Emil Kraepelin

Emil Kraepelin (1856 - 1926) is a German psychiatrist born in Neustrelitz (Mecklembourg) considered as the founder of modern scientific psychiatry.

Raise Bernhard von Gudden and to Wilhelm Wundt, founder of the experimental Psychologie, Kraepelin endeavoured, throughout its career, to create a classification of the mental diseases based on objective clinical criteria. After having been professor of psychiatry at the university of Dorpat, in Estonia, until 1890, it is established as psychiatrist with Munich.

Nosology of Kraepelin

Its nosography was refined through the eight editions of sound Traité psychiatry published 1883 with 1909, and intended to the doctors and for the students. Kraepelin is very attached to the evolution in the time of the diseases and thus primarily founded its classification this concept. A disease separates by its evolution. In the sixth edition of its treaty, in 1889, Kraepelin specifies the framework nosographic of the chronic psychoses and distinguishes two morbid entities: the maniaco-depressive psychoses and the dementia praecoxes . It uses the term of Psychose to indicate psychic states characterized by a major deterioration of the conscience of the subject (disorder serious of the identity) and of his report/ratio to reality.

Maniaco-depressive psychoses

The maniaco-depressive psychosis, now called bipolar Disorder, is a mental disease characterized by alternation, according to the very variable rate/rhythm and a frequency, accesses maniacs and accesses depressive readily melancholic persons separated by asymptomatic free intervals more or less long. It is the prototype of the cyclic dysthymies. They are characterized by major thymique disorders (= turbid of mood) whose evolution is periodic. Kraepelin was interested much in the study of the maniaco-depressive psychoses and distinguished 4 clinical forms from them:

the states maniacs . It defines the mania as an abruptly occurring state of intellectual and psychomotor excitation associated with an exaltation of mood, a state of extreme agitation whose subject is not aware (anosognosy). Symptoms: no tiredness, permanent activity, speed of the word…
the depressive states . They can result either in a simple melancholy (simple driving inhibition), or by a melancholy engraves to see confusional accompanied by delirious puffs (near to the anxious delirious puffs) and of hallucinations. It defines the melancholy as state of a serious, intense depression lived with a feeling of mental pain (major sadness) and characterized by the deceleration and the inhibition of the driving functions (emotional anesthesia).
fundamental states , characterized by the persistence of the thymique disorders.
mixed states . It is the maniaco-depressive psychosis itself. It results in the alternation of access maniacs and depressive accesses.

Dementia praecoxes

It defines the dementia praecox as a chronic psychosis occurring in a teenager or a young adult, characterized by serious intellectual and emotional disorders, with a progressive evolution towards a psychic collapse. The Dementia praecox of Kraepelin took the name of Schizophrénie with Eugen Bleuler in 1908. Symptoms: disorder of the memory, the language, the reasoning, access of negativism (behavior of refusal and opposition to the suggestions of others), of mannerism and period of excitation. Kraepelin distinguishes 4 forms from them:

the hebephrenic form . One finds in this form all the intellectual overdrawn aspects and one observes a psychomotor inhibition, i.e. a driving and psychological deceleration (bradykinesy), as well as important a Négativisme and dumbness. (see Hébéphrénie)
the catatonic form . This form is characterized by a catatonie and a catalepsy. Catatonie: driving behavior about permanent which does not answer in a way adapted to stimulations of the medium and which is often accompanied by impulses and stereotypy. State characterized by a loss of the spontaneousness of the driving initiative, the subject appears without reaction compared to the entourage with a fixed mimicry. (see also Catatonie). Catalepsy: behavior characterized by a particular muscular rigidity known as plastic rigidity. (see also Catalepsy).
the paranoid delirious form . The intellectual weakening is accompanied by one is delirious paranoid, i.e. fuzzy, vague, without logical construction, in which the subject approaches very varied topics (is delirious not systematized).
the attenuated paranoid form . Is delirious is more diffuse and the disintegration of the personality of the Subject is observed much less quickly.

Etiology

In 8th and last edition published in 1909, Kraepelin sticks to the etiology of the mental diseases and highlights a distinction between the exogenic diseases and the endogenous diseases.

the diseases Exogenic S . They are due to causes external with the patient thus caused by an event (S) of its life. The psychogenic origin of these diseases enables them to evolve to the cure.
the diseases Endogenous S . They are due to modifications of the psychic person, with psychological factors either hereditarily transmitted (cf Théorie of the degeneration), or related to the meeting of a predisposition existing at the patient with an external factor. These diseases have a chronic evolution leading to more or less long run with a complete forfeiture of the patient. They thus require one enfermement asilaire final. Terminal illness. In the nosography of Kraepelin, the PMD and the dementia praecox are two chronic diseases and endogenous. Kraepelin marks the opposition between disease Curable and terminal illness. One finds at his place a deep pessimism when with the possibilities of therapeutic, and it is in the endogenous etiology that this pessimism is made feel because he considers this terminal illness.

Travel to Java

In 1904, Kraepelin accomplishes a study trip to Java in order to test the universal value of its classification there. It identifies there a certain number of disorders specific to this area like the amok and the latah for which it finds correspondences with the diagnostic entities that it defined beforehand. This voyage marks the birth of the " psychiatry comparée".

References

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