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Compendium der Psychiatrie. zum Gebrauche für Studirende und Aerzte
... I tried to be consistent across these many decisions, but a blind re-review would surely reveal some unreliability. In addition to these 25 texts, I examined the section on "Primäre Verrücktheit" in Kraepelin's first textbook published when he was 27 years old (1883), 12 which is presented in full English translation for the first time in the supplementary appendix. This critical text-which is the only delusional psychotic syndrome contained in this textbook-is important because it illustrates Kraepelin's diagnostic approach to delusional psychoses at the beginning of his professional career, more than 15 years before he developed his concepts of both Dementia Paranoides as a key subtype of dementia praecox and his "mature" concept of Paranoia. ...
... When none was available, I worked with the French and German texts, relying extensively on online translators and dictionaries. I had the assistance of a professional German-English translator, Ms Astrid Klee, for Kraepelin's text 12 and the important but difficult text of Scholz. 13 ...
... I examine in more detail Kraepelin's description of "Primäre Verrücktheit" from the first edition of his textbook published in 1883 12 (table 2). An English translation of this chapter is shown in supplementary appendix. ...
We can trace, with high congruence, the clinical syndromes of depression and mania as described over the 20th century in psychiatric textbooks back to 1880 and to the earliest writing of Kraepelin published in 1883. However, this is not the case for Kraepelin's 2 delusional syndromes central to his overall nosology: Dementia Paranoides (later paranoid schizophrenia) and Paranoia. A detailed examination of 28 textbook descriptions of delusional psychoses from 1880 to 1900 reveals a diverse and partially overlapping set of syndromes with an admixture of symptoms and signs that would later be considered indicative of Dementia Paranoides and Paranoia. A similar pattern in seen in Kraepelin's own description of "Primäre Verrücktheit" from the first edition of his textbook (1883). No clear prototypes emerged in these textbooks or in Kraepelin's early writings for the 2 distinct delusional syndromes that would later evolve in his mature writings. Rather, the nosologic approach taken in these writings was symptom based and assumed that a viable diagnostic category could be constituted by including all delusional patients once those suffering from organic or mood disorders were excluded. While Kraepelin used the historical syndromes of mania and depression, with no appreciable change, as building blocks for his category of manic-depressive insanity, his nosologic system for the psychotic disorders-the syndromes of Dementia Praecox and Paranoia-was more innovative and without clear precedent in the prior psychiatric literature.
... Es entonces, que la primera clasificación que surgió fue en la antigua Grecia en el siglo IV antes de Cristo (a.C.), donde Hipócrates inició con la descripción y distinción entre "manía" y "melancolía" (García-Maldonado y col, 2011); no obstante, estos conceptos eran insuficientes para definir completamente los trastornos mentales por lo que Philip Barrough (1583 d.C) introduce la tercer categoría de "demencia" (Dm) con lo cual se empezó a definir los padecimientos neurocognitivos y es en el año de 1899 donde el Doctor Emil Kraepelin acuñe este término en la publicación del primer compendio de trastornos psiquiátricos (Kraepelin, 1883). ...
A lo largo de la historia de la medicina, un tema de gran interés que recientemente ha detonado como tópico de importancia han sido las causas, consecuencias y presencia de los trastornos neurodegenerativos sobre la población. Sin embargo, estas condiciones reciben una menor prioridad comparado con otras patologías degenerativas, tales como las enfermedades cardiovasculares o neoplásicas. Sin embargo existen reportes de que el número de adultos mayores de 65 años aumentarán por arriba de los 28 millones de personas para el año 2050 llevando a una preocupación por la correcta prevención, diagnóstico y tratamiento de enfermedades crónicas asociadas al envejecimiento. Demostrándose igualmente que la prevalencia de los trastornos neurocognitivos crece exponencialmente en la población que se encuentran entre los 65 y 85 años de edad; por lo que el impacto de estas enfermedades será cada vez más grave con respecto a los sistemas económicos y sociales. Por lo tanto el artículo brinda una actualización en los criterios diagnósticos de los Trastornos Neurocognitivos basado en las clasificaciones clínicas mar-cadas por el DSM-5, que puedan auxiliar no sólo al Médico General sino al Médico especializado en las disciplinas Neurológicas o Psiquiátricas para posibilitar el uso de un lenguaje en común. Igualmente establecemos una reflexión, sobre la importancia del correcto conocimiento de los criterios diagnósticos sobre el uso de biomarcadores genéticos y sobre el uso de pruebas complementarias diagnósticas.
... 72 Kraepelin included homosexuality in his path-breaking classification of mental disorders, although he opposed the idea of its criminalisation. 73 This interpretation of homosexuality was at odds with psychoanalysis. When the focus of the discussion in Poland was the new Penal Code, however, the differences between Mikulski and Nelken were less important. ...
The article demonstrates how the transnational flows of sexual knowledge created a consensus among medical and legal experts for the decriminalisation of homosexual acts in the Polish Criminal Code of 1932. This happened despite the absence of any significant activism that would demand such a reform in Poland. The German movement's goal to repeal the notorious anti-homosexual paragraph 175 of the German Penal Code was ultimately brought to fruition in Poland but not in Germany. The medical and legal knowledge spread through imperial networks and became useful for the new Polish nation-state in its search for identity and distinctiveness. The novelty of the reform ideas created in German-speaking countries led Polish legal experts to consider their adoption a perfect opportunity for the new nation-state to prove its modernity. Additionally, an authoritarian setting in Poland after 1926 allowed the decision makers to shut out the Church and parliament from the legislative process.
... 3) El profesor Bernhard von Gudden fue un destacado neuropsiquiatra especializado en patología cerebral, impulsor de su discípulo Kraepelin para que escribiera su Compendium der Psychiatrie (54), introductor del principio de "no restraint", empatía y tolerancia hacia los pacientes internados. Quizás confundió los roles de experto forense y terapeuta empático con su paciente Ludwig II en las orillas del lago Starnberg, confusión que no le permitió juzgar en toda su gravedad sus impulsos suicidas, como le advirtió su ayudante, puesto que estaba profundamente comprometido en asistirlo emocional, íntima y personalmente, conflicto que finalmente le costó la vida a manos del rey (55). ...
Bernhard von Guden diagnosed the Bavarian King Ludwig II with “paranoia” (madness), although Ludwig was not personally evaluated by this expert psychiatrist, a diagnosis that the Bavarian government used to justify removing Ludwig from power. 2. His increasingly abnormal behavior, his multiply building projects, for which he incurred much debt, his conviction that he descended from the Bourbons through “baptism”, his unbridled homosexual life, together formed the basis for the psychiatrist´s diagnosis. 3. According to modern criteria of psychiatry Ludwig displayed traits for schizotypal personality disorder together with an orbitofrontal syndrome, and an extravagance way of existence. 4.Bernhard von Gudden based his psychiatric diagnosis and expertise following the ethical principles of beneficence and primum non nocere, “to help, at least not to harm”
... Sleep architecture 3.1.1. Behavioral findings ( Fig. 2A and C) In 1883, Emil Kraepelin noted that abnormal sleep patterns and mental health are intrinsically linked (Kraepelin, 1883). This observation gained empirical support from studies that highlighted the connections between disruption to sleep/circadian rhythms and psychiatric disorders (Wulff et al., 2010). ...
