Tracing the Roots of Dementia Praecox: The Emergence of Verrücktheit as a Primary Delusional-Hallucinatory Psychosis in German Psychiatry From 1860 to 1880.

While the roots of mania and melancholia can be traced to the 18th century and earlier, we have no such long historical narrative for dementia praecox (DP). I, here, provide part of that history, beginning with Kraepelin's chapter on Verrücktheit for his 1883 first edition textbook, which, over the ensuing 5 editions, evolved into Kraepelin's mature concepts of paranoia and paranoid DP. That chapter had 5 references published from 1865 to 1879 when delusional-hallucinatory syndromes in Germany were largely understood as secondary syndromes arising from prior episodes of melancholia and mania in the course of a unitary psychosis. Each paper challenged that view supporting a primary Verrücktheit as a disorder that should exist alongside mania and melancholia. The later authors utilized faculty psychology, noting that primary Verrücktheit resulted from a fundamental disorder of thought or cognition. In particular, they argued that, while delusions in mania and melancholia were secondary, arising from primary mood changes, in Verrücktheit, delusions were primary with observed changes in mood resulting from, and not causing, the delusions. In addition to faculty psychology, these nosologic changes were based on the common-sense concept of understandability that permitted clinicians to distinguish individuals in which delusions emerged from mood changes and mood changes from delusions. The rise of primary Verrücktheit in German psychiatry in the 1860-1870s created a nosologic space for primary psychotic illness. From 1883 to 1899, Kraepelin moved into this space filling it with his mature diagnoses of paranoia and paranoid DP, our modern-day paranoid schizophrenia.

"Escrúpulos religiosos extremos" y delirio místico - religioso: entre la devoción cristiana y la psicopatología en Colombia, 1920-1960 / "Extreme religious scruples" or mystical delirium - religious: between christian devotion and psychopathology in Colombia, 1920-1960

OBJETIVO: comprender la semiología del delirio místico-religioso y la incidencia del contenido sociocultural en la configuración de los síntomas en la psicopatología moderna en Colombia, 1920-1960. METODOLOGÍA: investigación histórico-hermenéutica, mediante análisis de una serie de historias clínicas del antiguo Manicomio Departamental de Antioquia y del Asilo Psiquiátrico San Isidro del Valle del Cauca. RESULTADOS: entre las psicopatologías más recurrentes en las que se manifestaron los delirios se encuentra el grupo de las manías, principalmente la intermitente, psicosis maniaco-depresiva y melancolía; seguido por la esquizofrenia paranoide, y también fue frecuente en la psicosis puerperal o posparto; asimismo, se presentó en la parálisis general progresiva (neurosífilis) y en el síndrome cerebral agudo o estado de confusión agudo, nosografía moderna dada al delirio. Según las historias clínicas, la exaltación de ideas religiosas confluye en un delirio polimorfo. Los síntomas más recurrentes fueron las alucinaciones visuales y auditivas, logorrea o locuacidad, insomnio, negativismo alimentario acompañado de miedo a ser envenenado, excitación psicomotora o hiperquinética, accesos de furia controlados con camisa de fuerza y otros medios de contención, intento de suicidio y tendencia a la fuga de la casa, por lo tanto, se consideraba de peligrosidad para sí mismos y para los demás

OBJECTIVE: To understand the semiotics of mystical-religious delirium and the incidence of sociocultural content in the configuration of symptoms in modern psychiatry in Colombia, 1920-1960. METHODOLOGY: hermeneutic historical, research by analysis of a series of case histories of the old Madhouse Department of Antioquia and the Psychiatric Asylum San Isidro del Valle del Cauca. RESULTS: Among the most frequent psychopathologies in which delusions demonstrated is the group of hobbies, mainly intermittent, manic depression and melancholy; followed by paranoid schizophrenia, and was also common in puerperal or postpartum psychosis; He also appeared in general paresis (neurosyphilis) and acute brain syndrome or acute confusional state, delirium given modern nosography. According to medical records, the exaltation of religious ideas comes together in a polymorph delirium. The most frequent symptoms were visual and auditory hallucinations, logorrea or talkativeness, insomnia, accompanied food negativism fear of being poisoned, psychomotor or hyperkinetic excitement, fits of rage controlled straitjacket and other means of containment, attempted suicide and trend the escape of the house, therefore it was considered dangerous to themselves and others

[Paranoia Querulans in the First Half of the 20th Century: The Case of Elsa Asenijeff (1867-1941) and the German Psychiatric Literature of that Time]. / Der Querulantenwahn in der 1. Hälfte des 20. Jahrhunderts: Der Fall Elsa Asenijeff (1867­1941) und die deutschsprachige psychiatrische Literatur der Zeit.

