First-rank Symptoms Of Schizophrenia Research Articles

Diagnostic Significance of Schneiderian First Rank Symptoms

Schizophrenia is considered to be the heartland of psychiatry and core of its clinical practice. There have been disagreements regarding its diagnostic criteria. Schneiderian first rank symptoms have been given much importance ill international classification systems. Prevalence of first rank symptoms has been reported to be from 28% to 73%. This study was done to estimate the prevalence of first rank symptoms in schizophrenia in patients presenting in outpatients departments of Mayo hospital Lahore and Institute of mental health Lahore. 168 patients were studied. Fifty patients were suffering from schizophrenia. Twenty-live patients each were suffering from mania and psychotic depression. Fifty patients had neurotic (disorders and 18 patients were suffering from drug-induced psychosis. ICD-10 was used as diagnostic criteria and Mellor’s definitions of first rank symptoms were used. Prevalence of first rank symptoms in schizophrenia was found to be 56%. Very few patients from other diagnostic categories had first rank symptoms. Prevalence of first rank symptoms in schizophrenia is lower than reported from studies done in the West. Local criteria and instruments should be developed for use in our own population.

Pars Triangularis Volume Asymmetry and Schneiderian First Rank Symptoms in Antipsychotic-naïve Schizophrenia.

ObjectiveSchizophrenia is a disorder of language and self, with first-rank symptoms (FRS) as one of the predominant features in a subset of patients. Abnormal language lateralization is hypothesized to underlie the neurobiology of FRS in schizophrenia. The role of Broca’s area with its right-hemispheric counterpart, consisting of pars triangularis (PTr) and pars opercularis (POp) of the inferior frontal gyrus in FRS is undetermined. We compared the volumes and asymmetries of PTr & POp in anti-psychotic-naive schizophrenia patients with FRS (FRS[＋]) with those without FRS (FRS[−]) and healthy-controls (HC) using three dimensional, interactive, semi-automated volumetric morphometry.MethodsAntipsychotic naïve FRS(＋) (n = 27), FRS(−) (n = 24) and HC (n = 51) were carefully assessed with structured and semi-structured clinical tools. T1-weighted images were acquired in a 3T scanner. Volumes of regions of interest were measured independently for both sides using slicer-3D software, and asymmetry indices were calculated.ResultsFRS(＋) but not FRS(−) had a significant volume deficit in right PTr after controlling for the potential confounding effects of age, sex, and intracranial volume (p = 0.029). There was a significant leftward asymmetry of PTr in patients with FRS (i.e., leftward asymmetry in patients) (p = 0.026). No significant volume/asymmetry abnormalities were observed in POp.ConclusionStudy findings suggest reduced right PTr volume with leftward asymmetry to be associated with FRS in schizophrenia. This is consistent with the loss of Yakovlevian torque in schizophrenia. Role of PTr in the neurobiology of schizophrenia as a disorder of self, speech, and social cognition needs further systematic evaluation in future research.

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

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.

First rank symptoms for schizophrenia

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The paradoxical self: Awareness, solipsism and first-rank symptoms in schizophrenia

Schizophrenia as a pathology of self-awareness has attracted much attention from philosophical theorists and empirical scientists alike. I view schizophrenia as a basic self-disturbance leading to a lifeworld of solipsism adopted by the sufferer and explain how this adoption takes place, which then manifests in ways such as first-rank psychotic symptoms. I then discuss the relationships between these symptoms, not as isolated mental events, but as end-products of a loss of agency and ownership, and argue that symptoms like thought insertion and other ego-boundary disorders are by nature a multitude of paradoxes created by a fragmented awareness. I argue that such fragmentation does not always require or lead to a delusional elaboration as the definitive feature of its phenomenology, and present reasons for the role of the first-person pronoun as a mere metaphor used to represent the patient’s bizarre experiences where sensory perception and thinking processes converge. Further, I discuss the initial benefits of adopting a solipsistic stance and how despite being a maladaptive strategy, it nevertheless acts as a protective barrier for the integrity of one’s self. Lastly, I offer some suggestions for clinical practice, emphasizing the importance of understanding the patient’s suffering in any therapeutic alliance.

