Psychotic Mood Disorders Are Disorders of Thought and of Mood

  • C. Raymond Lake


Medical students and residents in psychiatry have been taught that schizophrenia is a disorder of thought, exclusive of disorders of mood. This dichotomy was imprinted upon academic psychiatry by the teachings of Kraepelin, Bleuler, and Schneider, despite almost 2,000 years of reports of cases of manic-depressive insanity whose behavior was described as psychotic suggesting disordered thought (Table 3.1). Only recently have serious questions been raised about this dichotomy despite these consistent observations of hallucinations and delusions in mood-disordered patients from the literature (Table 3.1) and also noted for 60 years in the DSMs (Tables 2.4, 9.3, 9.4, and 11.10). Psychotic thoughts, speech, and behavior that include hallucinations, delusions, and disorganization define a disorder of thought. Kraepelin’s dichotomy between the disorders of thought, the schizophrenias, and the disorders of affect, mood disorders, was simple, seemed to have separation, and continues to be widely embraced forming the keystone of psychiatry’s concept of the functional psychoses. Defective thought and speech garnered an extensive terminology that was sharply divided and mutually exclusive. Each term was indicative of either schizophrenia or bipolar disorder (Table 13.1). Most of these signs and symptoms were initially attributed to schizophrenia, not mania or depression. To explore such issues of disordered thoughts and speech, several investigators have studied the brain’s selective attention mechanism and its dysfunction in severe psychiatric disorders of thought including schizophrenia, mania, and depression.


Selective Attention Academic Psychiatry Severe Psychiatric Disorder Loose Association Functional Psychos 
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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department Psychiatry and Behavioral SciencesUniversity of Kansas, School of MedicineKansas CityUSA

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