History of the classification of mental disorders


Mental disorders refer to a broad range of conditions that can affect a person’s thinking, feeling, mood and behavior. These conditions include depression, anxiety disorders, bipolar disorder, schizophrenia and obsessive-compulsive disorder (OCD).

The dates for the classification of these mental health conditions are listed here.

Philippe Pinel  (1745-1826), French psychiatrist, is interested in the mental pathology of the elderly and its disabling aspect. We must give him the first classification of mental illness. He identifies different categories of patients.

Jean-Etienne Esquirol  (1772-1840), French psychiatrist, deepens the work of Pinel: he establishes the different forms of melancholy, establishes the distinction between hallucinations and illusions and draws a parallel between madness and passions.

Joseph Daquin  (1732-1815), French psychiatrist, classifies the insane into different groups: the insane, the quiet insane, the extravagant, the insane and the insane in dementia.

1810 : there are differences on the notion of mental illness; three schools stand out: the French, Scottish and English schools.

Antoine Ritti  (1844-1920), sends a report (1895) on the psychoses of the elderly subject.

Jules Seglas  (1856-1939), French psychiatrist, particularly studied the classification of disorders and diseases (called nosography) of psychoses including delusions and hallucinations.

Karl Ludwig Kahlbaum  (1828-1899), German psychiatrist, considers mental illness to be an illness that develops over time.

1860 : demonstration of the existence of a correlation between mental functions and the different parts of the brain. For example, Arnold Pick (1851-1924; Czech Republic) shows that the dysfunction of language and praxis is associated with damage to the temporal and frontal lobes.

1887 : S. Beljahow reports that neurons in the cerebral cortex of elderly patients with dementia are distorted and in the form of debris:

Emil Kraepelin  (1856-1926), German psychiatrist, distinguished in 1889 manic-depressive psychoses from early dementias. He defines psychotic states as a profound alteration in the subject’s consciousness. He will publish eight editions of his Treatise on Psychiatry from 1883 to 1909.

Emil Redlich  (1866-1930), Austrian neurologist, described, in 1898, plaques in the cerebral cortex of a 78-year-old woman who suffered from senile dementia. He is probably the first to speak of ‘senile plaques’.

Andre Leri  (1875-1930), French neurologist, presented a report in 1906 in which he described histological lesions (these lesions are amyloid plaques) that Alois Alzheimer would later describe as characteristic of Alzheimer’s disease.

Alois Alzheimer  (1864 – 1915), German psychiatrist, followed the case of a 51-year-old patient suffering from dementia with cognitive alterations, delirium and hallucinations, until her death in 1906. By examining the brain, he discovered histological lesions (called plaques and neurofibrillary degeneration) characteristic of Alzheimer’s disease. Alois Alzheimer published a second identical case in 1911 in a younger person.

1906  : Solomon C. Fuller (1872-1953), American psychiatrist, describes the presence of neurofibrillary degeneration in senile dementia.

Emil Kraepelin  (1856-1926), subsequently proposed designating this type of dementia by the name of his colleague Alois Alzheimer.

1912:  E. Kraepelin defines « Alzheimer’s disease » as a rare pre-senile dementia affecting the young subject, and qualified as « senile dementia » the vascular dementias of the elderly subject, caused by a lack of oxygen (caused by a blockage of vessels) in the brain. The idea of ​​the vascular origin of senile dementia lasted until the 1960s, with the common use of terms such as arteriopathic dementia  or  cerebral vascular insufficiency .

Around 1900 , two forms of senile dementia were identified: dementia linked to arteriosclerosis (aging of the arteries and arterioles which harden) and subcortical dementia which affects the cerebral structures located under the cortex.

At the beginning of the 20th century , elderly people with cognitive and/or behavioral disorders were very often placed in institutions against their will until their death. Around 1930, Grégoire Halberstadt devoted himself to the clinical study of early dementia.

1949  : publication of the 6th revision (ICD-6) of the International Statistical Classification of Diseases, containing for the first time a classification of mental disorders. The International Classification of Diseases is published by the World Health Organization (WHO)

1952  : The American Psychiatric Association publishes the first Diagnostic and Statistical Manual of Mental Disorders (DSM) which aims to create a common reference of mental disorders. In all, five editions will be published: the DSM I (1952), DSM II (1968), DSM-III (1980) and its revised form DSM-III-R (1987), the DSM-IV (1994) and its revised DSM-IV-TR (2000). A sixth edition (DSM V) is planned for 2013.

Mental disorders include five axes

Axis I  : Major clinical disorders: depression, anxiety disorders, bipolar disorder, attention disorder with or without hyperactivity, autism spectrum disorders, anorexia nervosa, bulimia and schizophrenia.

