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Will the Kraepelinian dichotomy survive DSM-V?

Abstract

Kraepelin proposed dementia praecox and manic-depressive illness as the two major psychotic disorders. This paradigm is still prevalent, but observations of overlapping boundaries between bipolar disorder and schizophrenia challenge this dichotomy. However, the concept of schizophrenia has been radically altered from the original Kraepelinian proposal. We defend the two psychoses positions, but suggest two flaws in the heuristic application: (1) overlapping features, such as psychotic symptoms, are not decisive in differential diagnosis; and (2) each disorder is a syndrome, not a disease entity. An alternative paradigm based on domains of pathology is more powerful for studies of etiology, pathophysiology, and therapeutic discovery.

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  • Authors+Show Affiliations

    ,

    Department of Psychiatry, Maryland Psychiatric Research Center, VA Capitol Health Care Network (VISN 5) MIRECC & University of Maryland School of Medicine, Baltimore, MD 21228, USA.

    Source

    MeSH

    Bipolar Disorder
    Diagnosis, Differential
    Diagnostic and Statistical Manual of Mental Disorders
    Humans
    Schizophrenia
    Syndrome

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19295511

    Citation

    Fischer, Bernard A., and William T. Carpenter. "Will the Kraepelinian Dichotomy Survive DSM-V?" Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology, vol. 34, no. 9, 2009, pp. 2081-7.
    Fischer BA, Carpenter WT. Will the Kraepelinian dichotomy survive DSM-V? Neuropsychopharmacology. 2009;34(9):2081-7.
    Fischer, B. A., & Carpenter, W. T. (2009). Will the Kraepelinian dichotomy survive DSM-V? Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology, 34(9), pp. 2081-7. doi:10.1038/npp.2009.32.
    Fischer BA, Carpenter WT. Will the Kraepelinian Dichotomy Survive DSM-V. Neuropsychopharmacology. 2009;34(9):2081-7. PubMed PMID: 19295511.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Will the Kraepelinian dichotomy survive DSM-V? AU - Fischer,Bernard A, AU - Carpenter,William T,Jr Y1 - 2009/03/18/ PY - 2009/3/20/entrez PY - 2009/3/20/pubmed PY - 2009/12/16/medline SP - 2081 EP - 7 JF - Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology JO - Neuropsychopharmacology VL - 34 IS - 9 N2 - Kraepelin proposed dementia praecox and manic-depressive illness as the two major psychotic disorders. This paradigm is still prevalent, but observations of overlapping boundaries between bipolar disorder and schizophrenia challenge this dichotomy. However, the concept of schizophrenia has been radically altered from the original Kraepelinian proposal. We defend the two psychoses positions, but suggest two flaws in the heuristic application: (1) overlapping features, such as psychotic symptoms, are not decisive in differential diagnosis; and (2) each disorder is a syndrome, not a disease entity. An alternative paradigm based on domains of pathology is more powerful for studies of etiology, pathophysiology, and therapeutic discovery. SN - 1740-634X UR - https://www.unboundmedicine.com/medline/citation/19295511/full_citation L2 - http://dx.doi.org/10.1038/npp.2009.32 DB - PRIME DP - Unbound Medicine ER -