The role of psychotropic drugs in the deconstruction of the Kraepelinian dichotomy

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Slide 1 :

The role of psychotropic drugs in the insidious deconstruction of the Kaepelinian dichotomy Oldrich Vinar 10 th CENP Congress Sarajevo, 17-21. October 2007

Slide 2 :

How many mental diseases are there? Wernicke-Kleist-Leonhard: thirty four Timothy Crow- Griesinger: Einheitspsychose – continuum: one

Slide 3 :

Kraepelinian slolution Not only symptomatology (the syndrome) is important for the diagnosis, but also the longitudinal course of the illness: Affective symptoms + periodical course vs. Thought disorder (Assoziationssprunghaftigkeit, E.Bleuler) + progression without a true remission

Slide 4 :

Progression in schizophrenia: Pseudoneurotic – Wahnstimmung - anxious-depressive – manic – idée fixe with obsesssive features – oneiroid – état mixte – schizoaffective - paranoid – hallucinatory paranoid – intrapsychic ataxia – prevalence of negative symptoms Is it a one-way street?

Slide 5 :

Retrogression of schizophrenia Florid hallucinatory-paranoid syndrome – remission – relapse with schizoaffective features – état mixte – (remission) – schizomania – remisssion – bipolar disorder – monopolar depressive disorder - amotivation - (pseudo)neurotic – full remission did it occur before the introduction of antipsychotic drugs?

Slide 6 :

Have antipsychotic drugs changed the course of schizophrenia? Not speaking about a decrease of suffering, better tolerance of symptoms, decrease in hospitalizations, amelioration of the quality of life of the patients and their families

Slide 7 :

Method DSM-IV criteria applied retrospectively to patients known by the author personally for 20 years at least, using their medical records Search for patients who crossed the nosological borders between schizophrenia and affective disorders

Slide 8 :

Results I 62 patients treated for at least 20 years The original diagnosis was not changed in: 26 patients (from 44) suffering from schizophrenia 2 patients (from 6) suffering from the schizoaffective disorder 8 patients (from 12) suffering from a mood disorder

Slide 9 :

Diagnosis changed From 44 patients suffering from schizophrenia at the start to schizoaffective disorder in 8 and to a mood disorder in 10 From 6 patients suffering from a schizoaffective disorder at the start to schizophrenia in one and to a mood disorder in 3 From 12 patients suffering from a mood disorder at the start, to a schizoaffective disorder in 3 and to schizophrenia in one.

Slide 10 :

Progression vs. retrogression Progression was seen in 5 patients Retrogression was seen in 21 patients Retrogression to a mood disorder occured only in patients treated with the second generation antipsychotics (SGA)

Slide 11 :

Crossing the borders SSRIs have prophylactic effects in adolescents with high risk of becoming ill with schizophreniia SGA (in combination with antidepressants) have therapeutic effects in pharmacoresistant depressive disorders antipsychotics have therapeutic effects in mania Olanzapin and aripiprazol have prophylactic effects in biolar disorder (electroconvulsive treatement has therapeutic effects in both: schizophrenia and mood disorders)

Slide 12 :

WARNING This report of my clinical experience does not bring a scientific evidence This retrospective analysis of clinical records enables a formulation of the hypothesis, that psychotropic drugs disrupted the Kraepelinian connection between the cross-sectional syndrome and the course of the illness, which has to be tested

Slide 13 :

The effects of antipsychotic drugs Antipsychotics can maintain the remission and enable the continuation of a healing process They make the the monotonous deterioration process rickety They disrupt the Kaepelinian connection between the symptomatology and the course of the illness

Slide 14 :

Supporting hypotheses Florid symptomps contribute to progression and deterioration Remission (state without any symptoms) and pharmacodynamic effects of antipsychotics (neoneurogenesis) have healing capacity

Slide 15 :

Kraepelin was not wrong He has not seen patients treated with antipsychotic drugs

Slide 16 :

Good bye schizophtrenia ? Perhaps yes … but especially because of the stigma

Slide 17 :

SOLUTION ? Clinical observatrion and psychopathology are not sufficient to solve the problem Neurobiological research, will bring the solution Genes and factors regulating their expression (influence of the family, infections - immunology, life events, esp. distress, and

Slide 18 :

PSYCHOTROPIC DRUGS – the study of the mechanism of their action with new physical and chemical methods Untill now, we have opened the nano-world of the space: now, we shall go to the nano-world of the time

Slide 19 :

What we should do for our patients Le roi est mort, vive le roi! Schizophrenia is dead (?), live the Bleuler‘s disease!

Slide 20 :

It is the doctor who organizes the worryings of a patient under the name of a disease (Michael Bálint)

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