Classification Of Affective Disorders Research Articles

Emil Wilhelm Magnus Georg Kraepelin (1856–1926)

Back to table of contents Previous article Next article Images in PsychiatryFull AccessEmil Wilhelm Magnus Georg Kraepelin (1856–1926)Eric J. Engstrom Ph.D.Matthias M. Weber M.D.Wolfgang Burgmair Ph.D.Eric J. Engstrom Ph.D.Search for more papers by this authorMatthias M. Weber M.D.Search for more papers by this authorWolfgang Burgmair Ph.D.Search for more papers by this authorPublished Online:1 Oct 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Remembering Emil Kraepelin in 1956, Francis J. Braceland lamented that contemporary neophytes, who brandished the epithet “father of descriptive psychiatry,” threatened to consign Kraepelin’s legacy to the dustbin of history (1). Today, however, on the occasion of his 150th birthday, Kraepelin’s legacy is as vibrant and contested as ever. His distinction between dementia praecox (later schizophrenia) and manic-depressive illness, especially the classification of affective disorders, has come to pervade psychiatric thought and practice. Kraepelin’s famous nosology evolved in the context of two important developments within German psychiatry in the 1860s and 1870s. On the one hand, it was a reaction to the collapse of the concept of unitary psychosis (i.e., the hypothesis that all psychiatric symptoms were manifestations of one single mental disorder). That hypothesis had been undermined by the clinical studies of Karl Ludwig Kahlbaum and Ewald Hecker, whose descriptions of catatonia and hebephrenia suggested the existence of discrete psychiatric disorders. On the other hand, Kraepelin’s nosology evolved from a critique of cerebral pathologists, such as Theodor Meynert and Paul Flechsig. Kraepelin criticized their efforts to link brain anatomy with clinical symptomatology as speculative and lacking empirical foundation. In search of alternatives, Kraepelin forged ahead in two directions. First, he turned to Wilhelm Wundt’s experimental psychology to study mental processes. In numerous stimulus reaction experiments, Kraepelin’s early research investigated the effects of exhaustion and various pharmacological stimulants on mental functioning. His aim was to generate quantifiable psychological norms that could be used to diagnose mental deviance. Second, he embarked on clinical research on the long-term course of his patients’ illnesses. He was convinced that careful, longitudinal documentation would enable him to delineate specific disease entities. He began systematically to collect and catalog hundreds of patient histories, developing elaborate research strategies and diagnostic instruments, such as his famous diagnostic cards ( Zählkarten ). On the basis of this clinical research, Kraepelin crafted a nosology that reshaped 20th-century psychiatry (2, 3). The pervasive influence of his nosology is attributable not simply to the validity of its categories; indeed, Kraepelin himself expected the advance of science to overtake them (2). Rather, it is also an outgrowth of his effectiveness as a teacher and administrator. An entire generation of students was influenced by his textbook—which saw eight editions published in his lifetime—and by his conviction that effective psychiatric care demanded strong institutional support. Later in his career, Kraepelin’s interests turned to public health issues. A convinced social-Darwinist, he became a fervent advocate of alcoholic abstinence and actively promoted a policy and research agenda in eugenics and racial hygiene (4). He was deeply concerned about the impact of urban life on mental health and was convinced that institutions such as the welfare state and the education system—because they tended to contravene the processes of natural selection—subverted the German people’s biological “struggle for survival” (5). Kraepelin believed that psychiatric science would help to alleviate the deleterious effects of modern civilization. Not least spurred on by the catastrophic human losses of the First World War, he founded the German Research Institute of Psychiatry ( Deutsche Forschungsanstalt für Psychiatrie ) in 1917, which in the 1920s became a mecca for psychiatric researchers from around the globe. Photograph shows Kraepelin on board the Oceana on his way to the International Medical Congress in Lisbon, 1906. Image courtesy of the Historical Archives of the Max-Planck-Institute of Psychiatry, Munich, Germany. Address correspondence and reprint requests to Dr. Weber, Max-Planck-Institute of Psychiatry, Historical Archives, Kraepelinstrasse 2-10, D-80804 Munich, Germany; [email protected] (e-mail). Supported by the Stiftung Deutsche Forschungsanstalt für Psychiatrie, Munich, Germany.

