Emil Kraepelin: Dementia Praecox “Dementia praecox consists of a series of states, the common characteristic of which is a peculiar destruction of internal connections of the psychic personality....the majority of the clinical pictures are the expression of a single morbid process, though outwardly they often diverge very far from one another.”
Kraepelin: Course and Outcome • Split “dementia praecox” from manic-depressive illness • Early onset • Marked deterioration • Chronic course • Diversity of signs and symptoms • Importance of volition and affect
Eugen Bleuler: Loosening of Associations “Of the thousands of associative threads that guide our thinking, this disease seems to interrupt, quite haphazardly, sometimes single threads, sometimes a whole group, and sometimes whole segments of them.”
Bleuler: Fundamental Symptoms • Renamed the disorder “schizophrenia” • Focused on the characteristic symptoms • Emphasized fragmenting of thinking • Partial recovery possible • No full “restitutio ad integrum” • A broader concept • Heterogeneity: the “group of schizophrenias”
Bleuler’s Fundamental Symptoms • Associations • Affective Blunting • Avolition • Autism • Ambivalence • Attention
Bleuler’s Description of Fundamental Symptoms • Certain symptoms of schizophrenia are present in every case and at every period of the illness even though, as with every other disease symptom, they must have attained a certain degree of intensity before they can be recognized with any certainty…for example, the peculiar association disturbance is always present, but not each and every aspect of it…besides these specific permanent or fundamental symptoms, we can find a host of other, more accessory manifestations such as delusions, hallucinations, or catatonic symptoms…as far as we know, the fundamental symptoms are characteristic of schizophrenia, while the accessory symptoms may also appear in other types of illnesses.