The Kraepelinian tradition

Psychogenetic Features of Heredity and Pathology

ABSTRACT

The purpose of this study is to provide an in-depth examination of the complex aspects of hereditary and pathological conditions arising based on psychogenetic factors, in particular, the disclosure of elements that determine the causes of their appearance. The following methods were used in the study: analytical, typological approaches, and generalization. It was found that genetic inheritance plays a significant role in the occurrence of autism spectrum disorders, bipolar disorder, schizophrenia, and other pathologies. The study revealed that the presence of a hereditary predisposition significantly increases the risk of developing these disorders in offspring. Genetic variations can affect various aspects of mental functioning and the molecular processes underlying these disorders. However, the important role of environmental factors in interaction with genetics has also been revealed. As part of this study, a plan was developed for a psychotherapist to work with parents raising a child with a mental disorder.

Emil Kraepelin and Walter Benjamin: distant contemporaries, diverse working methods, any resonance?

The work methods of eminent psychiatrist Emil Kraepelin (1856-1926) and of literary and cultural critic Walter Benjamin (1892-1940) are described based on the literature describing their ways of working. Kraepelin's approach of cross-sectional observation of symptoms and the longitudinal study of illness course in distinguishing 'disease entities' as well as his research strategy of investigating causes and correlates using methods of experimental psychology, pathology and neurobiology are described. Critical statements (on Kraepelin's work) highlighting preconceived concepts, ideological positions and a lack of critical reflection are reported. Walter Benjamin's use of citation and 'collage' in literary and cultural criticism, his use of the concepts of allegory, 'figures of thought' and 'dialectical images' is described. His theory of the past impacting on our understanding of present and immediate future is discussed. Benjamin's thinking is centered around the concept of 'experience'. The relevance of both scientists to current challenges is discussed referring to current psychiatric research and peer support, a key concept in discussions on mental health care. The paper argues that Kraepelin and Benjamin could be considered complementary in their approaches to mental health matters taking into account wider cultural contexts. (189 words).

Whole Person Modeling: a transdisciplinary approach to mental health research

The growing global burden of mental illness has prompted calls for innovative research strategies. Theoretical models of mental health include complex contributions of biological, psychosocial, experiential, and other environmental influences. Accordingly, neuropsychiatric research has self-organized into largely isolated disciplines working to decode each individual contribution. However, research directly modeling objective biological measurements in combination with cognitive, psychological, demographic, or other environmental measurements is only now beginning to proliferate. This review aims to (1) to describe the landscape of modern mental health research and current movement towards integrative study, (2) to provide a concrete framework for quantitative integrative research, which we call Whole Person Modeling, (3) to explore existing and emerging techniques and methods used in Whole Person Modeling, and (4) to discuss our observations about the scarcity, potential value, and untested aspects of highly transdisciplinary research in general. Whole Person Modeling studies have the potential to provide a better understanding of multilevel phenomena, deliver more accurate diagnostic and prognostic tests to aid in clinical decision making, and test long standing theoretical models of mental illness. Some current barriers to progress include challenges with interdisciplinary communication and collaboration, systemic cultural barriers to transdisciplinary career paths, technical challenges in model specification, bias, and data harmonization, and gaps in transdisciplinary educational programs. We hope to ease anxiety in the field surrounding the often mysterious and intimidating world of transdisciplinary, data-driven mental health research and provide a useful orientation for students or highly specialized researchers who are new to this area.

Emil Kraepelin as a historian of psychiatry - one hundred years on

This article reviews Emil Kraepelin's address 'Hundert Jahre Psychiatrie', at the opening of the Deutsche Forschungsanstalt für Psychiatrie in 1917, and published as an essay in 1918. Kraepelin's publication represents a part of his late work: his commitment as a historian of psychiatry. He composed a classic narrative of psychiatric progress, which includes an outlook on desirable future developments in therapy and prevention. The present article considers the essay's socio-historical context as well as its structure and content. The focus lies on its time of origin around the end of World War I, its sources in relation to the state of the art of historiography at that time and the history of its reception, including the English-language edition of 1962.

