Capsule 21

21. Therapeutic profile of neuroleptics in schizophrenia.
It was Christian Astrup who was first to report that patients with “unsystematic schizophrenia” responded more favorably to treatment with neuroleptics than patients with “systematic schizophrenia.”  Unsystematic schizophrenia was one of the five classes of “endogenous psychoses” in Leonhard’s classification, presented in his monograph on The Classification of Endogenous Psychoses, published in 1957. Astrup’s findings, in 1959, were further substantiated by Frank Fish, in 1964. In Fish’s study, less than 1 of 4 of patients with “systematic schizophrenia,” as opposed to more than 3 of 4 patients with “affect-laden paraphrenia,” showed a markedly or moderately favorable response to neuroleptics. “Affect-laden paraphrenia” is a form of  “unsystematic schizophrenia” that is characterized by paranoid delusions with affective loading and mood swings. It was identified as the most responsive form of schizophrenia to neuroleptics with an 84.4 % response rate. Response rates in the “systematic paraphrenias” and “systematic hebephrenias” were 40.3% and 23.3%, respectively.