Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-24T12:11:59.970Z Has data issue: false hasContentIssue false
  • English
  • Français

Too soon to discard Kraepelin: improving diagnosis by appropriate use of neo-Kraepelinian and unitary psychosis models

Published online by Cambridge University Press:  02 August 2022

Ahmed Huda Open the ORCID record for Ahmed Huda [Opens in a new window]  and
Joel Petch Open the ORCID record for Joel Petch [Opens in a new window]
Ahmed Huda*
Affiliation:
Consultant Psychiatrist with Tameside & Glossop Early Intervention Team, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK.
Joel Petch
Affiliation:
Senior Lecturer and Academic Lead for Year 2, Kent and Medway Medical School, Canterbury, UK.
*
Correspondence Dr Ahmed Samei Huda. Email: ahmed.huda@nhs.net
Get access Rights & Permissions [Opens in a new window]

Summary

There is a debate in psychiatry regarding whether it is better to use neo-Kraepelinian diagnostic categories or unitary models of psychosis in clinical practice. This article argues that clinicians should use either model as appropriate for the case in question, along with the conceptual framework used in the clinical management of psychosis without a clear biological cause. It first explores the values involved in the development of psychiatric classification systems, the purpose of classification and how we reached the current DSM/ICD and unitary models of psychosis. It then describes a diagnostic approach in which the choice of model should depend on the case in question, and offers a diagnostic protocol to guide the decision.

