Basic Symptom Concept Research Articles

SU108. Back to Basics of Basic Symptoms Concept: Which Phenomenon Scales Measure?

Background: Basic symptoms (BS) have been firstly defined by Huber in 1957 as prepsychotic basic states made from “endogenous/organic, neurological/psychopathological transition symptomatology” depicting early subtle subclinical self-experienced disturbances. Recent research in clinical high-risk population have suggested that BS are a core as their phenomenological characterization enable a better prediction of transition to psychosis. Since the Bonn Scale for the Assessment of Basic Symptoms (BSABS) in 1987, new scales have been published including the Examination of Anomalous Self-Experience (EASE; 2005) and the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY; 2013) and each scale assesses heterogeneous aspects of BS. However, given the fact that each scale presents an important variability in the assessment of symptoms, it becomes difficult for clinicians and researchers to choose the appropriate scale. Consequently, a description of which phenomena are specifically highlighted by the different scales could be useful. Methods: A comparative content analysis of items from the BSABS,1 EASE,2 SPI-CY,3 Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE),4 and Self-Experience Lifetime Frequency (SELF)5 scale has been conducted to identify phenomena associated with each scale. Results: Hundreds of items can be abbreviated to 22 phenomena. Analysis shows that several of BSABS items are focused on neurovegetative symptoms (25%) and sensory/perceptual distortions (28%) whereas EASE items focus mostly on self-consciousness disorders (19%), anxiety symptoms (15%), and thought disorders (13%). The SPI-CY’s main focus is adynamia dimension (19%) and sensory/perceptual distortions (31%). Finally, both IPASE and SELF scales are mainly focused on self-consciousness disorder (35% and 25%, respectively). Conclusion: Unraveling and comparing all items of the existing scales bring a better understanding of the BS concept and help derive some recommendations on their utilization. First, we found that BSABS is mostly focused on neurovegetative and perceptual symptoms and that the recent scales as EASE, IPASE, and SELF have shifted the concept of basic symptoms more toward self-consciousness disorders. Then, some scale such as the SPI-CY scale may be more useful for the prediction of conversion to psychosis as it is more focused on dimensions, which have been found to predict the onset. Finally, for their part, self-administered scales such as IPASE and SELF offer a more cost-effective assessment of BS but still need further validation, especially in clinical high-risk population.

The concept of basic symptoms: its scientific and clinical relevance.

The concept of basic symptoms: its scientific and clinical relevance.

The Basic-Symptom Concept and its Influence on Current International Research on the Prediction of Psychoses

The early detection of psychoses has become increasingly relevant in research and clinic. Next to the ultra-high risk (UHR) approach that targets an immediate risk of developing frank psychosis, the basic symptom approach that targets the earliest possible detection of the developing disorder is being increasingly used worldwide. The present review gives an introduction to the development and basic assumptions of the basic symptom concept, summarizes the results of studies on the specificity of basic symptoms for psychoses in different age groups as well as on studies of their psychosis-predictive value, and gives an outlook on future results. Moreover, a brief introduction to first recent imaging studies is given that supports one of the main assumptions of the basic symptom concept, i. e., that basic symptoms are the most immediate phenomenological expression of the cerebral aberrations underlying the development of psychosis. From this, it is concluded that basic symptoms might be able to provide important information on future neurobiological research on the etiopathology of psychoses.

Basic symptoms in schizophrenia, their clinical study and relevance in research

Basic symptoms consist of subtle sub-clinical disturbances subjectively experienced by schizophrenia patients. These are mainly related to drive, affect, thinking and language, perception, memory, motor action, central vegetative functions, control of cognitive processes, and stress tolerance. Initially described by Huber, from a phenomenological approach, basic symptoms are part of the earliest features of schizophrenia, and they can evolve along the course of the disorder. Their assessment during the prodromal phase of the disease (together with ultra-high risk criteria) is one of the 2 main approaches that allow the definition of states of clinical risk for the development of psychosis. The present review provides an updated view of the concept of basic symptoms, highlighting its potential value in establishing neurobiological correlates of interest in aetiopathogenic research.

