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[埃米尔·克雷佩林概念中的精神变态的静态与动态]

[Statics and dynamics of psychopathies in the concept of Ε. Κraepelin].

作者信息

Pyatnitskiy N Yu

机构信息

Mental Health Research Center, Moscow, Russia.

出版信息

Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(7):104-113. doi: 10.17116/jnevro2021121071104.

Abstract

The concept of psychopathic personalities presented in the 8-th last lifetime edition of E. Kraepelin's textbook is analyzed. The special interest was guided by the fact that many types of psychopathic personalities were described by E. Kraepelin in other rubrics: «primary morbid states», manic-depressive illness, paranoia, hysteria, Dementia praecox. E. Kraepelin gave also a prognosis of further development of psychopathic personality and by this way analyzed its dynamics. So, for example, he found that the prognosis of unstable personalities is less favorable compared to those with excitable type. E. Kraepelin subdivided the types of «liars and swindlers», "antisocial" and also hysterics according to the prognosis in stationary and regredient courses. The regredient course of psychopathy E. Kraepelin explained by behindhand maturing of psychopathic traits caused by partial infantilism. Constitutionally depressed, constitutionally excited, irritable and cyclothymic psychopathic types distinguished by their disposition to phasic manifesting affective disorders (MDP), but were capable also to remain stationary during the lifetime as the corresponding three types of psychopathic personalities delineated by E. Kraepelin in schizophrenia. The type of «nervous» (from the rubric of «primary morbid states») was the ground for obsessive-compulsive neurosis, sexual perversions and also was able to combine with more or less prominent traits of other psychopathic types. According to clinical features, the «nervous» type was the expression of the conceptually preceding notion of general «degenerative constitution». It is important to note that E. Kraepelin considered the possibilities of combinations of different psychopathic types (connections of psychopathic traits) but never considered the possibility of development from one innate psychopathic type in the other.

摘要

本文分析了E. 克雷佩林(E. Kraepelin)教科书第八版中所呈现的精神病态人格概念。之所以对此特别关注,是因为E. 克雷佩林在其他章节中描述了多种精神病态人格类型,如“原发性病态状态”、躁狂抑郁症、偏执狂、癔症、早发性痴呆。E. 克雷佩林还对精神病态人格的进一步发展进行了预后评估,并以此分析其动态变化。例如,他发现不稳定型人格的预后比兴奋型人格更差。E. 克雷佩林根据在静止期和衰退期的预后情况,对“说谎者和骗子”、“反社会型”以及癔症型进行了细分。E. 克雷佩林将精神病态的衰退过程解释为部分幼稚状态导致的精神病态特征成熟延迟。体质性抑郁型、体质性兴奋型、易怒型和环性心境障碍型精神病态类型,其特点是倾向于阶段性地表现出情感障碍(躁狂抑郁症),但也能够在一生中保持稳定,就像E. 克雷佩林在精神分裂症中所描述的相应三种精神病态人格类型一样。“神经质”型(来自“原发性病态状态”章节)是强迫性神经症、性变态的基础,也能够与其他精神病态类型或多或少的突出特征相结合。根据临床特征,“神经质”型是先前概念性的一般“退化体质”概念的体现。需要注意的是,E. 克雷佩林考虑了不同精神病态类型组合的可能性(精神病态特征的联系),但从未考虑过从一种先天的精神病态类型发展为另一种类型的可能性。

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