On the artistic production of the alienated: history of theories and practices of Brazilian alienism, 1852-1902

The article deals with the presence of artistic manifestations of inmates of the Hospício de Pedro II, the first psychiatric institution in Latin America (1852-1902). The methodological framework chosen focused on the historicisation of the framing processes of mental illness, in order to demonstrate its consequences for the notion of the subject and the art he produces and in the process of circulation of this knowledge in Brazil. Derrida's concept of archive fever was used to analyse the reasons why such manifestations and the therapies used based on them were ignored by local narratives about the artistic manifestations of individuals in asylums.

The relationship between physical activity states and depressive symptoms: Using ambulatory assessment to characterize day-to-day associations among individuals with and without bipolar spectrum disorder

INTRODUCTION

The role of activation in the pathogenesis of bipolar spectrum disorders (BSD) is of growing interest. Physical activity is known to improve mood, but it is unclear whether low activity levels contribute to inter-episode depressive symptoms observed in BSD. This study examined whether sedentary and vigorous activity, as well as the timing of the activity, were differentially associated with next-day depressive symptoms for individuals at low risk for BSD, high-risk for BSD, and diagnosed with BSD.

METHODS

Young adults (n = 111, ages 18-27) from three groups (low BSD risk, high BSD risk, and BSD diagnosis), participated in a 20-day ecological momentary assessment study. Physical activity was measured via wrist actigraphy counts. The percentage of time awake spent in sedentary, light, moderate, and vigorous activity states was calculated, as was the percentage of morning hours and evening hours in each activity state. Multilevel models examined whether the BSD risk group moderated associations between sedentary and vigorous activity and depressive symptoms, which were assessed three times daily.

RESULTS

There were no between-group differences in time spent in each activity state, nor were there main effects of sedentary or vigorous activity on depression. Increased time spent engaging in vigorous activity was associated with a greater reduction in subsequent depressive symptoms for the BSD group. An increase in the evening, but not morning, vigorous activity was significantly associated with a reduction in subsequent depressive symptoms for the BSD group after controlling for chronotype.

CONCLUSIONS

Interventions targeting physical activity may effectively help regulate inter-episode mood disturbances in BSD.

[Mathilde Ludendorff (1877-1966): specialist for nervous and mental diseases and Germanic philosopher]

Mathilde Ludendorff (nee Spiess, widowed von Kemnitz, divorced Kleine) was one of the first women who studied medicine in Imperial Germany. She wrote a feminist doctoral thesis, refuted Sigmund Freud's psychoanalysis early in her career, detected the fraud of Albert von Schrenck-Notzing's spiritualist research, became a specialist for nervous and mental diseases after only 17 months of training with Emil Kraepelin, as his-according to her own words-best pupil, treated General Ludendorff's first wife and soon became his second, developed a Germanic philosophy too radical for Adolf Hitler's taste, was considered as a primary culprit after a first denazification trial in 1949 and contested the expert opinion of her colleague Professor Georg Stertz about her own mental state. Her books are still in print and her Alliance for God Cognizance (Ludendorff) still exists and is monitored by the National Intelligence Agency.

Application of Mass Multivariate Analysis on Neuroimaging Data Sets for Precision Diagnostics of Depression

We used the Mass Multivariate Method on structural, resting-state, and task-related fMRI data from two groups of patients with schizophrenia and depression in order to define several regions of significant relevance to the differential diagnosis of those conditions. The regions included the left planum polare (PP), the left opercular part of the inferior frontal gyrus (OpIFG), the medial orbital gyrus (MOrG), the posterior insula (PIns), and the parahippocampal gyrus (PHG). This study delivered evidence that a multimodal neuroimaging approach can potentially enhance the validity of psychiatric diagnoses. Structural, resting-state, or task-related functional MRI modalities cannot provide independent biomarkers. Further studies need to consider and implement a model of incremental validity combining clinical measures with different neuroimaging modalities to discriminate depressive disorders from schizophrenia. Biological signatures of disease on the level of neuroimaging are more likely to underpin broader nosological entities in psychiatry.

