Leonhard's Classification Research Articles

Empirical validity of Leonhard's psychoses: A long-term follow-up study of first-episode psychosis patients

The validation of nosological diagnoses in psychiatry remains a conundrum. Leonhard's (1979) nosology seems to be one of the few acceptable alternative categorical models to current DSM/ICD systems.We aimed to empirically validate Leonhard's four classes of psychoses: systematic schizophrenia (SSch), unsystematic (USch), cycloid psychosis (Cyclo), and manic-depressive illness (MDI) using a comprehensive set of explanatory validators.243 patients with first-episode psychosis were followed between 10 and 31 years. A wide-ranging assessment was carried out by collecting data on antecedent, illness-related, concurrent, response to treatment, neuromotor abnormalities, and cognitive impairment variables.Compared with USch, Cyclo, and MDI, SSch displayed a pattern of impairments significantly larger across the seven blocks of explanatory variables. There were no significant differences between Cyclo and MDI in explanatory variables. Except for the majority of illness-onset features, USch displayed more substantial abnormalities in the explanatory variables than Cyclo and MDI. SSch and MDI showed higher percentages of correctly classified patients than USch and Cyclo in linear discriminant analyses.Partial validation of Leonhard's classification was found. SSch showed differences in explanatory variables with respect to Cyclo and MDI. USch showed also significant differences in explanatory variables regarding Cyclo and MDI, although with a lower strength than SSch. There was strong empirical evidence of the separation between both Leonhard's schizophrenia subtypes; however, the distinction between the Cyclo and MDI groups was not empirically supported. A mild to moderate discriminative ability between Leonhard's subtypes on the basis of explanatory blocks of variables was observed.

Développement d’un réseau nosographique collaboratif

ObjectivesThe use of massive amounts of digital data in mental health offers interesting perspectives that could influence the evolution of psychiatric nosography. The characteristics of this data could become key elements to understand the future organization of knowledge — and debates — in psychiatry. Such an evolution could take different shapes, including the development of a collaborative and networked psychiatric classification. Materials and methodsSeveral issues related to the use of large amounts of data in psychiatry were identified and developed in this context: (1) the growth of new health related data producers and storers, which could influence the development of some research topics or diagnostics to the detriment of others, depending on the availability or profitability of this data; (2) the fact that mental health data is often available in an unstructured form: textual data, like reports of complementary examinations, reports of hospitalization or expertises, but also imageries or videos, from institutional or alternative sources; (3) the need of scalability and flexibility of this data, to make it possible to integrate recent discoveries as well as to take into account the phenomenon of pathomorphosis or cultural factors in psychiatry. A collaborative framework is proposed to answer each of these issues, including the possibility of integration of different data forms, associated with a complete traceability of sources and a nominal registration. The need to structure data is also specified, with the use of tags to modelize diagnostic consensus that include professionals, patients and families. This collaborative tool would make it possible to consider data resulting from perceptions of patients or their families, enabling patients to benefit from a higher level of confidence and engagement, and limiting the deleterious effects of stigmatization. ResultsThe possibilities of a collaborative web tool integrated into the French Shared Medical File (Dossier Medical Partagé) are described, and two examples of practical situations are presented: A mental health professional reporting his influences on the diagnosis of schizophrenia: he integrates the symptoms described by the German psychiatrist Karl Leonhard (Leonhard classification), cultural references (cinematographic reference like A beautiful mind directed by Ron Howard), and links to articles on medical and psychiatric comorbidities among adults with schizophrenia. In the other example, a psychiatrist uses this tool to develop a collaborative diagnosis that integrated an active participation of the patient around the diagnostic. In France, the latest version of the digital Shared Medical File was launched in November 2018. The integration of a collaborative nosographic tool into this file would be an interesting answer to the difficulties that might happen for its use with patients suffering from mental disorders. It could thus limit the stigmatization of a shared diagnosis and enable a better understanding of practices among mental health professionals. ConclusionThe psychiatrists use specific knowledge resulting from multiple influences and theoretical orientations. The risk of incomprehension of practices in psychiatry by patients and their families being major, nosographic research trying to include the coexistence of these orientations appears necessary. Moreover, in the context of the development of large-scale data processing, it is essential that a collaborative human-scale interpretation of this knowledge exists. This would make the psychiatric nosography an ethical tool, allowing an active participation and dialogue between patients, families and health professionals, that could become key features of future psychiatric nosography.

