Editing Dementia praecox (section)

==Kraepelin's influence on the next century==
[[File:Emil Kraepelin 1926.jpg|thumb|right|Emil Kraepelin {{Circa|1920}}]]
In the 1899 (6th) edition of {{lang|de|Psychiatrie}}, Kraepelin established a paradigm for psychiatry that would dominate the following century, sorting most of the recognized forms of insanity into two major categories: dementia praecox and manic-depressive illness. Dementia praecox was characterized by disordered intellectual functioning, whereas manic-depressive illness was principally a disorder of affect or mood; and the former featured constant deterioration, virtually no recoveries and a poor outcome, while the latter featured periods of exacerbation followed by periods of remission, and many complete recoveries. The class, dementia praecox, comprised the paranoid, catatonic and hebephrenic psychotic disorders, and these forms were found in the [[Diagnostic and Statistical Manual of Mental Disorders]] until the fifth edition was released, in May 2013. These terms, however, are still found in general psychiatric nomenclature.{{cn|date=May 2022}}

===Change in prognosis===
In the seventh, 1904, edition of {{lang|de|Psychiatrie}}, Kraepelin accepted the possibility that a small number of patients may recover from dementia praecox. [[Eugen Bleuler]] reported in 1908 that in many cases there was no inevitable progressive decline, there was temporary remission in some cases, and there were even cases of near recovery with the retention of some residual defect. In the eighth edition of Kraepelin's textbook, published in four volumes between 1909 and 1915, he described eleven forms of dementia, and dementia praecox was classed as one of the "endogenous dementias". Modifying his previous more gloomy prognosis in line with Bleuler's observations, Kraepelin reported that about 26% of his patients experienced partial remission of symptoms. Kraepelin died while working on the ninth edition of {{lang|de|Psychiatrie}} with Johannes Lange (1891–1938), who finished it and brought it to publication in 1927.<ref>{{harvnb|Noll|2007a|pp=[https://books.google.com/books?id=jzoJxps189IC&pg=PA126 126–7]}}</ref>

===Cause===
Though his work and that of his research associates had revealed a role for heredity, Kraepelin realized nothing could be said with certainty about the aetiology of dementia praecox, and he left out speculation regarding brain disease or neuropathology in his diagnostic descriptions. Nevertheless, from the 1896 edition onwards Kraepelin made clear his belief that poisoning of the brain, "auto-intoxication," probably by sex hormones, may underlie dementia praecox&nbsp;– a theory also entertained by Eugen Bleuler. Both theorists insisted dementia praecox is a biological disorder, not the product of psychological trauma. Thus, rather than a disease of hereditary degeneration or of structural brain pathology, Kraepelin believed dementia praecox was due to a systemic or "whole body" disease process, probably metabolic, which gradually affected many of the tissues and organs of the body before affecting the brain in a final, decisive cascade.<ref>{{cite web|last=Noll|first=Richard|title=Whole Body Madness|url=http://www.psychiatrictimes.com/display/article/10168/2104852|publisher=Psychiatric times|access-date=26 September 2012}}</ref> Kraepelin, recognizing dementia praecox in Chinese, Japanese, Tamil and Malay patients, suggested in the eighth edition of {{lang|de|Psychiatrie}} that, "we must therefore seek the real cause of dementia praecox in conditions which are spread all over the world, which thus do not lie in race or in climate, in food or in any other general circumstance of life..."{{sfn|Noll|2007a|p=[https://books.google.com/books?id=jzoJxps189IC&pg=PA127 127]}}

===Treatment===
Kraepelin had experimented with hypnosis but found it wanting, and disapproved of Freud's and Jung's introduction, based on no evidence, of psychogenic assumptions to the interpretation and treatment of mental illness. He argued that, without knowing the underlying cause of dementia praecox or manic-depressive illness, there could be no disease-specific treatment, and recommended the use of long baths and the occasional use of drugs such as opiates and barbiturates for the amelioration of distress, as well as occupational activities, where suitable, for all institutionalized patients. Based on his theory that dementia praecox is the product of autointoxication emanating from the sex glands, Kraepelin experimented, without success, with injections of thyroid, gonad and other glandular extracts.{{sfn|Noll|2007a|p=[https://books.google.com/books?id=jzoJxps189IC&pg=PA127 127]}}

