The Demise of the Kraepelinian Binary Concept and the Aetiological Unity of the Psychoses

  • T. J. Crow
Conference paper


Emil Kraepelin’s key contribution was to establish that there is a relationship between the form of a psychotic illness and its outcome. Illnesses in which affective change is a prominent component have a better outcome than those in which affective features are less prominent and in which the psychotic phenomena cannot be understood as secondary to affective change. The success of the Kraepelinian system, even its survival, owes everything to the reality of this relationship. Yet the independence of the two Kraepelinian entities has never been satisfactorily established (and Kraepelin himself had doubts). Notwithstanding this, the influence of the Kraepelinian concept is pervasive: every textbook has separate chapters on schizophrenia and affective disorder. A major objective of operational diagnostic criteria such as the Research Diagnostic Criteria (RDC) and Diagnostic and Statistical Manual (DSM) III is to separate these two entities with maximum reliability.


Affective Disorder Schizo Affective Disorder Psychotic Illness Continuum Concept Research Diagnostic Criterion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Angst J, Scharfetter C (1990) Schizoaffective Psychosen. Ein nosologisches Ärgernis. In: Lungershausen E, Kaschka WP, Witkowski RJ (eds) Affektive Psychosen. Schattauer, StuttgartGoogle Scholar
  2. Angst J, Felder W, Lohmeyer B (1979) Schizoaffective disorders. I. Results of a genetic investigation. J Affective Disord 1:139–153CrossRefGoogle Scholar
  3. Angst J, Scharfetter C, Stassen HH (1983) Classification of schizo-affective patients by multidimensional scaling and cluster analysis. Psychiatr Clin (Basel) 16:254–264Google Scholar
  4. Beck AT (1972) Depression: causes and treatment. University of Pennsylvania, PhiladelphiaGoogle Scholar
  5. Book JA (1953) Schizophrenia as a gene mutation. Acta Genet Stat Med 4:133–139PubMedGoogle Scholar
  6. Burgoyne PS (1986) Mammalian X and Y crossover. Nature 319:258–259PubMedCrossRefGoogle Scholar
  7. Cloninger CR, Martin RL, Guze SB, Clayton PJ (1985) Diagnosis and prognosis in schizophrenia. Arch Gen Psychiatry 42:15–25PubMedCrossRefGoogle Scholar
  8. Collinge J, Boccio A, DeLisi LE, Johnstone EC, Lofthouse R, Owen F, Poulter M, Risby D, Shah T, Crow TJ (1989) Evidence for a pseudoautosomal locus for schizophrenia: a sibling pair analysis. Cytogenet Cell Genet 51:978Google Scholar
  9. Collinge J, DeLisi LE, Boccio A, Johnstone EC, Lane A, Larkin C, Leach M, Lofthouse R, Owen F, Poulter M, Shah T, Walsh C, Crow TJ (1991) Evidence for a pseudoautosomal locus for schizophrenia using the method of affected sibling pairs. Br J Psychiatry 158:624–629PubMedCrossRefGoogle Scholar
  10. Crow TJ (1986a) The continuum of psychosis and its implication for the structure of the gene. Br J Psychiatry 149:419–429PubMedCrossRefGoogle Scholar
  11. Crow TJ (1986b) Secular changes in affective disorder and variations in the psychosis gene. Arch Gen Psychiatry 43:1013–1014PubMedCrossRefGoogle Scholar
  12. Crow TJ (1987a) Psychosis as a continuum and the virogene concept. Br Med Bull 43:754– 767PubMedGoogle Scholar
  13. Crow TJ (1987b) Pseudoautosomal locus for psychosis? Lancet 2:1532PubMedCrossRefGoogle Scholar
  14. Crow TJ (1988) Sex chromosomes and psychosis: the case for a pseudoautosomal locus. Br J Psychiatry 153:675–683PubMedCrossRefGoogle Scholar
  15. Crow TJ, DeLisi LE, Johnstone EC (1989) Concordance by sex in sibling pairs with schizophrenia is paternally inherited: evidence for a pseudoautosomal locus. Br J Psychiatry 155:92–97PubMedCrossRefGoogle Scholar
  16. Crow TJ, DeLisi LE, Johnstone EC (1990) Reply… a locus closer to the telomere? Br J Psychiatry 156:416–420PubMedCrossRefGoogle Scholar