It was suggested in 1986 that cue-induced cocaine craving increases progressively during early abstinence and remains high during extended periods of times. Clinical evidence now supports this hypothesis and that this increase is not specific to cocaine but rather generalize across several drugs of abuse. Investigators have identified an analogous incubation phenomenon in rodents, in which time-dependent increases in cue-induced drug seeking are observed after abstinence from intravenous drug or palatable food self-administration. Incubation of craving is susceptible to variation in magnitude as a function of biological and/or the environmental circumstances surrounding the individual.
During the last decade, the neurobiological correlates of the modulatory role of biological (sex, age, genetic factors) and environmental factors (environmental enrichment and physical exercise, sleep architecture, acute and chronic stress, abstinence reinforcement procedures) on incubation of drug craving has been investigated. In this review we summarized the behavioral procedures adopted, the key underlying neurobiological correlates and clinical implications of these studies.
... In phase 2, from 1850 to 1860, based on the writings of Guislain (1852) and Bucknill and Tuke (1858), melancholia without delusions was mainly considered a disorder not of intellect but rather of mood, in accordance with the paradigm shift. In phase 3, from 1860 to 1880, in the writings of Griesinger (1861), Sankey (1884), Maudsley (1867), Krafft-Ebing (1903), and Kraepelin (1883), the cause of delusional melancholia was considered to be brain-based psychiatry. Since melancholia was mainly considered a disorder of mood, delusions were presumed not to be an independent disorder, but an emerging feature aligned with abnormal mood. ...
During the period extending from 1780 to 1880, the conceptualization of melancholia changed from an intellectual to a mood model. The modern view of depression, based on Kraepelinian dualism, has reflected changes in opinion on psychiatric taxonomy of individual melancholia. From the point of view of an “operational revolution,” the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) were based on a neoKraepelinian approach rooted in disease essentialism. In the revision process from the DSM-IV to the DSM-5, a combined dimensional and categorial approach was used. In the DSM-5, the diagnostic criteria for major depressive disorder are polythetic and operational in approach reflecting the heterogeneity of major depressive disorder. Although 227 different symptom combinations fulfilling the diagnostic criteria for major depressive disorder can be theoretically calculated, certain symptom combinations are more prevalent than others in real clinical situations. The heterogeneity of these operational criteria for major depressive disorder have been criticized in a manner informed by the Wittgensteinian analogy of the language game. Herein, our network analysis proposes a novel perspective on the psychopathology of major depressive disorder. The novel approach suggested here may lay the foundation for a redefinition of the traditional taxonomy of depression.
... 12 This essay began as an effort to understand the origins of Kraepelin's initial concept of Verrücktheit as articulated in his first edition. 20 I obtained all references Kraepelin cited and, then, translated and carefully studied them. However, as the story unfolded, it became clear that it could address the broader question of the historical roots of DP, providing parallels with my prior histories of the evolutions of melancholia 3 and mania. ...
While the roots of mania and melancholia can be traced to the 18th century and earlier, we have no such long historical narrative for dementia praecox (DP). I, here, provide part of that history, beginning with Kraepelin's chapter on Verrücktheit for his 1883 first edition textbook, which, over the ensuing 5 editions, evolved into Kraepelin's mature concepts of paranoia and paranoid DP. That chapter had 5 references published from 1865 to 1879 when delusional-hallucinatory syndromes in Germany were largely understood as secondary syndromes arising from prior episodes of melancholia and mania in the course of a unitary psychosis. Each paper challenged that view supporting a primary Verrücktheit as a disorder that should exist alongside mania and melancholia. The later authors utilized faculty psychology, noting that primary Verrücktheit resulted from a fundamental disorder of thought or cognition. In particular, they argued that, while delusions in mania and melancholia were secondary, arising from primary mood changes, in Verrücktheit, delusions were primary with observed changes in mood resulting from, and not causing, the delusions. In addition to faculty psychology, these nosologic changes were based on the common-sense concept of understandability that permitted clinicians to distinguish individuals in which delusions emerged from mood changes and mood changes from delusions. The rise of primary Verrücktheit in German psychiatry in the 1860-1870s created a nosologic space for primary psychotic illness. From 1883 to 1899, Kraepelin moved into this space filling it with his mature diagnoses of paranoia and paranoid DP, our modern-day paranoid schizophrenia.
... The term does not occur in his first edition. 16 In the second edition, 17 Kraepelin describes one catatonic syndrome-a subform of Verrücktheit. This diagnostic category, then a broad category of delusional psychoses, evolved later into Kraepelin's mature concept of paranoia (1899). ...
Through a close reading of texts, this essay traces the development of catatonia from its origination in Kahlbaum's 1874 monograph to Kraepelin's catatonic subtype of his new category of Dementia Praecox (DP) in 1899. In addition to Kraepelin's second to sixth textbook editions, I examine the six articles referenced by Kraepelin: Kahlbaum 1874, Brosius 1877, Neisser 1887, Behr 1891, Schüle 1897, and Aschaffenburg 1897 (Behr and Aschaffenburg worked under Kraepelin). While Brosius and Neisser confirmed Kahlbaum's descriptions, Behr, Schüle, and Aschaffenburg concluded that his catatonic syndrome was nonspecific and only more narrowly defined forms, especially those with deteriorating course, might be diagnostically valid. Catatonia is first described by Kraepelin as a subform of Verrücktheit (chronic nonaffective delusional insanity) in his second to fourth editions. In his third edition, he adds a catatonic form of Wahnsinn (acute delusional-affective insanity). His fourth and fifth editions contain, respectively, catatonic forms of his two proto-DP concepts: Psychischen Entartungsprocesse and Die Verblödungsprocesse. Kahlbaum's catatonia required a sequential phasic course. Positive psychotic symptoms were rarely noted, and outcome was frequently good. While agreeing on the importance of key catatonic signs (stupor, muteness, posturing, verbigeration, and excitement), Kraepelin narrowed Kahlbaum's concept, dropping the phasic course, emphasizing positive psychotic symptoms and poor outcome. In his fourth to sixth editions, as he tried to integrate his three DP subtypes, he stressed, as suggested by Aschaffenburg and Schüle, the close clinical relationship between catatonia and hebephrenia and emphasized the bizarre and passivity delusions seen in catatonia, typical of paranoid DP.
... In the course of the 1800s, the number of categories was increased from one ("idiocy/insanity") to seven in 1880 (DSM IV 1994). In 1883 Kraepelin published his Kompendium der Psychiatrie, in which he first presented his nosology or classification of disorders, dividing mental illnesses into exogenous, treatable disorders, and endogenous, incurable disorders (Kraepelin 2007). He continued to refine his classification, issuing nine revisions of his psychiatry textbook, which grew into several volumes. ...
... Clinicians have long reported that nearly all mood and anxiety disorders seem to occur in tandem with sleep abnormalities [1,14]. Sleep disturbance is listed as a criterion in DSM-5 for a number of mental health conditions including anxiety and depressive disorders [3]. ...
The importance of sleep for mental health has been known for some time. Although it was initially suggested that mental health conditions negatively impact sleep, it is now widely understood that this association is bidirectional. Adolescence is a period where people are at an increased risk of being sleep deprived largely due to a late shift in the circadian rhythm around puberty combined with early school start times. Combined these may lead to adolescents being at an increased risk of mental health problems. Adolescence is also a period of continued brain development with white matter maturation continuing in the frontal brain regions throughout adolescence and into early adulthood. White matter development involves myelination of axons that link areas of grey matter and is integral for communication speed and efficiency. Studies have demonstrated that sufficient sleep is required for myelination to occur. The uncinate fasciculus (UF) is one of the last white matter tracts to be myelinated with this process occurring throughout adolescence and running between the amygdala in the limbic system and the orbitofrontal (OFC) and medial prefrontal cortices (mPFC). Recent studies have shown that connectivity between the amygdala and OFC is important for an individual's ability to exert top-down executive control over amygdala based automatic emotional responses to experiences perceived as threatening. The current literature review provides an overview of these mechanisms and concludes by proposing a model of adolescent sleep deprivation leading to potential lifelong mental health issues through the moderating impact of reduced UF development.
