Kraepelin's basic attitude to the classification of psychoses was data-oriented and flexible. In his latter years he was close to revising his own celebrated dichotomy between manic-depressive insanity and dementia praecox in order to take account of a large group of intermediate psychoses, which today are called schizo-affective. His concept of a continuum from healthy to ill has stood the test of time and corresponds to modern epidemiological findings. Kraepelin's unitarian concept of manic-depressive insanity did not survive. It was differentiated and broken down into several subgroups, and a proportional diagnostic spectrum with a continuum from mania via bipolar disorders to depression has recently even been proposed. Bipolar disorders would in that case be comorbid disorders of mania plus depression. In contrast to Kraepelin's unitarian view the long-term prognosis of subgroups of mood disorders varies considerably. Overall it is nevertheless astonishing how much of Kraepelin's legacy has survived.
[Show abstract][Hide abstract] ABSTRACT: The presence of comorbidity in major psychoses (e.g., schizophrenia and psychotic subtypes of bipolar disorder and major depressive
disorder) seems to be the rule rather than the exception in both DSM-IV and ICD-10. Examining comorbidity in major psychoses,
however, requires an investigation into the different levels of comorbidity (either full-blown and subsyndromal) which should
be analyzed in both psychopathological and medical fields. On one hand, the high prevalence of psychiatric comorbidity in
major psychoses may be the result of the current nosographic systems. On the other hand, it may stem from a common neurobiological
substrate. In fact, comorbid psychopathological conditions may share a biological vulnerability, given that dysfunction in
specific brain areas may be responsible for different symptoms and syndromes. The high rates of comorbidity in major psychoses
require targeted pharmacological treatments in order to effectively act on both the primary diagnosis and comorbid conditions.
Nevertheless, few controlled trials in comorbid major psychoses had been carried out and treatment recommendations in this
field have mostly an empirical basis. The aim of the present article is to provide a comprehensive and updated overview in
relation to epidemiological and clinical issues of comorbidity in major psychoses.
KeywordsComorbidity–Major psychoses (MPs)–Schizophrenia (SK)–Bipolar disorder (BD)–Psychotic major depressive disorder (pMDD)
European Archives of Psychiatry and Clinical Neuroscience 10/2011; 261(7):489-508. DOI:10.1007/s00406-011-0196-4 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors sought to assess the longitudinal course of youths with bipolar spectrum disorders over a 4-year period.
At total of 413 youths (ages 7-17 years) with bipolar I disorder (N=244), bipolar II disorder (N=28), and bipolar disorder not otherwise specified (N=141) were enrolled in the study. Symptoms were ascertained retrospectively on average every 9.4 months for 4 years using the Longitudinal Interval Follow-Up Evaluation. Rates and time to recovery and recurrence and week-by-week symptomatic status were analyzed.
Approximately 2.5 years after onset of their index episode, 81.5% of the participants had fully recovered, but 1.5 years later 62.5% had a syndromal recurrence, particularly depression. One-third of the participants had one syndromal recurrence, and 30% had two or more. The polarity of the index episode predicted that of subsequent episodes. Participants were symptomatic during 60% of the follow-up period, particularly with subsyndromal symptoms of depression and mixed polarity, with numerous changes in mood polarity. Manic symptomatology, especially syndromal, was less frequent, and bipolar II was mainly manifested by depressive symptoms. Overall, 40% of the participants had syndromal or subsyndromal symptoms during 75% of the follow-up period, and 16% of the participants experienced psychotic symptoms during 17% the follow-up period. Twenty-five percent of youths with bipolar II converted to bipolar I, and 38% of those with bipolar disorder not otherwise specified converted to bipolar I or II. Early onset, diagnosis of bipolar disorder not otherwise specified, long illness duration, low socioeconomic status, and family history of mood disorders were associated with poorer outcomes.
Bipolar spectrum disorders in youths are characterized by episodic illness with subsyndromal and, less frequently, syndromal episodes with mainly depressive and mixed symptoms and rapid mood changes.
American Journal of Psychiatry 06/2009; 166(7):795-804. DOI:10.1176/appi.ajp.2009.08101569 · 12.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Next to Karl Leonhard (1904-1988), Helmut Rennert (1920-1994) was the internationally best known representative of psychiatry from the former German Democratic Republic (GDR). He rose to prominence above all through his model of the universal genesis of endogenous psychoses, which constituted an antithesis to Leonhard's differentiated division. The 'polar opposite' aspects of Rennert and Leonhard are represented with an emphasis on their contrasting views of psychiatric nosology. In this respect, Rennert's model conceptions constitute the primary focus of attention. The fact that both concepts continue to possess topical perspectives to this day is reflected in the current discussion regarding nosological, categorical, syndromatological and dimensional approaches in relation to the further development of the classification systems of mental disorders. The preparatory work on the future classification systems will potentially omit the dichotomy between schizophrenic and affective disorders. These endeavors are in accordance with Rennert's unitarian psychopathological view and support his acceptance of the psychopathological continuity from affective to schizophrenic syndromes. The current discussion concerning the future classification is in line with Rennert, whose aim was to provide an unconventional model that unites findings from the different fields of psychiatric research. The classification of mental disorders without a previous establishment on the basis of fundamental theoretical assumptions could certainly foster a dynamic development in the future. A differentiated knowledge of the history of the ideas of unitary psychosis and their further development might be helpful in this development and can be of particular use when critically questioning explanatory approaches that are prone to simplification.
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