Abstract. The historical roots of dementia praecox and schizophrenia are described in the context of . dementia praecox paranoides and paraphrenia, The Journal of Nervous and Mental Disease: October – Volume 54 – Issue 4 – ppg BOOK REVIEW: PDF Only. Source. DEMENTIA PRAECOX AND. Get this from a library! Dementia praecox and paraphrenia. [Emil Kraepelin; George M Robertson; R Mary Barclay].
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Dementia praecox a “premature dementia” or “precocious madness” is a disused psychiatric diagnosis that originally designated a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood.
Over the years, the term “dementia praecox” was gradually replaced by ” schizophrenia “, which remains in current diagnostic use. The term “dementia praecox” was first used in by Arnold Pick —a professor of psychiatry at Charles University in Prague. German psychiatrist Emil Kraepelin — popularised it in his first detailed textbook descriptions of a condition that eventually became a different disease concept and relabeled as schizophrenia.
This division, commonly referred to as the Kraepelinian dichotomyhad a fundamental impact on twentieth-century psychiatry, though it has also been questioned.
The primary disturbance in dementia praecox was seen to be a disruption in cognitive or mental functioning in attention, memory, and goal-directed behaviour. Kraepelin contrasted this with manic-depressive psychosis, now termed bipolar disorderand also with other forms of mood disorderincluding major depressive disorder. He eventually concluded that it was not possible to distinguish his categories on the basis of cross-sectional symptoms.
Dementia praecox – Wikipedia
Kraepelin viewed dementia praecox as a progressively deteriorating disease from which no one recovered. However, byand more explicitly byKraepelin admitted that while there may be a residual cognitive defect in most cases, the prognosis was not as uniformly dire as he had stated in the s. Still, he regarded it as a specific disease concept that implied incurable, inexplicable madness. Dementia is an ancient term which has been in use since at least the time of Lucretius in 50 B.
This condition could be innate or acquired, and the concept had no reference to a necessarily irreversible condition. It is the concept in this popular notion of psychosocial incapacity that forms the basis for the idea of legal incapacity. Moreover, it was now understood as an irreversible condition and a particular emphasis was placed on memory loss in regard to the deterioration of intellectual functions.
It was applied as a means of setting apart a group of young men and women who were suffering from “stupor. He did not conceptualise their state as irreversible and thus his use of the term dementia was equivalent to that formed in the eighteenth century as outlined above.
Indeed, until the advent of Pick and Kraepelin, Morel’s term had vanished without a trace and there is little evidence to suggest that either Pick or indeed Kraepelin were even aware of Morel’s use of the term until long after they had published their own disease concepts bearing the demdntia name.
Morel described several psychotic disorders that ended in dementia, and as a result he may be regarded as the first alienist or psychiatrist to develop a diagnostic system based snd presumed outcome rather than on the current presentation of signs and symptoms.
Morel, however, did not conduct any long-term or quantitative research on the course and outcome of dementia praecox Kraepelin would be the first in history to do that so this prognosis was based on speculation. It is impossible to discern whether the condition briefly described by Morel was equivalent to the disorder later called dementia praecox by Pick and Kraepelin. Psychiatric nosology in the nineteenth-century was chaotic and characterised by a conflicting mosaic of contradictory systems.
Inthe Danzig -based psychiatrist Karl Ludwig Kahlbaum — published his text on psychiatric nosology Die Gruppierung der psychischen Krankheiten The Classification of Psychiatric Diseases.
He was accompanied by his younger assistant, Ewald Hecker —and during a ten-year collaboration they conducted a series of research studies on young psychotic patients that would become a major influence on the development of modern psychiatry. Together Kahlbaum and Hecker were the paraphhrenia to describe and name such syndromes as dysthymiacyclothymiaparanoiacatatoniaand hebephrenia. When the element of time was added to the concept of diagnosisa diagnosis became more than just a description of a collection of symptoms: An additional feature of the clinical method was that the characteristic symptoms that define syndromes should be described without any prior assumption of brain pathology although such links would be made later as scientific knowledge progressed.
Karl Kahlbaum made an appeal for the adoption of the clinical method in psychiatry in his book on catatonia.
Without Kahlbaum and Hecker there deentia be no dementia praecox. Upon his appointment to a full professorship in psychiatry at the University of Dorpat now TartuEstonia inKraepelin gave an inaugural address to the faculty outlining his research programme for the years ahead. Attacking the prwecox mythology” of Meynert and the positions of Griesinger and GuddenKraepelin advocated that the ideas of Kahlbaum, who was then a marginal and little known figure in psychiatry, should be followed. Therefore, he argued, a ahd programme into the nature of psychiatric illness should look at a large number of patients over time to discover the course which mental disease could take.