... Bis zur 3. Auflage des Lehrbuchs ist die folgende Definition der Verrücktheit gültig (Kraepelin, 1883): Kraepelins Affinität zur Psychologie Wilhelm Wundts wurde bereits genannt (Hoff, 1994). ...
Paranoia, the illness of fixed beliefs and delusions, is central to 19th century psychiatric
classifications. As an intellectual disorder it is a paragon of psychiatric illness following the enlightenment. Even so, concepts of affectivity (e.g. feelings, sentiments, passions) play a major role in classifications of paranoia. This study examines the transition of classifications of paranoia and concepts of affectivity in anthropological psychiatry (1803 – 1845) and in the beginning of scientific psychiatry (1845 – 1899) in 19th century Germany. The comparison of both periods shows significant differences but also continuities and proves to be a valid method for historiography of psychiatric knowledge. A result is that the concept of passion has vanished. This has implications for psychotherapeutic and psychiatric approaches to paranoia and delusions.
... При этом психические признаки указанной психопатической предиспозиции, согласно E. Kraepelin, чрезвычайно напоминают неполные ремиссии или «выздоровление с дефектом» после приступов dementia praecox. Однако, как подчеркивал E. Kraepelin, существует также несчетное число людей, являюшихся носителями описанных выше трех типов психических черт, но ни разу в жизни душевно не заболевших (что вполне соответствует общей концепции E. Kraepelin о психопатической предиспозиции еще в первом издании учебника [9][10][11]). C другой стороны, E. Kraepelin [3] связывал отдельные симптомы dementia praecox c отдельными чертами предиспозиции: так, негативизму может соответствовать предшествующий закрытый или упрямый характер, проявляющейся в болезни импульсивности -раздражительность, манерности -капризность настроения, автоматическому подчинениюпреморбидная послушность. ...
The author analyzes concepts of E. Bleuler, E. Kraepelin and P.B. Gannushkin on premorbid personality of schizophrenic patients preceded the term 'schizoid psychopathy' and describes characteristics of psychiatric status of 'schizoid alcoholics' in the concept of K. Binswanger which provided the basis for coining the term 'schizoid psychopathy'.
... Sleep is part of a fundamental biological cycle that is coupled into every aspect of body function from behavior and information processing to metabolic storage and release. The association between sleep disruption and abnormal brain function was noted by Emil Kraepelin in 1883 in his psychiatry textbook [2], [3]. ...
Sleep is important for normal brain function, and sleep disruption is comorbid with many neurological diseases. There is a growing mechanistic understanding of the neurological basis for sleep regulation that is beginning to lead to mechanistic mathematically described models. It is our objective to validate the predictive capacity of such models using data assimilation (DA) methods. If such methods are successful, and the models accurately describe enough of the mechanistic functions of the physical system, then they can be used as sophisticated observation systems to reveal both system changes and sources of dysfunction with neurological diseases and identify routes to intervene. Here we report on extensions to our initial efforts [1] at applying unscented Kalman Filter (UKF) to models of sleep regulation on three fronts: tools for multi-parameter fitting; a sophisticated observation model to apply the UKF for observations of behavioral state; and comparison with data recorded from brainstem cell groups thought to regulate sleep.
... With Emil Kraepelin (1856Kraepelin ( -1926, psychiatry was established as a scientific discipline (Schott & Tölle, 2006, p. 123). In his highly influential textbook on psychiatry (Kraepelin, 1883), he refers frequently to patients' writings in the diagnosis of their condition. He provides several transcriptions of excerpts from patient letters, diaries and other texts, which he analyzes in regard to form and content; in his 7th edition (1904) he reproduces 14 short facsimiles of handwriting that illustrate changes in handwriting, which he assigned to various illnesses. ...
Handwritten texts carry significant information, extending beyond the meaning of their words. Modern neurology, for example, benefits from the interpretation of the graphic features of writing and drawing for the diagnosis and monitoring of diseases and disorders. This article examines how handwriting analysis can be used, and has been used historically, as a methodological tool for the assessment of medical conditions and how this enhances our understanding of historical contexts of writing. We analyze handwritten material, writing tests and letters, from patients in an early 20th-century psychiatric hospital in southern Germany (Irsee/Kaufbeuren). In this institution, early psychiatrists assessed handwriting features, providing us novel insights into the earliest practices of psychiatric handwriting analysis, which can be connected to Berkenkotter’s research on medical admission records. We finally consider the degree to which historical handwriting bears semiotic potential to explain the psychological state and personality of a writer, and how future research in written communication should approach these sources.
... La chronicité n"est devenu un marqueur de la maladie mentale qu"à partir de la deuxième moitié du XIXè siècle (Lanteri-Laura, 1972). La représentation de la schizophrénie comme une maladie chronique s"enracine ainsi dans le paradigme de la psychiatrie moderne, selon trois postulats de Kraepelin: les maladies mentales sont des catégories naturelles (théorie du naturalisme médical), ce sont des conditions héréditaires et menant à une détérioration progressive, et enfin, tous les symptômes des maladies mentales sont causés par des lésions du cerveau ou du système nerveux (Kraepelin, 1883). La catégorie de démence précoce, qui préfigure celle de schizophrénie, est ainsi conceptualisée comme une perte progressive et irrémédiable des facultés mentales de la personne. ...
Background: Over the last twenty years, predicting psychosis has become a priority of both research and policies in the mental health field. While psychiatrists promoting those approaches defend the use of “at risk mental states” categories, cases of patients presenting unclear symptoms that might be the signs of a beginning psychotic process or might as well reflect some adolescent unease are commonplace in youth psychiatry. Yet little is known about the routine practices of youth psychiatrists regarding prognosis. What kinds of expectations do psychiatrists have when treating young patients? Do they anticipate future mental disorders? Do they communicate their expectations to patients and their families? Method: we asked a sample of French youth psychiatrists how they used prognosis in their daily work. Interviews were analyzed using qualitative methodology. Results: While most of them did not spontaneously mention the fact that they made prognostications when treating young patients, psychiatrists described situations where their expectations regarding the future of their patients were problematic and called for specific action. They stressed the impossibility of making a reliable prognosis and feared to induce mental troubles if announcing them, as would do a self-fulfilling prophecy. These contradicting expectations towards prognosis were only managed at the cost of ambivalent attitudes and a deep emotional involvement. Conclusion: Inconspicuous risk management is part of youth psychiatrists’ daily work, and indetermination of prognosis reflects the many uncertainties concerning the boundaries between symptoms and existence in the realm of severe mental disorders.
... Progress in all of these areas requires a valid structure for classifying and quantifying psychiatric symptomatology. The modern diagnostic approach, first formalized by Kraepelin (1883), argued that distinct disorders could be characterized by careful syndromal observation coupled with course (i.e., diagnosis by prognosis). Approaches to determining how psychiatric syndromes should be carved out from the universe of symptoms have not advanced greatly since the modern diagnostic era began. ...
