Classification and Diagnosis of Organic Mental Disorders
Göran Lindqvist and Helge Malmgren
Acta Psychiatrica Scandinavica 1993: 88: Suppl 373

Copyright Munksgaard, Copenhagen. Abstracts and full text reprinted with permission.

Lindqvist G, Malmgren H. Organic Mental Disorders as Hypothetical Pathogenetic Processes.
Acta Psychiatr Scand 1993: 88: Suppl 373: 5-17. Full text (pdf).

Abstract:  A new diagnostic system for organic psychiatry is presented. We first define "organic psychiatry", and then give the theoretical basis for conceiving organic-psychiatric disorders in terms of hypothetical psychopathogenetic processes, HPP:s. Such hypothetical disorders are not strictly identical to the clusters of symptoms in which they typically manifest themselves, since the symptoms may be concealed or modified by intervening factors in non-typical circumstances and/or in the simultaneous presence of several disorders. The six basic disorders in our system are Astheno-Emotional Disorder (AED), Somnolence-Sopor-Coma Disorder (SSCD), Hallucination-Coenestopathy-Depersonalisation Disorder (HCDD), Confusional Disorder (CD), Emotional-Motivational Blunting Disorder (EMD) and Korsakoff's Amnestic Disorder (KAD). We describe their usual etiologies, their typical symptoms and course, and some forms of interaction between them.

Lindqvist G, Andersson H, Bilting M, Blomstrand C, Malmgren H, Wikkelsø C. Normal Pressure Hydrocephalus: Psychiatric Findings Before and After Shunt Operation Classified in a New Diagnostic System for Organic Psychiatry.
Acta Psychiatr Scand 1993: 88: Suppl 373:18-32.

Abstract:  23 patients with normal pressure hydrocephalus (NPH) underwent psychiatric examinations prior to and 80 days to 10 months after a ventriculo-peritoneal shunt operation. A global evaluation of the effect of the operation on the patients' mental symptoms indicated appreciable improvement in 10 cases and slight improvement in a further 4. 8 patients were assessed as unchanged, and one as mentally deteriorated. The psychiatric analyses was based on a new diagnostic system created by two of the authors (G.L., H.M.). The patients manifested varying, often complex psychiatric symptom constellations with symptomatological components from two or more organic mental disorders. Before the operation a mild or a moderately severe somnolence-sopor-coma disorder (SSCD) was diagnosed in 10 cases. After the operation all these patients became free from symptoms of SSCD. This was the most unequivocal change in connection with the operation, and the elimination of all symptoms of SSCD was the single factor which most effectively contributed to the total therapeutical result in these patients. All 23 cases were considered to have symptoms of a more or less severe astheno-emotional disorder (AED) preoperatively. The degree of severity of this disorder could not be determined with satisfactory certainty in some of the patients with complex symptoms. Amongst the 17 cases where the preoperative symptomatology allowed for a reasonably precise calculation of the degree of severity of AED, 6 were assessed as markedly improved after the operation and 10 as largely unchanged. In one patient, symptoms of the AED increased when the postoperative course was complicated by a subdural haematoma. Symptoms of an emotional-motivational blunting disorder (EMD) were diagnosed in 5 cases before the operation. After the operation 3 of these patients were symptom free in this respect while 2 were unchanged. Slight or moderately severe symptoms of Korsakoff's amnestic disorder (KAD) were before the operation found in 7 cases: at the postoperative examination 6 of these cases were improved, of which 4 were free from such symptoms; one was unchanged. According to our experience, confident prognoses concerning the effect of the shunt operation on symptoms of SSCD can be made preoperatively, while, for a particular patient, the therapeutic effect on AED, EMD and KAD is often difficult, or sometimes impossible, to foresee. This article contains three case reports which represent different forms and courses of the mental symptom patterns.

Malmgren H, Lindqvist G. The Semantic Status of Diagnostic Criteria for Organic Mental Syndromes and Disorders in DSM-III and DSM-III-R
Acta Psychiatr Scand 1993: 88: Suppl 373: 33-47.

Abstract:  After a general introduction referring to the contemporary debate about psychiatric classification, the nature of so-called "diagnostic criteria" in psychiatry is discussed with special reference to DSM-III(-R) and to organic mental syndromes and disorders. A set of diagnostic criteria for a disease category can be intended alternatively (i) as stating logically necessary and/or sufficient conditions for the diagnostic concept in question, or (ii) as providing contingent (probabilistic) indicators of the disease. In one possible interpretation, a main aim of DSM-III and DSM-III-R has been to formulate type (i), logical criteria, which amounts to an attempt to strictly identify syndromes or disorders with complex (polythetic) sets of easily observable symptoms and signs. It is shown that a logical interpretation would lead to such unwanted consequences for clinical and scientific practice that it could not possibly have been intended by the authors of DSM-III and DSM-III-R. But neither can the alternative interpretation in terms of type (ii), contingent or probabilistic indicators be consistently upheld. The conclusion of the essay is that the semantic status of the diagnostic criteria in DSM-III and DSM-III-R is fundamentally blurred. This unclarity may very well lead to divergent interpretations of the concepts and to corresponding uncertainties in their clinical and scientific application.

Malmgren H. Psychiatric classification and empiricist theories of meaning.
Acta Psychiatr Scand 1993: 88: Suppl 373: 48-64.

Abstract:  The philosophical background of the contemporary debate over psychiatric classification is reviewed in some detail. It is shown that the philosophy behind DSM-III and DSM-III-R is based on a theory about the semantic status of operational definitions, which was abandoned several decades ago by empiricist philosophers of science. It is argued that the newer empiricist and realist theories of meaning developed after 1960, particularly the idea of an indirect specification of meaning through contingent operational criteria, offer a better foundation for psychiatric classification.