The Kraepelinian dichotomy in terms of employment outcomes

We assess the effectiveness of return to employment, and hence social inclusion in patients with chronic schizophrenia and bipolar affective disorder within a British community mental health team.     

The Kraepelinian dichotomy in terms of suicidal behaviour

The Kraepelinian dichotomy sees schizophrenia and bipolar disorder as two distinctly separate diseases each with its own pathogenesis and disease process. This study looks at the difference between patients with schizophrenia and bipolar disorder in terms of suicidal behaviour. Both schizophrenia and bipolar disorder have been identified as significant risk factors for suicide, while bipolar and major depressive disorder appear to be the greatest diagnostic indicators. This study also aims to look at any differences in suicidal behaviour between the two major classes of bipolar disorder (bipolar I and bipolar II) to possibly determine how distinct these two conditions are in this respect. As expected, this study found that patients with a diagnosis of bipolar disorder were significantly more likely (OR=4.79) to have a history of suicidal behaviour than patients with a diagnosis of schizophrenia. Neither bipolar I nor bipolar II patients were significantly more likely to have a history of suicidal behaviour. However, this study yielded a weak association between bipolar II patients and suicidal behaviour (OR=1.83) compared to bipolar I patients, which may have been more significant under different circumstances such as a greater sample size.     

The dichotomy of drugs and psychotherapy

Psychiatrists increasingly combine medication with psychotherapy when treating depression and other disorders. Among the public and practitioners, however, there remains controversy about the compatibility of these treatments. The roots of the controversy can be traced to the ubiquity of dualistic beliefs about mind and body and the historical development of mental health professions. Confusion has also been generated by deriving notions of etiology from observations of phenomenology and treatment response. Understanding these issues will help the practitioner to more successfully combine treatment modalities when both are indicated.     

Dementia praecox and manic-depressive insanity in 1908: A Grade of Membership analysis of the Kraepelinian dichotomy

Grade of Membership (GoM) analysis, a multivariate classification technique based on fuzzy-set mathematics, was applied to the demographic, history, and mental-state data on 53 dementia praecox cases and 134 manic-depressive insanity cases admitted to Kraepelin's University Psychiatric Clinic in Munich in 1908. The original data recorded by Kraepelin and his collaborators on specialZählkarten (counting cards) were rated and coded in terms of the Present State Examination (PSE) Syndrome Check List. The statistical analysis resulted in a high degree of replication of Kraepelin's clinical entities. However, the dichotomy of dementia praecox and manic-depressive insanity was not fully supported. The catatonic syndrome tended to occupy an intermediate position between the two major psychoses. The possibility is discussed that catatonia in Kraepelin's time shared certain clinical features with the later diagnostic groupings of schizoaffective disorder, cycloid psychoses, and other atypical forms of psychotic illnesses.     

The therapeutic transnosological use of psychotropic drugs

The current clinical use of psychotropic drugs is transnosologically oriented. This is facilitated by the current classification of mental disorders (International Classification of Diseases, 10th Revision [ICD-10]) and is perhaps justified if depression and psychosis (taken here as examples) are considered as being complex syndromes with heterogeneous etiologies, but common pathogenesis, more than specific entities. However, this approach does not identify possible differences between specific psychiatric entities, which could in turn mask differences in therapeutic responses and, therefore, therapeutic outcome. This is compounded by the current disharmony between the nosological classification of diseases, drug development, clinical research, and therapeutic uses of psychotropic drugs. Functional pharmacology targeting abnormal behavioral traits could represent an avenue for future research and treatment.     

妊娠期患者的精神药物使用问题

概述:妊娠对于重性精神疾病患者来说至少面临两方面挑战:即精神疾病的遗传风险以及精神药物的可能致畸风险.本文复习了相关文献及研究证据,包括抗精神病药物、抗抑郁药物及心境稳定剂等在妊娠期患者的使用问题,最后介绍了最新治疗指南及FDA建议.     

Disorders of thought are severe mood disorders: the selective attention defect in mania challenges the Kraepelinian dichotomy a review

Kraepelin said severe mental illness was due to 2 diseases subsequently characterized as disorders of thought vs disorders of mood, ie, the Kraepelinian dichotomy. Schizophrenia, traditionally considered the disorder of thought, has been defined by the presence of hallucinations, delusions, catatonia, and disorganization. Tangentiality, derailment, loose associations, and thought blocking are typically considered pathognomonic of schizophrenia. By contrast, the mood disorders have been characterized only as disorders of the emotions, though both depression and mania, when severe, are now recognized to include the same psychotic features traditionally considered diagnostic of schizophrenia. This article addresses disordered thinking in mania in order to clarify the relationship between schizophrenia and psychotic mood disorders. Normally, the brain's selective attention mechanism filters and prioritizes incoming stimuli by excluding from consciousness extraneous, low-priority stimuli and grading the importance of more relevant data. Because this "filter/prioritizer" becomes defective in mania, tangential stimuli are processed without appropriate prioritization. Observed as distractibility, this symptom is an index of the breakdown in selective attention and the severity of mania, accounting for the signs and symptoms of psychotic thinking. The zone of rarity between schizophrenia and psychotic mood disorders is blurred because severe disorders of mood are also disorders of thought. This relationship calls into question the tenet that schizophrenia is a disease separate from psychotic mood disorders. Patients whose case histories are discussed herein gave their written informed consent to participate in this institutional human subjects committee-approved protocol.     

The Kraepelinian dichotomy: preliminary results of a 15-year follow-up study on functional psychoses: focus on negative symptoms

In a 15-year follow-up study, we used a comparative approach to assess course and outcome for all functional psychoses. The presented results focus on negative symptoms and refer to a sample of 76 patients with schizophrenia, 38 patients with a schizoaffective disorder and 32 patients with an affective disorder according to ICD-9. These patients were assessed at their first psychiatric hospitalization and 15 years later. In summary, the findings indicate that the course and outcome of schizophrenia is less favorable than that of affective and schizoaffective disorders. Negative symptoms occurred in all functional psychoses, but were more frequent and prominent in the schizophrenic group than in the other two diagnostic groups at any time of assessment. Narrower concepts of negative symptoms, conceptualized as the deficit syndrome, seem to be specific for schizophrenia and appear quite rarely in patients with affective psychoses. Overall, our study supports Kraepelin's original hypothesis that bifurcated the psychoses into the affective psychoses and schizophrenia, whereby the latter have a more deleterious long-term course and outcome.     

Behavioral toxicity of psychotropic drugs

The present review of psychomotor response to psychotropic substances is restricted to normal subjects and describes responses to the initial standard dose of psychotropic substances in common use. Only placebo-controlled studies which permitted statistical analysis of treatment group differences were considered for the summary. It was revealed that virtually all psychotropic substances have immediate detracting effects. The nature of the effects varied somewhat according to the class of drug. It is suggested that this kind of information has safety implications which could influence the choice of medication.     

Youth and psychotropic drugs in Belgium

The results of epidemiological studies show that in Belgium the use of psychotropic is high in the general population and in particular among young people. Systematically, one finds more users among girls than among boys, among young workers than among young school attenders, among young people whose parents are themselves users and in the regions of advanced urbanisation. These epidemiological data could be useful in orienting toward preventive actions to be undertaken.