Familiality of Psychotic Disorders: A Polynosologic Study in Multiplex Families.

Phenotype definition of psychotic disorders has a strong impact on the degree of familial aggregation. Nevertheless, the extent to which distinct classification systems affect familial aggregation (ie, familiality) remains an open question. This study was aimed at examining the familiality associated with 4 nosologic systems of psychotic disorders (DSM-IV, ICD-10, Leonhard's classification and a data-driven approach) and their constituting diagnoses in a sample of multiplex families with psychotic disorders. Participants were probands with a psychotic disorder, their parents and at least one first-degree relative with a psychotic disorder. The sample was made of 441 families comprising 2703 individuals, of whom 1094 were affected and 1709 unaffected. The Leonhard classification system had the highest familiality (h (2) = 0.64), followed by the empirical (h (2) = 0.55), DSM-IV (h (2) = 0.50), and ICD-10 (h (2) = 0.48). Familiality estimates for individual diagnoses varied considerably (h (2) = 0.25-0.79). Regarding schizophrenia diagnoses, Leonhard's systematic schizophrenia (h (2) = 0.78) had the highest familiality, followed by latent class core schizophrenia (h (2) = 0.74), DSM-IV schizophrenia (h (2) = 0.48), and ICD-10 schizophrenia (h (2) = 0.41). Psychotic mood disorders showed substantial familiality across nosologic systems (h (2) = 0.60-0.77). Domains of psychopathology other than reality-distortion symptoms showed moderate familiality irrespective of diagnosis (h (2) = 0.22-0.52) with the deficit syndrome of schizophrenia showing the highest familiality (h (2) = 0.66). While affective psychoses showed relatively high familiality estimates across classification schemes, those of nonaffective psychoses varied markedly as a function of the diagnostic scheme with a narrow schizophrenia phenotype maximizing its familial aggregation. Leonhard's classification of psychotic disorders may be better suited for molecular genetic studies than the official diagnostic systems.

The role of Pannexin gene variants in schizophrenia: systematic analysis of phenotypes.

Pannexins are a group of brain-expressed channel proteins thought to be regulators of schizophrenia-linked pathways including glutamate release, synaptic plasticity and neural stem proliferation. We got evidence for linkage of a catatonic phenotype to the PANX2 locus in a family study. Aim of our study was to evaluate the role of Pannexins in schizophrenia and clinical phenotypes, particularly with regard to periodic catatonia. We genotyped six single-nucleotide polymorphisms at PANX1, five at PANX2 and three at PANX3 in 1173 German cases with schizophrenia according to DSM-5 and 480 controls. Our sample included 338 cases with periodic catatonia corresponding to Leonhard's classification. Association with schizophrenia according to DSM-5 was limited to genotype rs4838858-TT [p=0.02, odds ratio (OR) 3.1] and haplotype rs4838858T-rs5771206G (p=0.02, OR 2.7) at PANX2. We found no significant association with clinical phenotypes. Our limited findings do not support a major contribution of PANX1-3 to disease risk of schizophrenia according to DSM-5. We cannot confirm an association of the PANX2 loci at chromosome 22q13 with periodic catatonia.

The chromosome 15q14 locus for bipolar disorder and schizophrenia: Is C15orf53 a major candidate gene?