OBJECTIVE: The writer Elsa Asenijeff was placed under guardianship based on the diagnosis paranoia querulans in 1921. The aim of this study was to commemorate her case and to question how this clinical picture was understood at the time in order to contribute to the history of this little researched disorder. METHODS: We illustrate the essence of Asenijeffs forensic examinations and of the descriptions of paranoia querulans in selected German psychiatric literature of the beginning of the 20th century. RESULTS: The literature describes paranoia querulans as a delusional disorder provoked by judicial conflict. The selected authors offer different theories of its genesis and classification. CONCLUSIONS: The symptoms described in the forensic examinations are in accordance with the doctrine of academic psychiatry of the time. The chosen literature also illustrates the difficulties of a clear distinction between mental health and illness.

The madness of Princess Alice: Sigmund Freud, Ernst Simmel and Alice of Battenberg at Kurhaus Schloß Tegel.

During the winter of 1930, Princess Alice of Battenberg was admitted to Kurhaus Schloß Tegel, where she was diagnosed with schizophrenic paranoia. When Freud was consulted about her case by Ernst Simmel, the Sanatorium's Director, he recommended that the patient's ovaries be exposed to high-intensity X-rays. Freud's suggestion was not based on any psychoanalytic treatment principles, but rooted in a rejuvenation technique to which Freud himself had subscribed. In recommending that psychotic patients should be treated with physical interventions, Freud confirmed his conviction that the clinical applicability of psychoanalysis should not be extrapolated beyond the neuroses, yet he also asserted that a proper consideration of endocrinological factors in the aetiology and treatment of the psychoses should never be excluded.

The Genealogy of Dementia Praecox I: Signs and Symptoms of Delusional Psychoses From 1880 to 1900.

We can trace, with high congruence, the clinical syndromes of depression and mania as described over the 20th century in psychiatric textbooks back to 1880 and to the earliest writing of Kraepelin published in 1883. However, this is not the case for Kraepelin's 2 delusional syndromes central to his overall nosology: Dementia Paranoides (later paranoid schizophrenia) and Paranoia. A detailed examination of 28 textbook descriptions of delusional psychoses from 1880 to 1900 reveals a diverse and partially overlapping set of syndromes with an admixture of symptoms and signs that would later be considered indicative of Dementia Paranoides and Paranoia. A similar pattern in seen in Kraepelin's own description of "Primäre Verrücktheit" from the first edition of his textbook (1883). No clear prototypes emerged in these textbooks or in Kraepelin's early writings for the 2 distinct delusional syndromes that would later evolve in his mature writings. Rather, the nosologic approach taken in these writings was symptom based and assumed that a viable diagnostic category could be constituted by including all delusional patients once those suffering from organic or mood disorders were excluded. While Kraepelin used the historical syndromes of mania and depression, with no appreciable change, as building blocks for his category of manic-depressive insanity, his nosologic system for the psychotic disorders-the syndromes of Dementia Praecox and Paranoia-was more innovative and without clear precedent in the prior psychiatric literature.

From Evolutive Paranoia, by August Wimmer (1902).

Literature on the history of 'paranoia' (as a clinical concept) is large and confusing. This is partly explained by the fact that over the centuries the word 'paranoia' has been made to participate in several convergences (clinical constructs), and hence it has named different forms of behaviour and been linked to different explanatory concepts. The Classic Text that follows provides information on the internal clinical evolution of the last convergence in which 'paranoia' was made to participate. August Wimmer maps the historical changes of ' Verrücktheit' as it happened within the main European psychiatric traditions since the early 19th century. After World War II, that clinical profile was to become reified and renamed as 'delusional disorder'.

The Clinical Features of Paranoia in the 20th Century and Their Representation in Diagnostic Criteria From DSM-III Through DSM-5.

This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms and signs to the diagnostic criteria for paranoia/delusional disorder in DSM-III through DSM-5. Clinical descriptions of paranoia appearing in 10 textbooks, published 1899 to 1970, revealed 11 prominent symptoms and signs reported by 5 or more authors. Three symptoms (systematized delusions, minimal hallucinations, and prominent ideas of reference) and 2 signs (chronic course and minimal affective deterioration) were reported by 8 or 9 of the authors. Four textbook authors rejected the Kraepelinian concept of paranoia. A weak relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern DSM manuals. Indeed, the diagnostic criteria for paranoia/delusional disorder shifted substantially from DSM-III to DSM-5. The modern operationalized criteria for paranoia/delusional disorder do not well reflect the symptoms and signs frequently reported by historical experts. In contrast to results of similar reviews for depression, schizophrenia and mania, the clinical construct of paranoia/delusional disorder has been somewhat unstable in Western Psychiatry since the turn of the 20th century as reflected in both textbooks and the DSM editions.

