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Putative schizophrenia subtypes based on clinical featuresKraepelin's clinical forms of dementia praecox Acknowledging the diversity of the clinical pictures subsumed under dementia praecox and the absence of pathognomonic symptoms, Kraepelin1 articulated, 'for the sake of a more lucid presentation', nine different 'clinical forms' (Table 1). However, he emphasized that 'we everywhere meet the same fundamental disorders in the different forms of dementia praecox, in very varied conjunctions, even though the clinical picture may appear at first sight ever so divergent'. The 'fundamental disorders', holding together the disease entity, were cognitive deficit (a 'general decay of mental efficiency') and executive dysfunction ('loss of mastery over volitional action'), most clearly manifested in the residual, 'terminal states' of the illness. Kraepelin was reluctant to impute aetiological significance to the clinical variants he described, and regarded the issue of a unitary process versus multiple disease states within schizophrenia 'an open question'. The renewal of interest in Kraepelin's dementia praecox since the 1990's has led researchers to attempt delineating a 'Kraepelinian' subtype of schizophrenia, in terms of negative or disorganized symptoms, poor outcome, neuropsychological deficits, and risk factors.54, 55, 56 However, as indicated in Table 1, Kraepelin's original typology allowed for much greater heterogeneity in the clinical manifestations of dementia praecox than it is currently assumed. Table 1 - Emil Kraepelin's 'clinical forms'1.
TABLE 1 FROM: Subtyping schizophrenia: implications for genetic research A Jablensky BACK TO ARTICLE Table 1. Emil Kraepelin's 'clinical forms'1 Next table | Figure and tables index
Bleuler's 'group of schizophrenias' Having coined the term 'schizophrenia' to replace dementia praecox, Bleuler45 stated that schizophrenia 'is not a disease in the strict sense, but appears to be a group of diseases.Therefore, we should speak of schizophrenias in the plural'. He acknowledged that the clinical subgroups of paranoid schizophrenia, catatonia, hebephrenia and simple schizophrenia – retained in the present DSM and ICD classifications – were not 'natural' nosological entities. What were then the multiple 'schizophrenias'? Bleuler argued that 'the disease schizophrenia must be a much broader concept than the overt psychosis of the same name'. Along with the 'latent' schizophrenias, which manifested mainly aberrant personality traits, he listed atypical depressive or manic states, Wernicke's motility psychoses, reactive psychoses, and other nonorganic, nonaffective psychotic disorders as belonging to the broad group of schizophrenias, suggesting that 'this is important for the studies of heredity', thus foreshadowing the notion of schizophrenia spectrum disorders. Date: 2016-04-22; view: 1000
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