Midtwentiethcentury European developments Bleulers influence

In Europe, the psychosocial and psychoanalytic traditions continued to develop in relative isolation from the mainstream of psychiatry, which largely retained its medical or disease orientation.

Among the academic psychiatrists, Eugen Bleuler(16) departed from Kraepelin by conceptualizing the relationship between manic-depressive (affective) illness and dementia praecox (schizophrenia) as a continuum without a sharp line of demarcation. Patients were distributed all along this spectrum, and an individual patient could be at different points on the spectrum at different times. Bleuler believed that a patient's location on the spectrum depended on the number of schizophrenic features he or she demonstrated. In that sense, Bleuler considered mood symptoms to be non-specific.

In 1933, Kasanin(17> identified a case series of patients who demonstrated the manic-depressive syndrome, but also displayed psychotic symptoms outside of mood episodes. These conditions seemed to lie outside of Kraepelin's dichotomy, and led to the concept of schizoaffective disorder. Some clinicians continue to see these observations as major challenges to the entire Kraepelinian nosology. (1.19)

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