Understanding that objective diagnostic methods must be based on scientific practice, Kraepelin had been conducting psychological and drug experiments on patients and normal subjects for some time when, inhe left Dorpat and took up a position as professor and director of the psychiatric clinic at Heidelberg University.
There he established a research program based on Kahlbaum’s proposal for a more oraecox qualitative clinical approach, and his own innovation: Kraepelin believed that by thoroughly describing praceox of the clinic’s new patients on index cards, which he had been using sinceresearcher bias could be eliminated from the investigation process.
After a while, the notes were taken out of the box, the diagnoses were listed, and the case was closed, the final interpretation of the disease was added to the original diagnosis.
In this way, we were able to see what kind of mistakes had been made and were able to follow-up the reasons for the wrong original diagnosis. The fourth edition of his textbook, Psychiatriepublished intwo years after his arrival at Heidelberg, contained some impressions of the patterns Kraepelin had begun to find in his index cards. Prognosis course and outcome began to feature alongside signs and symptoms in the description of syndromes, and he added a class of psychotic disorders designated “psychic degenerative processes”, three of which were borrowed from Kahlbaum and Hecker: Kraepelin continued to equate dementia praecox with hebephrenia for the next six years.
In the March fifth edition of PsychiatrieKraepelin expressed confidence that his clinical methodinvolving analysis of both qualitative and quantitative data derived from long term observation of patients, would produce reliable diagnoses including prognosis:. What convinced me of the superiority of the clinical method of diagnosis followed here over the traditional one, was the certainty with which we could predict in conjunction with our new concept of disease the future course of events.
Thanks to it the student can now find his way more easily in the difficult subject of psychiatry. In this edition dementia praecox is still essentially hebephrenia, and it, dementia paranoides and catatonia are described as distinct psychotic disorders among the “metabolic disorders leading to dementia”. In the 6th edition of PsychiatrieKraepelin established a paradigm for psychiatry that would dominate the following century, sorting most of the recognized forms of insanity into two major categories: Dementia praecox was characterized by disordered intellectual functioning, whereas manic-depressive illness was principally a disorder of affect or mood; and the former featured constant deterioration, virtually no recoveries and a poor outcome, while the latter featured periods of exacerbation followed by periods of remission, and many complete recoveries.
The class, dementia praecox, comprised the paranoid, catatonic and hebephrenic psychotic disorders, and these forms were found in the Diagnostic and Statistical Manual of Mental Disorders until the fifth edition was released, in May These terms, however, are still found in general psychiatric nomenclature.
The ICD still uses “hebephrenic” to designate the third type. In the seventh,edition of PsychiatrieKraepelin accepted the possibility that a small number of patients may recover from dementia praecox. Eugen Bleuler reported in that in many cases there was no inevitable progressive decline, there was temporary remission in some cases, and there were even cases of near recovery with the retention of some residual defect.
In the eighth edition of Kraepelin’s textbook, published in four volumes between andhe described eleven forms of dementia, and dementia praecox was classed as one of the “endogenous dementias”. Kraepelin died while working on the ninth edition of Psychiatrie with Johannes Lange —who finished it and brought it to publication in Though his work and that of his research associates had revealed a role for heredity, Kraepelin realized nothing could be said with certainty about the aetiology of dementia praecox, and he left out speculation regarding brain disease or neuropathology in his diagnostic descriptions.
Both theorists insisted dementia praecox is a biological disorder, not the product of psychological trauma. Thus, rather than a disease of hereditary degeneration or of structural brain pathology, Kraepelin believed dementia praecox was due to a systemic or “whole body” disease process, probably metabolic, which gradually affected many of the tissues and organs of the body before affecting the brain in a final, decisive cascade.
Kraepelin had experimented with hypnosis but found it wanting, and disapproved of Freud’s and Jung’s introduction, based on no evidence, of psychogenic assumptions to the interpretation and treatment of mental illness. He argued that, without knowing the underlying cause of dementia praecox or manic-depressive illness, there could be no disease-specific treatment, and recommended the use of long baths and the occasional use of drugs such as opiates and barbiturates for the amelioration of distress, as well as occupational activities, where suitable, for all institutionalized patients.
Based on his theory that dementia praecox is the product of autointoxication emanating from the sex glands, Kraepelin experimented, without success, with injections of thyroid, gonad and other glandular extracts. Kraepelin noted the dissemination of his new disease concept when in he enumerated the term’s appearance in almost twenty articles in the German-language medical press.
