Vinet-Couchevellou M, Sauvagnat F
Clinique mutualiste Bénigne-Joly, allée Roger-Renard, BP 39, 21141 Talant cedex, France; EA 4050, laboratoire de recherches en psychopathologie : nouveaux symptômes et lien social, université de Rennes 2, Rennes, France.
EA 4050, laboratoire de recherches en psychopathologie : nouveaux symptômes et lien social, université de Rennes 2, Rennes, France; Unité 6053 du CNRS, Université Paris 7, Paris, France.
Encephale. 2015 Apr;41(2):130-6. doi: 10.1016/j.encep.2013.10.005. Epub 2014 Feb 7.
The authors explore the history of pseudodementia in the elderly; an issue with growing momentum in a world where life duration expectancy has been constantly growing and the management and treatments of dementias has imposed an equally increasing burden. Although the issue is mainly therapeutic, some of the main tenets of the current approaches rest heavily on historical issues. The invention of the term pseudodementia (Pseudodemenz) is usually credited to Wernicke. However, the exact circumstances and the debates that have accompanied the emergence of the term have never been fully uncovered, and the references are not accurate. Most of the recent literature cites Kiloh as the key influence in structuring the current uses of the term, but the relationship between both sources is not clear.
A research of anteriority has been conducted on the basis of Medline via Pubmed, PsychINFO and google book, using the following keywords: pseudodementia, pseudodementia, depressive pseudodementia, pseudodémence, Pseudodemenz. We have researched the quotations to localize the origin of the concept. Complementarily, we have attempted to clarify the nature of the debates by exploring the relevant German psychiatric literature at the end of the XIXth century and the beginning of the XXth.
We have found that the very first occurrences of the notion appeared in a debate between the following authors: Ganser S.J.M. 1898, 1903; Wernicke C. 1898; Raecke J. 1901; Nissl F. 1902; Jung C.G. 1902, 1903; Stertz G. 1910; Bonhoeffer K. 1911; Schuppius S. 1914. We found that the term Pseudodemenz never appears in Wernicke's written works, although he was credited of its invention by his most direct students. It seems that the term was thought by the time it emerged to have originated in Wernicke's discussion of Ganser's syndrome.
Ganser's syndrome, often defined as carceral psychosis, is a specific hysterical twilight state characterized by "talking past the point" (Vorbeireden), amnesia and hysterical stigmas, in which some trauma was thought to be causative. Wernicke presented it as determined by a "restriction of the field of consciousness", echoing Janet's theory (École de la Salpêtrière). He rejected the twilight characteristic: this differential point seems to have initiated the introduction of the concept of pseudodementia. Raecke argued that such states should not be understood as forms of simulation thus contributing to a heated debate of the time. Referring to Janet's works and expanding the syndrome of "traumatic hysteria", he argued in favor of a specific inhibiting factor which disturbs the process of associations. Jung, refusing Nissl's article dismissing Ganser, Wernicke and Raecke's views, confirmed the hysterical hypothesis. In a new contribution to the debate, Ganser contested Wernicke's differential point, arguing that in Vorbeireden, there was a Benommenheit - some sort of giddiness - and a "superficiality of the contents of consciousness" rather than a limitation of consciousness. It has been rightly argued that Wernicke's view of the pseudodementia issues was mainly related to the debates on hysteria and trauma, and that no relationship with old age symptomatology was established by him. However, we have found that he alluded to at least one case in which such a relationship was hypothesized. Moreover, one should note that Wernicke's views on hysteria included the rather pervasive notion of "hysterical psychosis", exhibiting "allopsychosis", which could include what would nowadays be seen as schizophrenia or psychotic mood disorders.
First of all, the term Pseudodemenz, if it was ever used by Wernicke verbally, never appears in his published works. Besides, the debates concerning Ganser's syndrome, which served as a first paradigm to discuss pseudodementia, were highly influenced by the discussions on traumatic disorders, hysteria and simulation. Finally, although no direct connection is made between disorders of the senium and Pseudodemenz, the fact that Wernicke included both in what he termed "allopsychic disorders" seemed to indicate that some kind of relationship could not be absolutely excluded in Wernicke's mind.
作者探讨老年人假性痴呆的历史；在预期寿命不断增长且痴呆症的管理和治疗带来日益沉重负担的世界中，这一问题的势头日益增强。尽管该问题主要涉及治疗，但当前方法的一些主要原则在很大程度上依赖于历史问题。假性痴呆（Pseudodemenz）一词的发明通常归功于韦尼克。然而，该术语出现时的确切情况以及伴随其出现的争论从未被完全揭示，参考文献也不准确。最近的大多数文献将基洛视为构建该术语当前用法的关键影响因素，但两者之间的关系并不明确。
通过PubMed、PsychINFO和谷歌图书在Medline的基础上进行了一项优先性研究，使用了以下关键词：假性痴呆、假性痴呆、抑郁性假性痴呆、假性痴呆、Pseudodemenz。我们研究了引文以确定该概念的起源。作为补充，我们试图通过探索19世纪末和20世纪初的相关德国精神病学文献来阐明争论的性质。
我们发现该概念最早出现在以下作者之间的一场辩论中：甘泽尔S.J.M. 1898年、1903年；韦尼克C. 1898年；雷克J. 1901年；尼斯尔F. 1902年；荣格C.G. 1902年（此处原文重复，推测有误，按照常见情况应为1902年和1903年）、1903年；施特尔茨G. 1910年；博恩霍费尔K. 1911年；舒皮乌斯S. 1914年。我们发现Pseudodemenz一词从未出现在韦尼克的书面作品中，尽管他最直接的学生将其发明归功于他。该术语出现时似乎被认为起源于韦尼克对甘泽尔综合征的讨论。
甘泽尔综合征通常被定义为监狱精神病，是一种特定的癔症性朦胧状态，其特征为“答非所问”（Vorbeireden）、失忆和癔症性体征，其中一些创伤被认为是病因。韦尼克将其描述为由“意识领域的限制”所决定，呼应了让内的理论（萨尔佩特里埃学派）。他否认了朦胧特征：这一区别点似乎引发了假性痴呆概念的引入。雷克认为这种状态不应被理解为伪装形式，从而引发了当时的一场激烈辩论。他参考让内的作品并扩展了“创伤性癔症”综合征，主张存在一种特定的抑制因素扰乱联想过程。荣格拒绝了尼斯尔驳斥甘泽尔、韦尼克和雷克观点的文章，证实了癔症假说。在对辩论的新贡献中，甘泽尔对韦尼克的区别点提出质疑，认为在答非所问中存在一种Benommenheit——某种头晕——以及“意识内容的肤浅”而非意识的限制。有人正确地指出，韦尼克对假性痴呆问题的看法主要与关于癔症和创伤的辩论相关，他并未确立与老年症状学的关系。然而，我们发现他至少提及了一个假设存在这种关系的案例。此外，应该注意到韦尼克对癔症的看法包括相当普遍的“癔症性精神病”概念，表现为“异己精神病”，这可能包括如今被视为精神分裂症或精神病性心境障碍的情况。
首先，Pseudodemenz一词，如果韦尼克曾在口头使用过，也从未出现在他已发表的作品中。其次，关于甘泽尔综合征的辩论，作为讨论假性痴呆的第一个范例，受到了关于创伤性疾病、癔症和伪装的讨论的高度影响。最后，尽管老年期疾病与Pseudodemenz之间没有直接联系，但韦尼克将两者都纳入他所谓的“异己精神障碍”这一事实似乎表明，在他的脑海中某种关系不能被绝对排除。