Bipolar disorder (BD) and schizophrenia are complexly inherited and highly heritable disorders with currently unknown etiologies. Recently, two independent genome-wide association studies for BD identified a small region on chromosome 15q14-15.1, pointing to a locus close to the gene C15orf53. Previously, this genomic region was also found to co-segregate with periodic catatonia (SCZD10, OMIM %605419), an unsystematic schizophrenia according to Leonhard's classification, in several multiplex families, thus pointing to overlapping etiologies of both conditions. A susceptibility locus on chromosome 15q14-15.1 was narrowed down to a 4.38 Mb region in these affected families followed by mutation and segregation analyses of C15orf53. Association analysis of individuals affected by BD and/or SCZD10 (n = 274) and controls (n = 230) and expression analyses in distinct post-mortem human limbic brain tissues were conducted. C15orf53 revealed no mutations in our SCZD10 family members, but segregation of two common haplotypes was found. No association of identified haplotypes was found in our case–control samples. Gene expression could be demonstrated for immune-system-derived cells but not for the post-mortem human limbic brain tissue. Our results indicate that C15orf53 is probably neither causative for the etiology of BD nor for SCZD10 in our samples.

Is Ankyrin a genetic risk factor for psychiatric phenotypes?

BackgroundGenome wide association studies reported two single nucleotide polymorphisms in ANK3 (rs9804190 and rs10994336) as independent genetic risk factors for bipolar disorder. Another SNP in ANK3 (rs10761482) was associated with schizophrenia in a large European sample. Within the debate on common susceptibility genes for schizophrenia and bipolar disorder, we tried to investigate common findings by analyzing association of ANK3 with schizophrenia, bipolar disorder and unipolar depression.MethodsWe genotyped three single nucleotide polymorphisms (SNPs) in ANK3 (rs9804190, rs10994336, and rs10761482) in a case-control sample of German descent including 920 patients with schizophrenia, 400 with bipolar affective disorder, 220 patients with unipolar depression according to ICD 10 and 480 healthy controls. Sample was further differentiated according to Leonhard's classification featuring disease entities with specific combination of bipolar and psychotic syndromes.ResultsWe found no association of rs9804190 and rs10994336 with bipolar disorder, unipolar depression or schizophrenia. In contrast to previous findings rs10761482 was associated with bipolar disorder (p = 0.015) but not with schizophrenia or unipolar depression. We observed no association with disease entities according to Leonhard's classification.ConclusionOur results support a specific genetic contribution of ANK3 to bipolar disorder though we failed to replicate findings for schizophrenia. We cannot confirm ANK3 as a common risk factor for different diseases.

An intrinsic way of multiclassification of endogenous psychoses. A follow-through investigation/Budapest 2000/based upon Leonhard's classification.

While the long-term goal is to develop highly effective AIDS vaccines, first generation vaccines may be only partially effective. Other HIV prevention modalities such as preexposure prophylaxis with antiretrovirals (PrEP) may have limited efficacy as well. The combined administration of vaccine and PrEP (VAXPREP), however, may have a synergistic effect leading to an overall benefit that is greater than the sum of the individual effects. We propose two test-of-concept trial designs for an AIDS vaccine plus oral or topical ARV. In one design, evidence that PrEP reduces the risk of HIV acquisition is assumed to justify offering it to all participants. A two-arm study comparing PrEP alone to VAXPREP is proposed in which 30 to 60 incident infections are observed to assess the additional benefit of vaccination on risk of infection and setpoint viral load. The demonstrated superiority of VAXPREP does not imply vaccine alone is efficacious. Similarly, the lack of superiority does not imply vaccine alone is ineffective, as antagonism could exist between vaccine and PrEP. In the other design, PrEP is assumed not to be in general use. A 2 × 2 factorial design is proposed in which high-risk individuals are randomized to one of four arms: placebo vaccine given with placebo PrEP, placebo vaccine given with PrEP, vaccine given with placebo PrEP, or VAXPREP. Between 60 and 210 infections are required to detect a benefit of vaccination with or without PrEP on risk of HIV acquisition or setpoint viral load, with fewer infections needed when synergy is present.

