Nosologomania: DSM & Karl Jaspers' Critique of Kraepelin

Emil Kraepelin's nosology has been reinvented, for better or worse. In the United States, the rise of the neo-Kraepelinian nosology of DSM-III resuscitated Kraepelin's work but also differed from many of his ideas, especially his overtly biological ontology. This neo-Kraepelinian system has led to concerns regarding overdiagnosis of psychiatric syndromes ("nosologomania") and perhaps scientifically ill-founded psychopharmacological treatment for presumed neo-Kraepelinian syndromes. In the early 20th century, Karl Jaspers provided unique insights into Kraepelin's work, and Jaspers even proposed an alternate nosology which, though influenced by Kraepelin, also introduced the concept of ideal types. Jaspers' critique of Kraepelin may help us reformulate our current neo-Kraepelinian nosology for the better

Perspectives on the Mind

PHILOSOPHY, PSYCHIATRY, AND NEUROSCIENCE: THREE APPROACHES TO THE MIND Edward M. Hundert Clarendon Press: Oxford, 1989 $19.95 313 page

In Search of the Roots of Psychiatry

APPROACHES TO THE MIND: MOVEMENT OF THE PSYCHIATRIC SCHOOLS FROM SECT TOWARD SCIENCE Leston Havens, M.D. Harvard University Press Cambridge, Massachusetts 1987, 399 pages, $12, paperback

Comorbid bipolar disorder and obsessive-compulsive disorder: An old debate renewed

Abstract assent

Bipolar disorder in the digital age: new tools for the same illness

“Nothing is more difficult than to ascertain the length of time that a maniacal patient can exist without sleep.”—Dr. Sutherland (Br J Psychiatry 7(37):1–19, 1861). Dr. Sutherland’s patient was suffering from an acute manic episode, which today is called bipolar illness. 150 years later, we continue to struggle with the same challenges in ascertaining accurate symptoms from patients. In era of new digital tools, the quantified self-movement, and precision medicine, we can ask the question: Can we advance understanding and treatment for bipolar illness beyond asking the same questions as in 1861

Polarity of the First Episode and Time to Diagnosis of Bipolar I Disorder

Objective The current study explored the relationship between the polarity of the first episode and the timing of eventual diagnosis of bipolar I disorder, and associated clinical implications. Methods Twelve years of clinical data from the medical records of 258 inpatients meeting DSM-III-R or DSM-IV criteria for bipolar I disorder were analyzed. Subjects were divided into two groups according to the polarity of the first episode: those with depressive polarity (FE-D), and those with manic polarity (FE-M). Comparisons were made between the two groups on variables associated with the timing of diagnosis and related outcomes. Results In Population with bipolar I disorder, a significant longer time lapse from the first major mood episode to the confirmed diagnosis was associated with the FE-D group compared to the FE-M group [5.6 (+/- 6.1) vs. 2.5 (+/- 5.5) years, p<0.001]. FE-D subjects tended to have prior diagnoses of schizophrenia and major depressive disorder while FE-M subjects tended to have prior diagnoses of bipolar disorder and schizophrenia. A significantly higher rate of suicide attempts was associated with the FE-D group compared to the FE-M group (12.7 vs. 1.7%, p<0.001). Conclusion The results of this study indicate that first-episode depressive polarity is likely to be followed by a considerable delay until an eventual confirmed diagnosis of bipolar I disorder. Given that first-episode depressive patients are particularly vulnerable to unfavorable clinical Outcomes Such as suicide attempts, a more systematic approach is needed to differentiate bipolar disorder among depressed patients in their early stages.Rosa AR, 2008, J AFFECT DISORDERS, V107, P45, DOI 10.1016/j.jad.2007.07.021Chaudhury SR, 2007, J AFFECT DISORDERS, V104, P245, DOI 10.1016/j.jad.2007.02.022Berk M, 2007, J AFFECT DISORDERS, V103, P181, DOI 10.1016/j.jad.2007.01.027Benazzi F, 2007, LANCET, V369, P935GOODWIN FK, 2007, MANIC DEPRESSIVE ILLDaban C, 2006, COMPR PSYCHIAT, V47, P433, DOI 10.1016/j.comppsych.2006.03.009McElroy SL, 2006, BIPOLAR DISORD, V8, P596Kassem L, 2006, AM J PSYCHIAT, V163, P1754Colom F, 2006, J AFFECT DISORDERS, V93, P13, DOI 10.1016/j.jad.2006.01.032Perlis RH, 2005, AM J MANAG CARE, V11, pS271Perlis RH, 2005, BIOL PSYCHIAT, V58, P549, DOI 10.1016/j.biopsych.2005.07.029Gazalle FK, 2005, J AFFECT DISORDERS, V86, P313, DOI 10.1016/j.jad.2005.01.003Ghaemi SN, 2005, J AFFECT DISORDERS, V84, P273, DOI 10.1016/S0165-0327(03)00196-4Post JC, 2005, CURR OPIN ALLERGY CL, V5, P5Mitchell PB, 2004, BIPOLAR DISORD, V6, P530Goodwin FK, 2003, JAMA-J AM MED ASSOC, V290, P1467Morselli PL, 2003, BIPOLAR DISORD, V5, P265Daniels BA, 2003, J AFFECT DISORDERS, V75, P163, DOI 10.1016/S0165-0327(02)00041-1Baethge C, 2003, ACTA PSYCHIAT SCAND, V107, P260Hirschfeld RMA, 2003, J CLIN PSYCHIAT, V64, P161Goldberg JF, 2002, J CLIN PSYCHIAT, V63, P985Ghaemi SN, 2002, CAN J PSYCHIAT, V47, P125Suppes T, 2001, J AFFECT DISORDERS, V67, P45Hirsch M, 2001, YALE J CRIT, V14, P5Bowden CL, 2001, PSYCHIATR SERV, V52, P51Hirschfeld RMA, 2000, AM J PSYCHIAT, V157, P1873Ghaemi SN, 2000, J CLIN PSYCHIAT, V61, P804Perugi G, 2000, COMPR PSYCHIAT, V41, P13GHAEMI SN, 2000, J CLIN PSYCHIAT, V61, P809Ghaemi SN, 1999, J AFFECT DISORDERS, V52, P135Baldessarini RJ, 1999, J CLIN PSYCHIAT, V60, P77BALDESSARINI RJ, 1999, J CLIN PSYCHIAT S2, V60, P111LISH JD, 1994, J AFFECT DISORDERS, V31, P281WEHR TA, 1988, AM J PSYCHIAT, V145, P179

The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances