Die Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung (ADHS) bei Erwachsenen in den klinischen Beschreibungen und klassifikatorischen Reflexionen von Gustav Specht (1905) und Hermann Paul Nitsche (1910)

The notion that the adult form of attention deficit hyperactivity disorder (ADHD) is not a construct of modern psychiatry is increasingly prevailing. Looking into the history of psychiatry can make an enlightening contribution here. Guided by this aim and specifically following literature referred to by Emil Kraepelin (1856–1926), we analyzed the content of one study each by Gustav Specht (1860–1940) and the later Nazi psychiatrist Hermann Paul Nitsche (1876–1948) from 1905 and 1910, respectively, on the topic of chronic mania. Our investigation concluded that in their case studies both authors described people who would today be diagnosed as suffering from adult ADHD as the clinical descriptions reveal core symptoms of this entity as defined by modern classifications. They also mentioned currently discussed research questions. Both authors expressed their dissatisfaction with the classificatory situation of these patients at the time. Specht even postulated a “completely independent mental illness” that he called “chronic mania”, under which he classified all the patients suffering from today’s adult ADHD. He also pointed out that this diagnosis was not widely recognized at the time by psychiatrists as a full-fledged form of illness but used more as a diagnosis to avoid the embarrassment of not having one. Nitsche saw the “chronic manic states” as he called them as a “clinical peculiarity” but assigned them to the large group of “manic depressive insanity”, which could only be more finely differentiated in the future.