Kraepelin's Description Research Articles

Kraepelin's description of chronic mania: a clinical picture that meets the behavioral variant frontotemporal dementia phenotype.

Chronic mania is an under-investigated condition and few reports have associated this disorder with an organic background. The present work examines Kraepelin's reliable description of chronic mania from a current behavioral neurology viewpoint. Kraepelin had described a cluster of symptoms that are now recognized as core manifestations of the behavioral variant frontotemporal dementia (bvFTD) clinical phenotype. We also carried out additional reviews of original manuscripts from Kraepelin's peers, in order to find any case reports that might fulfill the current diagnostic proposal for bvFTD. Even though we failed to find an ideal case, we found some scholars who seemed to agree that chronic mania should be considered a special form of dementia. The present work highlights, through historical data, the possible overlapping features between primary psychiatric disorders and neuropsychiatric symptoms secondary to neurodegenerative conditions.

P01-368 - Between schizophrenia and dementia

IntroductionEven Emil Kraepelin's description of dementia praecox emphasized the change in cognition and the long-term deteriorating course of schizophrenic patients, opposed to the ones having manic-depressive psychosis or paranoia.Currently, neurocognitive impairment is considered a core component of schizophrenia, particularly affecting the domains of attention, executive-frontal lobe function, working memory, and episodic memory. The dorsolateral prefrontal cortex has been implicated in cognitive disorganization and current therapeutic options have only a modest effect on this chronic disability. Although these impairments cannot function as diagnostic tools, they are strongly related to the functional outcome of the illness, and have significant prognostic value.Negative symptoms, such as poverty of speech or blunted affect, are among the most chronic symptoms of schizophrenia. They respond poorly to antipsychotics, and are widely suspected to reflect a dorsolateral frontal lobe dysfunction, as well. This negative dimension is associated with a poor long-term cognitive outcome and may be closely related to the primary cognitive deficit in schizophrenia.Objectives and methods: The authors aim to provide an overview of the existing literature regarding these dimensions of schizophrenia, and the hypotheses of a possible association between schizophrenia and dementia.Results and conclusionsGiven the prognostic value of mild cognitive impairment, and regardless of the evidence of frontal lobe dysfunction in schizophrenia, few studies have examined the longitudinal relationship between psychosis and the development of (frontotemporal) dementia. This theoretical association raises the possibility that these distinct entities could result from a common neurodegenerative pathway.

Hommage an Kraepelin zu seinem 150. Geburtstag - Zerfahrenheit: Kraepelins spezifisches Symptom für Schizophrenie

Kraepelin described but one single specific sign for all forms of dementia praecox (later: schizophrenia) and coined a new word for it, "Zerfahrenheit" (various translations: distraction, dilapidation, incoherence, among others). What he meant by it, clearly results from Kraepelin's description even now. The origin of the idea could been found in German philosophy of the times of enlightenment, when it had been described already in a distinct way. That time coined the word "Verrücktheit" for it (usual translation: mental derangement; better translations would be the same as for "Zerfahrenheit"). Because of the influence of French psychiatry with its quite different background and the hurly burly about paranoia (Heinroth's Greek translation for "Verrücktheit") the knowledge of the sign got lost. Kraepelin restored the original meaning, without referring however to the sources directly. In spite of having been acknowledged as a specific sign for dementia praecox by all German psychiatrists, only one decade after the first description a new process of unclearing recommenced. This bow curved from Eugen Bleuler via Kurt Schneider and others to DSM III/IV and ICD-10. In the current paper we follow Kraepelin's process of clearing via all 9 editions of his textbook of psychiatry. Since the German original of Kraepelin's first extended description currently can be found only in larger libraries, the integral text of it is being reprinted (in English a recent translation by Jacques M. Quen is available). No corrections or changes are necessary. Kraepelin's 150th birthday is the best occasion for reminding of what remains unique in the clinical unity of schizophrenia, which for ever is linked to his name. It still is a solid sign for schizophrenia, for all its various forms.

