Reshaping the diagnostic borders: Historical analysis of the diagnostic changes following the introduction of the schizophrenia concept.

BACKGROUND: Although the concept of schizophrenia is still widely presented as having replaced that of dementia praecox, studies have shown that the former was broader than the latter, resulting in a more complex diagnostic redistribution. However, this is poorly documented by quantitative approaches. AIMS: We sought to test the hypothesis that the use of the concept of schizophrenia had caused a diagnostic redistribution and to quantify it. METHOD: A retrospective study, based on admission register archives of the Strasbourg University Clinic of Psychiatry was conducted. The frequency of diagnoses given to patients were examined at two key time periods: one before (TP1) and one after (TP2) the introduction of the schizophrenia concept (established between 1926 and 1928). Eight main diagnoses related to schizophrenia were considered. RESULTS: Patients diagnosed with schizophrenia at TP2 mainly received the diagnoses of dementia praecox but also depression, hebephrenia, manic depressive illness, hysteria, paraphrenia, catatonia and mania at TP1. Dementia praecox and hebephrenia were the most relayed by schizophrenia. Bayesian sensitivity analyses confirmed the robustness of our data against distinct scenarios challenging our hypothesis. CONCLUSIONS: Our results confirm the broadening of the concept of schizophrenia compared to that of dementia praecox but also qualify the different concepts supposed to have been impacted. They provide unique quantitative data that define the contours of the diagnostic redistribution thus provoked. They also give relevant input in the current context where the need to rethink the DSM/ICD concept of schizophrenia is still debated.

'Psychosis of civilization': a colonial-situated diagnosis.

In the late 1930s, when colonial psychiatry was well established in the Maghreb, the diagnosis 'psychosis of civilization' appeared in some psychiatrists' writings. Through the clinical case of a Libyan woman treated by the Italian psychiatrist Angelo Bravi in Tripoli, this article explores its emergence and its specificity in a differential approach, and highlights its main characteristics. The term applied to subjects poised between two worlds: incapable of becoming 'like' Europeans - a goal to which they seem to aspire - but too far from their 'ancestral habits' to revert for a quiet life. The visits of these subjects to colonial psychiatric institutions, provided valuable new material for psychiatrists: to see how colonization impacted inner life and to raise awareness of the long-term socio-political dangers.

Italian colonial psychiatry: outlines of a discipline, and practical achievements in Libya and the Horn of Africa.

This article describes the establishment of psychiatry in Italy's former colonies during the period 1906-43, in terms of the clinical and institutional mechanisms, the underlying theories and the main individuals involved. 'Colonial psychiatry' (variously called 'ethnographic', 'comparative' or 'racial' psychiatry) - the object of which was both to care for mentally afflicted colonists and local people and also to understand and make sense of their pathologies - received most attention in colonial Libya, starting in the first months of the Italian occupation (1911-12) and then taking institutional form in the 1930s; in the colonies of what was known as 'Italian East Africa', on the other hand, less was said about psychiatric care, and practical achievements were correspondingly limited.