Kraepelin and Bleuler revisited: cognition, heterogeneity, and the nature of psychosis

This presentation argues that modern evidence reconciles Kraepelin and Bleuler’s views of schizophrenia. Kraepelin correctly identified cognitive impairment as central, supported by robust findings linking deficits to functional outcomes and early developmental origins. However, his notion of inevitable deterioration is not supported; cognition is largely stable, favoring a neurodevelopmental model. Bleuler rightly emphasized heterogeneity, anticipating current biomarker-based classifications, but underplayed cognition’s centrality. Studies such as BSNIP demonstrate biologically distinct psychosis subtypes, especially those with severe cognitive deficits. The authors propose reframing psychosis as a heterogeneous “Bleuler syndrome” with cognitively defined “Kraepelinian subtypes,” enabling more precise, biologically informed diagnosis and treatment.

Speakers

Professor Matcheri Keshavan, Professor of Psychiatry, Harvard Medical School

Funding

RCPsych International Congress is financially supported by the purchase of exhibition stand packages. A full list of confirmed exhibitors can be found here: Exhibiting Organisations at International Congress 2026

Availability

This webinar is part of the Congress webinar 2026 package. If you attended all four days of Congress, you will have access to these as part of your Congress package. Otherwise the Congress webinar 2026 package can be purchased below.