J Neuropsychiatry Clin Neurosci 1991; 3:94-98
Copyright © 1991 by American Neuropsychiatric Association
Failure at task-specific regional brain activation: new conceptualization of a disease entity
BE Wexler
Connecticut Mental Health Center, New Haven 06508, USA.
The current diagnostic system in psychiatry is symptom-based, as described
in detail in DSM-III-R. In other branches of medicine the logic of
diagnosis is based on knowledge of the normal function of the organ system
affected by disease, and direct measures of pathophysiological process play
an increasingly important role in clinical practice. New understanding of
normal brain function has opened the way for psychiatry to begin to follow
this path and develop a brain-based, rather than symptom-based, nosology.
Different models of normal brain function, however, suggest quite different
theoretical and research approaches. One way in which these models differ
is the degree to which they link specific functions (and illnesses) to
specific anatomic locations. In a previous paper I discussed the value of
adopting a model of brain function that includes important roles for the
processes that integrate multiple brain regions into ever-changing
functional constellations. In this paper I have proposed the existence of a
disease characterized by abnormality in the general physiological mechanism
of task-specific regional brain activation. This is not an etiologic
diagnosis and therefore presents nothing more than a symptom- based
diagnosis about the cause of the disorder. However, I predict that this
diagnosis will define a group of patients that is more homogeneous with
respect to both clinical course and etiology than do the current
symptom-based diagnoses to which these patients would otherwise be
assigned. Furthermore, it may be possible to develop new treatments to
address this physiological dysfunction.