But it was not until and that the first three American publications regarding dementia praecox appeared, one of which was a translation of a few sections of Kraepelin’s 6th edition of on dementia praecox.
Adolf Meyer was the first to apply the new diagnostic term in America. He used it at the Worcester Lunatic Hospital in Massachusetts in the fall of He was also the first to apply Eugen Bleuler’s term “schizophrenia” in the form of “schizophrenic reaction” in at the Henry Phipps Psychiatric Clinic of the Johns Hopkins Hospital. The dissemination of Kraepelin’s disease concept to the Anglophone world was facilitated in when Ross Diefendorf, a lecturer in psychiatry at Yale, published an adapted version of the sixth edition of the Lehrbuch der Psychiatrie.
This was republished in and with a new version, based on the seventh edition of Kraepelin’s Lehrbuch appearing in and reissued in The term lived on due to its promotion in the publications of the National Committee on Mental Hygiene founded in and the Eugenics Records Office But perhaps the most important reason for the longevity of Kraepelin’s term was its inclusion in as an official diagnostic category in the uniform system adopted for comparative statistical record-keeping in all American mental institutions, The Statistical Manual for the Use of Institutions for the Insane.
Its many revisions served as the official diagnostic classification scheme in America until when the first edition of the Diagnostic and Statistical Manual: Schizophrenia was mentioned as an alternate term for dementia praecox in demetnia Statistical Manual. In both clinical work as well as research, between and five different terms were used interchangeably: This made the psychiatric literature of the time confusing since, in a strict sense, Kraepelin’s disease was not Bleuler’s disease.
Demeentia were defined differently, had different population parameters, and different concepts of prognosis. The reception of dementia praecox as an accepted diagnosis in British psychiatry came more slowly, perhaps only taking hold around the time of World War I.
There was substantial opposition to the use of the term “dementia” as misleading, partly due to findings of remission and recovery. Some argued that existing diagnoses such as “delusional insanity” paraphreniw “adolescent insanity” were better or more clearly defined. Instead the French maintained an independent classification system throughout the 20th century.
Fromwhen DSM-III totally reshaped psychiatric diagnosis, French psychiatry began to finally alter its views of diagnosis to converge with the North American system. Kraepelin thus finally conquered France via America. In Bleuler’s schizophrenia rose in prominence as an alternative to Kraepelin’s dementia praecox.
When Freudian perspectives became influential in American psychiatry in the s schizophrenia became an attractive alternative concept.
Bleuler corresponded with Freud and was connected to Freud’s psychoanalytic movement,  and the inclusion of Freudian interpretations of the symptoms of schizophrenia in his publications on the subject, as well as those of C.
Jung, eased the adoption of his broader version of dementia praecox schizophrenia in America over Kraepelin’s narrower and prognostically more negative one. The term “schizophrenia” was first applied by American alienists and neurologists in private practice by and officially in institutional settings inbut it took many years to catch on. It is first mentioned in The New York Times in Until the terms dementia praecox and schizophrenia were used interchangeably in American psychiatry, with occasional use of the hybrid terms “dementia praecox schizophrenia ” or “schizophrenia dementia praecox “.
Editions of the Diagnostic and Statistical Manual of Mental Disorders since the first in had reflected views of schizophrenia as “reactions” or “psychogenic” DSM-Ior as manifesting Freudian notions of “defense mechanisms” as in DSM-II of in which the symptoms of schizophrenia were interpreted as “psychologically self-protected”.
The diagnostic criteria were vague, minimal and wide, including either concepts that no longer exist or that are now labeled as personality disorders for example, schizotypal personality disorder.
There was also no mention of the dire prognosis Kraepelin had made. Schizophrenia seemed to be more prevalent and more psychogenic and more treatable than either Kraepelin or Bleuler would have allowed.
As a direct result of the effort to construct Research Diagnostic Criteria RDC in the s that were independent of any clinical diagnostic manual, Kraepelin’s idea that categories of mental disorder should reflect discrete and specific disease entities with a biological basis began to return to prominence.
Vague dimensional approaches based on symptoms—so highly favored by the Meyerians and psychoanalysts—were overthrown. For research purposes, the definition of schizophrenia returned to the narrow range allowed by Kraepelin’s dementia praecox concept. Furthermore, after the disorder was a progressively deteriorating one once again, with the notion that recovery, if it happened at all, was rare.
Some of the psychiatrists who worked to bring about this revision referred to themselves as the “neo-Kraepelinians”. From Wikipedia, the free encyclopedia. Scientific American Mind March Retrieved 2 March Dowbiggin inaccurately states that Morel used the term on page of the first volume of his publication Etudes cliniques Dowbigginp.