Historical Terminology
Michael Farrell in Psychosis Under Discussion, 2017
Catatonia, hebephrenia and dementia paranoides were all considered to be manifestations of one condition which Kraepelin called ‘dementia praecox’. Dementia we have already mentioned. The expression ‘praecox’, derived from the Latin meaning ‘maturing early’, relates to the word ‘precocious’ and means ‘young’. The overall term therefore conveys the idea of a mental disturbance that appeared in young people. Symptoms of dementia praecox were various. Emotions might not be shown or, if they were demonstrated, might be inappropriate. Behaviour might be stereotyped (rigidly patterned) or involve catatonic postures. The individual could be easily distracted or confused. Hallucinations of sounds or touch might be evident. Irrational beliefs might occur, such as delusions of persecution or grandiosity. Throughout all this, the individual’s mental powers deteriorated.
Schizophrenia
Ben Green in Problem-based Psychiatry, 2018
An illness like schizophrenia has been variously described over the years. The Greek physician Aretaeus gave recognisable descriptions of a schizophrenia-like psychosis in the 2nd century AD. Kahlbaum in 1863 described a psychosis beginning in the young called hebephrenia. Hecker in 1871 described a psychosis with onset in the young and associated with a downhill course. Catatonia (a movement disorder) and paranoia were also recognised entities. Morel used the term dementia praecox in 1852 and Kraepelin in 1893 considered dementia praecox further and said there were four types: simple, paranoid, hebephrenic and catatonic, depending on the clinical presentation. He believed it was a biological illness. Simple dementia praecox involved a slow social decline, with apathy and withdrawal rather than florid psychotic symptoms – such people became drifters or tramps. Paranoid dementia praecox involved fear and systematised persecutory delusions. The hebephrenic type was silly and facetious. (Such terms enter common usage, with their meaning slightly shifted – hebephrenia was misappropriated by the public and corrupted to the phrase ‘heebie-jeebies’.) Catatonic patients were those with predominant motor symptoms – increased muscle tone, preservation of posture (patients could be manipulated like passive mannequins into unusual postures which they would maintain for hours), waxy flexibility and fear. Despite their persistent immobility such catatonic patients were acutely aware of their surroundings. Before suitable pharmacological treatments arrived, unless the catatonic episode aborted spontaneously, the patient would die through starvation or thirst unless carefully nursed.
Schizophrenia
Charles Theisler in Adjuvant Medical Care, 2023
Schizophrenia, formerly known as dementia praecox, is a chronic severe mental disorder characterized by significant alterations in perception, thoughts, mood, and behavior. The disorder affects how a person feels, thinks, and perceives reality (e.g., delusions, false beliefs, hallucinations, impaired cognitive ability, unclear or confused thinking, or hearing voices that do not exist). As a result, schizophrenia is characterized by behavioral problems, flat affect, trouble focusing or learning, and difficulty relating to others. Individuals with schizophrenia seem to have lost touch with reality. There is no cure for schizophrenia. Managing symptoms is the best way of managing the illness.
Treatment of post-psychotic depression in first-episode psychosis. A systematic review
Published in Nordic Journal of Psychiatry, 2023
Isabel Bodoano Sánchez, Alba Mata Agudo, Margarita Guerrero-Jiménez, Braulio Girela Serrano, Paula Álvarez Gil, Carmen Maura Carrillo de Albornoz Calahorro, Luis Gutiérrez-Rojas
Depression in schizophrenia has historically been approached as intrinsic to the disorder itself much like positive and negative symptoms. Kraepelin distinguished between dementia praecox and manic-depressive illness but still included depression as a symptom present in the onset of dementia praecox [4]. Eugen Bleuler would include depression as one of schizophrenia’s secondary symptoms alongside hallucinations and delusions [5]. However, over the last twenty years, there has been a change in the approach to depression in schizophrenia. Depressive symptoms are seen not as part of the normal course of schizophrenia but as a comorbidity of this disorder. ICD-10 [6] has a specific diagnostic called ‘post-schizophrenic depression’ (F.20.4) that must occur within 12 months after the psychotic episode whilst psychotic symptoms are still present but are not predominant. On the other hand, DSM-IV [7] includes PPD in its appendix B as ‘postpsychotic depressive disorder of schizophrenia’ as a major depressive episode during the residual phase of schizophrenia whilst the diagnosis was removed from DSM-5 [8]. These manuals do not distinguish depression after a FEP from depression in chronic schizophrenia.
Testing the difference between bipolar disorder and schizophrenia on the basis of the severity of symptoms with C(α) test
Published in Journal of Applied Statistics, 2019
Alka Sabharwal, Gurprit Grover, Sakshi Kaushik
Since centuries there has been an uncertainty regarding the separation of bipolar disorder and schizophrenia as they share some key symptoms which often create confusion and lead to misdiagnosis, especially on initial presentation, further resulting in ineffective treatment and worsening of outcome [7]. In 1896, Kraepelin repudiated the unitary hypothesis [4] and conceptualized the separation of dementia praecox (later renamed as Schizophrenia) from manic-depressive insanity (later renamed as Bipolar Disorder), which shared many similar symptoms [18]. This dichotomy still continues today in the nosological classes of schizophrenia and bipolar disorders [9]. The symptoms of schizophrenia can be classified into three independent domains: positive, negative and disorganized [18]. Bipolar disorder, on the other hand, is an affective disorder characterized by alternating periods of mania and depression [12]. Cognitive, psychosis, neurovegetative and negative symptoms are common to both the disorders with different degrees of severity. Although bipolar disorder can be indistinguishable from schizophrenia, yet, course of illness is a primary factor of distinction between them [18].
Personal recovery within positive psychiatry
Published in Nordic Journal of Psychiatry, 2018
Well-being is central in positive psychiatry and emphasizes the experience of meaning and self-actualization, rather than positive emotions and joy actualization, as often mistakenly thought [2]. In the personal recovery process, promoting well-being and support in building hope and optimism are core features. Both positive psychiatry and personal recovery focus on positive attributes and strengths, which is in sharp contrast to the historical deterministic and pessimistic concepts of mental illnesses. For example, since Kreplin's dementia praecox at the end of the 19th century, schizophrenia was thought to follow a progressively deteriorating course. This left a heavy cloud over a person’s hope or attempts to rebuild a life after being labeled schizophrenic. People were coerced into accepting that they had ‘broken brains’ and were pressured to take medication that often had considerable side effects, avoid stress or ‘life’ itself (which by definition is not stress-free), live for long periods or possibly their entire life in restrictive environments, and hope at best to be ‘stabilized’. It was not until the 1970s that longitudinal clinical and epidemiology studies challenged the widely adopted notion that persons with mental illnesses could not get better [5–13]. In parallel, persons with life experience of mental illness started to share their stories of recovery, which brought attention to a new voice and an alternative to the dementia praecox ‘story’. In addition, qualitative research began to explore subjectivity and a broad range of experiences rather than focusing narrowly on symptoms. This began to challenge the notion of clinical recovery (which commonly meant ‘symptom reduction’) as the only desirable outcome [2,14], and enriched and deepened the understanding of personal recovery. Along with this important development grew, the recognition grew that traditional mental health services seldom provided hope or support personal goals, and often promoted dependence, and fostered stigma [15,16]. Within this context, the vision of personal recovery emerged.
Related Knowledge Centers
- Autism Spectrum
- Disorganized Schizophrenia
- Major Depressive Disorder
- Mood Disorder
- Psychosis
- Dementia
- Schizophrenia
- Bipolar Disorder
- Psychiatry
- Kraepelinian Dichotomy