1. became the more generally applied term by the close of the 19th century.
2. Gull (1894) described it, “a condition characterized by a sinking of the spirits, lack of courage or initiative, and a tendency to gloomy. The symptom occurs in weakened conditions of the nervous systems, such as neurasthenia and is specifically characteristic of melancholia.”
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3. Psychodynamic
1. Classical formulation = anger turned inward
2. Freud 1915
1. Mourning and Melancholia
1. “The disturbance of self-regard is absent in mourning; but otherwise the features are the same”
2. “Moreover, the exciting causes due to environmental influences are, so far as we can discern them at all, the same for both conditions.”.
2. Kraepelin’s synthesis
1. Set the stage for the current classification system. The initial division of mad patients or “dements” was based on the age of onset. Those that developed psychotic symptoms late in life (senile dementia) were placed under the care of Dr. Alzheimer. Those who were ill earlier in life were distinguished into two groups based on the course of illness. Patients with a chronic course of unremitting deterioration were diagnosed “dementia praecox” and those considered to recover completely between their episodes of illness were noted to have prominent mood symptoms and received the diagnosis “manic-depressive insanity”.
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2. Basic Characteristics of Kraepelin’s Mood disorder
1. Usually early age of onset
2. Prominent mood symptoms
3. Recurrent Episodes
4. Periods of recovery
5. Variable Courses
3. Leonhard
1. The Classification of Endogenous Psychosis
1. Found Kraepelin’s classification wholly inadequate and described 56 separate psychotic illnesses including several varieties of illness which alternated between specific affective states (eg “anxiety-euphoria psychosis”). Such bipolar illnesses were separated form the “monopolar” types. Subsequent research failed to validate Leonhard’s illnesses except for the division of manic depressive insanity into unipolar and bipolar depression based on the occurrence of manic episodes during the course of the illness.
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