Revisiting the Basic Symptom Concept: Toward Translating Risk Symptoms for Psychosis into Neurobiological Targets

In its initial formulation, the concept of basic symptoms (BSs) integrated findings on the early symptomatic course of schizophrenia and first in vivo evidence of accompanying brain aberrations. It argued that the subtle subclinical disturbances in mental processes described as BSs were the most direct self-experienced expression of the underlying neurobiological aberrations of the disease. Other characteristic symptoms of psychosis (e.g., delusions and hallucinations) were conceptualized as secondary phenomena, resulting from dysfunctional beliefs and suboptimal coping styles with emerging BSs and/or concomitant stressors. While BSs can occur in many mental disorders, in particular affective disorders, a subset of perceptive and cognitive BSs appear to be specific to psychosis and are currently employed in two alternative risk criteria. However, despite their clinical recognition in the early detection of psychosis, neurobiological research on the aetiopathology of psychosis with neuroimaging methods has only just begun to consider the neural correlate of BSs. This perspective paper reviews the emerging evidence of an association between BSs and aberrant brain activation, connectivity patterns, and metabolism, and outlines promising routes for the use of BSs in aetiopathological research on psychosis.

Basic symptoms in schizophrenia, their clinical study and relevance in research

Basic symptoms consist of subtle sub-clinical disturbances subjectively experienced by schizophrenia patients. These are mainly related to drive, affect, thinking and language, perception, memory, motor action, central vegetative functions, control of cognitive processes, and stress tolerance. Initially described by Huber, from a phenomenological approach, basic symptoms are part of the earliest features of schizophrenia, and they can evolve along the course of the disorder. Their assessment during the prodromal phase of the disease (together with ultra-high risk criteria) is one of the 2 main approaches that allow the definition of states of clinical risk for the development of psychosis. The present review provides an updated view of the concept of basic symptoms, highlighting its potential value in establishing neurobiological correlates of interest in aetiopathogenic research.

Anomalías de la experiencia subjetiva en psicosis: Concepto y validación empírica del modelo de los Síntomas Básicos

Resumen Introducción. Tradicionalmente, en la investigación, el diagnóstico y el tratamiento de los trastornos del espectro psicótico ha imperado un modelo de comprensión objetivista, centrado principalmente en los síntomas positivos y negativos. Aunque es innegable el valor de esta aproximación, implica considerables limitaciones ampliamente conocidas. De forma complementaria, existe una larga y prometedora tradición fenomenológica en la cual la experiencia subjetiva del síntoma del paciente adquiere una importancia fundamental. La aproximación de las anomalías de la experiencia subjetiva o, específicamente, de los Síntomas Básicos ha adquirido mucha fuerza dentro del contexto de detección precoz de psicosis y esquizofrenia. Objetivo. Esta revisión expone la aproximación fenomenológica de las anomalías de la experiencia subjetiva y se define detalladamente el modelo de los Síntomas Básicos, así como su proceso de validación empírica en el campo de detección precoz de psicosis. Método. Las bases de datos consultadas han sido PubMed Central® y PsycINFO®, así como libros de autores de referencia. Resultados. En las dos últimas décadas ha habido un creciente interés científico sobre esta orientación con resultados muy prometedores. Discusión y conclusión. El modelo más destacado a nivel empírico es el de los Síntomas Básicos, aunque recientemente también han ganado gran relevancia las alteraciones del flujo de la consciencia o del self. Se ha comprobado que las anomalías de la experiencia subjetiva consiguen delimitar un perfil de riesgo de psicosis más temprano que los síntomas psicóticos atenuados. Por tanto, son un complemento altamente válido en las estrategias de detección e intervención temprana de psicosis.

