Capsules from Four to Six

Thomas A. Ban

4. Development of the Diagnostic Concept of Dementia Praecox and Early Pharmacological Treatments of Schizophrenia. Development of the diagnostic concept of “schizophrenia” began with Kraepelin’s adoption of Morel’s “theory of degeneration,” by including “psychic degeneration processes,” as a distinct class of illness, in the 4th edition of his textbook, published in 1893, and by assigning   Hecker’s “hebephrenia,”  Kahlbaum’s “catatonia”  and “dementia paranoides,” a form of illness he separated from Kahlbaum’s “paranoia,” to the new class. It culminated in the formulation of a new nosologic disease-entity, he referred to as “dementia praecox,” (a term first used by Morel in 1860), in the sixth edition of his textbook, published in 1899. The term, “dementia praecox, was replaced with the term, “schizophrenia” by Eugene Bleuler, in 1908. Early pharmacological treatments of “schizophrenia” included cocaine, manganese, castor oil and the injection of sulfur oil to induce fever. Insulin coma therapy was introduced by Sakel in the mid-1930s. Treatment with insulin coma doubled social remissions in schizophrenia from 17% to 34%, when used within the first year of illness with low risks (below 0.5% fatality). Insulin coma therapy of schizophrenia was lingering on in mainland China and the Soviet Union until the 1980s.           

5. Model Psychosis and Exogenous Psychosis. The origin of the method of inducing psychosis with drugs, “model psychosis,” for studying the mental pathology induced, was in Morea de Tours’ research with “dawamsec,” an electuary of hashish, in the 1840s. The method was adopted by Prentiss and Morgan, in the 1890s, for studying the mental pathology induced by mescaline; by Stoll in the 1940s for studying the mental pathology induced by lysergic acid diethylamide; and by Szára, in the 1950s, for studying the mental pathology induced by dimethyltryptamine. The concept of “toxic psychosis” was introduced by Schröder, in 1906. It was re-conceptualized by Boenhoffer, in 1909, who introduced the concept of “exogenous psychosis” and distinguished “toxic” and “symptomatic psychoses” from the “endogenous psychoses.”

6. Barbiturates and Sleep Therapy. Barbital, diethyl barbituric acid, the first barbturte introduced into clinical practice, was synthesized by Fischer and von Mering, in 1903. Replacement of one of the ethyl groups of barbital by a phenyl radical yielded phenobarbital, the second barbiturate introduced, in 1912. Subsequently, more than 2500 different barbiturate preparations were synthesized, and almost 50 of them found a place in clinical practice as a hypnotic, sedative and/or anticonvulsant. Sleep therapy was introduced by McLeod, in 1900 with bromides and methylsulfonal in the treatment of “mania.”  A few years later, methylsulfonal  and bromides were replaced  by barbiturates. Sleep therapy was adopted by Klaesi, in 1922 in the treatment of schizophrenia with marginal benefit (10 higher remission rate than the spontaneous remission rate in a similar population), but with considerable risks (5% fatality from pneumonia or circulatory collapse).