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Bfm:978-3-7091-6371-9/1.Pdf Karl Leonhard Classification of Endogenous Psychoses and their Differentiated Etiology Second, revised and enlarged edition Edited by Helmut Beckmann Springer-Verlag Wien GmbH Prof. Dr. med. Dr. h. c. Helmut Beckmann Psychiatrische Klinik und Poliklinik, Universit:âts-Nervenklinik, Wiirzburg, Deutschland Prof. Dr. Karl Leonhardt, Berlin Translated from German by Charles H. Cahn Originally published as A ufteilung der endogenen Psychosen und ihre diJJerenzierte Atiologie, 7. neubearbeitete und ergiinzte Auflage © 1995 Thieme, Stuttgart The first English edition was published by Irvington Publishers, Ine., © 1979 This work is subject to copyright. AlI rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machines or similar means, and storage in data banks. © 1999 Springer-Verlag Wien Originally published by Springer-Verlag Wien New York in 1999 Softcover reprint of tbe hardcover 2nd edition 1999 Typesetting: Bernhard Computertext KG, A-I030 Wien Graphic design: Ecke Bonk Printed on acid-free and chlorine-free bleached paper SPIN: 10711564 Library of Congress Cataloging-in-Publication Data Leonhard, Karl, 1904- [Aufteilung der endogenen Psychosen und ihre differenzierte Ătiologie, English] Classification of endogenous psychoses and their differentiated etiology / Karl Leonhard. -- 2nd, rev. and enlarged ed. / edited by He1mut Beckmann. p. cm. Previously published: Classification of endogenous psychoses. New York: Irvington Publishers, 1979. "Originally published as: Aufteilung der endogenen Psychosen und ihre differenzierte Ătiologie, 7. neubearbeitete und ergănzte Auflage. © 1995 Thieme, Stuttgart" -- CIP t.p. verso. Inc1udes bibliographical references and index. ISBN 978-3-7091-7308-4 ISBN 978-3-7091-6371-9 (eBook) DOI 10.1007/978-3-7091-6371-9 1. Psychoses Classification. 1. Beckmann, Helmut, 1940- . II. Leonhard, Karl, 1904-Aufteilung der endogenen Psychosen. English. III. Title. RCS12.L413 1999 616.89'001'2- -dc21 ISBN 978-3-7091-7308-4 Editor's Comment Half a century ago KOLLE spoke about the "Oracle of Delphi of the Endoge­ nous Psychoses". Since then in spite of all innovations and technological achievements in the past decades this pronouncement has not lost anything of its significance and its application to the present day research situation. Mental and emotional disorders belong to the large group of"diseases of the people". From the public health point of view they are of extraordinary import for every community. Accordingly, some countries have generously supported research efforts in the neurosciences as well as in the physical sciences with the aim of achieving tangible progress in prevention and pre­ cise diagnosis, as well as rehabilitation. Such efforts have amongst others led to the declaration of the "Decade of the Brain" in the United States and more recently to that of the "World Decade of the Brain" in which all inter­ national societies concerned with the problem of mental health and rehabi­ litation have set the objective of introducing and carrying out more effective measures. However public support should not be overemphazised. Compared with cardiovascular diseases, rheumatic disorders, neurological conditions such as multiple sclerosis etc. the support for research in the psychoses is compa­ rably scanty and in many countries of the world completely absent. Psychiatry in the true sense of the word has achieved objective progress only since, beginning with the Age of Enlightenment, it has become more closely allied with the natural sciences, and through the influence of some prominent representatives, such as PINEL in France and GRIESINGER in Ger­ many, become associated with facuIties of medicine. This desirable situation has only been attained in some parts of the world; setbacks are continually experienced and peculiar amalgamations take place between the natural sci­ ences and shamanism. With the 7th new edition of Karl LEONHARD'S "Classification of Endogenous Psychoses and their Differentiated Etiology" the "World Decade ofthe Brain", proclaimed in 1990 approaches its middle. Results from the so­ called endogenous psychoses have so far been sparse. It is true that some symptoms of these disorders may be relieved with neuroleptic dmg therapy; cures however have not been achieved. Nothing is known about effective prevention. For the affective disorders the introduction of lithium as a pro­ phylactic measure is noteworthy, but even this treatment is not entirely reli­ able and may be associated with undesirable side effects placing an undue burden on the patient. The treatment of endogenous psychoses has almost VI Editor's Comment stood still in the last three decades. It is still necessary to use partly