Purpose:
Contemporary approaches to clinical diagnosis have not adequately exploited state-of-the-art empirical techniques in deriving diagnostic criterion sets that are statistically optimal based on 1) relevant external indicators and 2) replicability across data sets. We provide a proof of concept that optimal criterion sets can be derived with respect to alcohol use disorder (AUD) diagnosis that are both more efficient and precise than current systems.
Methods:
Using data from the National Epidemiologic Survey on Alcohol and Related Conditions we selected chronicity (i.e. persistence) of AUD diagnosis and comorbidity of AUD with other disorders as validation criteria on which to optimize the size of the AUD criterion set and the threshold for AUD diagnosis. We used cross-validation and consensus approaches for choosing a final solution.
Results:
Cross-validation did not produce a solution that replicated across random subsamples or differed from conventional diagnosis. Alternatively, consensus produced a more global solution that was associated with greater validity than "conventional" diagnosis.
Conclusion:
Such methods, if applied to extant diagnostic criteria and algorithms can generate simpler and more reliable rules and hold promise for greatly reducing misclassification of individuals in both research and applied clinical contexts.
... The fi rst period is characterized by criticism of Kahlbaum's concept of catatonia as a disease. [8][9][10] At that time, Kraepelin felt that catatonia was nonspecifi c and could occur in various psychoses. In the second phase, he subsumed catatonia, paranoi,a and hebephrenia under the generic term dementia praecox. ...
p>Following an historical overview of the development of the concept of catatonic schizophrenia, the impact of using different diagnostic criteria sets on the frequency of this subtype of schizophrenia will be described. This topic is not only of academic importance but also of clinical importance: the recognition of catatonic schizophrenia entails specific treatment options, including the use of benzodiazepines or electroconvulsive therapy.
ABOUT THE AUTHORS
Thomas Stompe, MD, is with the Psychiatric University Clinic Vienna, and the Justizanstalt Göllersdorf. Kristina Ritter, MD, is with the Psychiatric University Clinic Vienna. Hans Schanda, MD, is with the Psychiatric University Clinic Vienna, and the Justizanstalt Göllersdorf.
Address correspondence to: Thomas Stompe, MD, Psychiatric University Clinic Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria; fax +43 2954 2411 206; or email Thomas.stompe@chello.at .
The authors disclosed no relevant financial relationships.
EDUCATIONAL OBJECTIVES
Review the history of the concept of catatonia.
Examine the competing schools of thought about catatonic schizophrenia.
Review the reasons for the decline in the diagnosis of catatonic schizophrenia. </ol
... Psychiatric genetics emerged in the late nineteenth century as a style of thinking about the pathogenesis of "hereditary madness." Its origins lie among theories of degeneration (Morel 1857), the birth of biological psychiatry (Kraepelin 1883), and the development of biometric approaches to heredity (Galton 1883). However, it was not until Mendelian concepts of heredity were combined with biometrical approaches that "psychiatric genetics" emerged as an autonomous research program. ...
... Clinical psychologists are sent descriptions of generalized disorders in children's development, such as autism or Asperger's syndrome, or psychotic problems, specifically schizophrenia, in adult classifications. Kraepelin (1883) was the first to use the term 'dementia precox' to name what we now know as schizophrenia. In the fourth edition of his Compendium der Psychiatrie he discusses a type of dementia in young people. ...
This study shows the findings about prevalence and comorbidity of alterations in thinking in a paediatric clinical sample. Its aim was to find out about the empirical configuration (factor structure) of thought problems in minors with psychological problems. Method: The sample population included 300 minors from 6 to 12 years old who showed psychological alterations and had been referred by different medical specialists. The assessment instrument used was an adaptation of the Child Behaviour Checklist (CBCL), consisting of 96 items. Results: From the factorization carried out an empirical syndrome which partially coincides with Achenbach and Rescorla's (2001) factorization can be seen. The percentage of cases above the 98 percentile of the mean plus one and two standard deviations were calculated both in the thought problems factor from Achenbach's factorization and in the paediatric factorization. The prevalences found ranged between 2.1% (pc 98) and 24.5% (sd mean + 1). In all the cases the percentage of boys with thought problems was higher than that of girls. Furthermore, the thought problem factor showed a high degree of association with the following factors: dissocial, somatic complaints, confrontational/defiant, attention deficit hyperactivity disorder and, to a lesser extent, anxiety and depression.
... Les Français étaient plutôt centrés sur les variations d'une hystérie nerveuse et émotive. La remise en cause de l'inflation des « psychoses hystériques » s'appuie entre autres sur les travaux d'Emil Kraepelin [31] qui tente de réduire les références multiples à l'hystérie dans les affections mentales. Un vif débat diagnostique s'instaure, axé sur la différenciation hystérie versus catatonie et suscitant une véritable querelle doctrinale. ...
Les auteurs, constatant que les origines précises de la notion de pseudodémence n’ont jamais été clairement décrites, ont exploré le sens donné à ce terme dans la psychiatrie germanophone fin xixe et début xxe. Ils remarquent qu’elle est indépendante de la notion de démence sénile à cette époque et est clairement corrélée à trois phénomènes cliniques : les traumatismes dont la nature et les manifestations cliniques propres faisaient l’objet de discussions déjà intenses, les psychoses carcérales, et ce qu’on commençait à nommer « névrose de rente » (Rentenneurose). Le terme de Pseudodemenz n’apparaît pas dans les écrits de Wernicke, mais il est possible qu’il l’ait utilisé dans son enseignement oral. Les premiers débats se répartissent entre trois positions : celle de Ganser et son syndrome, celle de Wernicke (à qui on attribue la création de la notion de pseudodémence) et celle de Nissl. On constate qu’à cette époque, la question de la nature de l’« inhibition » est particulièrement cruciale, chaque position en proposant une lecture différente. Ces débats, limités à l’époque à la tétrade états traumatiques/hystéries/psychoses carcérales/névroses de rente, ne seront que bien plus tardivement circonscrits aux états pseudodémentiels chez les sujets âgés. Il importe de noter que la notion d’hystérie utilisée par Wernicke inclut les psychoses hystériques.
... Les Français étaient plutôt centrés sur les variations d'une hystérie nerveuse et émotive. La remise en cause de l'inflation des « psychoses hystériques » s'appuie entre autres sur les travaux d'Emil Kraepelin [31] qui tente de réduire les références multiples à l'hystérie dans les affections mentales. Un vif débat diagnostique s'instaure, axé sur la différenciation hystérie versus catatonie et suscitant une véritable querelle doctrinale. ...
Objective
The authors explore the history of pseudodementia in the elderly; an issue with growing momentum in a world where life duration expectancy has been constantly growing and the management and treatments of dementias has imposed an equally increasing burden. Although the issue is mainly therapeutic, some of the main tenets of the current approaches rest heavily on historical issues. The invention of the term pseudodementia (Pseudodemenz) is usually credited to Wernicke. However, the exact circumstances and the debates that have accompanied the emergence of the term have never been fully uncovered, and the references are not accurate. Most of the recent literature cites Kiloh as the key influence in structuring the current uses of the term, but the relationship between both sources is not clear.
Methodology
A research of anteriority has been conducted on the basis of Medline via Pubmed, PsychINFO and google book, using the following keywords: pseudodementia, pseudodementia, depressive pseudodementia, pseudodémence, Pseudodemenz. We have researched the quotations to localize the origin of the concept. Complementarily, we have attempted to clarify the nature of the debates by exploring the relevant German psychiatric literature at the end of the XIXth century and the beginning of the XXth.
