2024-02-29 22:28:08
In 1968, neurology and psychiatry were separated, because one responded to the biomedical model, while the other remained hermetic. Neurological diseases had some anatomical or physiological substrate while psychiatric diseases did not. Nevertheless, psychiatry remained medical, because we had become accustomed to entrusting mental and psychological disorders to doctors. The prevalence of these disorders has been very profitable for the medical trade, but it has confronted biomedicine with the limits of its anatomico-clinical model.
Wandering between the mythologies of the psyche and the molecular obsessions of neurophysiology, diagnoses undergo picturesque contortions.
Major hysteria attacks have become “psychogenic non-epileptic seizures” (CPNE), admitting the psychic origin, but introducing negative epilepsy with a normal electroencephalogram. A semantics more political than biomedical!
Epilepsy became a neurological illness after being a divine illness. Premature mortality is eleven times higher than in the general population, but ¾ of deaths seem linked to psychiatric comorbidity such as depression or drug addiction (4 times more suicides, 4 times more traffic accidents, 8 times more more falls, 8 times more drownings). Furthermore, there is a significant relationship between temporal lobe epilepsy and bipolar disorders. Certain paroxysmal manifestations (running away, theft, psychomotor agitation or impulsive acts) follow epileptic seizures. Discontinuation of treatment is often accompanied by bipolar disorder. The frequency of family history for these two conditions suggests a neurobiological substrate.
Other research into comorbidity is more surprising. Many patients with multiple sclerosis have a mood or anxiety disorder, which is not surprising given the severity of this disease. But by insisting on the fact that these disorders aggravate disability, we give them an organic valence.
Among migraineurs, depression is 3 times more common, generalized anxiety syndrome and panic disorder, 4 times more, and bipolar disorders 3 to 7 times more. The relationship between migraine and bipolar illness is so strong that some have proposed making it a subtype called rapid-cycling bipolar disorder (RRBD). This does not simplify the unstable diagnosis of bipolar illness.
Some note the strong relationship between depression and pain threshold, others evoke a neurophysiological predisposition to chronic pain.
Chronic depression quadruples the risk of vascular dementia. Late-onset depression doubles the risk of Alzheimer’s disease, and for some, it may be a warning sign.
After their separation on the criterion of the substrate, should neurology and psychiatry be united on the criterion of our ignorance?
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#Neurological #psychiatric #contortions #health #reasons