Who Was Emil Kraepelin and Why Do We Remember Him 160 Years Later?
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The Kraepelinian Tradition Paul Hoff, MD, Phd
Clinical research The Kraepelinian tradition Paul Hoff, MD, PhD Introduction n the 21st century, Emil Kraepelin’s views remain a majorI point of reference, especially regarding nosol- ogy and research strategies in psychiatry. However, the “neo-Kraepelinian” perspective has also been criticized substantially in recent years, the nosological dichotomy Emil Kraepelin (1856–1926) was an influential figure in of schizophrenic and affective psychoses being a focus the history of psychiatry as a clinical science. This pa- of this criticism. A thorough knowledge and balanced per, after briefly presenting his biography, discusses interpretation of Kraepelin’s work as it developed along- the conceptual foundations of his concept of mental side the nine editions of his textbook (published between illness and follows this line of thought through to late 1883 and 1927)1 is indispensable for a profound under- 20th-century “Neo-Kraepelinianism,” including recent standing of this important debate, and for its further de- criticism, particularly of the nosological dichotomy of velopment beyond the historical perspective. endogenous psychoses. Throughout his professional life, Kraepelin put emphasis on establishing psychiatry A brief biography as a clinical science with a strong empirical background. He preferred pragmatic attitudes and arguments, thus Emil Kraepelin was born in Neustrelitz (Mecklenburg, underestimating the philosophical presuppositions of West Pomerania, Germany) on February 15, 1856. He his work. As for nosology, his central hypothesis is the studied medicine in Leipzig and Wuerzburg from 1874 un- existence and scientific accessibility of “natural disease til 1878. He worked as a guest student at the psychiatric entities” (“natürliche Krankheitseinheiten”) in psychi- hospital in Wuerzburg under the directorship of Franz von atry. -
FROM MELANCHOLIA to DEPRESSION a HISTORY of DIAGNOSIS and TREATMENT Thomas A
1 FROM MELANCHOLIA TO DEPRESSION A HISTORY OF DIAGNOSIS AND TREATMENT Thomas A. Ban International Network for the History of Neuropsychopharmacology 2014 2 From Melancholia to Depression A History of Diagnosis and Treatment1 TABLE OF CONTENTS Introduction 2 Diagnosis and classifications of melancholia and depression 7 From Galen to Robert Burton 7 From Boissier de Sauvages to Karl Kahlbaum 8 From Emil Kraepelin to Karl Leonhard 12 From Adolf Meyer to the DSM-IV 17 Treatment of melancholia and depression 20 From opium to chlorpromazine 21 Monoamine Oxidase Inhibitors 22 Monoamine Re-uptake Inhibitors 24 Antidepressants in clinical use 26 Clinical psychopharmacology of antidepressants 30 Composite Diagnostic Evaluation of Depressive Disorders 32 The CODE System 32 CODE –DD 33 Genetics, neuropsychopharmacology and CODE-DD 36 Conclusions 37 References 37 INTRODUCTION Descriptions of what we now call melancholia or depression can be found in many ancient documents including The Old Testament, The Book of Job, and Homer's Iliad, but there is virtually 1 The text of this E-Book was prepared in 2002 for a presentation in Mexico City. The manuscript was not updated. 3 no reliable information on the frequency of “melancholia” until the mid-20th century (Kaplan and Saddock 1988). Between 1938 and 1955 several reports indicated that the prevalence of depression in the general population was below 1%. Comparing these figures, as shown in table 1, with figures in the 1960s and ‘70s reveals that even the lowest figures in the psychopharmacological era (from the 1960s) are 7 to 10 times greater than the highest figures before the introduction of antidepressant drugs (Silverman 1968). -
Women Neuropsychiatrists on Wagner-Jauregg's Staff in Vienna at the Time of the Nobel Award: Ordeal and Fortitude
