Clinical pharmacology and Leonhard's classification of endogenous psychoses

Introduction of therapeutically effective psychotropic drugs focused attention on the heterogeneity of psychiatric populations within the traditional diagnostic categories of psychiatric disorders. Recognition that valid diagnostic concepts are essential for progress in the biology and pharmacotherapy of psychiatric disorders resulted in a revival of interest in psychiatric nosology with a special emphasis on Leonhard's classification of 'endogenous psychoses'. Of particular importance for psychopharmacology in Leonhard's system is the recognition of two distinctive populations within the schizophrenic disorders, i.e., 'unsystematic schizophrenias' and 'systematic schizophrenias'; three distinctive populations within the bipolar disorders, i.e., 'manic-depressive illness,' 'cycloid psychoses' and 'unsystematic schizophrenias'; and two distinctive populations within depressive disorders, i.e., 'unipolar depression' and 'bipolar depression'. In this paper supporting data for Leonhard's classification of 'endogenous psychoses' are presented.     

Progress in the classification of functional psychoses

The three most widely used diagnostic systems in American psychiatry--the Feighner criteria, the Research Diagnostic Criteria, and DSM-III--appeared sequentially at 4-year intervals. The fact that the latter two systems each incorporated changes in essentially all diagnostic categories implied progress toward greater validity; however, this assumption has rarely been tested directly. To do this, the authors applied each of these three systems to 98 consecutively admitted patients with nonmanic psychoses. Although family history and 6-month follow-up data strongly supported the validity of diagnostic distinctions made in each of the three systems, they did not show increments in validity with successively developed criteria sets.     

Reexamination of interictal psychoses based on DSM IV psychosis classification and international epilepsy classification

We sought to examine interictal psychoses based on the international epilepsy classification and DSM IV criteria, with special attention paid to epilepsy types as well as to subcategories of psychoses. One hundred thirty-two outpatients were studied, each with definite evidence of both epilepsy and interictal psychosis clearly demarcated from postictal psychosis. We compared them with 2,773 other epilepsy outpatients as a control. Risk factors for psychosis were examined within the temporal lobe epilepsy (TLE) group and the more extended group of symptomatic localization-related epilepsy. Further, nuclear schizophrenia and other nonschizophrenic psychotic disorders were compared. We confirmed a close correlation between TLE and interictal psychoses. Within the TLE group, only early epilepsy onset and a history of prolonged febrile convulsions were revealed to be significantly associated with interictal psychosis. Within the symptomatic localization-related epilepsy group, such parameters as complex partial seizures, autonomic aura, and temporal EEG foci were closely associated with psychoses. There was also a significant difference between groups as to ictal fear and secondary generalization. Whereas patients with early psychosis onset and a low intelligence quotient were overrepresented in the nuclear schizophrenia group, drug-induced psychosis and alternative psychosis were underrepresented. TLE proved to be preferentially associated with interictal psychoses. Within the TLE group, medial TLE in particular was found to be more closely associated with psychosis. Our data support the original postulation of Landolt, stating that alternative or drug-induced psychoses constitute a definite subgroup of interictal psychoses, which are different from chronic epileptic psychoses that simulate schizophrenia.     

The importance of Karl Leonhard's classification of endogenous psychoses

In this paper the author highlights the importance that the classificatory work carried out by Leonhard has had for recent international developments in the classification of mental disorders. In particular, the diagnostic relevance of a distinction between bipolar and unipolar affective disorders and the separation of the cycloid psychotic disorders from other major psychoses is underscored.     

Problems concerning the concept of reactive psychoses

The problems of reactive psychoses are discussed from the following perspectives: terminology, prevalence, psychogenesis and trauma, predisposition and vulnerability, as well as outcome. Four definitions of reactive psychoses, which are used in Scandinavia, are presented and discussed. Each of them is beset with problems. The authors argues that the term 'reactive psychoses' should be limited to those functional psychoses which are not typically schizophrenic, manic-depressive or paranoid.     

Leonhard and the classification of psychomotor psychoses in childhood and adolescence

The classification 'psychomotor psychoses' goes back to Wernicke, Kleist and Leonhard. The incidence of psychomotor deficiencies is a typical trait. The motility psychoses (a form of the cycloid psychosis), the periodical catatonia (a form of unsystematic schizophrenias) and the catatonic forms of systematic schizophrenias belong to the group of 'psychomotor psychoses'. To some extent they correspond with the 'catatonic type' according to DSM-III (295.2). The number of children and adolescents with psychomotor psychoses, who were examined by Leonhard and Neum?rker have shown beside different clinical-psychopathological features a significant difference as regards the age-related manifestation of each psychomotor psychosis.     

神经元形态分类和命名的机制研究

The morphological and functional characteristics of neurons are quite varied and complex. There is a need for a comprehensive approach for distinguishing and classifying neurons. Similar to the biological species classification system, this study proposes a morphological classification system for neurons based on principal component analysis. Based on four principal components of neuronal morphology derived from principal component analysis, a nomenclature system for neurons was obtained. This system can accurately distinguish between the same type of neuron from different species.     

New nomenclature and classification scheme for the neuronal ceroid lipofuscinoses

We provide a new classification for the neuronal ceroid lipofuscinoses (NCLs) that takes into account recent genetic and biochemical advances. This was originally developed by an international group with clinical, molecular genetic, biological, and morphologic interests, further revised by a panel of world experts in the NCLs, and is now updated in light of recent research findings. The aim is to provide young people, carers, and professionals with a diagnostic label that is informative, leads to effective clinical management of symptoms and in the future perhaps a cure, as well as aiding basic scientific and clinical research. We suggest that clinicians should aim to provide every child and family with detailed diagnostic information at clinical, biochemical, and genetic levels where possible, which the new classification allows in a gene-led hierarchical manner. The robustness and applicability of this updated new classification have been independently audited in the clinical setting using a series of patients previously diagnosed with NCL according to standard ultrastructural, biochemical, or genetic criteria.