Basic Symptoms and the Prediction of First-Episode Psychosis

Recent focus on early detection and intervention in psychosis has renewed interest in subtle psychopathology beyond positive and negative symptoms. Such self-experienced sub-clinical disturbances are described in detail by the basic symptom concept. This review will give an introduction into the concept of basic symptoms and describe the development of the current instruments for their assessment, the Schizophrenia Proneness Instrument, Adult (SPI-A) and Child and Youth version (SPI-CY), as well as of the two at-risk criteria: the at-risk criterion Cognitive-Perceptive Basic Symptoms (COPER) and the high-risk criterion Cognitive Disturbances (COGDIS). Further, an overview of prospective studies using both or either basic symptom criteria and transition rates related to these will be given, and the potential benefit of combining ultra-high risk criteria, particularly attenuated psychotic symptoms, and basic symptom criteria will be discussed. Finally, their prevalence in psychosis patients, i.e. the sensitivity, as well as in general population samples will be described. It is concluded that both COPER and COGDIS are able to identify subjects at a high risk of developing psychosis. Further, they appear to be sufficiently frequent prior to onset of the first psychotic episode as well as sufficiently rare in persons of general population to be considered as valuable for an early detection of psychosis.

Relationship Between Subjective Experiences and Psychopathological Dimensions in Schizophrenia

Subjective experiences are subtle, self-experienced disturbances, a thorough description of which is provided within the framework of the concept of basic symptoms. Recent studies have shown that subjective experiences have important diagnostic implications for schizophrenia and related disorders. The purpose of the present study was to examine the relationship between subjective experiences and psychopathological dimensions in schizophrenia. Sixty-seven outpatients with schizophrenia were evaluated. Subjective experiences were comprehensively assessed using the Frankfurt Complaint Questionnaire (FCQ). Symptoms of schizophrenia were evaluated using the Manchester Scale (MS). Pearson's partial correlation analysis was performed between the FCQ and the MS scores, controlling for the influence of extrapyramidal adverse effects. The analysis revealed that the MS positive symptom score had significant positive correlations with the FCQ total score and subscales scores. The MS negative symptom score did not have significant correlations with the FCQ scores. The results of our study suggest that subjective experiences are significantly associated with positive symptomatology in schizophrenia, suggesting that they may share a common underlying neural basis. Future prospective studies are necessary to confirm the stability of these relationships and to explore the diagnostic and therapeutic implications of subjective experiences in a diverse group of patients at different stages of illness.

Subjective Symptoms of Schizophrenia in Research and the Clinic: The Basic Symptom Concept

Recent focus on early detection and intervention in psychosis has renewed interest in subtle psychopathology beyond positive and negative symptoms. These are self-experienced subclinical disturbances termed basic symptoms (BS). The phenomenologies of BS and their development in the course of psychotic disorders will be described.

The neural correlates of ego-disturbances (passivity phenomena) and formal thought disorder in schizophrenia

Ego-disturbances (passivity phenomena) and formal thought disorder are two hallmark symptoms of schizophrenia. Formal thought disorder has been highlighted already very early by Eugen Bleuler in his concept of basic symptoms (Grundsymptome). In contrast ego-disturbances (Ich-Störungen) or passivity phenomena have been declared as core symptoms of schizophrenia by Kurt Schneider in his concept of first-rank symptoms (Erstrangsymptome) that influenced the whole concept of schizophrenia until today (ICD10; DSM IV). We present new neuroimaging and cognitive neuropsychological results that help to explain what brain and cognitive functions may be involved in the emergence of these symptoms. Questions on cognitive and neural correlates of notions such as self-awareness, self-consciousness, introspective perspective or subjective experiences have re-emerged as topics of great interest in the scientific community. Employing new neuroscientific methods such as functional brain imaging, advances into thus far unexplored territory of mind-brain relationships have been made. These findings give new impulses for the search on the neural basis of psychopathological symptoms. We will review neuroscientific data and models on the pathogenesis of two of the core symptoms of schizophrenia, i.e. passivity phenomena and formal thought disorder.

