Am J Psychiatry 1996; 153:806-811
Copyright © 1996 by American Psychiatric Association
Clinical characteristics of Kraepelinian schizophrenia: replication and extension of previous findings
RS Keefe, E Frescka, SH Apter, M Davidson, JM Macaluso, J Hirschowitz and KL Davis
Department of Psychiatry, Mount Sinai School of Medicine, New York, USA.
OBJECTIVE: Subtypologies of schizophrenia based on cross-sectional
criteria, such as the nomenclature of the DSMs, have not been successful in
identifying valid diagnostic subgroups among patients with schizophrenia. A
subtypology that uses criteria to classify individuals on the basis of
longitudinal deficits in self-care may identify a more valid subgroup of
schizophrenic patients. METHOD: This study describes the clinical
characteristics of a group of schizophrenic patients identified on the
basis of a longitudinal criterion: at least 5 years of continuous and
complete dependence on others for obtaining and maintaining the basic
necessities of life, including food, clothing, and shelter. RESULTS:
Sixty-one "Kraepelinian" schizophrenic inpatients, when compared to 80 non-
Kraepelinian schizophrenic inpatients who were similar in years of illness,
age, and education, demonstrated more severe negative symptoms and more
severe formal thought disorder; yet the severity of their delusions,
hallucinations, and bizarre behavior did not differ significantly. None of
the Kraepelinian patients and eight non- Kraepelinian patients met
DSM-III-R criteria for schizoaffective disorder. CONCLUSIONS: Data from
this replication study suggest that Kraepelinian schizophrenic patients,
identified on the basis of a longitudinal course characterized by severe
dysfunctions in self-care, may represent an alternative, and possibly more
valid, method of subtyping schizophrenia.
