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Monday, October 8, 2012

Emil Kraepelin

 

We must place the work of Kraepelin in the context of German psychiatry in the second half of the nineteenth century, which replaced the principles of the Naturphilosophie by positivists. All schools participated in the task of transforming the psychiatric knowledge in a positive knowledge. In the beginning we have W. Griesinger with consideration of the affects mental and brain diseases and whose Pathologie und Therapie der Krankheit Psychische (1845) can be regarded as the founding text of the German scientific psychiatry. German psychiatrists now also described morbid forms, such as catatonia by Karl L. Kahlbaum and E. hebephrenia Hecker. Paul J. Möbius proposed the classification of mental disorders as endogenous or exogenous origin, paving the way to the work of Kraepelin.

Kraepelin was born on February 15, 1856 in Neustrelitz (Mecklenburg). He studied medicine in Leipzig, in Würzburg and again in Leipzig, influenced perhaps by his brother Karl, who was a biologist. Concerned from the beginning of psychiatry, in 1876 a course in the laboratory of experimental psychology Wilhelm Wundt (creator of experimental psychology) in Leipzig. He worked as assistant to Franz von Rinecker in the psychiatric hospital of the University of Würzburg, while still a student. After graduating, he attended for four years serving the neuroanatomy of Bernhard von Gudden in Munich. In 1878 he presented his thesis acute Ueber den Einfluss auf die Entstehung von Krankheit Geisteskrankheiten (On the influence of acute illnesses in the genesis of mental illness), which examines the place of psychology in psychiatry, in a court presided over by Bernhard von Gudden. That same year he was assistant Gudden in Munich psychiatric asylum.

Neuropathology was also studied in Leipzig Flechsig, who was an assistant between February and June 1882 in Leipzig Irrenklinik. He worked as a volunteer assistant in the department of nervous diseases at an der Nerven-Poliklinik Medizinische Klinik, University of Leipzig under Wilhelm Erb and Wundt's laboratory to conduct research on psychopharmacology and psychophysiology. Kraepelin was attracted to the investigation, but Erb Wundt and guided him to the psychiatric clinic. In 1883 he made the clearance in the department of medicine at the University of Leipzig and in autumn the same year he returned to Munich to work in the psychiatric asylum Gudden. A year later he was as an assistant in the nursing Leubus, Silesia. In 1885 he was appointed head of the mental illness of the general hospital in Dresden. He was appointed professor of psychiatry at the University of Dorpat (now Estonia) in 1886. Taught teaching in psychiatric services at the Universities of Dorpart (1886) and Heidelberg (1891). Here was among its partners and Gustav Aschaffenburg pathologist Alois Alzheimer, who would later to Munich in 1903 was appointed professor of psychiatry at the University of Munich, a post he held for nineteen years.

In 1917 he created the Deutsche Forschungsanstalt für Psychiatrie in Munich, designed and prepared essentially by Kraepelin. In 1922 with emeritus status, he left teaching to serve as head of the Psychiatric Research Institute of the City of Munich, which soon gained international fame (He had become in 1918 the German Institute for Psychiatric Research). Whose life is threatened by the large post-war economic crisis, was saved by the Rockefeller Foundation shortly before the death of Kraepelin (1926). What had happened in other branches of medicine in psychiatry happening now. For many years Kraepelin conducted hundreds of clinical observations in a very descriptive and very systematic. Examined the behavioral disturbances of inpatients, analyzed thousands of medical records and, with his vast experience, tried to classify mental processes. These findings can be found in the Compendium der Psychiatrie, later entitled Lerhbuch, published in Leipzig in 1883. In 1927 already reached the ninth edition, after his death.

It should be noted that, when he published the first edition had 27 years, when enabled for medical school. During his stay in Dorpart (1886-1891) appeared the second and third editions, no longer compendium to be treated. It incorporated the new criterion of disease progression as an element for establishing a differential diagnosis. The third edition added a chapter on Kahlbaum catatonia.

The fourth, fifth and sixth edition to be published Kraepelin in Heidelberg. The fourth and had seven hundred pages and included "degenerative mental processes" in dementia praecox, catatonia and paranoid dementia. The fifth edition was published in 1896 and the sixth, 1899. Kraepelin took the concept of "manic-depressive disposition" of the French school. The entity was defined by specific clinical "emotional disturbance" for its phasic course and finished with a complete remission. However, the definitive description appeared in the sixth edition, but alluded to it in the fifth under the heading of "transfer paper." Its cause is located as "pathological disposition" in the fifth edition or as "endogenous" in the sixth. Another work that was widely publicized was his Einführung in die Klinik psychiatrishche (Leipzig, 1901) (Introduction to the psychiatric clinic.) In Der Psychologische Versuch in der Psychiatrie (1896) described their psychological criteria inspired by the teachings of Wundt. He also offered a historical overview of nineteenth-century psychiatry in a comprehensive work that was published in 1918 in the Zeitschrift F. die gesamte Neurologie und Psychiatrie.

It appears that Kraepelin was a private person, very meticulous and respectful of authority. He had a passion for botany, and each year organizes a walking tour around Munich with his assistants. He took the nosotaxia to psychiatry. Individualized manic-depressive psychosis and dementia praecox described, which followed the direction marked by Kahlbaum and Hecker. He gave particular extension unit and by grouping three main clinical types, catatonia, isolated between 1863 and 1874 by Kahlbaum; hebephrenia described by Hecker in 1871, and a delusional way, which was described as paranoid. This new entity, clearly defined from the sixth edition of the Treaty (1899), as we have said, had quickly vast success in the psychiatric and paved the way for Bleuler's schizophrenia. The notion of paranoid delusions led him thus to limit the broad concept definitely paranoid delusional system restricted to a "durable and impossible to break, that is established with complete conservation of clarity and order in thought, in the will and action. " It was also he who gave its citizenship to the manic-depressive psychosis hitherto fragmented into a number of separate clinical forms, but at no time was concerned with the psychopathological hypothesis and contented himself with descriptive and classificatory considerations, believing that these conditions were psychosis cause "endogenous", whose origin should be sought in the internal organization of the predisposing personality.

The rating system was imposed Kraepelin virtually since its enactment. Their commitment to computer, clearly distinguishing the exogenous and endogenous psychoses and education development Bleuler completed when it replaced the concept of "dementia praecox" schizophrenia. Shortly later things changed again in psychiatry, but Kraepelin made possible the conversion of it into a discipline built on a core doctrine and structured around a defined clinical entities.

Kraepelin was also fond of music and literature. He wrote poems that were published after his death. He died on October 7, 1926.

We speak of "Kraepelin's classification" to refer to the division of mental illness in manic and schizophrenic groups.

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