Psychopathologie der Schizophrenie und Brain Imaging

Während Mitte des 19. Jahrhunderts (Griesinger) und 80 J. später Mayer-Gross [1] die Schizophrenie für eine Gehirnkrankheit hielten, begünstigte das immer noch negative Ergebnis aller auf die Entdeckung einer Somatose Schizophrenie gerichteten Untersuchungen einen Paradigmenwechsel, die in dem großen Schizophrenie-Referat von M. Bleuler (1951) zum Ausdruck kam. Bleuler hielt eine körperliche Ursache für undenkbar [2] und auf dem 1. Internationalen Kongress für Neuropathologie in Rom wurde die neuropathologische Psychosenforschung als unergiebig angesehen und seither praktisch eingestellt. Nachdem wir bei den Schizophrenien ein Basalgangliensyndrom und einen thalamischen Filterdefekt beschrieben und eine Teilgruppe als Limbopathien aufgefasst hatten [4], wurden von Bogerts, der in post mortem Studien eine Atrophie von Amygdala, Hippokampus, Pallidum internum und periventrikulären Strukturen des 3. Ventrikels fand, „Schizophrenien als Erkrankungen des limbischen Systems” dargestellt [3]. Unsere, auf psychopathologisch-somatische Korrelationen gerichteten Untersuchungen gingen spätestens seit den Monographien von 1957 [8] und 1961 [9] Hand in Hand mit der Verlaufs- und Früherkennungsforschung und der schrittweisen Entwicklung des Basissymptomkonzeptes (BSK) [10]. Am Anfang standen die Erstbeschreibungen der coenästhetischen Schizophrenie [14], des asthenischen reinen Defektes [8] [9] [15] und von letal endenden katatonen Schizophrenien, die erst neurohistologisch z. B. als atypische Enzephalitiden als symptomatische Schizophrenien von den idiopathischen zu trennen waren [16] [17]. Hier (wie bei den Temporallappenepilepsien) zeigte sich, dass schizophrene Syndrome und Einzelsymptome, einschließlich der Basissymptome psychopathologisch nicht unterscheidbar auch bei definierbaren Gehirnerkrankungen vorkommen [18] [60]. Der zönästhetische Typ, hatte eine Pilotfunktion für die Entwicklung des BSK, weil (1.) bei ihm die Basissymptomatik sowohl die Prodrome vor und nach der 1. psychotischen Episode bestimmte; weil hier (2.) erstmals die Entwicklung von uncharakteristischen Stufe-1- über charakteristische Stufe-2-BS zu psychotischen Symptomen beobachtet wurde; (3.) weil bei Patienten mit persistierenden reinen Defektsyndromen, in die ⅔ zönästhetischer Verläufe ausmünden, neuromorphologische Veränderungen i. S. eines Basalgangliensyndroms nachweisbar waren. Anhand klinisch-neuroradiologischer Korrelationsstudien bei 195 Klinikpatienten mit leichteren Residuen und Vollremissionen und 212 chronischen Schizophrenien mit Defektpsychosen [8] [9] [21] sowie bei 535 Patienten mit organischen Psychosyndromen aus verschiedenen Diagnosegruppen [20] bestätigt sich, dass Brain Imaging und biologisch-psychiatrische Forschung, wenn sie darauf zielen, mittels bildgebender Methoden bestimmten klinischen Symptomen und Syndromen bestimmte strukturelle oder funktionelle zerebrale Störungen zuzuordnen, nur in enger Verbindung mit Klinik, Psychopathologie und Verlaufsbeobachtung erfolgversprechend sind. In dieser Hinsicht unterscheiden sich schizophrene, schizoaffektive und affektive idiopathische Psychosyndrome nicht grundsätzlich