History of Psychiatry Women neuropsychiatrists on Wagner-Jauregg’s staff in Vienna at the time of the Nobel award: ordeal and fortitude Lazaros C Triarhou University of Macedonia, Greece Running Title: Women Neuropsychiatrists in 1927 Vienna Corresponding author: Lazaros C. Triarhou, Laboratory of Theoretical and Applied Neuroscience and Graduate Program in Neuroscience and Education, University of Macedonia, Egnatia 156, Thessalonica 54006, Greece. E-Mail: [email protected] ORCID id: 0000-0001-6544-5738 2 Abstract This article profiles the scientific lives of six women on the staff of the Clinic of Neurology and Psychiatry at the University of Vienna in 1927, the year when its director, Julius Wagner-Jauregg (1857–1940), was awarded the Nobel Prize in Physiology or Medicine. They were all of Jewish descent and had to leave Austria in the 1930s to escape from the National Socialist regime. With a solid background in brain science and mental disorders, Alexandra Adler (1901–2001), Edith Klemperer (1898–1987), Annie Reich (1902–1971), Lydia Sicher (1890– 1962) and Edith Vincze (1900–1940) pursued academic careers in the United States, while Fanny Halpern (1899–1952) spent 18 years in Shanghai, where she laid the foundations of modern Chinese psychiatry, before going to Canada. At the dawn of their medical career, they were among the first women to practice neurology and psychiatry both in Austria and overseas. Keywords Women in psychiatry, Jewish physicians, University of Vienna, Interwar period, Austrian Annexation 3 Introduction There is a historic group photograph of the faculty and staff of the Neurology and Psychiatry Clinic in Vienna, taken on 7 November 1927 (Figure 1). -
First Rank Symptoms: Concepts and Diagnostic Utility
REVIEW Afr J Psychiatry 2010;13:263-266 First rank symptoms: concepts and diagnostic utility S Saddichha 1, R Kumar 2, S Sur 3, BNP Sinha 4 1National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India 2Department of Psychiatry, Central Institute of Psychiatry, India 3Ranchi Institute of Neuropsychiatry and Allied Sciences, India 4University Hospital of North Tees, Cleveland, UK Abstract First Rank Symptoms (FRS) were first defined by Schneider as diagnostic of schizophrenia. Since then, there has been an immense debate on their diagnostic and prognostic utility. This review attempts to understand the concepts of FRS as depicted over the years and the diagnostic and prognostic implications of FRS in mental illnesses including schizophrenia. Review of relevant material showed that there are wide variations in the concepts of FRS which may be classified according to broad and narrow definitions. These variations have also led to the differences in the diagnostic systems currently being used. Although the diagnostic utility of FRS in schizophrenia remains, it is not clearly so with other mental illnesses in which these symptoms may also be observed. In addition there is controversy over the prognostic implications with evidence divided between poor and no influence on outcome. Key words: First rank symptoms; Schizophrenia; Diagnosis; Prognosis Received: 01-07-2009 Accepted: 30-07-2009 Introduction as well as the diagnostic and prognostic implications of FRS in Eliciting first rank symptoms (FRS), giving rise to the mental illnesses including schizophrenia. diagnoses of schizophrenia and related illnesses, forms part of the clinical assessment process. Although the concept of Concept of FRS FRS is evolving these symptoms are widely used in several It has been suggested that instead of being clear cut diagnostic criteria for schizophrenia, having initially been symptoms, FRS lie along a continuum which can be arranged proposed by Schneider (1959). -
Bipolar Disorder - Accessscience from Mcgraw-Hill Education
Bipolar disorder - AccessScience from McGraw-Hill Education http://accessscience.com/content/900194 (http://accessscience.com/) Article by: Grunze, Heinz School of Neurology, Neurobiology, and Psychiatry, Newcastle University, Newcastle, United Kingdom. Publication year: 2016 DOI: http://dx.doi.org/10.1036/1097-8542.900194 (http://dx.doi.org/10.1036/1097-8542.900194) Content Course of bipolar disorder What is the neurobiology behind bipolar Bibliography How frequent is bipolar disorder? disorder? Additional Readings Treatment of bipolar disorder A major mental disorder in which there are life-long episodes of both mania and depression; also known as manic-depressive illness. The first recognizable descriptions of mania and depression date back to the writings of Aretaeus of Cappadocia (a Greek physician who lived around 150–200 CE). The modern history of bipolar disorder begins in the mid-nineteenth century with the concept of folie circulaire (“circular insanity”), proposed by the French psychiatrist Jean-Pierre Falret. Later, around the beginning of the twentieth century, it was defined by the work of the German psychiatrist Emil Kraepelin. See also: Affective disorders (/content/affective-disorders/013750) Bipolar disorder is characterized by sudden and often unexplained mood swings, ranging from delirious mania to severe depression. These mood changes are regularly accompanied by other mental and behavioral symptoms, such as fluctuations of volition, activity level, and cognitive functioning. Symptomatic criteria for bipolar disorder have been conceptualized in diagnostic manuals [the two most important being the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) by the American Psychiatric Association and the International Classification of Diseases (ICD-10) by the World Health Organization], with only minor differences between these manuals. -