  17. Decina P, Luscas LR, Linder JR, Horwath E (1989) Parent-child pairs with major psychiatric diseases (Abstr 105). 142nd Meeting of the American Psychiatric Association, WashingtonGoogle Scholar
  18. Ferguson-Smith MA (1965) Karyotype-phenotype correlations in gonadal dysgenesis and their bearing on the pathogenesis of malformations. J Med Genet 2:142–155PubMedCrossRefGoogle Scholar
  19. Flor-Henry P (1983) Cerebral basis of psychopathology. Wright, BristolGoogle Scholar
  20. Forssman H (1970) The mental implications of sex chromosome aberrations. Br J Psychiatry 117:353–363PubMedCrossRefGoogle Scholar
  21. Gershon ES, Rieder RO (1980) Are mania and schizophrenia genetically distinct? In: Belmaker RH, van Praag HM (eds) Mania, an evolving concept. Spectrum, New York, pp 97–109Google Scholar
  22. Gershon ES, Hamovit J, Guroff JJ, Dibble E, Leckmann JF, Sceery W, Targum SD, Nurnberger JI, Goldin LR, Bunney WE (1982) A family study of schizo-affective, bipolar I, bipolar II, unipolar and normal control patients. Arch Gen Psychiatry 39:1157–1167PubMedCrossRefGoogle Scholar
  23. Gershon ES, DeLisi LE, Hamovit J, Nurnberger JI, Maxwell ME, Schreiber J, Dauphinais D, Dingman CW, Guroff JJ (1988) A controlled family study of chronic psychoses: schizophrenia and schizo-affective disorder. Arch Gen Psychiatry 45:328–336PubMedCrossRefGoogle Scholar
  24. Goetzl U, Green R, Whybrow P, Jackson R (1974) X linkage revisited; a further study of manic-depressive illness. Arch Gen Psychiatry 31:665–672PubMedCrossRefGoogle Scholar
  25. Holliday R (1987) The inheritance of epigenetic defects. Science 238:163–170PubMedCrossRefGoogle Scholar
  26. Kant O (1942) The incidence of psychoses and other mental abnormalities in the families of recovered and deteriorated schizophrenic patients. Psychiatr Q 16:176–186Google Scholar
  27. Karlsson JL (1974) Inheritance of schizophrenia. Acta Psychiatr Scand [Suppl] 274:1–116Google Scholar
  28. Kendell RE (1987) Other functional psychoses. In: Kendell RE, Zealley AK (eds) Companion to psychiatric studies, 4th edn. Livingstone, Edinburgh, pp 363–377Google Scholar
  29. Kendell RE, Gourlay J (1970) The clinical distinction between the affective psychoses and schizophrenia. Br J Psychiatry 117:261–266PubMedGoogle Scholar
  30. Kendell RE, Brockington IF (1980) The identification of disease entities and the relationship between affective and schizophrenic psychoses. Br J Psychiatry 137:324–331PubMedCrossRefGoogle Scholar
  31. Kendler KS, Hays P (1983) Schizophrenia subdivided by the family history of affective disorder. Arch Gen Psychiatry 40:951–955PubMedCrossRefGoogle Scholar
  32. Kendler KS, Gruenberg AM, Tsuang MT (1986) A DSM-III family study of the nonschizophrenic psychotic disorders. Am J Psychiatry 143:1098–1105PubMedGoogle Scholar
  33. Klerman GL, Lavori PW, Rice J, Reich T, Endicott J, Andreasen NC, Keller MB, Hirschfield RMA (1985) Birth-cohort trends in rates of major depressive disorder among relatives of patients with affective disorder. Arch Gen Psychiatry 42:689–693PubMedCrossRefGoogle Scholar
  34. Koller PC, Darlington CD (1934) The genetical and mechanical properties of the sex chromosomes I rattus norvegicus. J Genet 29:159–173CrossRefGoogle Scholar
  35. Kraepelin E (1920) Die Erscheinungsformen des Irreseins. Z Gesamte Neurol Psychiatr 62:1– 29 (In English 1974: Patterns of mental disorder. In: Hirsch SR, Shepherd M (eds) Themes and variations in European psychiatry. Wright, Bristol, pp 7–30)CrossRefGoogle Scholar
  36. Leader (1987) A continuum of psychosis? Lancet 2:889–890Google Scholar
  37. Lewis AJ (1958) Fertility and mental illness. Eugen Rev 50:91–106PubMedGoogle Scholar
  38. Loranger AW (1981) Genetic independence of manic-depression and schizophrenia. Acta Psychiatr Scand 63:444–452PubMedCrossRefGoogle Scholar