von organischen Psychosen bei definierbaren Hirnkrankheiten [20]. Bei funktional-dynamischen Parametern muss die Differenzierung in prozessaktive und prozessinaktive Stadien anhand des aktuellen klinisch-psychopathologischen Syndroms z. Z. der Erhebung der somatischen Parameter, z. B. elektroenzephalographischer oder neurochemischer, MRT- oder PET-Befunde [29] erfolgen. Die Inkonsistenz und fehlende Replizierbarkeit von mit neuromorphologischen Verfahren (PEG, EchoEG, CT, MRT) erhobenen Befunden ist auch hier, wie bei den neueren funktionellen bildgebenden Methoden (z. B. PET, fMRT), häufig auf klinisch-psychopathologisch unzureichende, z. B. ausschließlich diagnoseorientierte Definitionen der Stichproben zurückzuführen. Anhand der Bonner-Schizophrenie-Langzeitstudie [38] [58] und der Bonn-Kölner-Früherkennungsstudie [13] [50] [56] [57]; (s. a. [12]: 412 - 422) wurde gezeigt, dass die von Kraepelin, Andreasen und Crow konzipierten dichotomen Verlaufsmodelle der Schizophrenie in der ursprünglichen Form nicht aufrechtzuerhalten sind: Negative bzw. Minussymptome i. S. von BS gehen den positiven viele Jahre voraus, negative Schizophrenien gehen in positive über und umgekehrt; differente Psychosyndrome können nicht pauschal als „negative Schizophrenien” diagnostiziert und mit hirnmorphologischen Befunden in Beziehung gesetzt werden; bei der Suche nach zerebralen Strukturveränderungen ist als klinisches Kriterium eine irreversible psychopathologische Veränderung mit der Komponente eines reinen dynamisch-kognitiven Defizienzsyndroms maßgebend [15] [21] [34], während andere persistierende Psychosyndrome wie Strukturverformungen und „reinen Psychosen” keine hirnmorphologischen Normabweichungen erwarten lassen. „Schizophrenie” ist nicht regelmäßig mit hirnmorphologischen Strukturveränderungen assoziiert: Es gibt eine Gruppe von neuroradiologisch negativen Schizophrenien mit kleinen, dysplastischen Ventrikeln, anderen Konstitutionsanomalien und Häufung von prämorbiden Persönlichkeitsstörungen mit einer gegenüber organischen Psychosyndromen am deutlichsten qualitativ heterogenen typisch schizophrenen Persönlichkeitsverformung [8]. Hirnmorphologische, das basalgangliennahe Ventrikelsystem bevorzugende Veränderungen sind bei der Teilgruppe mit irreversibler dynamisch-kognitiver Defizienz („reiner Defekt” [9] [15]), doch nicht bei Verläufen mit Vollremissionen, Strukturverformungen und reinen Psychosen, nachzuweisen. Nach Dewan wurden durch unsere Studien erstmals eine Korrelation zwischen psychopathologischen und hirnmorphologischen Befunden bei bestimmten Kranken mit der Komponente des „pure residual syndrome”, und eine Progredienz der hirnatrophischen, parallel zu den psychopathologischen Veränderungen beschrieben [39]. Quantitativ-morphometrische und MRT-Veränderungen an Anteilen des limbischen Systems und neurophysiologische Befunde sind Hinweise, dass Störungen in limbischen Schlüsselstrukturen von Bedeutung sind, die die BS und die aus ihnen hervorgehenden Erstrangsymptome erklären. Abschließend werden Kriterien und Bedeutung des Prozessaktivitätskonzeptes bei den Studien mit funktionellen bildgebenden Methoden dargestellt. [11] [12] [29] [49] [51] [56]