ICD-11: Example of psychotic disorders

The revision of the current classification criteria for disorders issued by the World Health Organization (WHO) (International Classification of Disorders, ICD-10) is underway and will also include a revision of the classification criteria of the mental and behavioural disorders. Working groups for specific groups of mental disorders had produced suggestions for revised diagnostic criteria and included a working group on schizophrenia and other primary psychotic disorders. This presentation will focus on this group of mental disorders. Major changes suggested were an introduction of symptom and course specifiers, the inclusion of cognitive symptoms and a de-emphasising of the so-called first rank symptoms of schizophrenia, a cross-sectional approach towards the classification of schizoaffective disorder and a reorganization of the acute psychotic disorders. Initial internet-based field trials showed some incremental improvements of diagnostic reliability, but more crucial for an adjustment of the revised classification criteria will be the expected results of the upcoming clinic-based field trials.Disclosure of interestUnterstützung bei Symposien/Symposia Support.– Janssen-Cilag GmbH, Neuss– Aristo Pharma GmbH, Berlin– Lilly Deutschland GmbH, Bad Homburg– Servier Deutschland GmbH, München– Fakultätsmitglied/Faculty Member– Lundbeck International Neuroscience Foundation (LINF), Dänemark

Max Scheler's influence on Kurt Schneider.

Kurt Schneider (1887-1967) met Max Scheler (1874-1928) in 1919 when he enrolled in the latter's philosophy seminars at the University of Cologne. Kurt Schneider was then a junior psychiatrist and Max Scheler a renowned philosophy professor and co-founder of the phenomenological movement in philosophy. We uncover the facts about their intellectual and personal relationship, summarize the main articles and books that they wrote and consider whether Max Scheler did influence the young Kurt Schneider. We conclude that Scheler's philosophy of emotion impressed Schneider, and that the latter's notion of 'vital depression' as the core element in melancholia was essentially applied Schelerian philosophy. Schneider's more celebrated contributions to psychiatry - his notion of first rank symptoms of schizophrenia - owed nothing to Scheler or any other philosopher.

Causal narratives and psychotic phenomena.

Causal narratives and psychotic phenomena.

Schneiderian first rank symptoms in schizophrenia: A developmental neuroscience evaluation

IntroductionSelf disorders in schizophrenia have been suggested to have distinct neurobiological underpinnings. Using comprehensive neuro-scientific assessments including a neurophysiological, a neurochemical and a neuropsychological marker, this study assesses disordered-“self” in schizophrenia. MethodsTwenty schizophrenia patients with first rank symptoms (FRS;FRS+), 20 patients without FRS (FRS−) and 20 healthy controls (HC) were assessed for psychopathology, especially on specially designed FRS score sheets with a narrow and a broad definition. Resting state electroencephalography was acquired using 256-electrodes; gamma spectral-power was measured in 8 regions of interest. Serum BDNF and self-monitoring were also assessed. Comparative and correlation analysis were conducted in addition to a step-wise discriminant function analysis. ResultsFRS+ group with greater positive symptom score and a lower negative symptom score, showed significantly increased gamma spectral power, especially on right hemispheric regions, along with lower BDNF levels and lower scores on self-monitoring compared to FRS− and HC. Serum BDNF levels and gamma spectral power in the region corresponding right inferior parietal lobule were identified as predictors that most accurately classified the defined groups. ConclusionsSchizophrenia patients satisfying the criteria of presence of first rank symptoms represent a distinct neurodevelopmental subgroup with associated features of predominantly positive symptoms, significantly lower neurotrophin levels, aberrant resting state brain activity in the heteromodal association cortex and performing poorer on self-monitoring tasks.

First rank symptoms of schizophrenia: their nature and origin.

Kurt Schneider's insight nearly 80 years ago that schizophrenia could be demarcated from other psychoses by a small set of particular delusions and hallucinations powerfully influenced diagnostic practice. The theoretical status of such 'first rank symptoms' as a whole, however, has rarely been addressed. But if they are sensitive and specific to the condition, it is about time that their essential nature and potential origin be considered. This is the purpose of the present paper. I argue that these psychopathological phenomena are indeed relatively sensitive and specific to the condition, that their nature can be formulated within a Schelerian model of what constitutes a human being, and that their origin fits anthropological and neuropsychological notions of the make-up of contemporary human beings.

First rank symptoms for schizophrenia

First rank symptoms for schizophrenia

First rank symptoms for schizophrenia.