Bipolar Disorders 100 Years After Manic-Depressive Insanity
Bipolar Disorders 100 years after manic-depressive insanity Edited by Andreas Marneros Martin-Luther-University Halle-Wittenberg, Halle, Germany and Jules Angst University Zürich, Zürich, Switzerland KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW eBook ISBN: 0-306-47521-9 Print ISBN: 0-7923-6588-7 ©2002 Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow Print ©2000 Kluwer Academic Publishers Dordrecht All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: http://kluweronline.com and Kluwer's eBookstore at: http://ebooks.kluweronline.com Contents List of contributors ix Acknowledgements xiii Preface xv 1 Bipolar disorders: roots and evolution Andreas Marneros and Jules Angst 1 2 The soft bipolar spectrum: footnotes to Kraepelin on the interface of hypomania, temperament and depression Hagop S. Akiskal and Olavo Pinto 37 3 The mixed bipolar disorders Susan L. McElroy, Marlene P. Freeman and Hagop S. Akiskal 63 4 Rapid-cycling bipolar disorder Joseph R. Calabrese, Daniel J. Rapport, Robert L. Findling, Melvin D. Shelton and Susan E. Kimmel 89 5 Bipolar schizoaffective disorders Andreas Marneros, Arno Deister and Anke Rohde 111 6 Bipolar disorders during pregnancy, post partum and in menopause Anke Rohde and Andreas Marneros 127 7 Adolescent-onset bipolar illness Stan Kutcher 139 8 Bipolar disorder in old age Kenneth I. Shulman and Nathan Herrmann 153 9 Temperament and personality types in bipolar patients: a historical review Jules Angst 175 viii Contents 10 Interactional styles in bipolar disorder Christoph Mundt, Klaus T. -
A4-Depression Disease Fact Sheet
Depression Fact Sheet What is Depression? Major depressive disorder (simply known as clinical depression or just depression) is a mental disorder that causes a persistent feeling of sadness and loss of interest¹. Depression is characterized by extended peCommonriods of low mo osymptd. It can lomsead to ainclude: variety of emotional and physical problems and can negatively affect a person's personal life as well as sleeping, eating habits, and general health decrease a person’s ability to function at work and at home. Key facts Depression is a common illness worldwide, with more than 264 million people affected². Major depression is one of the most common mental disorders with a 1-year prevalence of 7.1% with 2/3 having severe functional impairment but with only 1/3 seeking help³. Major depression reduces life expectancy by about 10 years. History The term depression derives from the Latin verb deprimere ("to press down"). The Greek physician Hippocrates årat described a syndrome of melancholia (“black bile”) characterized by all "fears and despondencies, if they last a long time"⁴. Depression became a synonym of melancholia by the end of the 19th century, probably thanks to the German psychiatrist Emil Kraepelin who was the årst to use it as a global term. The denomination “Major depressive disorder” was introduced the mid-1970s and was incorporated into the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III in 1980. Symptoms Not everyone who is depressed experiences every symptom of depression. In many cases, depression symptoms are severe enough to cause problems in daily activities, such as work, school, social activities or relationships. -
The Rise and Fall of the Diagnosis of Functional Psychoses: an Essay