effective and insufficiently reliable chemical substances in our treatment. In spite of all the enticements of modern marketing strategies better medications have not yet been found. It is worth remembering that already in the 19th century (for instance KAI-lLBAUM and several French authors) a number of nosological entities had been described among the endogenous psychoses. In the same century, how­ ever, researchers such as Heinrich NEUMANN and Wilhelm GRIESINGER had postulated a "unitary psychosis". Emil KRAEPELIN (1856-1925) proposed a partial compromise by separat­ ing the large field of dementia praecox with unfavorable prognosis from the field of manic-depressive conditions with favorable prognosis. This cre­ ation of a bimodal concept led to a dichotomy which for research has not proved to be very fruitful up to the present time. In spite of this subdivision KRAEPELIN described masterfully many subcategories, taking into acount cross-sectional and longitudinal symptomatology which even today may be considered to be quite valid, but towards the end of his life he lost the strength to develop this classification further. Eugen BLEULER (1857-1939) took over the concept of dementia praecox/manic-depressive illness, but completely ignored the prognostic aspects which KRAEPELIN (apart from a few exceptions) had held to be of greatest value. Thus he combined a large proportion of psychoses, which KRAEPELI had included under the manic­ depressive illnesses, with the conditions which he now called "schizophre­ nias" or "schizophrenia". He himself was convinced that he was dealing with several nosological entities; nevertheless it is a tragic aspect of his creative research that all his life he was looking for so-called "basic disturbances" of "schizophrenia", which of course he did not find, because they do not exist. BLEULER did not bluntly reject FREun's psychoanalysis; his positive attitude helped by Adolf MAYER resulted in his being made to feel welcome in Anglo­ American psychiatry. Furthermore his cross-sectional symptomatological description, leaving aside prognosis, was accepted there more easily, for example by MAYER-GROSS. During the last several decades at certain intervals of time and with good intention classification systems have been worked out by psychologists and psychiatrists by means ofvoting and consensus; descriptions of these systems come into the hands ofmental health professionals in great regularity in the form of authoritative guidelines. All too easily it is being overlooked that behind it all no progress is made in research, merely restructurization. The latter has not been derived from lifelong observations of patients. Therefore from the scientific point ofview this remains at least questionable. Interrater reliability keeps on being stressed at the expense of clinical validity. It even happened that clinical investigations requiring a high degree of knowledge and experience possessed by only the most skilful were delegated to "trained" students, psychologists, and scientific assistants in their first years of apprenticeship. Of course such mathematically attractive results cannot provide satisfaction. Witness the fruitlessness ofour decades long research. }.'ditors Comment VTI Contemporaneously with KRAEPELIN'S efforts Carl WERNICKE (1848-1905) in Berlin, Breslau and later Halle worked in the field of central neurology (particularly ofaphasia) as well as in the field ofdescriptive psychiatry, From his findings in psychopathology he repeatedly postulated a "theory of dis­ junction" ("Sejunktionstheorie"), that is, an interruption of the connections between neural systems, leading either to a loss of functions, an excess of function or a faulty function. This disjunction may, for example in the area of psychomotility, lead to akinesia, hyperkinesia, or parakinesia. He sug­ gested that a similar process occurred in thinking and in disturbances of the will. In so doing he found a powerful opponent in Karl JASPERS, who labelled him as a "brain mythologist". JASPERS had evidently overlooked the essential element in Wernicke's research, that is the careful elaboration of psy­ chopathological conditions in cross-section as well as in their longitudinal course; even today in their precision WERNICKE'S descriptions are of great value. Among other surviving concepts WERNICKE coined the terms "akine­ sia", "hyperkinesia", "anxiety psychosis". His pupil Karl KLEIST (1879-1960) followed WERNICKE in neurology as well as in psychiatry and psychopathology; by means of extensive studies of patients with brain trauma, KLEIST thoroughly confirmed and expanded WERNICKE'S observations (TEICHMANN 1990). Differences between WERNICKE and KRAEPELIN became
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