Early and accurate diagnosis and treatment of schizophrenia may have long-term advantages for the patient; the longer psychosis goes untreated the more severe the repercussions for relapse and recovery. If the correct diagnosis is not schizophrenia, but another psychotic disorder with some symptoms similar to schizophrenia, appropriate treatment might be delayed, with possible severe repercussions for the person involved and their family. There is widespread uncertainty about the diagnostic accuracy of First Rank Symptoms (FRS); we examined whether they are a useful diagnostic tool to differentiate schizophrenia from other psychotic disorders. To determine the diagnostic accuracy of one or multiple FRS for diagnosing schizophrenia, verified by clinical history and examination by a qualified professional (e.g. psychiatrists, nurses, social workers), with or without the use of operational criteria and checklists, in people thought to have non-organic psychotic symptoms. We conducted searches in MEDLINE, EMBASE, and PsycInfo using OvidSP in April, June, July 2011 and December 2012. We also searched MEDION in December 2013. We selected studies that consecutively enrolled or randomly selected adults and adolescents with symptoms of psychosis, and assessed the diagnostic accuracy of FRS for schizophrenia compared to history and clinical examination performed by a qualified professional, which may or may not involve the use of symptom checklists or based on operational criteria such as ICD and DSM. Two review authors independently screened all references for inclusion. Risk of bias in included studies were assessed using the QUADAS-2 instrument. We recorded the number of true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN) for constructing a 2 x 2 table for each study or derived 2 x 2 data from reported summary statistics such as sensitivity, specificity, and/or likelihood ratios. We included 21 studies with a total of 6253 participants (5515 were included in the analysis). Studies were conducted from 1974 to 2011, with 80% of the studies conducted in the 1970's, 1980's or 1990's. Most studies did not report study methods sufficiently and many had high applicability concerns. In 20 studies, FRS differentiated schizophrenia from all other diagnoses with a sensitivity of 57% (50.4% to 63.3%), and a specificity of 81.4% (74% to 87.1%) In seven studies, FRS differentiated schizophrenia from non-psychotic mental health disorders with a sensitivity of 61.8% (51.7% to 71%) and a specificity of 94.1% (88% to 97.2%). In sixteen studies, FRS differentiated schizophrenia from other types of psychosis with a sensitivity of 58% (50.3% to 65.3%) and a specificity of 74.7% (65.2% to 82.3%). The synthesis of old studies of limited quality in this review indicates that FRS correctly identifies people with schizophrenia 75% to 95% of the time. The use of FRS to diagnose schizophrenia in triage will incorrectly diagnose around five to 19 people in every 100 who have FRS as having schizophrenia and specialists will not agree with this diagnosis. These people will still merit specialist assessment and help due to the severity of disturbance in their behaviour and mental state. Again, with a sensitivity of FRS of 60%, reliance on FRS to diagnose schizophrenia in triage will not correctly diagnose around 40% of people that specialists will consider to have schizophrenia. Some of these people may experience a delay in getting appropriate treatment. Others, whom specialists will consider to have schizophrenia, could be prematurely discharged from care, if triage relies on the presence of FRS to diagnose schizophrenia. Empathetic, considerate use of FRS as a diagnostic aid - with known limitations - should avoid a good proportion of these errors.We hope that newer tests - to be included in future Cochrane reviews - will show better results. However, symptoms of first rank can still be helpful where newer tests are not available - a situation which applies to the initial screening of most people with suspected schizophrenia. FRS remain a simple, quick and useful clinical indicator for an illness of enormous clinical variability.

Schneiderian first rank symptoms and gamma oscillatory activity in neuroleptic naïve first episode schizophrenia: a 192 channel EEG study.

ObjectiveSchneiderian first-rank symptoms (FRS) and abnormal EEG gamma activity in schizophrenia have been reported independently to have a neurodevelopmental basis. We aimed to investigate spontaneous gamma power in two groups of first episode schizophrenia patients (those who experience FRS and those who do not).MethodsA comparative hospital based study having 37neuroleptic naïve male patients with schizophrenia divided into two groups-FRS(+) and FRS(-) groups based on the presence of FRS. Thirty age, sex, education and handedness matched individuals served as controls (N). All participants underwent a 192-channel resting Electroencephalography (EEG) recording. Gamma spectral power was calculated for low- (30-50 Hz) and high-gamma 1 & 2 (51-70 and 71-100 Hz) bands. Spectral power was compared between three groups using MANOVA and supplementary one-way ANOVA with Bonferroni test controlling for multiple comparisons. Linear regression was used to identifying predictor variables for FRS. Pearson correlation coefficient was computed between spectral power parameters and various clinical variables.ResultsSignificantly higher high gamma band-1 power was observed over right frontal (p<0.05), parietal (p<0.05) and temporal (p<0.05) regions in FRS(+) than FRS(-) group and normal controls. Right parietal high gamma-1 power and paranoid cluster on PANSS significantly predicted number of FRS in total schizophrenia patients; paranoid cluster on PANSS showed significant correlation with number of FRS in FRS(+) group.ConclusionFindings of our study add to the evidence that areas contained within the hetero modal association cortex are associated with FRS. The study findings also strengthen the neurodevelopmental basis of FRS in schizophrenia.