Bergsholm P. Is Schizophrenia Disappearing? The Rise and Fall of the Diagnosis of JOURNAL OF MENTAL HEALTH Functional Psychoses: an Essay. J Ment Health Clin Psychol (2018) 2(4): 10-14 AND CLINICAL PSYCHOLOGY www.mentalhealthjournal.org Mini Review Article Open Access Is Schizophrenia Disappearing? The Rise and Fall of the Diagnosis of Functional Psychoses: an Essay Per Bergsholm* Department of Psychiatry, District General Hospital of Førde, Box 1000, 6807, Førde, Norway Article Info Abstract Article Notes The category diagnosis of functional psychoses builds on views of influential Received: June 01, 2018 professionals. Until the second half of the 1800s, the conceptions of mania and Accepted: July 19, 2018 melancholia from the Greek antiquity included largely all functional psychoses. *Correspondence: Disturbed mood and energy were central symptoms, and the idea of unitary Dr. Per Bergsholm, MD, PhD, Department of Psychiatry, psychosis prevailed. From the 1900s this was followed by a dichotomy between District General Hospital of Førde, Box 1000, 6807, Førde, schizophrenia and affective psychoses and broadening of the schizophrenia Norway; Email: [email protected]. concept. Affective symptoms were strongly downgraded. Many psychoses with mixed features were described, and there have now long been four main © 2018 Bergsholm P. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. categories of functional psychoses – affective, schizophrenic, schizoaffective/ cycloid/reactive/polymorphic, and delusional/paranoid psychoses. The last Keywords three are included in “psychotic disorders”. The boundaries between categories Affective have varied with time, place and professionals’ views. DSM-5 is updated with Category separate chapters for catatonia and psychotic symptoms, both unspecific, and Diagnosis removal of the subtypes of schizophrenia. -
Nonpharmacological Management of Dementia Charles T Nevels, MD
8/1/2018 Nonpharmacological Management of Dementia Charles T Nevels, MD Incidence of Neurocognitive disorders 1 in 9 individuals over 65 years of age have dementia 1 person develops dementia every 67 seconds in the United States Incidence of dementia almost doubles with every 5 year increase in age of a cohort. Per 2013-2014 CDC/CMS data 50.4% of all SNF patients have dementia More recent data shows the percentage increasing to near 60%. 2013-2014 CDC/CMS data shows 48.3% of all SNF patients have depression Researchers examined data on more than 3.7 million admissions to 15,600 facilities nationwide from 2012 to 2014. Even after excluding dementia and Alzheimer’s disease, which are a common causes of nursing home admissions, people with behavioral health issues account for about half of all residents, researchers note in the American Journal of Geriatric Psychiatry, 2018. With behavioral health problems, patients were also more likely to be sent to one- star homes, the lowest quality facilities, the study also found. Formal nomenclature for Dementia per DSM-5 is: Major/Minor Neurocognitive Disorders (with or without behaviors) Alzheimer’s disease (Probable/possible) Frontotemporal lobar degeneration (Probable/possible) Lewy Body disease (Probable/possible) Vascular disease (CVA, PVD, PAD, cerebrovascular ds, etc) Traumatic brain injury (TBI) Substance/medication – induced (ETOH, methamphetamine, etc) HIV infection Parkinson’s disease (Probable/possible) Huntington’s disease Prion disease 1 8/1/2018 A picture of Alois Alzheimer and his co‐workers in which Friedrich Lewy is standing to the very right side of the picture Other Causes Due to another medical condition, i.e. -
The Rise and Fall of the Diagnosis of Functional Psychoses: an Essay Per Bergsholm
Bergsholm BMC Psychiatry (2016) 16:387 DOI 10.1186/s12888-016-1101-5 DEBATE Open Access Is schizophrenia disappearing? The rise and fall of the diagnosis of functional psychoses: an essay Per Bergsholm Abstract Background: The categories of functional psychoses build on views of influential professionals. There have long been four main categories – affective, schizophrenic, schizoaffective/cycloid/reactive/polymorphic, and delusional/ paranoid psychoses. The last three are included in “psychotic disorders”. However, this dichotomy and the distinctions between categories may have been over-estimated and contributed to lack of progress. Ten topics relevant for the diagnosis of functional psychoses: 1. The categories of functional psychoses have varied with time, place and professionals’ views, with moving boundaries, especially between schizophrenia and affective psychoses. 2. Catatonia is most often related to affective and organic psychoses, and paranoia is related to grandiosity and guilt, calling in question catatonic and paranoid schizophrenia. Arguments exist for schizophrenia being a “misdiagnosis”. 3. In some countries schizophrenia has been renamed, with positive consequences. 4. The doctrine of “unitary psychosis”, which included abnormal affect, was left in the second half of the 1800s. 5. This was followed by a dichotomy between schizophrenia and affective psychoses and broadening of the schizophrenia concept, whereas affective symptoms were strongly downgraded. 6. Many homogeneous psychoses with mixtures of schizophrenic and affective symptoms were described and related to “psychotic disorders”, although they might as well be affective disorders. 7. Critique of the extensive schizophrenia concept led to, in DSM-III and ICD-10, affective symptoms being exclusion criteria for schizophrenia and acceptance of mood-incongruent psychotic symptoms in affective psychoses. -