Alternative Diagnostic Models of the Psychotic Disorders: Evidence-Based Choices

Standard diagnostic systems, the predominantly categorical DSM-5 and ICD-11, have limitations in validity, utility, and predictive and descriptive power. For psychotic disorders, these issues were partly addressed in current versions, but additional modifications are thought to be needed. Changes should be evidence based. We reviewed categorical, modified-categorical, and continuum-based models versus factor-based models of psychosis. Factors are clusters of symptoms or single prominent aspects of illness. Consistent evidence from studies of the genetics, pathobiology, and clinical presentation of psychotic disorders all support an underlying structure of factors, not categories, as best characterizing psychoses. Factors are not only the best fit but also comprehensive, as they can encompass any key feature of illness, including symptoms and course, as well as determinants of risk or response. Factors are inherently dimensional, even multidimensional, as are the psychoses themselves, and they provide the detail needed for either grouping or distinguishing patients for treatment decisions. The tools for making factor-based diagnoses are available, reliable, and concordant with actual practices used for clinical assessments. If needed, factors can be employed to create categories similar to those in current use. In addition, they can be used to define unique groupings of patients relevant to specific treatments or studies of the psychoses. Lastly, factor-based classifications are concordant with other comprehensive approaches to psychiatric nosology, including personalized (precision treatment) models and hierarchical models, both of which are currently being explored. Factors might be considered as the right primary structural choice for future versions of standard diagnostic systems, both DSM and ICD.

A New Paradigm to Indicate Antidepressant Treatments

This article develops the idea that clinical depression can be seen as a typical human response, largely rooted in human culture, to events of loss or times of adversity. Various biological, psychological, and social factors may cause some individuals to have a depressive reaction that is ineffectually limited in time and/or severity. Recovery occurs mainly based on natural resilience mechanisms, which come into play spontaneously, but which are sometimes inhibited or blocked by specific pathological biopsychosocial mechanisms. One of the mechanisms for this could be the influence of the circuits that regulate pleasure and happiness, along the dorsal diencephalic connection (DDC) pathway from the forebrain to the midbrain via the habenula. Therapy works by undermining the biopsychosocial factors that prevent the natural recovery mechanism from working. Treatment should, therefore, be seen as facilitating rather than causing natural recovery. This approach is in line with the high recovery rate after placebo treatments and the positive influence of pharmacological treatments with completely different sites of action. Acceptance of this model means that when studying new treatments for depression, a new paradigm must be applied in which the relative value of antidepressant treatment is specifically weighted in terms of enabling the natural resilience process.

"Apples and pears are similar, but still different things." Bipolar disorder and schizophrenia- discrete disorders or just dimensions ?

Starting with the dichotomous view of Kraepelin, schizophrenia and bipolar disorder have traditionally been considered as separate entities. More recent, this taxonomic view of illnesses has been challenged and a continuum psychosis has been postulated based on genetic and neurobiological findings suggestive of a large overlap between disorders. In this paper we will review clinical and experimental data from genetics, morphology, phenomenology and illness progression demonstrating what makes schizophrenia and bipolar disorder different conditions, challenging the idea of the obsolescence of the categorical approach. However, perhaps it is also time to move beyond DSM and search for more refined clinical descriptions that could uncover clinical invariants matching better with molecular data. In the future, computational psychiatry employing artificial intelligence and machine learning might provide us a tool to overcome the gap between clinical descriptions (phenomenology) and neurobiology.

Breaking the web: life beyond the at-risk mental state for psychosis

Psychiatry's most recent foray into the area of risk and prevention has been spear-headed by work on at-risk mental states for psychotic disorders. Twenty-five years' research and clinical application have led us to reformulate the clinical evolution of these syndromes, blurred unhelpful conceptual boundaries between childhood and adult life by adopting a developmental view and has changed the shape of many mental health services as part of a global movement to increase quality. But there are problems: fragmentary psychotic experiences are common in young people but transition from risk-state to full syndrome is uncommon away from specialist clinics with rarefied referrals and can, anyway, be subtle; diagnostic over-shadowing by the prospect of schizophrenia and other psychotic disorders may divert clinical attention from the kaleidoscopic and disabling range of probably treatable psychopathology with which people with risk syndromes present. We use a 19th Century lyric poem, The Lady of Shallot, as an allegory for Psychiatry warning us against regarding these mental states only as pointers towards diagnoses that probably will not occur. Viewed from the fresh perspective of common mental disorders they tell us a great deal about the psychopathological crucible of the second and third decades, the nature of diagnosis, and point towards new treatment paradigms.

