First rank symptoms in Mania: An indistinct diagnostic strand

Abstract

Introduction: First rank symptoms (FRS) are considered to be pathognomic for Schizophrenia. However, FRS is not distinctive feature of Schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. Its existence in the first episode of bipolar disorder may be predictor of poor short-term outcome and decompensating course of illness. Objective: To determine the frequency of first rank symptoms in manic patients. Method: The cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. 120 manic patients were recruited from November 2014 to May 2015.FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool. Result: The mean age of the patients was 37.62 ± 12.51, and the patient less than 35 years had 69.6% FRS with p-value of 0.009. The mean number of previous manic episode was 2.17 ± 2.23. 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a p-value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness. 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity. 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception. Conclusion: The study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders and association of younger age with FRS.