Use of Kraepelinian concepts in international computer diagnosis

Abstract

In the 1960s, diagnosis in the UK followed Kraepelinian principles whereas that in the United States of America was influenced by Freudian concepts. The US Department of Health became alarmed at the large proportion of patients with schizophrenia entering State Mental Hospitals compared to the proportion entering the Area Mental Hospitals in England and Wales. Social theories of mental illness were in vogue and some thought that mental illness reflected the state of society. The US UK Study employing Kraepelinian principles of diagnosis found no essential difference in the mental hospital statistics of the two countries. Later, the study examined the similar problems of discrepancy between depression in the UK and dementia in the US with similar results this time confirmed by outcome. Over the succeeding years psychiatric diagnosis in the USA was to undergo a radical overhaul and fall into line with that of most of the rest of the world, and even move ahead with the publication of DSM III. In order to allow larger population studies to be examined the computer-assisted program AGECAT was developed again, along Kraepelinian principles. Cases of mental illness were defined according to purpose rather than as substantive objects in their own right. Using these methods it has been possible to assess the prevalence and incidence of mental disorders in older people in Europe and Asia and question the fundamental pathology of Alzheimer’s (Kraepelin’s pupil and colleague) Disease using population sampled brain tissue. Derivatives of AGECAT, for younger subjects adapted for clinical use aim to carry Kraepelinian principles into the treatment of populations at present unserved by psychiatric care.