The evolution of Kraepelin's nosological principles
The evolution of Kraepelin's nosological principles
复制标题
DOI：
10.1002/wps.20774
复制
发表时间：
2020-10-01
期刊：
影响因子：
73.3
通讯作者：
Kendler, Kenneth S.
中科院分区：
文献类型：
--
作者：
Heckers, Stephan;Kendler, Kenneth S.
埃米尔·克雷佩林（Emil Kraepelin）在他的八个版本的教科书中开发了一种新的精神病学分类学。之前的论文探讨了他对特定诊断的构建，包括早发性痴呆和躁狂抑郁症。在这里，我们仔细阅读了他的介绍性教科书章节，其中介绍了他的疾病分类学的一般原则。我们确定了三个阶段：1）第 1-4 版，他在其中描述了搜索数据的分类学原则； 2）第5-7版，他在其中宣布了其疾病分类原理的成熟版本并开发了新的疾病类别； 3）第8版，其中他限定了他的疾病分类学主张，并允许对精神疾病进行更大的区分。我们认为克雷佩林的疾病分类学基于三个原则。首先，精神病学与其他科学一样，研究自然现象。其次，精神状态不能简化为神经状态，但科学会进步，最终将揭示自然如何创造异常的精神状态和行为。第三，精神病学诊断的验证者有一个层次结构，对临床特征（体征、症状和病程）的仔细研究比神经病理学和病因学研究更重要。这三个原则是在克雷佩林教科书的八个版本的过程中出现的，并通过他自己的研究和现有的科学方法得到了体现。他的科学观点在今天仍然具有现实意义：它们产生并同时限制了我们当前的精神病学分类学。
Emil Kraepelin developed a new psychiatric nosology in the eight editions of his textbook. Previous papers have explored his construction of particular diagnoses, including dementia praecox and manic-depressive insanity. Here we are providing a close reading of his introductory textbook chapter, that presents his general principles of nosology. We identify three phases: 1) editions 1-4, in which he describes nosological principles in search of data; 2) editions 5-7, in which he declares the mature version of his nosological principles and develops new disease categories; 3) edition 8, in which he qualifies his nosological claims and allows for greater differentiation of psychiatric disorders. We propose that Kraepelin's nosology is grounded in three principles. First, psychiatry, like other sciences, deals with natural phenomena. Second, mental states cannot be reduced to neural states, but science will progress and will, ultimately, reveal how nature creates abnormal mental states and behavior. Third, there is a hierarchy of validators of psychiatric diagnoses, with the careful study of clinical features (signs, symptoms and course) being more important than neuropathologic and etiological studies. These three principles emerged over the course of the eight editions of Kraepelin's textbook and were informed by his own research and by available scientific methods. His scientific views are still relevant today: they have generated and, at the same time, constrained our current psychiatric nosology.