[Mental signs of individual predisposition to madness in French psychiatry of the late XIX-early XX centuries].

The author analyze conceptions of mental signs of predisposition (diathesis, vulnerability) to non-psychotic and delusional mental disorders of functional origin described in the works of leading French psychiatrists of the late 19th/early 20th centuries (E. Regis, P. Serieux, J. Capgras, E. Dupre, J. Levy-Valensi etc). The descriptions of characteristics of some constitutional types and the differences in the structure of constitutional types and the structure of delusional disorders developed on their basis are compared.

The description of the litigious querulant: Heinrich von Kleist's Novella Michael Kohlhaas.

OBJECTIVE: To illustrate the use of fiction in understanding psychiatric disorders and refocus attention towards fiction as a valuable source of psychopathology, thereby contributing to the restoration of the narrative in psychiatry. METHOD: A psychopathological analysis of the novella Michael Kohlhaas written by Heinrich von Kleist, one of the outstanding literary figures of the German romantic movement of the early 19th century. RESULTS: The protagonist of Kleist's novella, Michael Kohlhaas, a querulant horse trader, carries out an armed uprising disproportionate to the minor injustice of the unlawful seizure of his horses. Following unsuccessful attempts at legal recourse, Kohlhaas takes up arms against the authorities, and in the course of his uncompromising pursuit of justice eventually sacrifices his own and his family's lives. Kleist accurately portrays Kohlhaas' psychopathological development from a psychologically balanced, emotionally warm family man to one who causes utter destruction, mayhem and the loss of innocent lives. This literary work is a remarkably authentic, insightful and rich representation of litigious/querulant behaviour, described by classical authors as litigious paranoia, a diagnostic category currently subsumed under 'delusional disorder, persecutory type', in DSM-5 and 'persistent delusional disorder' in ICD-10. CONCLUSIONS: Kleist's novella offers important clues to better understand the development of litigious-querulant behaviour and the inner world of its sufferers. An analysis of the novella also illustrates the contribution that fiction could make to resuscitate the narrative as a complement to criterion-based diagnostic practice prevailing in contemporary psychiatry. © 2014 S. Karger AG, Basel.

Psychiatry on trial: the Norway 2011 massacre.

On July 22, 2011, Anders Breivik, a Norwegian citizen, detonated a fertilizer bomb near government buildings in Oslo, killing eight people, and then proceeded to a nearby island where the Labor Party was holding a youth camp. There, he killed 69 people before being arrested. Just before these events, he posted a "compendium" on the Web explaining his actions and encouraging others to do likewise. Much of the ensuing media coverage and trial focused on whether he was sane and whether he had a psychiatric diagnosis. One team of court-appointed psychiatrists found him to be psychotic with a diagnosis of paranoid schizophrenia and legally insane. A second team found him neither psychotic nor schizophrenic and, thus, legally sane. Their contrary opinions were not reconciled by observing his behavior in court. We discuss why experienced psychiatrists reached such fundamentally opposing diagnostic conclusions about a "home-grown" terrorist holding extreme political views.

[Sensitive character: an almost forgotten personality disorder - illustrated by the case Anton Reiser]. / Der sensitive Charakter: Eine fast vergessene Persönlichkeitsstörung - illustriert am Fall Anton Reiser.

n his famous 1918 book "The sensitive relative delusion" Ernst Kretschmer not only described this specific delusional disorder but also the underlying sensitive personality disorder. Until now, relatively little attention has been paid to this part of his work. The incomplete reception is outlined, followed by a description of the symptoms, psychodynamics and course of sensitive personality disorder. The interpretation of "Anton Reiser: a psychological novel" - the autobiographical work by Karl Philipp Moritz in 1785 ­ is used as an example since it describes Anton Reiser as a sensitive personality.

[Paraphrenia: the modernity of Emil Kraepelin's thinking]. / Parafrenia: attualità del pensiero di Emil Kraepelin.