Multivariate statistical methods in the classification of affective disorders

Multivariate statistical methods in the classification of affective disorders

Current concepts of the classification of affective disorders.

The introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which uses a descriptive approach to operational definitions of psychiatric diagnostic groups, is an important step forward. Still the present classification systems of DSM or the International Classification of Diseases (ICD) are preliminary. A systematic descriptive approach based on data collection as a foundation for diagnostic definitions is strongly recommended. Data-based definitions have a good change of surviving later changes of diagnostic fashion. Treatment studies will be more valuable when the course of a disorder is included in its definition. The diagnosis of depression has to include operationalized subthreshold syndromes, such as minor depression and recurrent brief depression. In the face of the elementary importance of the distinction between uni- and bipolar disorders, a development of the definition of hypomania is proposed. Based on this definition, bipolar disorders are more prevalent in the normal population than is commonly assumed. Most diagnostic subgroups of depression are artificial. They are not diagnostic entities, but subtypes of the same spectrum disorder. During his/her lifetime, a patient may therefore receive two or more diagnoses, but still suffer from a single disorder. Dual diagnoses, such as double depression and combined depression, define more severely affected patients with major depression, characterized by higher suicide attempt rates. Thus the differentiation of subgroups is more than an academic exercise but has a practical use.

The classification of affective disorders.

The classification of affective disorders.

Classification of Affective Disorders

Classification of Affective Disorders

Symposium on new approaches to diagnosis and treatment of affective disorders. Introduction.

British Journal of Clinical PharmacologyVolume 19, Issue S1 p. 5S-6S Free Access Symposium on new approaches to diagnosis and treatment of affective disorders. Introduction. A Clare, A ClareSearch for more papers by this author A Clare, A ClareSearch for more papers by this author First published: February 1985 https://doi.org/10.1111/j.1365-2125.1985.tb02735.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References Feinstein, A. R. (1978). A critical overview of diagnosis in psychiatry. In Psychiatric diagnosis, eds V. M. Rakoff, H. C. Stancer & H. B. Kedward, chap. 9. pp 189– 206. Johnson, D. A. W. (1974). A study of the use of antidepressant medication in general practice. Br. J. Psychiatry, 125, 186– 192. Kiloh, L. G. & Garside, R. F. (1963). The independence of neurotic and endogenous depression. Br. J. Psychiatry, 109, 451– 463. Leonhard, K. (1972). Aufteilung der endogenen Psychosen in der Forschungsrichtung von Wernicke und Kleist. In Psychiatrie der Gegen-wart: Forschung und Praxis, eds. K. P. Kisker, J. E. Meyer, M. Muller & E. Stromgren Klinische Psychiatrie i. Berlin: Springer Verlag. Lewis, A. J. (1934). Melancholia: a historical review. J. Mental Sci., 80, 1– 42. Paykel, E. S. (1971). Classification of depressed patients: a cluster analysis derived grouping. Br. J. Psychiatry, 118, 275– 288. Robins, E. & Guze, S. B. (1972). Classification of affective disorders: The primary-secondary, the endogenous-reactive and the neurotic-psychotic. In Recent advances in the psychobiology of depressive illness, eds. T. A. Williams, M. M. Katz & J. A. Shield Washington, D.C.: U.S. Government Printing Office. Tyrer, P. (1978). Drug treatment of psychiatric patients in general practice. Br. med. J., 2, 1008– 1010. Weissman, M. M. (1981). Depression and its treatment in a US urban community. Arch. gen. Psychiatry, 38, 417– 421. Volume19, IssueS1February 1985Pages 5S-6S ReferencesRelatedInformation

The DSK‐III Classification of Affective Disorders

The DSK‐III Classification of Affective Disorders

The genetics of depression. A family study of unipolar and neurotic-reactive depressed patients.