Results
We have found that the very first occurrences of the notion appeared in a debate between the following authors: Ganser S.J.M. 1898, 1903; Wernicke C. 1898; Raecke J. 1901; Nissl F. 1902; Jung C.G. 1902, 1903; Stertz G. 1910; Bonhoeffer K. 1911; Schuppius S. 1914. We found that the term Pseudodemenz never appears in Wernicke's written works, although he was credited of its invention by his most direct students. It seems that the term was thought by the time it emerged to have originated in Wernicke's discussion of Ganser's syndrome.
Discussion
Ganser's syndrome, often defined as carceral psychosis, is a specific hysterical twilight state characterized by “talking past the point” (Vorbeireden), amnesia and hysterical stigmas, in which some trauma was thought to be causative. Wernicke presented it as determined by a “restriction of the field of consciousness”, echoing Janet's theory (École de la Salpêtrière). He rejected the twilight characteristic: this differential point seems to have initiated the introduction of the concept of pseudodementia. Raecke argued that such states should not be understood as forms of simulation thus contributing to a heated debate of the time. Referring to Janet's works and expanding the syndrome of “traumatic hysteria”, he argued in favor of a specific inhibiting factor which disturbs the process of associations. Jung, refusing Nissl's article dismissing Ganser, Wernicke and Raecke's views, confirmed the hysterical hypothesis. In a new contribution to the debate, Ganser contested Wernicke's differential point, arguing that in Vorbeireden, there was a Benommenheit – some sort of giddiness – and a “superficiality of the contents of consciousness” rather than a limitation of consciousness. It has been rightly argued that Wernicke's view of the pseudodementia issues was mainly related to the debates on hysteria and trauma, and that no relationship with old age symptomatology was established by him. However, we have found that he alluded to at least one case in which such a relationship was hypothesized. Moreover, one should note that Wernicke's views on hysteria included the rather pervasive notion of “hysterical psychosis”, exhibiting “allopsychosis”, which could include what would nowadays be seen as schizophrenia or psychotic mood disorders.
Conclusions
First of all, the term Pseudodemenz, if it was ever used by Wernicke verbally, never appears in his published works. Besides, the debates concerning Ganser's syndrome, which served as a first paradigm to discuss pseudodementia, were highly influenced by the discussions on traumatic disorders, hysteria and simulation. Finally, although no direct connection is made between disorders of the senium and Pseudodemenz, the fact that Wernicke included both in what he termed “allopsychic disorders” seemed to indicate that some kind of relationship could not be absolutely excluded in Wernicke's mind.
In the nineteenth century, the professional examination of sequelae of psychological trauma began. Discussions centered around the question of how the relationship between body and psyche developed during traumatisation, what mechanisms were responsible for the symptoms diagnosed and what individual dispositions might have been involved. The importance of will and the question of simulation also played a role. The diagnoses that recur repeatedly in the course of these debates are indications of how views on aetiology, pathogenesis, therapy, etc. changed and how social evaluations shifted. The different social, legal and political conditions had a determining influence. The spectrum of possibly traumatising events widened considerably, while the number of diagnoses decreased more and more until “post-traumatic stress disorder” became established as the central diagnosis.
We offer an approach to mourning and melancholia through the freudian perspective. We review the criteria for the one and the another looking for their differential denominators, but our reading maintain us questioning instead of providing an answer to our interrogation. As a result, we abandon any attempt of distinction between mourning and melancholia, concluding that the most interesting movement would be to examine the underlying process involved in both cases through the concept of identification.
This leads us to open an interrogation that is left in suspense: if the identification process –consistent in an erection of the object in the ego, and therefore it’s persistance and the bond with it too– is involved as a result in both, mourning and melancholia, up to what point can we assert that an object while mourning is given up for lost? Is the object resigned, or is the subject resigned to face the identification process? (Journal: Revista Escritos de Posgrado - UNR)
Die Klinische Psychologie als facettenreiches Fach innerhalb der Psychologie erstreckt sich über grundlagen- und anwendungswissenschaftliche Aspekte und verschiedenste berufliche Anwendungsfelder. Ein Hauptcharakteristikum der Klinischen Psychologie ist daher auch ihre interdisziplinäre Grundorientierung. Zudem unterstreicht die erweiterte Fachbenennung „Klinische Psychologie und Psychotherapie“ den wissenschaftstheoretischen und berufspolitischen Anspruch, gesellschaftliche und gesundheitspolitische Verantwortung für die Diagnostik, Prävention, Therapie und Rehabilitation psychischer Störungen zu übernehmen. Im ersten Kapitel dieses Lehrbuchs werden zunächst Kernbegriffe und Hintergründe zum Verständnis des Faches eingeführt, allem voran der Begriff der „psychischen Störungen“. Die Grenzen zwischen „normalem“ und „abweichendem“ Verhalten, zwischen „gesund“ und „krank“ werden zwar anhand allgemeiner deskriptiver Aspekte formuliert, sie bleiben aber in vielen Bereichen fließend und nicht eindeutig definierbar. Dies können auch jüngste Überarbeitungen diagnostisch-klassifikatorischer Systeme wie das DSM in seiner 5. Revision und die zukünftige ICD-11 nicht leisten. Aus diesem Diskurs heraus wurden neue dimensionale und diagnoseunabhängige, sog. Mehrebenenansätze, formuliert um (abweichendes) menschliches Verhalten zu charakterisieren.
Dos libros del psiquiatra peruano Honorio Delgado, Psicología (1933) y La personalidad y el carácter (1943), son analizadas en detalle en la presente comunicación ya que ambos nos permiten conocer la concepción de la psicología que tenía su autor. El primero, Psicología, escrito en colaboración con el filósofo Mariano Iberico, propone una psicología estrechamente vinculada a la filosofía, destacando el rol de la introspección y de la intuición. El segundo, La personalidad y el carácter, presenta los conceptos de Delgado acerca de la personalidad, y expone diversas teorías de la personalidad, destacando sobre todo las alemanas (Kretschmer, Jung, Spranger, entre otras).
Emil Kraepelin developed a new psychiatric nosology in the eight editions of his textbook. Previous papers have explored his construction of particular diagnoses, including dementia praecox and manic-depressive insanity. Here we are providing a close reading of his introductory textbook chapter, that presents his general principles of nosology. We identify three phases: 1) editions 1-4, in which he describes nosological principles in search of data; 2) editions 5-7, in which he declares the mature version of his nosological principles and develops new disease categories; 3) edition 8, in which he qualifies his nosological claims and allows for greater differentiation of psychiatric disorders. We propose that Kraepelin's nosology is grounded in three principles. First, psychiatry, like other sciences, deals with natural phenomena. Second, mental states cannot be reduced to neural states, but science will progress and will, ultimately, reveal how nature creates abnormal mental states and behavior. Third, there is a hierarchy of validators of psychiatric diagnoses, with the careful study of clinical features (signs, symptoms and course) being more important than neuropathologic and etiological studies. These three principles emerged over the course of the eight editions of Kraepelin's textbook and were informed by his own research and by available scientific methods. His scientific views are still relevant today: they have generated and, at the same time, constrained our current psychiatric nosology.
Purpose
This study examined what aspects in life in Eastern and Western Germany are considered by patients, therapists and society to cause (or indicate) emotional suffering so that an outpatient psychotherapy is sought and warranted.