Kraepelin's Final Views on Dementia Praecox

In 1921, at the age of 65, 6 years after completing the final edition of his textbook, 22 years after first proposing the concept of dementia praecox (DP), and 1 year before retiring from clinical work, Emil Kraepelin completed the last edition of his "Introduction to Clinical Psychiatry," which contained a mini-textbook for students, 10 pages of which were devoted to DP. This work also included a series of new detailed case histories, 3 of which examined DP. This neglected text represents a distillation of what Kraepelin judged, near the end of his long career, to be the essential features of DP. The relevant text and case histories are translated into English for the first time. Kraepelin did not define DP solely by its chronic course and poor prognosis, acknowledging that remissions and even full recovery might be possible. His clinical description emphasized the frequency of bizarre delusions and passivity symptoms. He recognized the heterogeneity of the clinical presentations, outlining 6 subtypes of DP, including dementia simplex, depressive and stuporous dementia, and an agitated and circular DP. Kraepelin's original concept of DP was not impervious to change and expanded somewhat, especially with the inclusion of Diem's concept of simple DP. He also reviews several contributions of Bleuler, including his concept "latent schizophrenia." He writes poignantly of the psychological consequences of DP. His 3 DP cases, for advanced students, included simple DP, "periodic catatonic," and "speech confusion."

The History of Psychedelics in Psychiatry

Initial interest in the value of psychedelic drugs ("psychotomimetics") in psychiatry began in the early 20^th century, with explorations of the possibility that mescaline or peyote could produce psychosis-like effects. Over time, interest was focused on whether the effects of psychedelics could inform as to the underlying basis for psychiatric disorders. As research continued, and especially after the discovery of LSD in 1943, increasing interest in a role for psychedelics as adjuncts to psychotherapy began to evolve and became the major focus of work with psychedelics up to the present day.

'I think' (the thoughts of others). The German tradition of apperceptionism and the intellectual history of schizophrenia

Although contemporary approaches to schizophrenia pinpoint 'disturbances of the self' as a central aetiological factor, historical insight into the link between accounts of schizophrenia and theories of subjectivity and self-consciousness is poor. This paper aims to overcome this gap by providing the outlines of a largely forgotten but crucial part of the intellectual history of schizophrenia. In particular, the impact of the German tradition of apperceptionism on nineteenth-century accounts of schizophrenia is unearthed. This tradition emerged from German Idealism, and culminated in Emil Kraepelin's account of dementia praecox. In addition to filling an important gap in the historiography of psychiatry, this analysis contributes to ongoing efforts to correct some common misunderstandings regarding Kraepelin's theoretical position.

The evolution of Kraepelin's nosological principles

Emil Kraepelin developed a new psychiatric nosology in the eight editions of his textbook. Previous papers have explored his construction of particular diagnoses, including dementia praecox and manic-depressive insanity. Here we are providing a close reading of his introductory textbook chapter, that presents his general principles of nosology. We identify three phases: 1) editions 1-4, in which he describes nosological principles in search of data; 2) editions 5-7, in which he declares the mature version of his nosological principles and develops new disease categories; 3) edition 8, in which he qualifies his nosological claims and allows for greater differentiation of psychiatric disorders. We propose that Kraepelin's nosology is grounded in three principles. First, psychiatry, like other sciences, deals with natural phenomena. Second, mental states cannot be reduced to neural states, but science will progress and will, ultimately, reveal how nature creates abnormal mental states and behavior. Third, there is a hierarchy of validators of psychiatric diagnoses, with the careful study of clinical features (signs, symptoms and course) being more important than neuropathologic and etiological studies. These three principles emerged over the course of the eight editions of Kraepelin's textbook and were informed by his own research and by available scientific methods. His scientific views are still relevant today: they have generated and, at the same time, constrained our current psychiatric nosology.

