Dementia praecox

• schizophrenia and relationship to term dementia praecox
  • dementia praecox first used in 1891 by Arnold Pick, a professor of psychiatry at the German branch of Charles University in Prague
    • term dementia praecox was popularized by German psychiatrist Emil Kraepelin in 1896 in his first detailed description of a condition
      • Kraepelin broadened the notion of dementia praecox, leaving out the degenerative aetiology, and incorporated the notion of Griesinger and other authors of a predisposing diffuse cerebral pathology
        • Kraepelin noted that age of onset, family history and premorbid personality or temperament were useful in distinguishing between dementia praecox and manic-depressive insanity
          • he emphasized hereditary factors in dementia praecox and found evidence of a hereditary factor in a majority of his cases
          • raised the possibility that obstetric complications such as difficult labour, previous miscarriages, stillborn children, and premature births were significant factors in the aetiology of psychosis
          • emphasized that dementia praecox is a central nervous system disease involving very serious lesions of the cerebral cortex, the lesions are rather permanent or can only be regenerated in part, if at all
          • believed that many other biologic abnormalities, including endocrinologic, cause schizophrenia
      • the condition dementia praecox would be eventually reframed and relabeled as schizophrenia
        • Bleuler (1908), a Swiss psychiatrist, introduced the term schizophrenia
          • was influenced by Wundt, Freud and Jung in his understanding of mental illness
          • Bleuler criticized the term ‘dementia praecox’ because schizophrenia did not always first appear in adolescence and did not invariably end in deterioration
            • Bleuler wrote that this disease lacked an adjective, called for a new name because he felt the name dementia praecox was awkward - he stated that the naem dementia praecox name only designated the disease, not the diseased
            • term ‘schizophrenia’ (splitting of mind) implies a psychological aetiology
    • some suggest that, because current data supports a central nervous system aetiology for schizophrenia, the concept of dementia praecox warrants resurrection (1)
      • authors suggest abandoning the term schizophrenia in favour of the more broad and generic term dementia praecox
        • suggested that replacing ‘schizophrenia’ with ‘dementia praecox’ in the 21st century will facilitate further research and help clarify the nosology of various brain disorders currently included in the schizophrenias.
      • neuroimaging findings including enlargement of the lateral ventricles, undersized superior temporal gyrus, and prefrontal abnormalities, are seen in patients with schizophrenia
        • additionally, these findings are correlated with the clinical symptoms of schizophrenia (3)

Notes:

• originally the term dementia was synonymous with insanity unrelated to age, cognitive status, or reversibility

Reference:

• (1) Howells JG (ed.) The Concept of Schizophrenia: Historical Perspectives. American Psychiatric Press, Washington DC, 1991.
• (2) Dementia praecox to schizophrenia: the first 100 years.Psychiatry Clin Neurosci. 1999 Aug;53(4):437-48. Review
• (3) Psychopharmacol Bull. 2007;40(4):156-67