Diagnosis and course of affective psychoses: was Kraepelin right?

STUDY BASED DISCUSSION

Abstract

Kraepelin’s basic attitude to the classification of psychoses was data-oriented and flexible. In his latter years he was close to revising his own celebrated dichotomy between manic-depressive insanity and dementia praecox in order to take account of a large group of intermediate psychoses, which today are called schizo-affective. His concept of a continuum from healthy to ill has stood the test of time and corresponds to modern epidemiological findings. Kraepelin’s unitarian concept of manic-depressive insanity did not survive. It was differentiated and broken down into several subgroups, and a proportional diagnostic spectrum with a continuum from mania via bipolar disorders to depression has recently even been proposed. Bipolar disorders would in that case be comorbid disorders of mania plus depression. In contrast to Kraepelin’s unitarian view the long-term prognosis of subgroups of mood disorders varies considerably. Overall it is nevertheless astonishing how much of Kraepelin’s legacy has survived.

Key words

affective disorders schizo-affective disorders spectrum 

Notes

Disclosure

The authors have no conflict of interest to declare.

References

  1. 1.
    Angst J (2007) The bipolar spectrum. Br J Psychiatry 190:189–191PubMedCrossRefGoogle Scholar
  2. 2.
    Angst J (1978) The course of affective disorders. II. Typology of bipolar manic-depressive illness. Arch Psychiatr Nervenkr 226:65–73PubMedCrossRefGoogle Scholar
  3. 3.
    Angst J (2004) Hypomania: definition, assessment, prevalence and clinical significance. In: IX Congresso Nazionale della Società Italiana di Psicopatologia. Rome, p 57–69Google Scholar
  4. 4.
    Angst J (1966) Zur Ätiologie und Nosologie endogener depressiver Psychosen. Eine genetische, soziologische und klinische Studie. Springer, BerlinGoogle Scholar
  5. 5.
    Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD, Skeppar P, Vieta E, Scott J (2005) The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 88:217–233PubMedCrossRefGoogle Scholar
  6. 6.
    Angst J, Baenninger R, Nuesperli M, Scharfetter C, Stassen HH (1985) Syndromale Gruppierungen endogener Psychosen in genetischer Sicht. In: Pflug B, Foerster K, Straube E (eds) Perspektiven der Schizophrenie-Forschung. Gustav Fischer Verlag, Stuttgart, pp 25–38Google Scholar
  7. 7.
    Angst J, Gerber-Werder R, Zuberbühler H-U, Gamma A (2004) Is bipolar I disorder heterogeneous? Eur Arch Psychiatry Clin Neurosci 254:82–91PubMedCrossRefGoogle Scholar
  8. 8.
    Angst J, Scharfetter C (1990) Schizoaffektive Psychosen—ein nosologisches Ärgernis. In: Lungershausen E, Kaschka WP, Witkowski RJ (eds) Affektive Psychosen. Schattauer, Stuttgart, pp 23–31Google Scholar
  9. 9.
    Angst J, Scharfetter C, Stassen HH (1983) Classification of schizo-affective patients by multidimensional scaling and cluster-analysis. Psychiatr Clin 16:254–264Google Scholar
  10. 10.
    Berrios GE (1996) The history of mental symptoms. Descriptive psychopathology since the nineteenth century. Cambridge University Press, CambridgeGoogle Scholar
  11. 11.
    Brand S, Luethi M, von Planta A, Hatzinger M, Holsboer-Trachsler E (2007) Romantic love, hypomania, and sleep pattern in adolescents. J Adolesc Health 41:69–76PubMedCrossRefGoogle Scholar
  12. 12.
    Dunner DL, Fleiss JL, Fieve RR (1976) The course of development of mania in patients with recurrent depression. Am J Psychiatry 133:905–908PubMedGoogle Scholar
  13. 13.
    Häfner H, Maurer K, Trendler G, an der Heiden W, Schmidt M, Könnecke R (2005) Schizophrenia and depression: challenging the paradigm of two separate diseases—a controlled study of schizophrenia, depression and healthy controls. Schizophr Res 77:11–24PubMedCrossRefGoogle Scholar
  14. 14.
    Hoche P (1912) Die Bedeutung der Symptomenkomplexe in der Psychiatrie. Z Ges Neurol Psychiatr 12:540–551CrossRefGoogle Scholar
  15. 15.
    Kahlbaum K (1863) Die Gruppirung der psychischen Krankheiten und die Eintheilung der Seelenstörungen. A.W. Kafemann, DanzigGoogle Scholar
  16. 16.
    Kahlbaum K (1884) Über cyclisches Irresein. Allg Z Psychiatr 40:405–406Google Scholar
  17. 17.
    Kahlbaum K (1882) Über cyklisches Irresein. Der Irrenfreund 24:145–157Google Scholar
  18. 18.
    Kessing LV, Hansen MG, Andersen PK, Angst J (2004) The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders—a life-long perspective. Acta Psychiatr Scand 109:339–344PubMedCrossRefGoogle Scholar
  19. 19.
    Kick H (1981) Die Dichotomie der idiopathischen Psychosen im Syndromprofilvergleich der Kraepelinschen Krankheitsbeschreibungen. Nervenarzt 52:522–524PubMedGoogle Scholar
  20. 20.
    Kolle K (1956) Emil Kraepelin 1856–1926. In: Kolle K (ed) Grosse Nervenärzte. 21 Lebensbilder. Georg Thieme Verlag, Stuttgart, pp 175–186Google Scholar
  21. 21.
    Kraepelin E (1913) Das manisch-depressive Irresein. In: Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Barth, Leipzig, pp 1183–1395Google Scholar
  22. 22.
    Kraepelin E (1915) Die Tätigkeitsneurosen (Ponopathien). In: Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Verlag Johann Ambrosius Barth, Leipzig, pp 1400–1417Google Scholar
  23. 23.
    Kraepelin E (1974) Patterns of mental disorder. In: Hirsch SR, Shepherd M (eds) Themes and variations in European psychiatry. An anthology. John Wright & Sons, Bristol, pp 7–30Google Scholar
  24. 24.
    Kretschmer E (1921) Körperbau und Charakter. Untersuchungen zum Konstitutionsproblem und zur Lehre von den Temperamenten. Springer, BerlinGoogle Scholar
  25. 25.
    Marneros A (2006) Beyond the Kraepelinian dichotomy: acute and transient psychotic disorders and the necessity for clinical differentiation. Br J Psychiatry 189:1–2PubMedCrossRefGoogle Scholar
  26. 26.
    Marneros A (2006) Continuity between psychosis and bipolarity. Aspects Affect 2:160–164Google Scholar
  27. 27.
    Marneros A (2007) The paradigm of overlapping affective and schizophrenic spectra: schizoaffective conditions. In: Marneros A, Akiskal HS (eds) The overlap of affective and schizophrenic spectra. Cambridge University Press, Cambridge, pp 1–24Google Scholar
  28. 28.
    Perris C (1966) A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses. Acta Psychiatr Scand 42:1–189Google Scholar
  29. 29.
    Slater E (1938) Zur Periodik des manisch-depressiven Irreseins. Z Ges Neurol Psychiatr 162:794–801CrossRefGoogle Scholar
  30. 30.
    Winokur G, Clayton PJ, Reich T (1969) Manic depressive illness. C.V. Mosby Company, St LouisGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.Psychiatrische UniversitätsklinikZurichSwitzerland

Personalised recommendations