Janusz Rybakowski: 120 years of the Kraepelinian dichotomy of "endogenous psychoses" in historical perspective


Janusz Rybakowski’s reply to Carlos Morra's comment


       Thanks to Carlos Morra for his nice reception of my essay on the 120th anniversary of Kraepelinian dichotomy. As I pointed out, this conceptualization of "dementia praecox" and "manisch-depressives Irresein" practically paved the way to psychiatric diagnosis and treatment in the 20th century and some elements still remain valid.

       As to the possibility of a "Kraepelinian trichotomy" I would reserve the third entity to something in between two piers of the dichotomy. This phenomenon was probably most adequately called "schizoaffective illness" (Kasanin 1933) and can in some way relate to Kraepelin's concept of "paraphrenia" (the presence of psychotic symptoms without disturbances of emotion and volition) occurring in a part of subjects with either "dementia praecox" or manisch-depressives Irresein," as stated in the ninth edition of Kraepelin's textbook. Further progress in molecular genetics and psychopharmacology, as well as clinical observations, has brought the evidence for a relationship between these two elements of dichotomy and a continuum concept was also put forward by Timothy Crow (1986).  



Kasanin J. The acute schizoaffective psychoses. Am J Psychiatry 1933; 90: 97-126.

Crow TJ. The continuum of psychosis and its implication for the structure of the gene. Br J Psychiatry. 1986; 149:419-29.


April 9, 2020