Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.
Department of Psychiatry, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA.
Psychol Med. 2021 Nov;51(15):2631-2636. doi: 10.1017/S003329172000118X. Epub 2020 May 4.
Although the rise of operationalized diagnostic criteria and the creation of DSM-III were influenced in the USA by a neo-Kraepelinian 'revival' of interest in psychiatric nosology, Kraepelin was only a distal influence on the specific diagnostic criteria proposed. The historical origins of the DSM-III criteria for mania and major depression (MD) are traceable back to the 1950s and contain no direct link to Kraepelin's writings. George Dreyfus, a student and assistant to Kraepelin, authored in 1907 a monograph on Involutional Melancholia which reviewed cases seen by Kraepelin in Heidelberg. In this monograph, Dreyfus presents the 'characteristic' symptoms for mania and depression 'as described by Kraepelin.' This historical finding provides the unprecedented opportunity to examine the resemblance between the criteria proposed for mania and depression in DSM-III, inspired by Kraepelin's nosologic vision, and those specifically suggested by Kraepelin 73 years earlier. Kraepelin's symptoms and signs for mania paralleled seven of the eight DSM-III criteria (except the decreased need for sleep), with two not included in DSM-III (increased mental activity and short bursts of sadness). Kraepelin's signs and symptoms paralleled six of the nine DSM-III criteria for MD, lacking suicidal ideation and changes in appetite/weight and sleep but including obsessions, reduced expressive movements, and decreased mood responsiveness. Although Kraepelin's overall approach to mania and depression emphasized their close inter-relationship in the cyclic course of manic-depressive illness, it is noteworthy Kraepelin's 'characteristic' symptoms for mania and depression as described by Dreyfus, bear substantial but incomplete resemblance to the criteria proposed in DSM-III.
尽管操作性诊断标准的兴起和 DSM-III 的制定在美国受到了新克雷佩林主义对精神疾病分类学兴趣的复兴的影响，但克雷佩林对所提出的具体诊断标准只有间接影响。DSM-III 躁狂症和重度抑郁症（MD）诊断标准的历史起源可以追溯到 20 世纪 50 年代，与克雷佩林的著作没有直接联系。克雷佩林的学生和助手乔治·德雷福斯（George Dreyfus）于 1907 年撰写了一本关于退行性忧郁症的专着，其中回顾了克雷佩林在海德堡看到的病例。在这本专着中，德雷福斯提出了“特征性”的躁狂和抑郁症状“如克雷佩林所描述的”。这一历史发现为我们提供了一个前所未有的机会，来检验受克雷佩林分类学理念启发而在 DSM-III 中提出的躁狂和抑郁诊断标准与克雷佩林 73 年前提出的标准之间的相似之处。克雷佩林的躁狂症症状和体征与 DSM-III 的八项标准中的七项相吻合（除了睡眠需求减少），其中两项没有包含在 DSM-III 中（精神活动增加和短暂的悲伤）。克雷佩林的 MD 症状和体征与 DSM-III 的九项标准中的六项相吻合，缺乏自杀意念以及食欲/体重和睡眠的变化，但包括强迫症、表达运动减少和情绪反应性降低。尽管克雷佩林对躁狂症和抑郁症的总体方法强调了它们在躁狂抑郁症循环过程中的密切关系，但值得注意的是，德雷福斯描述的克雷佩林的“特征性”躁狂症和抑郁症症状与 DSM-III 中提出的标准有很大但不完全的相似之处。