Cognitive effects of conventional and atypical antipsychotics in schizophrenia

“Mental efficiency is always diminished to a considerable extent. The patients are distracted, inattentive, tired, dull, do not take pleasure in work, their mind wanders, they lose the connection, they ‘cannot keep the thought in mind‘…” (Kraepelin, 1898)Cognitive dysfunction has long been recognised as a cardinal feature of schizophrenia, dating back to Kraepelin's description of dementia praecox (1919). Cognitive dysfunction in schizophrenia is seen early in the illness and is initially mild, increasing in severity in some chronic patients. It is recognised as a primary and pervasive deficit that is independent of positive symptoms in that it persists after resolution of acute symptoms. It is not restricted to a subgroup and is seen to a greater or lesser extent in almost all patients suffering from schizophrenia (Goldberg et al, 1990).

Personality antecedents of alcoholism in a national area probability sample.

Kraepelin viewed alcoholism as a symptom complex caused by heritable individual differences in emotional predisposition and volitional control. Recent clinical and genetic research has distinguished subtypes of alcoholics with different personality traits, symptoms, course, mode of inheritance, and response to treatment. The heritable personality traits that influence the initiation, continuation, and severity of alcoholism were examined by interview of a national area probability sample of 1019 non-institutionalized adults across the continental United States of America. We found that harm avoidance inhibits the initiation and frequency of drinking, but increases the risk of developing problems once frequent drinking has begun. Novelty seeking increases the initiation of drinking and the probabilities of frequent and problem drinking. This supports Kraepelin's description of the etiology and course of alcoholism as a symptom complex related to individual differences in emotional predisposition.

Wahnsyndrome bei sensorischer Beeinträchtigung - Überblick und Modellvorstellungen

Since Kraepelin's description of the "paranoia of the deaf" in 1915, the connection between sensory impairment and paranoid states in old age has been repeatedly confirmed. Parallels may be drawn to delusional syndromes caused or triggered by linguistic isolation, sensory aphasia and the perceptual disturbances in early schizophrenia. An overview on the different delusional phenomena in sensory-perceptual dysfunction is given, followed by a pathogenetic model proposed in analogy to the "perceptual-release" theory of hallucinations: Reduction of sensory input and blurring of afferent schemas in the perception process result in a compensatory stimulation and "release" of paranoid patterns of information processing. Consistency of perception is reestablished at the price of rigid, delusional interpretation of ambiguous social situations.

Historical essay: Kraepelin's description of Alzheimer's disease.

A translation is offered for the first time of Kraepelin's description of Alzheimer's Disease. It is discussed with regard to its context, and the importance that his elaboration gave to the discovery.

New directions in diagnosis: the longitudinal processes of schizophrenia.

Kraepelin's description of "dementia praecox" was a synthesizing influence in a field that had for too long been fragmented in its thinking about severe psychiatric disorders. Now, once again, the field is attempting to deal with some of the complexities involved in psychopathology and its evolution, complexities that have been reemphasized by newer descriptive research methods. To account for patients deviations from stereotyped diagnostic and prognostic concepts, multiple aspects of course of disorder have been defined and principles of multiaxial diagnosis supported. These principles can provide a basic structure for practice and research using a biopsychosocial orientation within the context of a system model.

Dementia Praecox and Paraphrenia.

The German psychiatrist Emil Kraepelin (1856 - 1926) is justly called father of modern psychiatry. He was the first to identify dementia praecox (schizophrenia) and manic-depression, and he pioneered the use of drugs to treat mental illness. He was also joint discoverer of Alzheimer's disease - which he named after his collaborator, Dr Alois Alzheimer. Kraepelin presented these and other discoveries in successive editions of his Psychiatrie: Ein Lehrbuch (definitive 8th edition also now available from Thoemmes Press). Much of this gigantic textbook can only be read in the original German; but parts of it were translated into English, and they had a very profound influence on the development of world psychiatry for the rest of the 20th century. Although Bleuler's name for the disease came to replace Kraepelin's term, Kraepelin's general description of the syndrome and division of it into subforms such as hebephrenia and catatonia has persisted. He succeeded in tying together into a single recognizable diagnostic category a disparate array of symptoms that, before Kraepelin, had not been seen as cohering. Despite myriad later refinements, Kraepelin's description of the syndrome is still the classic presentation; it very much lives on in the Diagnostic and Statistical Manual used by present-day psychiatrists. Dementia Praecox and Paraphrenia (1919) was the book in which Kraepelin first presented his work on schizophrenia to the English-speaking world. It was probably the most influential psychiatric text of the entire 20th century, and has now become rare. Thoemmes Press is pleased to make this facsimile of the first edition available as a single volume.