuries regarding this condition, are presented. Next, the origins of the concept of panic as a collective or individual fear reaction are traced from a mythological and historical standpoint, up to its current, almost accidental, introduction into the official psychiatric diagnostic systems. Since the word "panic" has its roots in the Greek god Pan and the unpleasant states inflicted by him, this god is described, as well as St Gilles - also known as St Aegidios, the Athenian - the healing saint for those suffering from panic, honor and phobias. Finally, the current diagnostic features of panic disorder are systematically compared with the corresponding troubles inflicted on people by the mythical god Pan. It is concluded that the introduced term "panic" appropriately and successfully replaced the old ones.

Melancholia and depression during the 19th century: a conceptual history

The meaning of ‘melancholia’ in classical antiquity is opaque and has little in common with 20th-century psychiatric usage (Drabkin, 1955; Heiberg, 1927). At that time, melancholia and mania were not polar opposites (i.e. one was not defined as having opposite features to the other). Melancholia was defined in terms of overt behavioural features such as decreased motility, and morosity (Roccatagliata, 1973; Simon, 1978). Hence, in medical usage, ‘melancholia’ referred to a subtype of mania and named, in general, states of reduced behavioural output. These included disorders that might “exhibit depressed, agitated, hallucinatory, paranoid and even demented states … the ancient diagnosis of melancholy has no correct analogue in modern psychiatric practice …” (Siegel, 1973, p. 274).