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nferen1104 Am J Psychiatry 159:7, July 2002 Clinical Case Conference A Case of “Pfropfschizophrenia”: Kraepelin’s Bridge Between Neurodegenerative and Neurodevelopmental Conceptions of Schizophrenia Avram H. Mack, M.D. James J. Feldman, M.D., M.P.H. Ming T. Tsuang, M.D., Ph.D., D.Sc. The notion that schizophrenia, as conceived by Kraepelin,is a neurodegenerative disorder has been challenged by new research on the nature of the cognitive impairment in this disease; instead, schizophrenia is increasingly described as a neurodevelopmental disorder (1). For Kraepelin, the unifying observation among the catatonic, hebephrenic, and paranoid types of dementia praecox was a continued decline of intellectual function. However, empirical findings have demonstrated that cognitive function does not universally decline in patients with schizophrenia. Some authors have suggested that low intellectual functioning is a premorbid and fixed feature (2). Others have sought to separate patients according