S72. FUNCTIONAL DISCONNECTION WITHIN THE PRESENCE HALLUCINATION NETWORK IN PSYCHOTIC PATIENTS WITH FIRST-RANK SYMPTOMS

SummaryFirst rank symptoms have assumed an important role in the assessment of schizophrenia. Only recently, however, have there been empirical studies of their reliability and validity. In this study, we examined the relationship between first rank and other psychiatric symptoms in 100 schizophrenic patients. The results are consistent with other research reports suggesting that first rank symptoms do not represent a homogeneous group of symptoms within an individual patient.

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Shall we really say goodbye to first rank symptoms?

European Psychiatry ◽

10.1016/j.eurpsy.2016.04.010 ◽

2016 ◽

Vol 37 ◽

pp. 8-13 ◽

Cited By ~ 17

Author(s):

A. Heinz ◽

M. Voss ◽

S.M. Lawrie ◽

A. Mishara ◽

M. Bauer ◽

...

Keyword(s):

Meta Analysis ◽

High Specificity ◽

Good Evidence ◽

Diagnostic Process ◽

Future Research ◽

Phenotypic Trait ◽

Warning Sign ◽

Systematic Assessment ◽

Specific Care ◽

First Rank Symptoms

AbstractBackgroundFirst rank symptoms (FRS) of schizophrenia have been used for decades for diagnostic purposes. In the new version of the DSM-5, the American Psychiatric Association (APA) has abolished any further reference to FRS of schizophrenia and treats them like any other “criterion A” symptom (e.g. any kind of hallucination or delusion) with regard to their diagnostic implication. The ICD-10 is currently under revision and may follow suit. In this review, we discuss central points of criticism that are directed against the continuous use of first rank symptoms (FRS) to diagnose schizophrenia.MethodsWe describe the specific circumstances in which Schneider articulated his approach to schizophrenia diagnosis and discuss the relevance of his approach today. Further, we discuss anthropological and phenomenological aspects of FRS and highlight the importance of self-disorder (as part of FRS) for the diagnosis of schizophrenia. Finally, we will conclude by suggesting that the theory and rationale behind the definition of FRS is still important for psychopathological as well as neurobiological approaches today.ResultsResults of a pivotal meta-analysis and other studies show relatively poor sensitivity, yet relatively high specificity for FRS as diagnostic marker for schizophrenia. Several methodological issues impede a systematic assessment of the usefulness of FRS in the diagnosis of schizophrenia. However, there is good evidence that FRS may still be useful to differentiate schizophrenia from somatic causes of psychotic states. This may be particularly important in countries or situations with little access to other diagnostic tests. FRS may thus still represent a useful aid for clinicians in the diagnostic process.ConclusionIn conclusion, we suggest to continue a tradition of careful clinical observation and fine-grained psychopathological assessment, including a focus on symptoms regarding self-disorders, which reflects a key aspect of psychosis. We suggest that the importance of FRS may indeed be scaled down to a degree that the occurrence of a single FRS alone should not suffice to diagnose schizophrenia, but, on the other hand, absence of FRS should be regarded as a warning sign that the diagnosis of schizophrenia or schizoaffective disorder is not warranted and requires specific care to rule out other causes, particularly neurological and other somatic disorders. With respect to the current stage of the development of ICD-11, we appreciate the fact that self-disorders are explicitly mentioned (and distinguished from delusions) in the list of mandatory symptoms but still feel that delusional perceptions and complex hallucinations as defined by Schneider should be distinguished from delusions or hallucinations of “any kind”. Finally, we encourage future research to explore the psychopathological context and the neurobiological correlates of self-disorders as a potential phenotypic trait marker of schizophrenia.

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The DSM-III Concepts of Schizophrenic Disorder and Schizophreniform Disorder

The British Journal of Psychiatry ◽

10.1192/bjp.151.5.611 ◽

1987 ◽

Vol 151 (5) ◽

pp. 611-618 ◽

Cited By ~ 18

Author(s):

Roger O. A. Makanjuola ◽

Sunday A. Adedapo

Keyword(s):

Mental Health ◽

Developing Countries ◽

Health Services ◽

Clinical Outcome ◽

Lower Incidence ◽

Schizophreniform Disorder ◽

Schizophrenic Disorder ◽

Social Outcome ◽

First Rank Symptoms ◽

Symptoms And Signs

Consecutive new patients presenting at a Nigerian psychiatric unit over a 14-month period and fulfilling the DSM-III criteria for schizophreniform disorder, (active) schizophrenia and residual schizophrenia were studied. There were no differences between the three groups with respect to background social data. The schizophreniform patients had a lower incidence of previous psychotic episodes. There were no differences between the first two groups with respect to the distribution of PSE symptoms and signs, Schneider's First Rank Symptoms, or severity of psychopathology. Initial clinical outcome, and longer-term clinical and social outcome, assessed 25–38 months after index presentation, was best in the schizophreniform patients and worst in the patients with residual schizophrenia. The findings are consistent with schizophreniform disorder lying on a spectrum of schizophrenic disorders. They also highlight inadequacies in mental health services in Nigeria and other developing countries.

