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. 2009 Aug;34(9):2081-7.
doi: 10.1038/npp.2009.32. Epub 2009 Mar 18.

Will the Kraepelinian dichotomy survive DSM-V?

Bernard A Fischer  1 , William T Carpenter Jr
Affiliations

Will the Kraepelinian dichotomy survive DSM-V?

Bernard A Fischer et al. Neuropsychopharmacology. 2009 Aug.

Abstract

Kraepelin proposed dementia praecox and manic-depressive illness as the two major psychotic disorders. This paradigm is still prevalent, but observations of overlapping boundaries between bipolar disorder and schizophrenia challenge this dichotomy. However, the concept of schizophrenia has been radically altered from the original Kraepelinian proposal. We defend the two psychoses positions, but suggest two flaws in the heuristic application: (1) overlapping features, such as psychotic symptoms, are not decisive in differential diagnosis; and (2) each disorder is a syndrome, not a disease entity. An alternative paradigm based on domains of pathology is more powerful for studies of etiology, pathophysiology, and therapeutic discovery.

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Conflict of interest statement

Disclosure/Conflict of Interest

BAF: None

WTC: European Regional Patent Number 1487998 (June 6, 2007) “Methods for Diagnosing and Treating Schizophrenia” (any potential compensation pledged to the University of Baltimore Foundation). In 2006–2008, Dr. Carpenter has been an advisor to or prepared educational material for: Merck, McNeil, Pfizer, Janssen, Solvay, Wyeth, Astra Zeneca, Lilly, Cephalon and Teva. No conflict presently anticipated for 2009.

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