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A neuropsychological study on Leonhard’s nosological system

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Abstract

Phenotype validation of endogenous psychosis is a problem that remains to be solved. This study investigated the neuropsychological performance of endogenous psychosis subtypes according to Wernicke–Kleist–Leonhard’s classification system (WKL). The participants included consecutive admissions of patients with schizophrenia spectrum disorder or mood disorder with psychotic symptoms (N = 98) and healthy comparison subjects (N = 50). The patients were assessed by means of semi-structured interviews and diagnosed through the WKL system into three groups: a manic-depressive illness and cycloid psychosis group (MDC), unsystematic schizophrenia (USch) and systematic schizophrenia (SSch). All the participants completed a comprehensive neuropsychological battery. The three Leonhard’s psychosis subtypes showed a common neuropsychological profile with differences in the severity of impairment relative to healthy controls. MDC patients showed better performance on premorbid intelligence, verbal memory and global cognitive index than USch and SSch patients, and they showed better performance on processing speed, and working memory than SSch patients. USch patients outperformed SSch patients in verbal memory, working memory and global cognitive index. Neuropsychological performance showed a modest accuracy for classification into the WKL nosology. Our results suggest the existence of a common profile of cognitive impairment cutting across WKL subtypes of endogenous psychosis but with significant differences on a severity continuum. In addition, classification accuracy in the three WKL subtypes by means of neuropsychological performance was modest, ranging between 40 and 64% of correctly classified patients.

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Data availability

The anonymised dataset is available from the corresponding author on reasonable request.

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Acknowledgement

SegPEPs Group-- Alejandro Ballesteros: Navarra Institute for Health Research (IdiSNA), Pamplona, Spain, Mental Health Department, Osakidetza, Vitoria, Spain. Elena García de Jalón: Navarra Institute for Health Research (IdiSNA), Pamplona, Spain, Mental Health Department, Servicio Navarro de Salud – Osasunbidea, Pamplona, Spain. Rebeca Hernández- Anton: Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain. Lucía Janda: Navarra Institute for Health Research (IdiSNA), Pamplona, Spain, Mental Health Department, Servicio Navarro de Salud – Osasunbidea, Pamplona, Spain. David Peralta: Navarra Institute for Health Research (IdiSNA), Pamplona, Spain, Mental Health Department, Servicio Navarro de Salud – Osasunbidea, Pamplona, Spain. María Ribeiro: Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain. Ángela S. Rosero: Navarra Institute for Health Research (IdiSNA), Pamplona, Spain, Mental Health Department, Servicio Navarro de Salud – Osasunbidea, Pamplona, Spain. Maria Zandio: Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.

Funding

This work was supported by the Government of Navarra (grants 17/31, 18/41, 87/2014) and the Carlos III Health Institute (FEDER Funds) from the Spanish Ministry of Economy and Competitivity (14/01621 and 16/02148).

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Authors and Affiliations

  1. Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain

    Manuel J. Cuesta & Lucía Moreno-Izco

  2. Navarra Institute for Health Research (IdiSNA), Pamplona, Spain

    Manuel J. Cuesta, Ana M. Sánchez-Torres, Gustavo Gil-Berrozpe, Ruth Lorente-Omeñaca, Lucía Moreno-Izco & Victor Peralta

  3. Mental Health Department, Servicio Navarro de Salud – Osasunbidea, Pamplona, Spain

    Victor Peralta

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  1. Manuel J. Cuesta
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SegPEPs Group

  • Alejandro Ballesteros
  • , Elena García de Jalón
  • , Rebeca Hernández-Anton
  • , Lucía Janda
  • , David Peralta
  • , María Ribeiro
  • , Ángela S. Rosero
  •  & Maria Zandio

Contributions

MJC and VP designed the study and supervised the draft completion. AMS-T, GJG-B, RL-O and LM-I collected the cognitive and clinical data, managed the literature searches and contributed to the data analyses. Authors included in SEGPEPs contributed to participants’ recruitment and to the clinical assessments. MJC wrote the first draft of the manuscript. All authors contributed to and approved the final draft of the manuscript.

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Correspondence to Manuel J. Cuesta.

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The authors declare no conflicts of interest.

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The investigations were approved by Institutional Review Board of the Ethical Committee of Navarra (Spain).

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All patients provided written informed consent, in accordance with the 1964 Declaration of Helsinki.

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Not applicable.

Additional information

SegPEPs Group members and their respective affiliation has been added in acknowledgements section.

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Cuesta, M.J., Sánchez-Torres, A.M., Gil-Berrozpe, G. et al. A neuropsychological study on Leonhard’s nosological system. Eur Arch Psychiatry Clin Neurosci 272, 427–436 (2022). https://doi.org/10.1007/s00406-021-01298-0

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