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Emil Kraepelin: Dementia Praecox Emil Kraepelin: Dementia Praecox

““Dementia praecox consists of Dementia praecox consists of a series of states, the a series of states, the common characteristic of common characteristic of which is a peculiar which is a peculiar destruction of internal destruction of internal connections of the psychic connections of the psychic personality....the majority of personality....the majority of the clinical pictures are the the clinical pictures are the expression of a single expression of a single morbid process, though morbid process, though outwardly they often diverge outwardly they often diverge very far from one another.”very far from one another.”

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Kraepelin: Course Kraepelin: Course and Outcomeand Outcome

• Split “dementia praecox” from Split “dementia praecox” from manic-depressive illnessmanic-depressive illness

• Early onsetEarly onset• Marked deteriorationMarked deterioration• Chronic courseChronic course• Diversity of signs and symptomsDiversity of signs and symptoms• Importance of volition and affectImportance of volition and affect

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Eugen Bleuler: Loosening Eugen Bleuler: Loosening of Associationsof Associations

““Of the thousands of Of the thousands of associative threads associative threads that guide our that guide our thinking, this disease thinking, this disease seems to interrupt, seems to interrupt, quite haphazardly, quite haphazardly, sometimes single sometimes single threads, sometimes a threads, sometimes a whole group, and whole group, and sometimes whole sometimes whole segments of them.”segments of them.”

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Bleuler: Fundamental Bleuler: Fundamental SymptomsSymptoms

• Renamed the disorder “schizophrenia”Renamed the disorder “schizophrenia”• Focused on the characteristic Focused on the characteristic

symptomssymptoms• Emphasized fragmenting of thinkingEmphasized fragmenting of thinking• Partial recovery possiblePartial recovery possible• No full “restitutio ad integrum”No full “restitutio ad integrum”• A broader conceptA broader concept• Heterogeneity: the “group of Heterogeneity: the “group of

schizophrenias”schizophrenias”

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Bleuler’s Fundamental Bleuler’s Fundamental SymptomsSymptoms

• AssociationsAssociations

• Affective BluntingAffective Blunting

• AvolitionAvolition

• AutismAutism

• AmbivalenceAmbivalence

• AttentionAttention

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Bleuler’s Description of Bleuler’s Description of Fundamental SymptomsFundamental Symptoms

• Certain symptoms of schizophrenia are present in Certain symptoms of schizophrenia are present in every case and at every period of the illness even every case and at every period of the illness even though, as with every other disease symptom, they though, as with every other disease symptom, they must have attained a certain degree of intensity before must have attained a certain degree of intensity before they can be recognized with any certainty…for they can be recognized with any certainty…for example, the peculiar association disturbance is example, the peculiar association disturbance is always present, but not each and every aspect of it…always present, but not each and every aspect of it…besides these specific permanent or fundamental besides these specific permanent or fundamental symptoms, we can find a host of other, more symptoms, we can find a host of other, more accessory manifestations such as delusions, accessory manifestations such as delusions, hallucinations, or catatonic symptoms…as far as we hallucinations, or catatonic symptoms…as far as we know, the fundamental symptoms are characteristic of know, the fundamental symptoms are characteristic of schizophrenia, while the accessory symptoms schizophrenia, while the accessory symptoms may also appear in other types of illnesses.may also appear in other types of illnesses.