Unformatted text preview: rs. Better diagnosis will lead to better care: after pinpointing a patient's brain disorder, a physician will be able to prescribe the treatment that is best suited to it. And earlier diagnosis could allow doctors to slow or halt the progress of a disorder before it becomes debilitating. History of Diagnosis
THE FIRST MODERN ATTEMPT to identify individual psychiatric disorders was made in the 19th century by German scientist Emil Kraepelin, who distinguished two of the most severe mental illnesses: schizophrenia, which he called dementia praecox, and manic-depressive illness, which is now known as bipolar disorder. Much of his careful observational work focused on following the course of the illnesses over the lifetime of his patients. He defined schizophrenia as a disease with psychotic failure to successfully negotiate stages in psychological development. The symptoms of each illness indicated the point in development at which the trouble arose. The psychoanalytic theory of that period did not allow for the possibility that different psychiatric illnesses might have completely different causes, let alone the modern idea that mental disorders might arise from abnormalities in brain circuits. Diagnosis returned to a central position in psychiatry in the 1950s, though, with the discovery of drugs for treating psychiatric disorders. Researchers found that chlorpromazine (better known by one of its brand names, Thorazine) could control the psychotic symptoms of schizophrenia and that lithium salts could stabilize the moods of patients with bipolar disorder. By 1960 the first antidepressant and antianxiety drugs were introduced. It quickly became critically important to match the patient with the right treatment. The new antidepressants did not work for schizophrenia and could precipi- Some PSYCHIATRIC ILLNESSES may turn out to be clusters of diseases that have similar symptoms but REQUIRE DIFFERENT TREATMENTS.
symptoms (such as hallucinations and delusions) that had an insidious onset-- in other words, the initial symptoms may be hard to detect-- and a chronic, downhill course. In contrast, manic-depressive illness was characterized by discrete episodes of illness alternating with periods of relatively healthy mental function. In the early 20th century, however, work on psychiatric diagnosis went into eclipse as a result of the influence of the psychoanalytic theories developed by Sigmund Freud and his followers. In their conception of mental illness, symptoms arose from a tate an episode of mania in someone with bipolar disorder. Lithium was remarkably effective for bipolar disorder but not for schizophrenia. In the 1980s the publication of DSM-III and subsequent manuals enabled psychiatrists to use standardized interviews and checklists of symptoms to make their diagnoses....
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