Disturbance of intentionality: a phenomenological study of body-affecting first-rank symptoms in schizophrenia.

ObjectivesIn 1950, Kurt Schneider proposed that a considerable number of schizophrenia patients develop first-rank symptoms (FRS). In such cases, patients report made experiences, replaced control of will, thought insertion, broadcast or withdrawal and delusional perception, respectively. Although a number of recent studies tend to explain FRS in terms of neurobiological and neuropsychological processes, the origin of these symptoms still remains unknown. In this paper, we explore the subjective experience of patients with the following two FRS: (1) "made" impulses and (2) “made" volitional acts.MethodThe method applied for the study of two FRS consists first in the overview of psychiatric and philosophical literature and second in the further investigation of subjective experience in patients with FRS. Psychopathological and phenomenological aspects of FRS are discussed by means of patient cases.ResultsWe discovered a profound transformation of intentionality and agency in schizophrenia patients with body-affecting FRS. This concept offers an insight into the interrelatedness between particular FRS.ConclusionWe propose that the subjective experience of schizophrenia patients with body-affecting FRS is rooted in the disturbance of intentionality and diminished sense of agency. This theoretical account of body-affecting FRS will open up new directions in both phenomenological and neurobiological psychiatric research.

Planum Parietale Volume in Antipsychotic-Naïve Schizophrenia

To the Editor: “The parietal lobe receives little attention in current neuropathological models of schizophrenia, and there has been little systematic investigation of this area,”1 despite its recognized importance in processes that are likely disturbed in schizophrenia, such as language,2 spatial working memory, and attention. The inferior parietal lobule (IPL), a part of the parietal lobe, also forms the part of the heteromodal association cortex that has been proposed as the site of the key abnormality in schizophrenia.3 It is subdivided into the supramarginal gyrus (area 39) and angular gyrus (area 40). These two structures are a part of the semantic-lexical network that supports “word meanings,” represented by a “grid of connectivity” that constitutes a “final pathway for the chunking of words into thought.”2 Further, PET and fMRI studies have confirmed the role of the IPL, particularly the angular gyrus, in language comprehension.4 First-rank symptoms (FRS), a group of intriguing experiences characterized by a striking breach of “self versus non-self” boundaries, have had a critical influence on the diagnosis of schizophrenia.5 The IPL is also implicated in the pathogenesis of FRS in schizophrenia.3

Dissociation and Psychosis in Dissociative Identity Disorder and Schizophrenia

Dissociative symptoms, first-rank symptoms of schizophrenia, and delusions were assessed in 40 schizophrenia patients and 40 dissociative identity disorder (DID) patients with the Multidimensional Inventory of Dissociation (MID). Schizophrenia patients were diagnosed with the Structured Clinical Interview for the DSM–IV Axis I Disorders; DID patients were diagnosed with the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised. DID patients obtained significantly (a) higher dissociation scores; (b) higher passive-influence scores (first-rank symptoms); and (c) higher scores on scales that measure child voices, angry voices, persecutory voices, voices arguing, and voices commenting. Schizophrenia patients obtained significantly higher delusion scores than did DID patients. What is odd is that the dissociation scores of schizophrenia patients were unrelated to their reports of childhood maltreatment. Multiple regression analyses indicated that 81% of the variance in DID patients’ dissociation scores was predicted by the MID's Ego-Alien Experiences Scale, whereas 92% of the variance in schizophrenia patients’ dissociation scores was predicted by the MID's Voices Scale. We propose that schizophrenia patients’ responses to the MID do not index the same pathology as do the responses of DID patients. We argue that neither phenomenological definitions of dissociation nor the current generation of dissociation instruments (which are uniformly phenomenological in nature) can distinguish between the dissociative phenomena of DID and what we suspect are just the dissociation-like phenomena of schizophrenia.

First rank symptoms: concepts and diagnostic utility

First Rank Symptoms (FRS) were first defined by Schneider as diagnostic of schizophrenia. Since then, there has been an immense debate on their diagnostic and prognostic utility. This review attempts to understand the concepts of FRS as depicted over the years and the diagnostic and prognostic implications of FRS in mental illnesses including schizophrenia. Review of relevant material showed that there are wide variations in the concepts of FRS which may be classified according to broad and narrow definitions. These variations have also led to the differences in the diagnostic systems currently being used. Although the diagnostic utility of FRS in schizophrenia remains, it is not clearly so with other mental illnesses in which these symptoms may also be observed. In addition there is controversy over the prognostic implications with evidence divided between poor and no influence on outcome.