Sixty unipolar (23 male and 37 female) patients and 67 patients (25 male and 42 female) suffering from a neurotic-reactive depressive disorder, consecutively admitted to the Department of Psychiatry of Umeå University have participated in a family study aimed at identifying morbidity risks for psychiatric illnesses among first degree relatives (n = 437). Besides the classification of affective disorders used in Umeå for research purposes the patients have been classified, according to the ICD-9, DSM-III, age at onset (below or above 40 years), and the Winokur's classification of primary affective disorders. However, only the findings regarding the Umeå classification and the Winokur's classification are given in the present article. Of the patients 90% fulfilled Kendell's criteria for depression at the time of the investigation whereas the others were in a phase of remission when studied. The diagnosis of secondary cases were made without knowledge of the diagnoses of the probands. Among relatives of unipolar probands only two secondary cases of bipolar affective disorder were found--one among parents, and one among siblings (MR% 1.1 and 0.6 respectively). The overall morbidity risk for affective disorders (MR% 22.8 among parents and 15.5 among siblings) proved to be higher than in previous studies. In the families of neurotic-reactive patients the morbidity risk for bipolar affective disorders was also very low (MR% 1.0 among parents and 0.7 among siblings), whereas the overall MR% for affective disorders proved to be surprisingly high (12.1 among parents and 6.7 among siblings). No increased risk for schizophrenia or alcoholism was found among the relatives of either group. When the relatives were divided according to their sex no clear-cut difference in morbidity risk emerged when fathers and brothers were compared with mothers and sisters but alcoholisms occurred more frequently in male relatives. Preliminary findings in second degree relatives suggest that secondary cases of affective disorders might occur among second degree relatives of patients classified as suffering from "sporadic depression" according to Winokur's classification.

Problems in the classification of affective disorders.

Some of the concepts which have figured prominently in recent studies of the classification of affective disorders are examined. The include the "primary-secondary", the "bipolar--unipolar" and the depression/anxiety dichotomy. The problems posed by these three principles are closely entwined with one another. Inconsistencies in diagnosis will arise from the application of these principles until a broad consensus has been achieved regarding the nature of the relationship between "vital" or "endogenous" depression and other disorders of affect. Allocation into one of these two broad categories has to be made prior to all other diagnostic decisions within the field on affective disorder. Hence differences in the classification and nomenclature of emotional illness between the United States and European countries will cause groups of patients comprising "unipolar", "primary" and "secondary" disorders to differ in composition until divergent viewpoints have been resolved. There is a hierarchial order implicit in the Kraepelinian system of classification which should be made more explicit; it would foster standardisation and consistency in diagnostic practice. But the order of precedence should be regarded as a set of hypotheses rather than fixed rules. Some recent observations regarding schizo-affective and schizomanic disorders have refused one of these hypotheses and so refined knowledge.

The classification of affective disorders: A synthesis of old and new concepts

The classification of affective disorders: A synthesis of old and new concepts

The classification of affective disorders — A reassessment of the bipolar-unipolar dichotomy: A clinical, laboratory, and family study

We studied a sample of 26 unipolar and 134 bipolar probands for a selection of familial, demographic, clinical and laboratory variables. We found a high proportion of unipolar illness in the relatives of bipolar probands and bipolar illness in the relatives of unipolar probands, inconsistent with the present dichotomous classification of affective disorders. The two groups were also similar on a number of clinical and demographic variables, and displayed equal amounts of cortical dysfunction as measured by electroencephalographic and neuropsychological techniques. The groups differed significantly on only 2 variables, with unipolars having a greater proportion of females and a later onset age than bipolars. We interpret these findings to be suggestive of homogeneity rather than heterogeneity for the more severe forms of affective disorder and offer several alternatives to the present unipolar/bipolar dichotomy which require further testing.

The classification of affective disorders.

The classification of affective disorders.

Studies in the classification of affective disorders. The relationship between anxiety states and depressive illnesses. II.

This is the second of two papers dealing with the classification of affective disorders in which the relationship between anxiety states and depressive illnesses is examined. The question at issue is whether a line of demarcation may be drawn between the two disorders or whether they are more appropriately regarded as merging insensibly along a continuum of affective disturbance.

Studies in the classification of affective disorders. The relationship between anxiety states and depressive illnesses. I.

Disorders in which anxiety or depression is the predominant feature constitute a large part of contemporary psychiatric practice. They are also being increasingly recognized as the underlying causes of many conditions in general medicine and family practice for which, even after prolonged investigation, no physical basis can be discovered.

Unipolar and bipolar primary affective disorder.

The classification of affective disorders has been a topic of controversy for years. The literature is filled with tentative attempts to order this large group of patients. Such attempts have brought surprisingly little resolution of the issues involved. There are those who would make numerous subdivisions within the affective disorders, and others who see affective illness as a unitary disorder.