Basic symptom concept (BSC) and prodromal psychosis

Basic symptom concept (BSC) and prodromal psychosis

Psychopathologie des Wahns, Psychonomieprinzip und biologische Wahntheorie1

The psychopathology of the delusional experiences of schizophrenic patients is analyzed on the basis of a sample of 119 drug-naive patients and 502 patients of the Bonn-Schizophrenia-Study. The phenomenology, the forms and themes of delusion, the delusional certainty, the impact on behaviour ("Realitätsbedeutung"), the levels of development of delusional perception and the meaning of the psychological working-up of the primordial delusional experiences ("Wahnarbeit") are described. The structure-dynamic and the 'gestalt'-psychological approaches of Janzarik and Kisker try to derive the phenomenon of delusional psychoses from the psychonomy of the emotional connections, as far as they cannot be explained as immediate symptoms of a somatic illness. [7]. The present study also shows that subjective experiences of schizophrenic patients, suffering from delusions, largely develop psychonomically according to the rules of the psychic motivational dynamic, and that the share of the comprehensible working-up and assimilation with regard to the "schizophrenic end-phenomena" [16] has been considered too little by the traditional psychiatry. But, there are in the view of the basic symptom concept, especially in process active stages, hints at a higher share of the somatic component as to the structure of delusional syndromes. Looking at the processes, determined by the psychic causality on the one side, and at the boundaries of "genetic understanding" [39] in the delusional psychosis on the other side, we tried to answer the question to what extent the delusional psychosis can be understood according to the "principle of psychonomy" [5,6], and, in what respect it seems to be "apsychonomic" and thereby presumably somatically founded. The inquiry yields starting points for a biological hypothesis of delusion, compatible with a multidimensional conception, that reveals understandable connections between delusion and biography and shows the reach of the "principle of psychonomy".

Cenesthetic pain sensations illustrated by an artist suffering from migraine with typical aura.

In addition to attacks with the well-known pulsating characteristics of migrainous headache, migraine patients may experience a variety of peculiar pain sensations which are phenomenologically similar to the spontaneous sensations occurring in patients with thalamic disturbances and to the cenesthesias described as basic symptoms in functional psychoses. A 36-year-old artist with a history of migraine with typical aura provided impressive illustrations of cenesthetic pain sensations experienced during his migraine attacks, including sensations of pressure and sensations of pulling. It is suggested that cenesthetic pain sensations represent aura symptoms of migraine indicative of focal cerebral dysfunction, probably in the thalamic region. The occurrence of cenesthetic pain sensations as a migraine symptom supports the notion of an organic etiology of cenesthesias, as postulated in Huber's concept of basic symptoms of functional psychoses.

The early phase of schizophrenia and prediction of outcome

This review covers psychiatric research into the true onset of schizophrenia and its implications for the early diagnosis, differential diagnosis, therapy, prevention and general understanding of schizophrenia. Mayer-Gross's classical 1932 work anticipated some aspects of the basic symptom concept, which has been gradually developed since the 1950s. The precursor syndromes of the basic symptom concept are characterized by experiential dynamic and cognitive symptoms (in contrast to the disorders of behavior and expression of the third revised Diagnostic and statistical manual of mental disorders), usually recognizable only through patients' self reports. Patients are aware of their deficits and develop coping strategies. Basic symptoms can be assessed by a standardized survey, the Bonn Schedule for the Assessment of Basic Symptoms. Prepsychotic precursor syndromes, on average, precede the first psychotic episode as prodromes for 3.3 years and as outpost syndromes tor 10 years. Certain first-rank symptoms of schizophrenia develop from certain transition-relevant cognitive basic symptoms, contrary to Kraepelinian-type course models. Except in anosognosia schizophrenias, the basic symptoms come first, followed by positive psychotic symptoms and, finally, negative symptoms. The Bonn prospective early-recognition study suggests that many seemingly neurotic and psychopathic conditions are prepsychotic basic stages of endogenous psychoses and indicates that early recognition and therapy improves long-term prognosis.