Schneiderian first rank symptoms and inferior parietal lobule cortical thickness in antipsychotic-naïve schizophrenia

Inferior parietal lobule (IPL) is implicated in the pathogenesis of first rank symptoms (FRS) in schizophrenia by functional neuroimaging studies. However, the relationship between IPL cortical thickness and FRS is yet to be explored. In this study, cortical thickness of IPL was analyzed in antipsychotic-naïve schizophrenia patients (total number=51) with [FRS(+); N=25] and those without FRS [FRS(−); N=26] in comparison with group-matched healthy controls (N=47). FRS(+) patients showed significant cortical thickness deficit in right IPL (specifically angular gyrus) in comparison with both FRS(−) patients (p=0.005) and healthy controls (p=0.0002); lack of difference on the left side might possibly be related to larger variance in healthy controls. Deficient cortical thickness involving IPL in FRS(+) schizophrenia patients adds further support to the role of internal monitoring system in the pathogenesis of FRS in schizophrenia.

P01-397 - Clinical relevance of self-disorders (Ich-Störungen) in schizophrenia: a review of studies on diagnosis, factor structure and outcome

ObjectiveThe notion of “Ich-Störungen” (self-disorders) depicts a major aspect of Kurt Schneider's concept of first rank symptoms of schizophrenia. Terms such as “passivity phenomena”, “delusions of alien control” and “ego pathology” have been used to characterise these phenomena once postulated to be pathognomonic for schizophrenia. The present review focuses on clinical studies examining the symptoms’ diagnostic and nosological implications.MethodsWe conducted a semi-structured literature review. 374 references were obtained using the key words “ego disorder/(psycho)pathology”, “thought insertion”, “alien control”, “passivity symptoms/phenomena/experiences”, “first rank symptoms”, “schneiderian” and “self disorders”. We distinguished two major fields of research:(1)neurobiological and neuropsychological studies based on phenomenological or neurocognitive paradigms;(2)studies on diagnosis and nosology (including assessment instruments and factor analyses), outcome and prognostic value.Of the studies on the second field, 83 have clinical relevance and are reviewed here.ResultsSeveral specific instruments with sound foundations in psychopathology have been developed for the assessment of self-disorders; however, they have rarely been included in research. Factor analyses have consistently shown a highly loaded factor consisting of self-disorders, in some studies distinct from other first-rank symptoms. There is contradictory data on outcome and prognosis.ConclusionsSelf-disorders remain ill-defined and inconsistently included into diagnostic criteria, and therefore lack nosological significance. Their clinical relevance has been insufficiently studied, although they have been consistently shown to form a highly specific factor within the schizophrenia symptom spectrum. The present review stresses the need for a global definition of self-disorders on the basis of phenomenology.

PW01-168 - Disturbance of intentionality: a phenomenological approach for the development of schneiderian first-rank symptoms in schizophrenia

ObjectivesIn 1950, Kurt Schneider proposed that a considerable number of schizophrenic patients develop first-rank symptoms (FRS). In such cases, patients experience third-person auditory verbal hallucinations, audible thoughts, made experiences, replaced control of will, thought insertion, broadcast and withdrawal. This group of symptoms might therefore be seen as pathognomonic of schizophrenic psychopathology. Although a number of studies tend to explain these symptoms in terms of neurobiological and neuropsychological processes, the cause and development of FRS still remains unknown.MethodsThe method applied for the development of an explanatory model of FRS consists first in the overview of psychiatric and philosophical literature and secondly in the further development of the concept of disturbed intentionality and its implication to the FRS in schizophrenia. Intentionality is understood as a basic characteristic of conscious experience as being directed towards its object and, at the same time, implying a sense of mineness. This report also reviews and discusses some generally accepted views of FRS.ResultsCurrent psychiatric research shows a significant increase of interest phenomenological explanations of FRS. In this contribution we introduce a phenomenological model of FRS based on the concept of intentionality. We also show that this concept offers an insight into the interrelatedness between particular FRS.ConclusionsWe propose that the experience of FRS in patients with schizophrenia is rooted in the disturbed and inverted intentionality of their mental and bodily actions. This theoretical model of FRS will open up new directions in psychiatric research.