KRAEPELIN AND BLEULER: A COMPARISON OF DEMENTIA PRAECOX AND SCHIZOPHRENIA

Abstract

A systematic comparison of Kraepelinian dementia praecox and Bleulerian schizophrenia is presented, together with a review of the historical background of their respective diagnostic systems. Each system is then analyzed and revised into a diagnostic checklist format with lists of inclusion and exclusion criteria, to make them comparable to, and compatible with, all seven of the diagnostic systems which prevail today, such as DSM-III and RDC. None of the seven contemporary systems, each of which is thought to be either "neo-Kraepelinian" or "neo-Bleulerian," faithfully represents the essential features of the two original systems from which they are derived. An analysis which highlights previously unrecognized and largely unappreciated features of the Kraepelinian and Bleulerian diagnostic systems, features which appear to be crucially lacking in all seven of the prevailing systems of today, leads to the recommendation that all nine systems be applied simultaneously to one patient population in future research on the evaluation of new diagnostic tests and treatments for schizophrenia. This would be accomplished by formulating a composite cross-diagnostic checklist incorporating all nine systems. The prevailing practice of using a single diagnostic system to the exclusion of all others is shown to have marked weaknesses. (1) Any one diagnostic system alone might fail to reveal the true benefits of any given test or treatment, while the application of all major systems simultaneously maximizes the likelihood of success; (2) Instead of having each new diagnostic test or treatment for schizophrenia evaluated many times by many different clinicians, each using a different diagnostic system on a completely different patient population, the method of composite cross-system diagnosis makes it possible to obtain simultaneous diagnoses according to all of the systems, all made the same clinician(s), on the same population of patients.