Methods
In Germany, psychotherapy is covered by health insurance after patients submit an application accompanied by a written report from the therapist. We took a random sample of such applications and performed a qualitative text analysis of the reports, identifying all text units where some form of emotional suffering, distress or handicap was described. A coding system was developed based on the units, and all units were subsequently coded. The proportion of units per category was compared between reports from Western and Eastern Germany using chi‐square tests.
Results
Out of 500 randomly selected reports, n = 25 were from Eastern Germany. An age‐ and sex‐matched sample from Western Germany was added. From these 50 reports, a total of 716 text units describing some form of emotional suffering were extracted (359 units from reports from Eastern Germany and 357 from Western Germany). Thirteen categories of emotional suffering emerged. In Eastern Germany, emotional suffering was considerably more frequently described in terms of somatic symptoms and in feeling nervous and tense. Patients from Western Germany were more often described as feeling depressed and hopeless, helpless, anxious and without drive (ϕ = 0.19, p = .02).
Conclusion
There is evidence that there are differences between Eastern and Western Germany in how emotional suffering is expressed and/or described.
From early modern legal debates about sodomitical, or unnatural, forms of lust, early nineteenth-century European forensic medicine inherited a shortlist of what eventually came to be called perversions of the sex drive. This brief article traces this forensic-medical prehistory of sexual perversion focusing on one such prototypical sexual aberration: sex with female corpses.
The ability to fully comprehend the mental experience of those suffering from psychotic symptoms can sometimes elude the empathic capabilities of therapists. Even the most experienced psychiatrists, psychologists and psychotherapists have difficulty in dealing with, and understanding the strangeness of the symptoms and their full significance to those affected. Particularly the phenomenon of ego boundary disorders is difficult to compare with other comprehensible experiences due to the extreme level of alienation. Here, an attempt will be made to understand the disorders using psychological and philosophical models, and to reveal the problem in a way that makes a beneficial psychotherapeutic relationship possible. The empathic approach should not restrict itself to just understanding meanings, but must take into account the structural changes. An assessment oriented only on the surface of the symptoms runs the risk of disregarding the full scope of the disorder of those affected. It takes quite fundamental considerations to internal human structures and the concept of empathy in order to cope with the extent of the disorder.
Importance:
First-rank symptoms (FRS), proposed by Kurt Schneider in 1939, subsequently became influential in schizophrenia diagnosis. We know little of their prehistory. How often were FRS described before 1939 and in which countries and time periods? Which FRS was most frequently noted?
Observations:
Forty psychiatric texts from 37 authors, published 1810-1932, were identified that described FRS. In a systematic subsample, half of the textbooks examined contained such descriptions with little differences between countries or over time. Somatic passivity was most commonly noted, followed by thought insertion, thought withdrawal, and made actions. This pattern resembled that reported in recent studies of schizophrenia. A novel term-delusions of unseen agency-was seen in psychiatric texts and then found, from 1842 to 1905, in a range of official reports, and psychiatric, medical, and general audience publications. The Early Heidelberg School (Gruhle, Mayer-Gross, Beringer) first systematically described "self-disturbances" (Ichstörungen), many of which Schneider incorporated into FRS.
Conclusions and relevance:
From the beginning of Western descriptive psychopathology in the early 19th century, symptoms have been observed later described as first-rank by Schneider. A term "delusion of unseen agency"-closely related to Schneider's first-rank concept-was popular in the second half of the 19th century and described in publications as prominent as the Encyclopedia Britannica and New England Journal of Medicine. The descriptions of these specific symptoms, with substantial continuity, over more than 2 centuries and many countries, suggest that an understanding of their etiology would teach us something foundational about the psychotic illness.
Im 19. Jahrhundert begann die professionelle Auseinandersetzung mit Traumafolgestörungen. Die Diskussionen kreisten um die Frage, wie sich bei der Traumatisierung das Verhältnis von Körper und Psyche gestaltete, welche Mechanismen für die diagnostizierten Symptome verantwortlich und welche individuelle Disposition möglicherweise gegeben waren. Auch die Bedeutung des Willens wie die Frage der Simulation spielten eine Rolle. Die im Verlaufe dieser Debatten immer wieder neu auftretenden Diagnosen sind Hinweise darauf, wie sich die Ansichten zu Ätiologie, Pathogenese, Therapie etc. änderten und wie sich die sozialen Bewertungen verschoben. Die unterschiedlichen sozialen, rechtlichen und politischen Bedingungen waren dabei von einem bestimmenden Einfluss. Das Spektrum der möglichen traumatisierenden Ereignisse erweiterte sich sehr, während die Zahl der Diagnosen immer mehr abnahm, bis sich die „posttraumatische Belastungsstörung“ als zentrale Diagnose durchsetzte.
In developing his mature concept of hebephrenic dementia praecox (DP) in his 4th (1893) through 6th textbook editions (1899), Kraepelin worked from the hebephrenic syndrome first described by Hecker (1871) and then carefully studied by his student Daraszkiewicz (1892). Working under Kraepelin’s supervision, Daraszkiewicz followed Hecker in emphasizing several key features of hebephrenia (distinctive deteriorative course, importance of silliness and minimal positive psychotic symptoms) but expanded the syndrome to include cases developing severe dementia, rejected the link to prodromal depressive and manic phases, and reduced the emphasis on thought disorder. Daraszkiewicz proposed a soft subtyping of hebephrenia based on level of deterioration, which Kraepelin adopted in his 4th edition with an additional emphasis on severe positive psychotic symptoms. In his 5th edition, Kraepelin created a third subform with even more pronounced and bizarre delusions and hallucinations. In his 6th edition, which contained his first articulation of DP, Kraepelin eliminated his hebephrenia subforms presenting a single syndrome, which, compared to Hecker, included more emphasis on positive psychotic and catatonic symptoms and severe dementia. Kraepelin’s paths to hebephrenic and paranoid DP differed in important ways. Paranoid DP was a de novo syndrome created by differentiation from paranoia. Hebephrenia, by contrast, evolved from a disorder created in the Kahlbaum/Hecker paradigm of the iterative study of clinical features, course and outcome. Kraepelin further implemented this approach in substantially reworking, over several drafts, the hebephrenic syndrome to fit into his emerging construct of dementia praecox.
Psicosis es un término utilizado para referirse a un grupo de trastornos mentales graves cuya principal característica es la pérdida de contacto con la realidad. La palabra “psychose” se empleaba clásicamente para referirse a la enfermedad mental, y no es hasta finales del siglo XIX cuando el concepto de psicosis empieza a definirse de una forma más concreta.
Der Beitrag wirft einen Blick in die Geschichte der Psychiatrie und fokussiert zwei Behandlungsmodelle, die Ende des 19. Jahrhunderts gegeneinander in Stellung gebracht wurden: die Behandlung im Einzelraum bzw. der Isolationszelle und die sogenannte Bettbehandlung im gemeinsamen Kranken- bzw. Wachsaal. Wie am Beispiel der Behandlung in der Isolationszelle gezeigt wird, konfrontierten die nicht-intendierten Effekte, die der Raum provozierte, die Ärzte mit den performativen Dimensionen desselben, der sich in dieser Eigenschaft einer letztgültigen Bestimmung, Nutzung oder Regulierung durch die Institution entzog. Diese nicht-intendierten Effekte, die der Raum in der Interaktion mit den Patienten mit sich brachte, flankierte schließlich den Wechsel des Behandlungssettings, der mit dem (zumindest propagierten) Ende der Unterbringung in den Zellen und der Einführung der Wachsaalbehandlung nicht zuletzt den Beginn einer „modernen“ und „humanen“ Psychiatrie maßgeblich mitbegründen sollte.
Hintergrund: Die Umwelt setzt sich aus einer Komposition aus Hintergründen und spezifischen Objekten zusammen, die unterschiedlich wahrgenommen und verarbeitet werden können. Im Rahmen von Aufmerksamkeits- und Gedächtnisstudien wurde bisher nur selten eine Differenzierung dieser Komponenten berücksichtigt. Die vorliegende Dissertation befasst sich mit der Entwicklung und Evaluation einer Bilderserie, die eine spezifische Unterscheidung von neutralen Hintergründen und variierenden Objekten (negativ, positiv, neutral) hinsichtlich wissenschaftlicher Studienzwecke erlaubt und versucht diese im Hinblick auf die Untersuchung von Entstehungs- und Aufrechterhaltungsbedingungen bei der Posttraumatischen Belastungsstörung und somit deren Einsatz im klinischen Kontext zu etablieren. Material und Methoden: Die Stichprobe setzte sich aus 30 gesunden Personen zwischen 20 und 60 Jahren zusammen, davon waren 14 Frauen. Die Bilderserie enthielt jeweils 30 Bilder mit negativen, neutralen bzw. positiven Hinweisreizen auf neutralem Hintergrund. Die Evaluation hinsichtlich der Bedeutung für wissenschaftliche Studien, vor allem bei Patienten mit Posttraumatischer Belastungsstörung wurde anhand der Erhebung zentraler Einflussfaktoren bezüglich affektiver Symptomatik umgesetzt. Ergebnisse: 71% der Bilder konnten den vorab definierten Kategorien zugeordnet werden. Außerdem zeigte sich kein Einfluss von Alter oder Geschlecht auf die Kategorisierung. Die Einflussfaktoren Emotionsverarbeitung und Angst zeigten hingegen signifikante Einflüsse auf die Bildwahrnehmung, wohingegen Empathie, Stress, Aufmerksamkeit und Persönlichkeitsmerkmale keinen signifikanten Einfluss hatten. Diskussion: Die neu entwickelte Bilderserie konnte positiv evaluiert werden. Sie dient als Grundlage zur weiteren Erforschung der visuellen Verarbeitungsprozesse bei Posttraumatischer Belastungsstörung. In Hinblick auf Emotionsverarbeitung und Angst zeigte sich ein relevanter Einfluss und gibt damit Hinweise für die Entstehungs- bzw. Aufrechterhaltungsbedingungen der Posttraumatischen Belastungsströrung.
Background: A core symptom of major depressive disorder (MDD), is sleep disturbance, specifically hypersomnia or insomnia. Sleep is highly regulated by circadian rhythms, controlled by circadian genes, that act through a series of feedback loops to regulate the sleep-wake cycle.
Objectives: To the best of our knowledge, a systematic review regarding the core circadian genes and their role in MDD has not been published recently. More specifically, a review of these genes and their role in sleep disturbances in depressed individuals appears to have never been done. As such, we decided to integrate both concepts into one comprehensive review.
Method: The review was done using the appropriate search terms in the following search engines: OVID Medline, Embase, PsycINFO and Pubmed.
Results: Despite the numerous genetic studies done, few have yielded positive findings. Of those that have, frequently there are other studies that are unable to replicate the original findings. Based on the data summarized in this review, none of the circadian genes appear to be associated with MDD, but a few are more promising than others. These genes are: CRY1, CRY2, PER2 and NPAS2. When investigating the role of circadian genes in sleep disturbances among individuals with MDD, the most promising candidate gene is TIMELESS. Although the results in this area are limited further research is warranted.
Conclusion: Given the promising leads from this review, future studies should investigate circadian genes in sleep disturbances among the depressed population.
Schizophrenia is one of the most enigmatic mental disorders, and language is one of its most essential and distinctive traits. Language and Schizophrenia provides a complete overview of schizophrenic language, utilising both psychological and philosophical perspectives to explore the unique way language impacts on this mental disorder. Language and Schizophrenia investigates specific features of schizophrenic language using cognitive psychology alongside the opposing field of phenomenological psychiatry, concluding that neither of these approaches fully succeeds in explaining the linguistic features unique to Schizophrenia. Cardella's innovative approach of combining psychological perspectives with philosophy offers a direct alternative to traditional cognitive perspectives, emphasising the fundamental role that language plays in the disorder. This book provides a thorough analysis of the deep link between language and schizophrenia and will be of great value to researchers and postgraduates studying schizophrenia, phenomenology, neuropsychology and philosophy of language.
Two first works of swiss psychiatrist E. Bleuler that revise the symptomatology of Kraepelinian dementia praecox leaning on some findings of the psychoanalysis of S. Freud, C. Jung, F. Riklin, K. Abraham and on the P. Janet’s concept of psychasthenia are analyzed. The early concept of primary (testifying the direct organic lesion) and secondary (of psychogenic origin) symptoms of schizophrenia formulated by E. Bleuler is compared with his following concept of «basic» and «accessory» symptoms of schizophrenia. The concept of primary and secondary symptoms of schizophrenia was created firstly as a ground for the prognosis of the disease, and the concept of basic and accessory symptoms for the confident diagnosis of the disease. E. Bleuler’s concept accentuated the diagnosis of schizophrenia on the psychopathological and pathopsychological state of the patient, in contrast to E. Kraepelin’s concept of dementia praecox based on the course and outcome, made possible the expansion of schizophrenia boundaries at the expense of different psychotic and nonpsychotic disorders that other authors attributed to the forms of «degenerative madness», neuroses and psychopathies.
How deep are the historical roots of our concept of major depression (MD)? I showed previously that psychiatric textbooks published in 1900–1960 commonly described 18 characteristic depressive symptoms/signs that substantially but incompletely overlapped with the current DSM (Diagnostic and Statistical Manual of Mental Disorders) MD criteria. I here expand that inquiry to the key years of 1880–1900 during which our major diagnostic categories of manic-depressive illness (MDI) and dementia praecox were developed. I review the symptoms of depression/melancholia in 28 psychiatric textbooks and 8 other relevant documents from this period including monographs, reviews and the first portrayal of melancholia Kraepelin in 1883. Descriptions of melancholia in the late nineteenth and twentieth century textbooks closely resembled each other, both reporting a mean of 12.4 characteristic symptoms, and emphasizing core features of mood change and alterations in cognitive content and psychomotor behavior. The detailed monographs, reviews and the early description of Kraepelin were more thorough, reporting a mean of 16.6 of these characteristic symptoms. These nineteenth century texts often contained phenomenologically rich descriptions of changes in mood and cognition, loss of interest and anhedonia and emphasized several features not in DSM including changes in volition/motivation, posture/facial expression and derealization/depersonalization. In the early nineteenth century, melancholia was often defined primarily by delusions or as the initial phase of a unitary psychosis transitioning to mania and then dementia. By 1880, the concept of depression as an independent mood disorder with characteristic symptoms/signs and a good prognosis had stabilized. Kraepelin incorporated this syndrome into his diagnostic concept of MDI, changing its name to ‘Depressive States’, but did not alter its underlying nature or clinical description.
Background
Over the last twenty years, predicting psychosis has become a priority of both research and policies. Those approaches include the use of the At Risk Mental State category (ARMS) and of standardized predictive tools. In comparison to most developed countries, early interventions programs are only little developed in France. However, cases of young patients presenting unclear symptoms that might be a beginning psychosis or might as well reflect some adolescent unease are commonplace in psychiatry. Yet little is known about the routine practices of youth psychiatrists regarding psychosis risk management. Do they anticipate mental disorders?