Keywords

Bipolar affective disorderspsychotic disordersschizophreniacomorbidityphenomenology
Type
Article
Information
BJPsych Advances , Volume 29 , Issue 3 , May 2023 , pp. 177 - 186
Check for updates
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). American Psychiatric Publishing.Google Scholar
Berrios, GE, Beer, D (1994) The notion of unitary psychosis: a conceptual history. History of Psychiatry, 5: 13–36.CrossRefGoogle ScholarPubMed
Berrios, GE (1996) The History of Mental Symptoms: Descriptive Psychopathology since the Nineteenth Century. Cambridge University Press.CrossRefGoogle Scholar
Crisp, AH, Gelder, MG, Rix, S, et al. (2000) Stigmatisation of people with mental illnesses. British Journal of Psychiatry, 177: 4–7.CrossRefGoogle ScholarPubMed
Cross-Disorder Group of the Psychiatric Genomics Consortium (2013) Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet, 381: 1371–9.CrossRefGoogle Scholar
David, A, Fleminger, S, Kopelman, M, et al. (2009) Lishman's Organic Psychiatry: A Textbook of Neuropsychiatry. Wiley-Blackwell.CrossRefGoogle Scholar
David, AS (2010) Why we need more debate on whether psychotic symptoms lie on a continuum with normality. Psychological Medicine, 40: 1935–42.CrossRefGoogle ScholarPubMed
De Giorgi, R, De Crescenzo, F, D'Alò, GL, et al. (2019) Prevalence of non-affective psychoses in individuals with autism spectrum disorders: a systematic review. Journal of Clinical Medicine, 8: 1304.CrossRefGoogle ScholarPubMed
First, MB, Pincus, HA, Levine, JB, et al. (2004) Clinical utility as a criterion for revising psychiatric diagnoses. American Journal of Psychiatry, 161: 946–54.CrossRefGoogle ScholarPubMed
First, MB, Rebello, TJ, Keeley, JW, et al. (2018) Do mental health professionals use diagnostic classifications the way we think they do? A global survey. World Psychiatry, 17: 187–95.CrossRefGoogle ScholarPubMed
Frances, A (2016) A report card on the utility of psychiatric diagnosis. World Psychiatry, 15: 32–3.CrossRefGoogle ScholarPubMed
Freeman, D (2016) Persecutory delusions: a cognitive perspective on understanding and treatment. Lancet Psychiatry, 3: 685–92.CrossRefGoogle ScholarPubMed
Green, MF, Horan, WP, Lee, J (2019) Nonsocial and social cognition in schizophrenia: current evidence and future directions. World Psychiatry, 18: 146–61.CrossRefGoogle ScholarPubMed
Harrison, PJ (2015) Recent genetic findings in schizophrenia and their therapeutic relevance. Journal of Psychopharmacology, 29: 85–96.CrossRefGoogle ScholarPubMed
Heslin, M, Lomas, B, Lappin, JM, et al. (2015) Diagnostic change 10 years after a first episode of psychosis. Psychological Medicine, 45: 2757–69.CrossRefGoogle ScholarPubMed
Huda, AS (2019) The Medical Model in Mental Health: An Explanation and Evaluation. Oxford University Press.CrossRefGoogle Scholar
IGDA Workgroup, WPA (2003) IGDA. 8: Idiographic (personalised) diagnostic formulation. British Journal of Psychiatry, 182(suppl 45): s55–7.CrossRefGoogle Scholar
Jaspers, K (1913) Allgemeine Psychopathologie. Reprinted (1963) as General Psychopathology: Vol. I (trans Hoenig, J, Hamilton, MW). Johns Hopkins University Press.Google Scholar
Jauhar, S, Krishnadas, R, Nour, MM, et al. (2018) Is there a symptomatic distinction between the affective psychoses and schizophrenia? A machine learning approach. Schizophrenia Research, 202: 241–7.CrossRefGoogle Scholar
Kendell, R, Jablensky, A (2003) Distinguishing between the validity and utility of psychiatric diagnoses. American Journal of Psychiatry, 160: 4–12.CrossRefGoogle ScholarPubMed
Kirov, G, Rees, E, Walters, J (2015) What a psychiatrist needs to know about copy number variants. BJPsych Advances, 21: 157–63.CrossRefGoogle Scholar
Kraemer, HC, Noda, A, O'Hara, R (2004) Categorical versus dimensional approaches to diagnosis: methodological challenges. Journal of Psychiatric Research, 38: 17–25.CrossRefGoogle ScholarPubMed
Lally, J, Ajnakina, O, Stubbs, B, et al. (2017) Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. British Journal of Psychiatry, 211: 350–8.CrossRefGoogle ScholarPubMed
Legge, SE, Santoro, ML, Periyasamy, S, et al. (2021) Genetic architecture of schizophrenia: a review of major advancements. Psychological Medicine, 51: 2168–77.CrossRefGoogle ScholarPubMed
Leonhard, K (1961) Cycloid psychoses – endogenous psychoses which are neither schizophrenic nor manic-depressive. Journal of Mental Science, 107: 633–48.CrossRefGoogle ScholarPubMed
McGorry, PD, Killackey, E, Yung, A (2008) Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry, 7: 148–56.CrossRefGoogle ScholarPubMed
McIntyre, JS, Yager, J, Everett, A, et al. (2021) The DSM-5 Clinical and Public Health Committee (CPHC): operations, mechanics, controversies and recommendations. Psychological Medicine, 51: 2493–500.CrossRefGoogle Scholar
Nourredine, M, Gerring, A, Fourneret, P, et al. (2021) Association of attention-deficit/hyperactivity disorder in childhood and adolescence with the risk of subsequent psychotic disorder a systematic review and meta-analysis. JAMA Psychiatry, 78: 519–29.CrossRefGoogle ScholarPubMed
O'Connell, KS, Coombes, BJ (2021) Genetic contributions to bipolar disorder: current status and future directions. Psychological Medicine, 51: 2156–67.CrossRefGoogle ScholarPubMed
Parnas, J (2012) The DSM-IV and the founding prototype of schizophrenia: are we regressing to a pre-Kraepelinian nosology. In Philosophical Issues in Psychiatry II: Nosology (eds Kendler, KS, Parnas, J): 237–59. Oxford University Press.CrossRefGoogle Scholar
Parnas, J, Henriksen, MG (2014) Disordered self in the schizophrenia spectrum: a clinical and research perspective. Harvard Review of Psychiatry, 22: 251–65.CrossRefGoogle ScholarPubMed
Parnas, J (2015) Differential diagnosis and current polythetic classification. World Psychiatry, 14: 284–7.CrossRefGoogle ScholarPubMed
Pollak, TA, Lennox, BR, Müller, S, et al. (2020) Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin. Lancet Psychiatry, 7: 93–108.CrossRefGoogle Scholar
Radua, J, Ramella-Cravaro, V, Ioannidis, JP, et al. (2018) What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry, 17: 49–66.CrossRefGoogle ScholarPubMed
Sadler, JZ (2005) Values and Psychiatric Diagnosis. Oxford University Press.Google Scholar
Soares-Weiser, K, Maayan, N, Bergman, H, et al. (2015) First rank symptoms for schizophrenia. Cochrane Database of Systematic Reviews, 1: CD010653.Google ScholarPubMed
Strauss, GP, Cohen, AS (2017) A transdiagnostic review of negative symptom phenomenology and etiology. Schizophrenia Bulletin, 43: 712–9.CrossRefGoogle ScholarPubMed
Tortelli, A, Errazuriz, A, Croudace, T, et al. (2015) Schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England: systematic review and meta-analysis of incidence rates. Social Psychiatry and Psychiatric Epidemiology, 50: 1039–55.CrossRefGoogle ScholarPubMed
van der Gaag, M, Cuijpers, A, Hoffman, T, et al. (2006) The five-factor model of the Positive and Negative Syndrome Scale I: confirmatory factor analysis fails to confirm 25 published five-factor solutions. Schizophrenia Research, 85: 273–9.CrossRefGoogle ScholarPubMed
van Os, J, Reininghaus, U (2016) Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry, 15: 118–24.CrossRefGoogle ScholarPubMed
World Health Organization (2022) ICD-11: International Classification of Diseases 11th Revision (Version: 02/2022). WHO (https://icd.who.int/en).Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.