Axis II  : Personality disorders and mental retardation: paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, personality disorder, avoidant personality disorder, dependent personality disorder, obsessional neurosis, and mental retardation.

Axis III  : Specific medical aspects and physical disorders: these are brain damage and other medical/physical disorders that can aggravate existing illnesses or symptoms.

Axis IV  : Psychosocial and environmental factors

Axis V  : Global Assessment of Functioning Scale

Around 1960  : reorganization of psychiatry as a whole; importance of the social aspect of patient care; global approach to the patient which takes into account the psychological and social aspects.

1969  : first geriatric psychiatry manual published by the Swiss psychiatrist Christian Müller.

1970s : Doctors realized that the majority of senile dementias had the characteristics of Alzheimer’s disease.

1974 : Hachinski described dementia by multiple infarctions, dementia distinct from that of the Alzheimer type, and established a scale which bears his name (scale adapted by Loeb and Gandolfo, in 1983, after the support of the scanner).

Beginning of the 1980s : the care of the elderly is the subject of particular attention from French psychiatry. In 1981, a summary of psychogeriatrics was published in French by the Swiss psychiatrists C. Müller and Jean Wertheimer.

1981 : introduction of the term psychogeriatrics, defined as the medical discipline concerned with the prevention of the consequences of aging, the psychology of nursing practice, the relational and behavioral problems of the patient’s family (caregiver) and professional environment. Not to be confused with psychogerontology, which is the science that seeks to understand, and possibly correct, the behavior of the aging person.

1990  : tenth revision of the International Statistical Classification of Diseases (ICD-10) with its chapter 5 on ‘mental and behavioral disorders’. This chapter is structured as follows:

1.  Organic mental disorders, including symptomatic disorders.
– Dementia in Alzheimer’s disease (early onset, late onset, atypical or mixed form, unspecified).
– Vascular dementia (with acute onset, multiple infarcts, mixed, cortical and subcortical, unspecified).
– Dementia associated with other diseases classified elsewhere (Pick’s disease, Creutzfeldt-Jakob disease, Huntington’s disease, Parkinson’s disease, human immunodeficiency virus (HIV), other diseases).
– Organic amnesic syndrome, not induced by alcohol or other psychoactive substances.
– Delirium, not induced by alcohol or other psychoactive substances (not added to dementia, added to dementia, unspecified).
– Other mental disorders, due to brain damage or dysfunction, or to a physical condition (examples: organic hallucinatory state, organic catatonia, organic delusional disorder, mood disorders, organic anxiety disorder, dissociative disorder, lability (asthenia) emotional, mild cognitive impairment).
– Personality and behavioral disorders due to brain disease, injury and dysfunction (eg post-encephalitic syndrome, post-concussion syndrome).
– Organic or symptomatic mental disorder, unspecified.

2.  Mental and behavioral disorders related to the use of psychoactive substances .

3.  Schizophrenia, schizotypal disorders and delusional disorders .

4.  Mood (affective) disorders .
– Manic episode.
– Bipolar affective disorder.
– Depressive episodes.
– Recurrent depressive disorders. 
– Persistent mood disorders (eg cyclothymia, dysthymia).
– Other mood disorders.

5.  Neurotic Disorders, Disorders Related to Stressors and Somatoform Disorders . – Phobic anxiety disorders (eg agoraphobia, social phobias).
– Other anxiety disorders (examples: panic disorder, generalized anxiety).
– Obsessive Compulsive Disorder.
– Reactions to a major stressor, and adjustment disorders.
– Dissociative disorders.
– Somatoform disorders.
– Other neurotic disorders (eg neurasthenia).

6.  Behavioral syndromes associated with physiological disturbances and physical factors .

7.  Personality and behavioral disorders in adults .

8.  Mental retardation .

9.  Disorders of psychological development .

10.  Behavioral and emotional disorders usually appearing during childhood and adolescence .

11.  Mental disorder, not otherwise specified .

1994 : Hachinski advanced the concept of “vascular cognitive disorders” encompassing vascular dementia. According to him, vascular dementia is not strictly speaking a dementia syndrome as it is defined for Alzheimer’s disease.

1999 : publication of the book ‘Psychiatry of the elderly subject’ (authors Jean-Marie Léger, Jean-Pierre Clément, Jean Wertheimer).

2003 : O’Brien et al. propose the term  vascular  cognitive impairment, which encompasses the different forms of vascular damage. These disorders are not necessarily accompanied by dementia.

2004 : Roman et al. propose the term “vascular cognitive diseases”. This term encompasses the notions of  vascular cognitive deficit  and vascular dementia. Vascular cognitive deficit refers to the concept of « mild cognitive decline » (a stage often preceding Alzheimer’s disease), and is therefore limited to non-demented patients.