The DAOA/G30 locus and affective disorders: haplotype based association study in a polydiagnostic approach

BackgroundThe DAOA/G30 (D-amino acid oxidase activator) gene complex at chromosomal region 13q32-33 is one of the most intriguing susceptibility loci for the major psychiatric disorders, although there is no consensus about the specific risk alleles or haplotypes across studies.MethodsIn a case-control sample of German descent (affective psychosis: n = 248; controls: n = 188) we examined seven single nucleotide polymorphisms (SNPs) around DAOA/G30 (rs3916966, rs1935058, rs2391191, rs1935062, rs947267, rs3918342, and rs9558575) for genetic association in a polydiagnostic approach (ICD 10; Leonhard's classification).ResultsNo single marker showed evidence of overall association with affective disorder neither in ICD10 nor Leonhard's classification. Haplotype analysis revealed no association with recurrent unipolar depression or bipolar disorder according to ICD10, within Leonhard's classification manic-depression was associated with a 3-locus haplotype (rs2391191, rs1935062, and rs3916966; P = 0.022) and monopolar depression with a 5-locus combination at the DAOA/G30 core region (P = 0.036).ConclusionOur data revealed potential evidence for partially overlapping risk haplotypes at the DAOA/G30 locus in Leonhard's affective psychoses, but do not support a common genetic contribution of the DAOA/G30 gene complex to the pathogenesis of affective disorders.

Remission in schizophrenia application of a "new concept" on an "old study"

New concept:It is well known that schizophrenia has wide heterogenity of its long-term course and outcome. In 2004 ”The Remission in Schizophrenia Working Group” (Andreasen, Carpenter, Kane et al) developed an operational criteria system for the measurement of remission. In their consensus remission was defined by using an absolute threshold of severity of the diagnostic symptoms of schizophrenia rather than improvement from the baseline. Remission is a low-mild symptom intensity level, where the symptoms do not influence behavior. To measure remission they used a complex psychopathological scale, PANSS.Old study:At the beginning of the 1970s we started a study, in which we investigated 185 patients. They were diagnosed according to Leonhard's classification of functional psychoses schizophrenia and cycloid psychoses (schizoaffective psychoses). We reinvestigated them 30 years later, using numerous psychopathological tests, including PANSS. For measuring the level of functioning, we estimated GAF also. The level of functioning was considered “good” when the GAF was higher than 60%. According to that 49% of schizophrenic patients had good prognosis, while this rate of schizoaffective patients was 95%.Results:We applied the remission conception to our patients and found that only 19% of the schizophrenic patients were in remission, in contrast with schizoaffective patients, where this rate was 90%.Conclusion:This result confirmed that function and social adaptation did not move in parallel with the severity of psychopathological symptoms, and that this remission concept is a stringent standard.

Beneficial effect of atypical antipsychotics on prefrontal brain function in acute psychotic disorders

Disturbance of prefrontal brain functions is assumed to be responsible for prominent psychopathological symptoms in psychotic disorders. Treatment with atypical, in contrast to typical antipsychotics is considered as a possible strategy for an improvement of prefrontal brain function. In the present study, response control as a specific prefrontal brain function was assessed by means of the Nogo-anteriorization (NGA) derived from the event-related potentials elicited during a Go-NoGo task in a consecutive sample of 39 patients suffering from acute psychotic disorders (brief psychotic disorders, 298.8, n = 34 and schizoaffective disorders, 295.70, n = 5; cycloid psychoses according to the Leonhard classification). A highly significant positive correlation between the amount of antipsychotic medication in terms of chlorpromazine equivalents per day and the NGA as a measure of prefrontal response control was only found in the subgroup of patients treated exclusively or predominantly with atypical antipsychotics but not for those treated with typical antipsychotics. These results are in line with the notion that atypical antipsychotics may exert a beneficial effect on prefrontal brain function.