Psychoses Is a Very Serious One and Any Explanation Tending Toward a More Accurate Diagnostic and Therapeutic Approach Requires Earnest Consideration
VOL. 17, 1931 PHYSIOLOGY: LANG AND PA TERSON This theory of mutation would account for differences in the rate of evolution of different organisms, differences in the rate of evolution at different periods in phylogenetic development, the genetic stability of certain genera and species over long periods of time, and the rare occur- rence of mutations in most of the existing species of plants and animals. Evolution would depend, to a considerable extent, on the emergent evolu- tion of the gene-duplication and deficiency of gene material in different quantities and in different structural combinations. Clausen, R. E., "Inheritance in Nicotiana Tabacum. X. Carmine-Coral Variega- tion," Cytologia, 1, 358-368 (1930). Dobzhansky, T., "Translocations Involving the Third and the Fourth Chromosomes of Drosophila Melanogaster," Genetics, 15, 347-399 (1930). Dobzhansky, T., "Cytological Map of the Second Chromosome of Drosophila Melano- gaster," Biol. Zentr., 50, 671-685 (1930). Morgan, T. H., Bridges, C. B., and Sturtevant, A. H., "The Genetics of Drosophila," Biblio. Gen., 2, 1-262 (1925). Painter, T. S., "A Cytological Map of the X-Chromosome of Drosophila Mfelwo- gaster," Science, 73, 647-648 (1931). Stadler, L. J., "The Experimental Modification of Heredity in Crop Plants," Sci. Agr., 11, 557-572 (1931). Sturtevant, A. H., "The Effects of Unequal Crossing-Over at the Bar Locus in Droso- phila," Genetics, 10, 117-147 (1925). A PRELIMINARY REPORT ON FUNCTIONAL PSYCHOSES By H. BECKETT LANG* AND JoHN A. PATERSON** MARCY STATE HOSPITAL, MARCY, N. Y. Read before the Academy Tuesday, November 17, 1931 The problem of the Dementia Praecox, Manic Depressive and Epileptic psychoses is a very serious one and any explanation tending toward a more accurate diagnostic and therapeutic approach requires earnest consideration. -
From Early Pioneers to Recent Brain Network Findings
Biological Psychiatry: Review CNNI Connectomics in Schizophrenia: From Early Pioneers to Recent Brain Network Findings Guusje Collin, Elise Turk, and Martijn P. van den Heuvel ABSTRACT Schizophrenia has been conceptualized as a brain network disorder. The historical roots of connectomics in schizophrenia go back to the late 19th century, when influential scholars such as Theodor Meynert, Carl Wernicke, Emil Kraepelin, and Eugen Bleuler worked on a theoretical understanding of the multifaceted syndrome that is currently referred to as schizophrenia. Their work contributed to the understanding that symptoms such as psychosis and cognitive disorganization might stem from abnormal integration or dissociation due to disruptions in the brain’s association fibers. As methods to test this hypothesis were long lacking, the claims of these early pioneers remained unsupported by empirical evidence for almost a century. In this review, we revisit and pay tribute to the old masters and, discussing recent findings from the developing field of disease connectomics, we examine how their pioneering hypotheses hold up in light of current evidence. Keywords: Association fibers, Connectomics, Dissociation, History of psychiatry, Integration, Schizophrenia http://dx.doi.org/10.1016/j.bpsc.2016.01.002 The hypothesis that schizophrenia is a disorder of brain connectomics in schizophrenia, Figure 1 shows a selection of connectivity has its roots in the 19th century, in which mental visionary scholars that contributed to the development of the illness was first attributed to the brain [for review, see (1)]. disconnectivity theory of schizophrenia. However, the methodological tools to test the disconnectivity Of note, the nomenclature in psychiatry has changed theory were long lacking, leaving it unsupported by neuro- substantially over the years (7).