  39. Maier W, Hallmayer J, Heun R (1989) A controlled family study in affective and schizophrenic disorders: support for continuum models and spectrum concepts. Abstracts of the 1st World Congress of Psychiatric Genetics, vol 1, p 35Google Scholar
  40. Mendlewicz J, Rainer JD (1974) Morbidity risk and genetic transmission in manic depressive illness. Am J Hum Genet 26:692–701PubMedGoogle Scholar
  41. Menninger K, Ellenberger H, Pruyser P et al. (1958) The unitary concept of mental illness. Bull Menninger Clin 22:4–12PubMedGoogle Scholar
  42. Mott FW (1910) Hereditary aspects of nervous and mental disease. Br Med J 2:1013–1020PubMedCrossRefGoogle Scholar
  43. Ødegaard O (1972) The multifactorial inheritance of predisposition to schizophrenia. In: Kaplan AR (ed) Genetic factors in “schizophrenia”. Thomas, Springfield, pp 256–275Google Scholar
  44. Penrose LS (1942) Auxiliary genes for determining sex as contributory causes of mental illness. J Ment Sci 88:308–316Google Scholar
  45. Penrose LS (1968) Critical survey of schizophrenia genetics. In: Howells JG (ed) Modern perspectives in world psychiatry. Oliver and Boyd, Edinburgh, pp 3–19Google Scholar
  46. Pollock HM, Malzberg B (1940) Hereditary and environmental factors in the causation of manic-depressive psychosis and dementia praecox. Am J Psychiatry 96:1227–1247Google Scholar
  47. Powell A, Thomson N, Hall DJ, Wilson L (1973) Parent-child concordance with respect to sex and diagnosis in schizophrenia and manic-depressive psychosis. Br J Psychiatry 123:653–658CrossRefGoogle Scholar
  48. Price RA, Kidd KK, Pauls DL, Gershon ES, Prusoff BA, Weissman MM, Goldin LR (1985) Multiple threshold models for affective disorders: the Yale-NIMH collaborative family study. J Psychiatr Res 19:533–546PubMedCrossRefGoogle Scholar
  49. Reich T, Cloninger CR, Suarez B, Rice J (1982) Genetics of the affective psychoses. In: Wing L, Wing JK (eds) Psychoses of uncertain aetiology. Cambridge University Press, Cambridge, pp 147–159 (Handbook of psychiatry, vol 3)Google Scholar
  50. Rice J, Reich T, Andreasen N, Endicott J, van Eerdewegh M, Fishman R, Hirschfeld RMA, Klerman GL (1987) The familial transmission of bipolar illness. Arch Gen Psychiatry 44:441–447PubMedCrossRefGoogle Scholar
  51. Risch N, Baron M, Mendlewicz J (1986) Assessing the role of X-linked inheritance in bipolar-related major affective illness. J Psychiatr Res 20:275–288PubMedCrossRefGoogle Scholar
  52. Rosenthal D (1962) Familial concordance by sex with respect to schizophrenia. Psychol Bull 59:401–421PubMedCrossRefGoogle Scholar
  53. Rosenthal D (1970) Genetic theory and abnormal behavior. McGraw-Hill, New YorkGoogle Scholar
  54. Slater ETO (1936) Inheritance of manic-depressive insanity. Lancet 1:429–431Google Scholar
  55. Slater ETO (1953) Psychotic and neurotic illness in twins. HMSO, LondonGoogle Scholar
  56. Stassen HH, Scarfetter C, Winokur G, Angst J (1988) Familial syndrome patterns in schizophrenia, schizoaffective disorder, mania, and depression. Eur Arch Psychiatry Neurol Sci 237:115–123PubMedCrossRefGoogle Scholar
  57. Van Eerdewegh MM, Gershon ES, van Eerdewegh PM (1980) X-chromosome threshold models of bipolar manic-depressive illness. J Psychiatr Res 15:215–238CrossRefGoogle Scholar
  58. Winokur G (1984) Psychosis in bipolar and unipolar affective illness with special reference to schizo-affective disorder. Br J Psychiatry 145:236–242PubMedCrossRefGoogle Scholar
  59. Winokur G, Clayton PJ, Reich T (1969) Manic-depressive illness. Mosby, St. LouisGoogle Scholar
  60. Zerbin-Rudin E (1972) Genetic research and the theory of schizophrenia. Int J Ment Health 1:42–62Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • T. J. Crow
    • 1
  1. 1.Division of Psychiatry, Clinical Research CentreNorthwick Park HospitalHarrowUK

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