Method
The Grounded Theory is an agreed-upon qualitative method in social science field that links subjective experiences (individual narratives) to social processes (professional norms and mental health policies). 12 French youth psychiatrists were interviewed about psychosis early management and their daily prognosis practices with teenagers.
Results
If all participants were aware of early intervention programs, most of them did not make use of standardized scales. Psychiatrists’ reluctance toward a psychosis risk standardized assessment was shaped by three difficulties: first the gap between theoretical knowledge and practice; second their impossibility to make reliable prognoses; and third, the many uncertainties surrounding medical judgment, adolescence and the nature of psychosis. Nevertheless, they provided their young patients with multiple months follow up without disclosing any risk category.
Conclusion
Anticipating a psychosis onset remains a highly uncertain task for psychiatrists. In France, psychiatrists’ inconspicuous risk management might be supported by the universal costs coverage that is not conditional on a diagnosis disclosure.
Emil Kraepelin (1856-1926) is considered one of the founders of modern psychiatric nosology. However, his conceptualization of obsessive-compulsive phenomena is relatively understudied. In this article, we compare and contrast excerpts from the eighth edition (1909-1915) of Kraepelin's Textbook of Clinical Psychiatry focusing on what Kraepelin called "obsessive neurosis" and related "original pathological conditions" with the current DSM-5 criteria for obsessive-compulsive disorder (OCD). Consistently with DSM-5 OCD, Kraepelin described obsessive neurosis as characterized by obsessive ideas, compulsive acts, or both together. His detailed descriptions of these symptoms are broadly coherent with their characterization in DSM-5, which is also true for the differential diagnoses he provided. He also mentioned cases illustrating decreased insight into symptoms and association with tic disorders. In conclusion, Kraepelin's experience, which reflects decades of consistent clinical work, may help validate current ideas and explain how the current conceptualization has emerged and developed. Even though one can hardly say that the classification laid out in DSM-5 goes back to Kraepelin's views directly, it still is true that Kraepelin played an outstanding role in systematizing psychiatric diagnostic criteria in general, and provided a major contribution to the conceptual history of OCD.
When the later famous psychiatrist Emil Kraepelin (1856-1926) was called to the University of Dorpat/Tartu at the age of 30, he probably did not busy himself much with the multicultural situation that he found there. Like many of his academic contemporaries, he regarded this Baltic university, then still German-speaking and one of the most important in the Russian Empire, as a kind of exile or at least only a way station for his career, which he hoped to pursue within the German Empire. He brought his research programme for the upcoming discipline of psychiatry with him, as the author of the compendium which, in the course of several editions, became a multi-volume, influential textbook. But at his new venue he found not only a complicated situation of (university) politics caught between negotiation processes among the various cultural groups, but also students from many regions and with different mother tongues, who had to adapt to the official language of instruction. In addition, he took over a recently founded university psychiatric clinic, where all parts of the population were represented, but with whom he could communicate only in a rudimentary manner, as far as the non-German-speaking population groups were concerned. But how did the patients from such different language families manage to make themselves heard in the world of university clinics headed by mostly German-speaking physicians, especially in psychiatry, a discipline particularly dependent upon language? What translation processes were performed by whom over the working therapeutic day, and what were the effects of this partial loss of speech on clinical research? What opportunities resulted from precisely this multi-lingual situation in a contact zone between Western Europe and Russia for psychiatric science and practice? This paper attempts to provide some preliminary answers to these questions, using already known and newly discovered sources.
This was the first paper by the Italian alienist Eugenio Tanzi (1856–1934). It surveyed existing works and provided an analysis of clinical categories such as monomania, sensory madness, moral insanity, Wahnsinn, Verrücktheit and systematized delusions, which had been used in France, Germany, Britain and Italy since the early nineteenth century to deal with paranoia. As pointed out by Tanzi, discrepancies and discontinuities in diagnostic concepts affected both psychiatric nosology and practice. Paranoia (from the Greek παρά and νοια) made for greater clarity in psychiatric terminology, and denoted a broad category, including both acute and chronic delusional states which were considered to be distinct from mania and melancholia, and usually not to lead to mental deterioration.
Obgleich wir den „Spontanverlauf“ endogener Psychosen — d. h. unbeeinflußt von verlaufsgestaltenden Umweltbedingungen — nicht feststellen können, brauchen wir möglichst exakte deskriptive Verlaufsuntersuchungen für prognostische Aussagen und für die Bestimmung des Wertes einer Therapie.
Although the term dementia has been largely used since many centuries in drama and theatrical literature the first scientific descriptions of dementia were made at the beginning of 19th century. One of the first clinical description may be found in «Des Maladies Mentales» by Esquirol of 1838. According to Esquirol dementia is “a chronic and afebrile mental disease characterized by an impairement of sensitivity, intelligence and willing”.…“senile dementia is established slowly. It commences with enfeeblement of memory, particularly the memory of recent impressions. The sensations are feeble; the attention, at first fatiguing, at length becomes impossible; the will is uncertain and without impulsion; the movements are slow and impratical”.
This book investigates what was distinctive about the predisposition to psychosis Freud posited in Daniel Paul Schreber, a presiding judge in Saxony’s highest court. It argues that Freud’s 1911 Schreber text reversed the order of priority in late 19th Century conceptions of the disposing causes of psychosis – the objective-biological and subjective-biographical – to privilege subjective disposition to psychosis, but without returning to the paradigms of early 19th Century Romantic psychiatry and without obviating the legitimate claims of biological psychiatry in relation to hereditary disposition. Freud’s Schreber between Psychiatry and Psychoanalysis takes the psychotic judge Daniel Paul Schreber as its reference point, but it is not a general treatment of Schreber, or of Freud’s reading of the Schreber case. It focuses rather on what was new in Freud’s thinking on the disposition to psychosis, what he learned from his psychiatrist contemporaries and what he did not, and whether or not psychoanalysts have fully received his aetiology.
A contemporary of Emil Kraepelin, Oskar Panizza was a psychiatric trainee under Bernhard von Gudden at the Oberbayerische Kreisirrenanstalt München. While participating in Gudden's famous degeneration studies, Panizza became psychotic. He quit his job and became a writer, trying to cope with psychotic episodes by publishing literary works. Most of his works were confiscated and Panizza himself was locked up and persecuted. His experience of his psychotic symptoms made him critical of the psychiatric orthodoxy of the time, and he preached a kind of psychological psychiatry that anticipated important features of the Antipsychiatry movement of the 1970s. After serving a year in prison for his writings, Panizza left Germany and went to Zürich, Switzerland. In 1898 he was deported from Switzerland and went to Paris, where his book of poems, Parisiana and his money were confiscated. In 1901 he had to return to the Oberbayerische Kreisirrenanstalt where a diagnosis of paranoia was made. Then he lived in Paris for the next three years, but his psychotic symptoms worsened and he fled back to the Oberbayerische Kreisirrenanstalt, where he was examined by Prof. Gudden, Dr. Ungemach and by his former colleague Emil Kraepelin, who had become head of department. The encounters with Oskar Panizza gave Emil Kraepelin some of the ideas on which he developed his concept of 'paraphrenias' and in Lectures on Clinical Psychiatry , Kraepelin illustrated the 'systematic paraphrenias', by the life of his former colleague Oskar Panizza who died in hospital in Bayreuth in 1921.
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