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Speed, Accuracy, and Efficiency of Judgements of Coincidence between Speech Acts and Auditory Perception during a Delayed Auditory Feedback Paradigm: A Behavioral Study in Patients with Schizophrenia

Timing & Time Perception ◽

10.1163/22134468-20191163 ◽

2020 ◽

Vol 8 (2) ◽

pp. 177-191

Author(s):

Daniela Hubl ◽

Nicolas Moor ◽

Jochen Kindler ◽

Mara Kottlow ◽

Thomas Dierks ◽

...

Keyword(s):

Reaction Time ◽

Response Bias ◽

Speech Acts ◽

Significant Drop ◽

Delayed Auditory Feedback ◽

Self Monitoring ◽

Patient Groups ◽

Time Accuracy ◽

First Rank Symptoms ◽

Speed Accuracy

The inability to differentiate between one’s actions and their consequences from sensory inputs originating from an alien source might cause classical first-rank symptoms in schizophrenia, such as audio-verbal hallucinations (AVH). We aimed to determine whether patients with or without AVH perform differently in a task challenging the audio-verbal self-monitoring system compared to controls. Controls (n = 21) and schizophrenia patients with (AH, n = 11) and without AVH (NH, n = 9) participated. Subjects had to discern whether they heard a sound they had just uttered with or without delay. Reaction time, accuracy as well as sensitivity and response bias were compared between groups. There were no group effects in reaction time. Controls were significantly more accurate in the detection of delays compared to AH and to NH. However, the most salient observation was that these deficits were not uniformly present, but were selectively elicited by the delay, reducing patients’ response accuracy to chance level. The analysis of the data based on signal detection theory revealed a significant drop in sensitivity in both patient groups compared to the controls, and a response bias: Particularly the patients with AVH seemed to be biased not to consider a delay, rather than falsely signaling a delay. Such a deficit may blur the distinction between external events and self-initiated actions, thus eventually interfering with the patients’ sense of agency.

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P.551 Effects of the transcranial magnetic stimulation on the sense of agency and body ownership impairments in schizophrenia with first-rank symptoms

European Neuropsychopharmacology ◽

10.1016/j.euroneuro.2020.09.403 ◽

2020 ◽

Vol 40 ◽

pp. S312-S313

Author(s):

A. Laurin ◽

Y. Le Strat ◽

M. Marinescu ◽

S. Tébéka ◽

C. Dubertret

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Sense Of Agency ◽

Body Ownership ◽

First Rank Symptoms

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Delusional Memories: First-Rank Symptoms?

The British Journal of Psychiatry ◽

10.1192/bjp.159.4.472 ◽

1991 ◽

Vol 159 (4) ◽

pp. 472-474 ◽

Cited By ~ 9

Author(s):

Alec Buchanan

Keyword(s):

Present State ◽

First Rank Symptoms ◽

State Examination

Delusional memories have an established place in psychiatric phenomenology and use of the term extends to its inclusion in the Present State Examination (Winget al,1974). Not all writers have used the term, however, and present definitions are inconsistent. This paper attempts to clarify the significance of delusional memories for a diagnosis of schizophrenia according to Schneiderian criteria.

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Factor structure and familiality of first-rank symptoms in sibling pairs with schizophrenia and schizoaffective disorder

The British Journal of Psychiatry ◽

10.1192/bjp.177.1.15 ◽

2000 ◽

Vol 177 (1) ◽

pp. 15-19 ◽

Cited By ~ 31

Author(s):

Josephine Loftus ◽

Lynn E. Delisi ◽

Timothy J. Crow

Keyword(s):

Factor Structure ◽

Principal Components ◽

Genetic Predisposition ◽

Schizoaffective Disorder ◽

Sibling Pairs ◽

Factor I ◽

Third Person ◽

Components Analysis ◽

Major Factors ◽

First Rank Symptoms

BackgroundSince their introduction as diagnostic criteria by Schneider in 1937, nuclear symptoms have played a key role in concepts of schizophrenia, but their relationship to each other and to genetic predisposition has been unclear.AimsTo ascertain the factor structure and familiality of nuclear symptoms.MethodsNuclear (Schneiderian) symptoms were extracted from case notes and interviews in a study of 103 sibling pairs with DSM–III–R schizophrenia or schizoaffective disorder.ResultsPrincipal components analysis demonstrated two major factors: one, accounting for about 50% of the variance, groups thought withdrawal, insertion and broadcasting, with delusions of control; and the second, accounting for <20% of the variance, groups together third-person voices, thought echo and running commentary. Factor I was significantly correlated within sibling pairs.ConclusionsThe correlation within sibling pairs suggests that, contrary to the conclusion of some previous studies, some nuclear symptoms do show a degree of familiality and therefore perhaps heritability.

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Schneider's First-Rank Symptoms of Schizophrenia: Prevalence and Diagnostic Use

The British Journal of Psychiatry ◽

10.1192/bjp.156.1.109 ◽

1990 ◽

Vol 156 (1) ◽

pp. 109-111 ◽

Cited By ~ 14

Author(s):

S. B. Malik ◽

M. Ahmed ◽

A. Bashir ◽

T. M. Choudhry

Keyword(s):

Thought Insertion ◽

Diagnostic Use ◽

First Rank Symptoms ◽

Different Cultures

The prevalence of Schneiderian first-rank symptoms in 75 schizophrenic in-patients was found to be 67%. The commonest were somatic passivity, thought broadcast, and thought insertion. This suggests a considerable variation in the prevalence of first-rank symptoms and their individual frequencies in different cultures. First-rank symptoms thus have inherent weaknesses.

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