Reduced prefrontal response control in patients with schizophrenias: a subgroup analysis

We investigated the function of the anterior cingulate cortex (ACC) with the continuous performance test (CPT) in patients with chronic schizophrenias. We had previously shown that the NoGo anteriorisation (NGA), which consists of a more anterior center of gravity (centroid) of the event-related potentials during the inhibition of a prepared motor response, correlates with physiological activation of the ACC in healthy probands. However, in patients with schizophrenias, the event-related potentials are located more anteriorly in the Go condition and more posteriorly in the NoGo condition, which leads to a decreased NGA reflecting reduced activation of the ACC. We now extend our observations to a larger number of patients with different subgroups of chronic schizophrenias according to Leonhard's classification system. While the schizophrenic patients as a group showed only a trend towards a decreased NGA, there was a significant reduction of the NGA in patients with systematic schizophrenias but not in those with unsystematic schizophrenias. Our results show that a subclassification of "schizophrenic" patients is useful to detect differences between subgroups, which may reflect differences in pathophysiology.

Rightward cerebral asymmetry in subtypes of schizophrenia according to Leonhard's classification and to DSM-IV: a structural MRI study

Although well documented, brain structural abnormalities in schizophrenia are non-specific, and morphometric parameters show significant overlap between patients and healthy controls. Such inconsistencies in neuroimaging findings could represent different levels of severity along a single pathogenic process or distinct clinical and etiopathological psychoses within a schizophrenic spectrum. The aim of the present study was the investigation of distinct brain abnormalities in different subtypes of schizophrenia. Forty patients were classified according to DSM-IV and Leonhard's classifications. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS) and the Negative Symptom Rating Scale (NSRS). Patients were compared to 20 healthy volunteers on volumetric measures of cerebral structures (hemisphere, hippocampus and planum temporale) and ventricular–brain ratio (VBR) obtained by magnetic resonance imaging. Patients showed rightward asymmetry of cerebral hemispheres and increased VBR. Rightward asymmetry correlated with severity of negative symptoms and prevailed in the systematic forms of Leonhard, suggesting a distinct pattern of left hemisphere abnormality in this subgroup of psychoses. Increased VBR values showed a single normal distribution in the subgroups, indicating that ventricular enlargement is not restricted to a subgroup but is present to a certain degree in all cases.

The Concept of Hebephrenia over the Course of Time with Particular Reference to the Wernicke-Kleist-Leonhard School

Summary: The concept of hebephrenia has undergone more changes than almost any other diagnostic category in clinical psychiatry. In the present article we want to outline these changes from Hecker's first description of hebephrenia to contemporary concepts mainly based on Bleuler's viewpoints. Due to rather heterogeneous and vaguely defined symptomatology, hebephrenia lost relevance as a diagnostic category in today's classification systems. As an alternative approach, Kleist and Leonhard see hebephrenias as forming distinct clinical entities with insidious beginning and a chronically progressive course leading to specific and stable residual syndromes, mainly featured by disturbed affectivity and, thus, initiative. As known up to now, hebephrenias within Leonhard's classification show poor prognosis, little response to treatment and low heredity. This concept of hebephrenia seems to be more appropriate to demarcate a homogeneous subtype which can be the subject of further promising research to clarify aetiology and nosology of schizophrenic spectrum psychoses.

Validity and reliability of leonhard's classification of endogenous psychoses: preliminary report on a prospective 25- to 30-year follow-up study.

A 25- to 30-year controlled follow-up investigation of endogenous psychoses started in 1997. The research program labeled "Budapest 2000" was initiated in 1967 as a controlled prospective study. The assessment of 108 patients and 24 normal control persons has so far been completed. With regard to the "middle groups" in the Leonhardian classification, diagnoses of bipolar manic-depressive psychosis, cycloid psychosis, periodic catatonia, systematic paraphrenia, systematic catatonia and hebephrenia proved to be valid in the long term. Revision of the category affect-laden paraphrenia seems to be called for.

