[General aspects of the diagnostic process in acute organic psychoses]

Following the Central European tradition of the triad system of psychiatry of Kurt Schneider (I. Abnormal Reactions/Personalities, II. Acute/Chronic Organic Psychosis, III. Schizophrenia/Cyclothymia) (19) a series of 210 cases of acute organic psychoses was collected. In contrast to DSM-III and in accord with W.A. Lishman (10), this series comprises not only delirium, but the entire range of impairments of consciousness from the "Durchgangssyndrom" of H.H. Wieck (24) to clouding of consciousness and coma, twilight states or apallic syndromes. From this series we present some elementary quantitative data concerning the age distribution of different etiologies, that are generally considered helpful in the diagnostic process. In contrast to this opinion, a single case of bromazepam-induced delirium shows: The anamnesis may be misleading, the general and neurological examination as well as the radiological, laboratory and electrophysiological tests could be insignificant. The essential diagnostic tool is the descriptive or phenomenological psychopathological observation. Compared to it, the general data of the age distribution of different etiologies of organic psychoses are of comparably little help in making a diagnosis. Artificial intelligence and medical expert systems are set out to replace the diagnosis of the physician. Eliminative materialistic neuroscience is set out to replace old-fashioned descriptive psychopathology by quantitative electrical and chemical data. Through the method of systematically confronting general quantitative data with suitably chosen single cases it should be possible to find out essential differences between general reductionist statements and the properties of complex qualitative phenomena like the individual human mind.