The heterogeneous course of schizophrenia

Findings on the course and outcome of schizophrenia, the limitations of Kraepelin's opinion, and data supporting a continuum hypothesis of endogenous psychoses are presented. The European long-term investigations, the Zürich, Lausanne and Bonn studies are consistent with the view that diagnoses must be made independently of outcome; nearly a quarter show full psychopathological and 56% a social remission. Several factors are relevant to the longterm course and outcome. In the Bonn Study, 43% of subjects showed long-term remission, with only a mild deficit state (‘pure defect’) consisting of dynamic and cognitive basic symptoms, and 35% revealed characteristic schizophrenic residues. Eighty-seven per cent were living at home permanently at the most recent follow-up; 56% were socially recovered, i.e., fully employed, yet only 38.6% were at their previous occupational level. Twelve course types could be differentiated and were ranked according to social remission rate. The results led to a revision of classical descriptions of an incessant progression of schizophrenia. The outcome is largely independent of the duration of illness; there is no increasing deterioration in the later decades of the disease, often showing a trend toward improvement (the ‘second, positive bend’), even 20–40 years after onset. According to Zubin, the results of the European long-term studies and the Vermont Study have revolutionized our knowledge about schizophrenia and emancipated it from the yoke of inevitable chronicity. The findings of the Bonn Study, the first systematic study of prodromes, and of the prospective basic symptom-oriented study on the early diagnosis of schizophrenia led, in parallel with the gradual development of the basic symptom concept, to a new view of the evolution of schizophrenia.

Prodrome der Schizophrenie

This review deals with the opinions and findings of the last six decades regarding occurrence, frequence, and phenomenology of precursor stages of schizophrenic and schizoaffective psychoses. Already in his classical delineation of the onset of schizophrenia Mayer-Gross (1932) differentiated between uncharacteristic and characteristic precursors of schizophrenia and anticipated essential aspects of the concept of basic stages and basic symptoms which has been gradually developed by clinical psychiatrists and psychologists since the 50s. In his monograph "The beginning schizophrenia" Conrad (1958) resumed the "promisingly undertaken, but prematurely coming to a standstill" work of the descriptive-phenomenological psychopathology of the Heidelberg School (Jaspers, K. Schneider, Mayer-Gross, Gruhle) and investigated systematically early abnormalities of behaviour with the method of morpho-analysis. However, the study of Conrad refers already to the onset of the first psychotic episode, the "trema" which is not identical with the outpost syndromes and prodromes in the sense of Mayer-Gross and the authors of the basic symptom concept. The "trema" is characterized mainly by disorders of behaviour and expression, the precursor syndromes by dynamic and cognitive basic deficiencies, experiential and not behavioural in kind, typically only recognizable by the self-reports of the patients. The ability of recognition and realization of the basic symptoms as complaints and disorders and to develop coping strategies was the presupposition for a standardized survey and assessment of basic symptoms in the Frankfurt Questionnaire (FBF) and the Bonn Schedule for the Assessment of Basic Symptoms (BSABS).(ABSTRACT TRUNCATED AT 250 WORDS)

Competence and responsibility in schizophrenia.

In a survey of the historical background it is shown that the classical doctrine on responsibility in schizophrenia has left its mark on the wordings of the psychiatric textbooks of the different countries. Closely combined with the imputation of enduring irresponsibility in schizophrenia was the opinion that civil rights are largely suspended if a person is given the diagnosis of schizophrenia. By the more recent research results of the studies of course and long-term outcome of schizophrenia and related psychoses and the development of the basic symptom concept has shown that it is not justified on principle to summarily deprive a person, diagnosed as schizophrenia, of civil rights as well as of criminal responsibility. New directions and some guidelines for an adequate assessment of competence and responsibility in schizophrenia are described. The knowledge of the newer findings and the application and utilization of the concept of basic symptoms and non-psychotic basic stages enable to overcome the doctrines of incurability, principle heterogeneity and numinous singularity and may lead to a rather appropriate and adequate social appreciation of the disease. Insight, freedom, responsibility, and competence of a person diagnosed as schizophrenia are in the postpsychotic pure residues and basic stages much more frequently preserved and available than hitherto assumed.(ABSTRACT TRUNCATED AT 250 WORDS)