Paraphrenia is a chronic psychotic disorder similar to paranoid schizophrenia, but with a better-preserved affect and rapport, and a much less personality deterioration. It was at first described by Kraepelin in 1913 as a group of patients who exhibited delusional symptoms typical of dementia praecox, but with minimal disturbances of emotion and volition. After the publication of Mayer-Gross's report in 1921, the view to differentiate paraphrenia from schizophrenia was considered to be unfounded and the term "paraphrenia" was not included in the current DSM-IV-TR and ICD-10 diagnostic criteria. Consequently, this disorder is now diagnosed relatively infrequently. However, several authors have recently suggested that the paraphrenia concept has not lost its usefulness. It seems to be that many psychiatrists recognize the illness, but labelled it as "atypical psychosis", "schizoaffective disorder" or "psychotic disorder not otherwise specified" for the lack of a better diagnostic category. Very few systematic studies on paraphrenia have been conducted in the past 70 years. Aim of this article is to underline the modernity of Kraepelin's thinking and his "paraphrenia" concept, suggesting that it could be possible to define and recognize the illness if practitioners would be induced to use a viable diagnostic entity.

A paranoia em 1904 - uma etapa na construção nosológica de Emil Kraepelin / Paranoia in 1904 - a stage in Emil Kraepelin's construction of this nosology / La paranoïa en 1904 - une étape de la construction nosologique d'Emil Kraepelin / La paranoia en 1904 - una etapa de la construción nosologica de Emil Kraepelin

Este artigo apresenta o texto de Kraepelin sobre a paranoia, extraído da sétima edição de seu tratado de psiquiatria (1904), traduzido para o português e publicado pela primeira vez em 1905, na revista Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins. Indica-se a posição desta categoria na nosologia de Kraepelin, bem como se discute aspectos da difusão de suas ideias no Brasil.(AU)

This article introduces Kraepelin's text on paranoia, taken from the seventh edition of his Treatise on Psychiatry (1904), translated into the Portuguese and published for the first time in 1905 in Revista Brasileira de Psiquiatria, neurologia e ciências afins (Brazilian Journal of Psychiatry, Neurology and Related Sciences. The article indicates the place of paranoia in Kraepelin's nosology and discusses aspects of the diffusion of his ideas in Brazil.(AU)

Cet article nous présente le texte de Kraepelin sur la paranoïa, extrait de la septième édition de son manuel de psychiatrie (1904), traduit en portugais et publié en 1905 dans la revue Archives Brésiliennes de Psychiatrie, Neurologie et des Sciences Connexes. On indique la position de cette catégorie dans la nosologie de Kraepelin et discute les aspects de la diffusion de ses idées au Brésil.(AU)

Este artículo presenta el texto de Kraepelin sobre la paranoia, extraído de la séptima edición de su tratado de psiquiatría (1904), traducido para el portugués y publicado por la primera vez en 1905, en la revista Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins. Se indica en él, la posición de esta categoría en la nosología de Kraepelin, así como se discuten aspectos de la difusión de sus ideas en el Brasil.(AU)

[Trichoma (Plica polonica) - a contemporary case with a historical disease]. / Der Weichselzopf (Plica polonica) - eine aktuelle Kasuistik zu einem historischen Krankheitskonzept.

We describe a 62-year-old patient with a chronic delusional disorder who presented with severely matted hair ("plica polonica"). Until the late 19th century such dreadlocks were considered as cause, consequence and treatment of mental disease. The historical development of "plica polonica" is briefly reviewed as an example of early and once popular psychiatric disease concepts.

Thorstein Veblen and Dementia praecox.

Both of Thorstein Veblen's wives and another woman he loved had nervous breakdowns, while a fourth woman to whom he was emotionally very close committed suicide. Yet when Veblen published an article entitled "Dementia praecox," he did not mention his personal contact with serious mental disorder. This detachment is consistent with Veblen's approach to writing. Veblen considered himself to be a detached observer who wrote objectively about society rather than subjectively about himself.

[Doctor and patient: Paul Flechsig and Daniel Paul Schreber]. / Arzt und Patient: Paul Flechsig und Daniel Paul Schreber.

During his three stays in psychiatric institutions between 1884 and 1911, Daniel Paul Schreber was also twice treated in the psychiatric and neurological hospital of Leipzig University headed by Paul Flechsig. In his "Memoirs of a Nervous Patient," Schreber also described the treatment he had received there, which in his perception seemed to be of crucial importance for his later fate. Research on the Schreber case in the last 25 years, based mainly on the interpretation of his own memoirs, supported the view that in fact Flechsig was to blame to a great extent for the outbreak of Schreber's paranoid schizophrenia in February 1894. This paper aims at forwarding exonerating arguments in favor of Flechsig, concluding that what he did did not differ distinctively from the standard tenets of organic psychiatry taught at that time. Of course this does not change the fact that Schreber did not receive the right kind of treatment. However, it puts Flechsig's approach into the right perspective.