Splitting Schizophrenia: Periodic Catatonia–Susceptibility Locus on Chromosome 15q15

The nature of subtypes in schizophrenia and the meaning of heterogeneity in schizophrenia have been considered a principal controversy in psychiatric research. We addressed these issues in periodic catatonia, a clinical entity derived from Leonhard's classification of schizophrenias, in a genomewide linkage scan. Periodic catatonia is characterized by qualitative psychomotor disturbances during acute psychotic outbursts and by long-term outcome. On the basis of our previous findings of a lifetime morbidity risk of 26.9% of periodic catatonia in first-degree relatives, we conducted a genome scan in 12 multiplex pedigrees with 135 individuals, using 356 markers with an average spacing of 11 cM. In nonparametric multipoint linkage analyses (by GENEHUNTER-PLUS), significant evidence for linkage was obtained on chromosome 15q15 (P = 2.6 x 10(-5); nonparametric LOD score [LOD*] 3.57). A further locus on chromosome 22q13 with suggestive evidence for linkage (P = 1.8 x 10(-3); LOD* 1.85) was detected, which indicated genetic heterogeneity. Parametric linkage analysis under an autosomal dominant model (affecteds-only analysis) provided independent confirmation of nonparametric linkage results, with maximum LOD scores 2.75 (recombination fraction [theta].04; two-point analysis) and 2.89 (theta =.029; four-point analysis), at the chromosome 15q candidate region. Splitting the complex group of schizophrenias on the basis of clinical observation and genetic analysis, we identified periodic catatonia as a valid nosological entity. Our findings provide evidence that periodic catatonia is associated with a major disease locus, which maps to chromosome 15q15.

W12.01 The development and heuristic value of Leonhard's classification

W12.01 The development and heuristic value of Leonhard's classification

The Genetic Heterogeneity of “Schizophrenia”

Summary: The main reason for the inconsistent findings in schizophrenia research is the lack of diagnostic conformity. This has not changed markedly following the introduction of modern operational diagnostic systems. Taking schizophrenia as a disease entity or assuming schizophrenic spectrum psychoses to represent a continuum of diseases without any clear dividing lines, the results of family and twin studies point to a multifactorial etiology based on a polygenic mode of transmission. Further, then it has to be assumed a familial continuum from schizophrenia to affective psychosis and other spectrum disorders. However, in family and twin studies based on Leonhard's classification, there is clearcut evidence that schizophrenic spectrum psychoses have to be divided into clinical and etiological subgroups with a completely different genetic background. for example, systematic catatonia is, for the most part, a sporadic disease, whereas periodic catatonia aggregates in families in a manner consistent with a major gene effect. Further, the results indicate that schizophrenic spectrum psychoses consist of three main valid categories: cycloid psychoses, unsystematic schizophrenias and systematic schizophrenias. In the case of cycloid psychosis and systematic schizophrenias, genetic loading seem to be very low, while “environmental” factors, for example, birth complications, may play an important etiological role. Unsystematic schizophrenias, however, are predominantly inherited and “environmental” factors are not very prominent.