Addiction from the harmful dysfunction perspective: How there can be a mental disorder in a normal brain

Is addiction a medical disorder, and if so, what kind of disorder is it? Addiction is considered a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Critics argue that the brain changes result instead from normal neuroplasticity and learning in response to the intense rewards provided by addictive substances, thus addiction is not a disorder but rather a series of normal-range if problematic choices. Relying on the harmful dysfunction analysis of medical disorder to evaluate disorder versus nondisorder status, I argue that even if one accepts the critics' reinterpretation of NIDA's brain evidence and rejects the brain disease account, the critics' conclusion that addiction is not a medical disorder but is rather a matter of problematic nondisordered choice does not follow. This is because there is a further possible account of addiction, the evolutionary "hijack" view, that holds that addiction is due to the availability of substances and stimuli that were unavailable during human species evolution and that coopt certain brain areas concerned with human motivation, creating biologically undesigned peremptory desires. I argue that if the hijack theory is correct, then it opens up the possibility that addiction could be a true motivational medical disorder for which there is no underlying neurological-level dysfunction. Finally, I explore the implications of this account for how we see the social responsibility for addiction and how we attempt to control it.

The theory of symptom complexes, mind and madness

Kahlbaum's seminal approach to symptom complexes, as opposed to disease entities, is still relevant. Many psychopathologists have approached mental symptom complexes without prejudging them as necessary physical deficits or diseases, favouring a broader dimensional and anthropological view of mental disorders. Discussions of symptom complexes gained prominence in psychiatry in the early twentieth century - through Hoche - and in the period leading up to World War II - through Carl Schneider. Their works, alongside those of Kraepelin, Bumke, Kehrer, Jaspers and others, are reviewed in relation to the theme of symptom complexes, the mind, and mental disorders. A particular feature of symptom complexes is their relationship to aspects of the normal mind and how this affects clinical manifestations. It is further suggested that symptom complexes might offer a useful bridge between the psychic and the biological in theories of the mind.

On making sense. An exploration of Wundt's apperceptionist account of meaningful speech

In the wake of the critical reorientation in the historiography of psychology, a number of scholars challenged the one-sided structuralist and positivist interpretation of Wilhelm Wundt's work. This paper aims at contributing to these recent efforts, by providing an analysis of the way in which Wundt's apperceptionism conditioned his account of the relation between thought and speech, and by extrapolation, of disorganized thought and speech. While Wundt's pivotal role in the development of the psychology of language is relatively well-known, discussions on this part of his theorizing tend to focus exclusively on his gestural or motor account of language. This obliterates the complex theoretical background of Wundt's theory of language and speech, as well as its systematic place within his psychological system. Highlighting this neglected dimension of Wundt's theorizing, however, could open up a new horizon of pressing research questions in the historiography of psychology.

A crise do diagnóstico em psiquiatria e os manuais diagnósticos

Discute-se o caminho percorrido pela psiquiatria através dos manuais diagnósticos até o momento atual, com o projeto do Research Domain Criteria (RDoC), que busca, eliminando a subjetividade, alcançar uma excelência terapêutica na psiquiatria. São apresentadas quatro perspectivas para se pensar o diagnóstico das doenças psiquiátricas: as doenças que são descritas nos manuais de psiquiatria e que encontram correspondentes em pacientes na prática clínica; os transtornos que foram descritos nos manuais de psiquiatria e que geraram diagnósticos imprecisos; as síndromes culturais e o sofrimento psíquico que é estruturado de forma subjetiva e individual. Conclui-se que uma abordagem terapêutica deve levar em conta a natureza complexa do sofrimento psíquico, gerando mais cautela e individualização no que diz respeito às abordagens terapêuticas.

[Schizophrenia: pars pro toto for psychiatry? : A historical essay on the status of schizophrenia in psychiatric discourse]

In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions concerning psychiatric epistemology and practice. Taking a conceptual history approach, this essay examines how "schizophrenia" is represented in psychiatric discourse and what aspects of its representation account for the pars pro toto status. Three such aspects are identified: a pragmatic, an existential and a justificatory aspect. Following up these aspects in present day psychiatric discourse, it is concluded that "schizophrenia" is losing its special status as the representations of psychiatry and of mental illness have changed and become more diverse. Tentative conclusions regarding current debates about the abolition of "schizophrenia" are drawn.