[The report on Ludwig II by Gudden and his colleagues in relation to the state of knowledge at that time]. / Guddens Kollegiatsgutachten über Ludwig II. im Wissen seiner Zeit.

Bernhard von Gudden and his prominent co-experts Grashey, Hagen and Hubrich wrote an expert opinion on Ludwig II that was based on statements of sworn witnesses of the 41-year-old monarch's pathological behavior. With the contemporary material available today it can be understood why Gudden reached the diagnosis of "paranoia (madness)", which was in accordance with the state of psychiatric knowledge at that time. Even the official investigations initiated after the deaths of Ludwig II and Gudden did not come to a different conclusion. Gudden was a highly respected physician, researcher and clinical teacher; however, in the treatment of Ludwig he misjudged the consequences of his diagnosis and they both paid for his miscalculation with their lives. The Bavarian royal tragedy has many roots but a negligent or even deliberate misdiagnosis is not one of them.

Psychoeducational and Cognitive Behavioral Treatment Programs: Implementation and Evaluation From 1995 to 2015 in Kraepelin's Former Hospital.

OBJECTIVE: Programs that view individuals as capable of taking an active role in managing their illness have gained importance in Europe and the United States. This article describes the implementation and evaluation of group psychoeducational and cognitive behavioral treatment programs at the Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany, over the past 20 years. METHODS: Implementing psychoeducational programs was the first step to establish cognitive behavioral psychotherapy and dispel the myth of schizophrenia for patients. Programs are also provided for patients with mood disorders, substance use disorders, or both. These groups include topics such as psychoeducation about the illness, establishing rewarding activities, stress management, cognitive therapy, and relapse prevention. RESULTS: More than 1000 patients with schizophrenia or mood disorders (380 schizophrenia, 563 major depression, and 110 bipolar) have participated in illness management groups to learn about their illness and its treatment, and to learn skills to manage their illness. Patients have expressed satisfaction with the programs, and research has supported their effectiveness. CONCLUSIONS: Individuals with severe disorders can benefit from psychoeducational and cognitive treatment programs if the programs are adapted to the level of neuropsychological functioning and compensate for cognitive deficits and emotional overload. These findings suggest that providing information about the illness and coping skills for patients and relatives are important for treatment outcome.

The 'atypicality' of antipsychotics: a concept re-examined and re-defined.

Recent clinical trials have raised questions over the perceived advantages of second-generation 'atypical' antipsychotics over those from the first generation. An atypical antipsychotic in its original sense is one that lacks extrapyramidal side effects. However, the addition of other clinical features to the original concept of atypicality, such as efficacy against negative and cognitive symptoms, seems to have become a feature of searches for novel antipsychotics in the past two decades. Although this approach has led to some therapeutic advances, we propose that it has also hampered antipsychotic drug research and that reframing the concept of atypicality could have a key role in making genuine breakthroughs in schizophrenia therapy.

The work of Emil Kraepelin and his research group in München.

Emil Kraepelin is well known due to his development of the psychiatric classification. The ICD-10 and DSM-IV classification is based on the dichotomy of endogenous psychoses into affective psychoses and schizophrenia as early as 1899. Moreover, beside his classification system he put enormous impact on the development of psychiatry to an empirical field of science. The research activities of Kraepelin and his coworkers show that he was not only the most active researcher in the field of psychiatry in his time but also that his research activities included a lot of clinical and experimental work in different disciplines of psychiatry, including psychology, pharmacology and natural sciences as 'Hilfswissenschaften'. Due to his extraordinary position also in his time he brought together important researchers of this time, in particular after the foundation of a psychiatric research institute. Alois Alzheimer, Franz Nissl, Robert Gaupp, or Korbinian Brodman are only a few of his well known coworkers. Kraepelin tried to bring foreward the empirical knowledge in psychiatry, he did not want to have cessation in psychiatry in general and in the classification of psychiatric disorders in particular. He discussed and partly revisted his view and his theoretical approach in the different editions of his textbook according to the state of his empirical knowledge. This is also true for the dichotomy. More than twenty years after the 6th edition of his textbook, he wrote in an essay 'Die Erscheinungsformen des Irreseins' ('The manifestations of insanity') regarding the dichotomy: "No experienced diagnostician would deny that cases where it seems impossible to arrive to a clear decision, despite extremely careful observation, are unpleasantly frequent." and "....therefore, the increasingly obvious impossibility to separate the two respective illnesses satisfactorily should raise the suspicion that our question is wrong". This contribution shows that Kraepelin himself questioned his dichotomy of dementia praecox and manic depressive insanity, a discussion which is lively still today--more than 80 years later.

The discovery of Alzheimer's disease.

On November 3, 1906, a clinical psychiatrist and neuroanatomist, Alois Alzheimer, reported "A peculiar severe disease process of the cerebral cortex" to the 37th Meeting of South-West German Psychiatrists in Tubingen, He described a 50-year-old woman whom he had followed from her admission for paranoia, progressive sleep and memory disturbance, aggression, and confusion, until her death 5 years later. His report noted distinctive plaques and neurofibrillary tangles in the brain histology. It excited little interest despite an enthusiastic response from Kraepelin, who promptly included "Alzheimer's disease" in the 8th edition of his text Psychiatrie in 1910. Alzheimer published three further cases in 1909 and a "plaque-only" variant in 1911, which reexamination of the original specimens in 1993 showed to be a different stage of the same process, Alzheimer died in 1915, aged 51, soon after gaining the chair of psychiatry in Breslau, and long before his name became a household word.