Images In Psychiatry: Karl Leonhard, 1904–1988

Back to table of contents Previous article Next article Images In PsychiatryFull AccessImages In Psychiatry: Karl Leonhard, 1904–1988BRENDAN T. CARROLL, M.D.BRENDAN T. CARROLLSearch for more papers by this author, M.D.Published Online:1 Oct 1998https://doi.org/10.1176/ajp.155.10.1309AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Karl Leonhard was born in 1904 and is customarily regarded as a follower of the Wernicke-Kleist school of thought (1). In 1936, he accepted a position as head of the department at the Frankfurt University Mental Hospital. He followed Karl Kleist (1879–1960) and worked closely with him until Kleist’s retirement in 1950 (2). Kleist had been a pupil of Karl Wernicke and had developed a complicated psychopathology based on Wernicke’s experience, gained mostly from the study of traumatic brain injuries. Although well-known for his work on aphasia, Wernicke (1848–1905) was a pioneer in biological psychiatry in the areas of both descriptive psychopathology and a comprehensive neuropathological framework (2).Leonhard developed a highly differentiated classification system for the endogenous psychoses. He focused on refining Kleist’s clinical descriptions and turned to genetics in his quest for etiological hypotheses. Drawing on nearly 60 years of personally conducted long-term follow-up and family studies, Leonhard delineated sharply circumscribed subtypes based on signs that were easily observable, easily elicitable, or both (1).Leonhard’s work, originally published only in German, was largely ignored in American psychiatry (2). After the translation of his monograph in 1979, however, he gained the attention of Washington University (St. Louis) and other diagnostically oriented psychiatry departments (3). While modern researchers can find obvious shortcomings in Leonhard’s nosology concerning methodology and etiology, his clinical descriptions are excellent. The Leonhard classification is complex, yet it foreshadowed modern classification of psychoses. Specifically, Leonhard promoted 1) affective psychoses with a unipolar-bipolar dichotomy, 2) schizophrenia with multiple subtypes and family studies, 3) periodic catatonia, and 4) cycloid psychoses (4). His systems of description and classification remain valuable for investigators examining the psychopathology and other essential features of the psychoses. The Wernicke-Kleist-Leonhard Society met in Wurtzburg in 1989 for its first symposium and is still active today (3).Address reprint requests to Dr. Carroll, Department of Psychiatry, VA Medical Center, 116A, 17273 State Route 104, Chillicothe, OH 45601; [email protected] (e-mail). Photograph courtesy of Rick Hatton.

Cycloid psychoses predominate in severe postpartum psychiatric disorders

Background: The nosological status of postpartum psychoses has remained controversial because of their often `atypical' symptomatology. A polydiagnostic approach may further clarify this issue. Methods: In a retrospective study, we applied the ICD-10 and Leonhard's classification to 39 patients with severe postpartum psychiatric disorders. The patients were personally reexamined on average 12.5 years (6–26 years) after the onset of the illness. Results: An acute onset and a polymorphous psychotic symptomatology with rapid changes characterized the majority of our cases. Unipolar depressive disorders (28%) and acute polymorphous psychotic disorders (21%) represented the largest proportions within the ICD-10-classification. Applying Leonhard's classification, over half the patients (54%) suffered from a cycloid psychosis. Among cycloid psychoses, motility psychoses clearly predominated. Schizophrenias occurred rarely (10%) according to both classifications. Limitations: Due to the unknown prevalence of the various diagnoses among women of child-bearing age, it is impossible to statistically infer a specific association between childbirth and a distinct diagnosis from our data. Conclusions: Our findings suggest that cycloid psychoses, in particular motility psychoses, account for the majority of postpartum psychoses, and do not support the hypothesis of a nosological independence of postpartum psychoses.

On interrater reliability for Leonhard's classification of endogenous psychoses.

Twenty-two patients with a diagnosis of schizophrenia according to DSM-III-R and ICD-10 criteria, for whom the long-term courses of illness were all well documented, were classified by 4 independent investigators using Leonhard's classification of endogenous psychoses. With regard to the large nosological groups of cycloid psychoses (including the subtypes of anxiety-happiness psychosis, confusional psychosis and motility psychosis), of unsystematic schizophrenias (including the subtypes of affect-laden paraphrenia, cataphasia and periodic catatonia), and of systematic schizophrenias (divided into systematic catatonias, systematic paraphrenias, and hebephrenias), is was possible to reach a high level of agreement in the diagnosis, representing a Cohen kappa coefficient of 0.82 and 0.89, respectively. In only 2 out of 22 patients were discrepancies observed in the assignment to the above-mentioned groups. This clearly shows the high reliability of Leonhard's classification, which allows a differentiated diagnostic and prognostic judgement of schizophrenic psychoses according to the DSM-III-R and ICD-10.