P. Cioni - Vol. 5 Settembre 1999, n.3
Testo Bibliografia Summary Riassunto Indice
La diagnosi di schizofrenia: una
prospettiva storica
The diagnosis of schizophrenia: a historical
perspective
In diagnosing schizophrenia, two major positions were maintained since the recognition of the disorder in the 19th Century, i.e., the view that it is a distinct disease entity and the view that it is part of the clinical picture of a unitary psychosis (Einheitpsychose). Unifying theories of mental disorder were championed by Griesinger, Neumann and Morel, whereas Kraepelin, Kahlbaum, Hecker and Eugen Bleuler endorsed the separate entity view. However, during the first decades of the 20th Century, Kraepelin focused attention on the longitudinal course of the disease, including only those patients whose outcome was worse, thus restricting diagnosis only to cases who did not improve sufficiently, whereas Bleuler made diagnosis cross-sectionally; the latter resulted in overinclusion. Swinging between over- and hypo-inclusion characterised the issue of diagnosis of schizophrenia to date, with Kretschmer adding the concept of a continuum and the relationship of the disease with personality, and Adolf Meyer psychodynamic concepts and the view of the disease as an interaction between psychobiological and environmental factors. Kleist and Leonhard further dissected psychoses and Kurt Schneider countered Kretschmer views by subtracting value from personality factors and introducing the concept of first rank symptoms, patterned on Bleuler’s symptom classification. France did not dominate the scene, but Magnan and Gaëtan de Clérambault put forward the etiopathogenic concepts of poorly structured personality ("degenerated") and "mental automatisme due to "autochthonous neuronal excitation" to explain schizophrenia. After the 2nd World War, cultural predominance over psychiatric matters shifted to the United States, where Feighner and Robert Spitzer (Research Diagnostic Criteria and DSM-III/-III-R) and Nancy Andreasen (DSM-IV) used Kraepelin’s framework to restrict diagnosis; Andreasen incorporated Crow’s two-syndrome concept in the last version of the DSM by introducing the concept of negative symptoms. The concept of spectrum was added during the early Seventies and was modelled after the continuum concept.