===Use of term spreads===
[[File:Cartoon by Emil Kraepelin.jpg|right|thumb|"Psychiatrists of Europe! Protect your sanctified diagnoses!" A satirizing cartoon by Emil Kraepelin based on [[:de:Völker Europas, wahrt eure heiligsten Güter|a famous contemporary political painting]] (Below).]]
[[File:Voelker Europas.jpg|right|thumb|The political painting {{lang|de|Völker Europas, wahrt eure heiligsten Güter|}} ("People of Europe, defend your sacred treasures!")]]
Kraepelin noted the dissemination of his new disease concept when in 1899 he enumerated the term's appearance in almost twenty articles in the German-language medical press.{{sfn| Noll| 2007a|p = [https://books.google.com/books?id=jzoJxps189IC&pg=PA127 127]}} In the early years of the twentieth century the twin pillars of the Kraepelinian dichotomy, dementia praecox and manic depressive psychosis, were assiduously adopted in clinical and research contexts among the Germanic psychiatric community.{{sfn|Noll|2007a|p= [https://books.google.com/books?id=jzoJxps189IC&pg=PA127 127]}} German-language psychiatric concepts were always introduced much faster in America (than, say, Britain) where émigré German, Swiss and Austrian physicians essentially created American psychiatry. Swiss-émigré Adolf Meyer (1866–1950), arguably the most influential psychiatrist in America for the first half of the 20th century, published the first critique of dementia praecox in an 1896 book review of the 5th edition of Kraepelin's textbook. But it was not until 1900 and 1901 that the first three American publications regarding dementia praecox appeared, one of which was a translation of a few sections of Kraepelin's 6th edition of 1899 on dementia praecox.

Adolf Meyer was the first to apply the new diagnostic term in America. He used it at the Worcester Lunatic Hospital in Massachusetts in the fall of 1896. He was also the first to apply Eugen Bleuler's term "schizophrenia" (in the form of "schizophrenic reaction") in 1913 at the Henry Phipps Psychiatric Clinic of the Johns Hopkins Hospital.

The dissemination of Kraepelin's disease concept to the Anglophone world was facilitated in 1902 when Ross Diefendorf, a lecturer in psychiatry at Yale, published an adapted version of the sixth edition of the {{lang|de|Lehrbuch der Psychiatrie}}. This was republished in 1904 and with a new version, based on the seventh edition of Kraepelin's {{lang|de|Lehrbuch}} appearing in 1907 and reissued in 1912.{{Sfn |Dain|1980|pp=[https://books.google.com/books?id=OJMgz7cJjLcC&pg=PA34 34], [https://books.google.com/books?id=OJMgz7cJjLcC&pg=PA341 341 n. 38]}}{{Sfn |Diefendorf|1912|pp=219–75}} Both dementia praecox (in its three classic forms) and "manic-depressive psychosis" gained wider popularity in the larger institutions in the eastern United States after being included in the official nomenclature of diseases and conditions for record-keeping at Bellevue Hospital in New York City in 1903. The term lived on due to its promotion in the publications of the National Committee on Mental Hygiene (founded in 1909) and the Eugenics Records Office (1910). But perhaps the most important reason for the longevity of Kraepelin's term was its inclusion in 1918 as an official diagnostic category in the uniform system adopted for comparative statistical record-keeping in all American mental institutions, ''The Statistical Manual for the Use of Institutions for the Insane''. Its many revisions served as the official diagnostic classification scheme in America until 1952 when the first edition of the ''Diagnostic and Statistical Manual: Mental Disorders'', or DSM-I, appeared. Dementia praecox disappeared from official psychiatry with the publication of DSM-I, replaced by the Bleuler/Meyer hybridization, "schizophrenic reaction".

Schizophrenia was mentioned as an alternate term for dementia praecox in the 1918 ''Statistical Manual''. In both clinical work as well as research, between 1918 and 1952 five different terms were used interchangeably: dementia praecox, schizophrenia, dementia praecox (schizophrenia), schizophrenia (dementia praecox) and schizophrenic reaction. This made the psychiatric literature of the time confusing since, in a strict sense, Kraepelin's disease was not Bleuler's disease. They were defined differently, had different population parameters, and different concepts of prognosis.

The reception of dementia praecox as an accepted diagnosis in British psychiatry came more slowly, perhaps only taking hold around the time of World War I. There was substantial opposition to the use of the term "dementia" as misleading, partly due to findings of remission and recovery. Some argued that existing diagnoses such as "delusional insanity" or "adolescent insanity" were better or more clearly defined.<ref>{{harvnb|Ion|Beer|2002a|pp=285–304}}; {{harvnb|Ion|Beer|2002b|pp=419–31}}</ref> In France a psychiatric tradition regarding the psychotic disorders predated Kraepelin, and the French never fully adopted Kraepelin's classification system. Instead the French maintained an independent classification system throughout the 20th century. From 1980, when DSM-III totally reshaped psychiatric diagnosis, French psychiatry began to finally alter its views of diagnosis to converge with the North American system. Kraepelin thus finally conquered France via America.