Thomas A. Ban: In historical perspective Peralta, Cuesta and their associates’ findings on the highest familiality of Leonhard’s classification in polynosologic study

Thomas A. Ban’s reply to Marcelo Cetkovich’s comment


Thank you for your comments. I was glad to see your appreciation of Christian Astrup’s (1959) contributions. It was Astrup who first discovered that by dividing schizophrenia on the basis of Karl Leonhard’s (1957) classification into “unsystematic schizophrenia” and “systematic schizophrenia”, the population with the diagnosis of “unsystematic schizophrenia” was pharmacologically more homogeneous in terms of responsiveness to neuroleptics than the population with the diagnosis of “systematic schizophrenia”. Astrup’s (1959) findings were further elaborated by Frank Fish (1964), who identified “affect-laden paraphrenia”, one of the three subpopulations of “unsystematic schizophrenia”, as the pharmacologically most homogeneous subpopulation of schizophrenia with marked to moderate response rate to neuroleptics in 84.4%. As pharmacologically homogenous populations are a prerequisite for interpretable findings in neuropsychopharmacological research, “affect-laden paraphrenia” is a suitable subpopulation of schizophrenia for neuropsychopharmacological research. It is also a suitable population for molecular genetic research with the employment of the “candidate gene” approach. If attention had been played to Fish’s (1964) findings, which were published in 1964, we probably would not have had the dopamine hypothesis of schizophrenia, but rather, a dopamine hypothesis of “affect-laden paraphrenia”.

You are correct, Peralta and his associates’ (2015) finding of higher “familiality” in the “systematic schizophrenias” than in the “unsystematic schizophrenias” is in the opposite direction to the finding of Leonhard (1999) and some other investigators who published on higher “familiality” in “unsystematic schizophrenia” than in “systematic schizophrenia”. The finding of high “familiality” in ”cycloid psychosis” by Peralta and his associates (2015)  is also in  variance with the finding of Leonhard (1999) and some others. It would be important to find out from where the discrepancy comes. Regardless of the discrepancy, the fact remains that in their “polynosologic” study in psychotic disorders, Peralta and associates found the  highest “familiality” with diagnoses derived by Leonhard’s (1957) nosology, followed by empirically derived diagnoses, DSM-IV diagnoses and ICD-10 diagnoses in this order.



Astrup C. The effect of ataraxic drugs on schizophrenic subgroups related to experimental findings. Acta Psychiatr Scand 1959; 34 (suppl 136): 388-93.

Fish F. The influence of the tranquilizers on the Leonhard schizophrenic syndromes. Encephale  1964; 53: 245-9.

Leonhard K. Aufteilung der endogenen Psychosen. Berlin: Akademie Verlag; 1957.

Leonhard K. Classification of Endogenous Psychoses and their Differentiated Etiology. Revised and enlarged edition. Vienna/New York: Springer; 1999.

Peralta V, Goldberg X, Ribeiro M, Sanches-Torres AM, Fananas L, Cuesta MJ. Familiality of psychotic disorders: A polynosologic study in multiple families. Schizophrenia Bulletin Advance Access 2015 doi: 101093/schbul/sbv


Thomas A. Ban

May 12, 2016