Presence Of First-rank Symptoms Research Articles

Prevalence of first rank symptoms in mania

Background: First rank symptoms (FRSs) are seen frequently in mania. There has been a scarcity of data published in consideration with the Indian population on the prevalence of FRS in mania. Aim: The aim of this study is to explore the pattern of occurrence of FRS and assess association between the presence of FRS and severity of mania. Subjects and Methods: A cross-sectional study was conducted in the psychiatry department of tertiary care institution of North India. Fifty patients selected by convenient sampling, diagnosed with mania as per Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) classification. Informed consent taken, semi-structured per forma used, present state examination-9 Hindi version used for FRS, Young Mania Rating Scale (YMRS) to assess severity of mania. Descriptive statistics were used. The Chi-square test was used for the comparison between the groups. Mann–Whitney U-test was used for the comparison between individual FRS and YMRS score. Results: Mean age FRS + was 35.32 years (±13.85), 71% were males; majority belonged to urban locality, married, residing in nuclear family, educated up to matriculation, and unemployed. There was no significant association of these variables with FRS. The Presence of ≥1 FRS was 62%; voices commenting on one's action (83.9%), voices arguing (77.4%), thought broadcast (38.7%), delusional perception (23.8%), thought withdrawal and thought echo (both 12.9%), made volitional acts, somatic passivity, and thought insertion (in 3.2% each). None had the presence of made feelings and made impulse/drives. Mean YMRS was 40.16 ± 7.91. No statistical significance found between FRS and YMRS scoring, except for thought withdrawal. Conclusions: The present study confirms FRS in substantial cases of mania. FRS in mania can lead to misdiagnosis of schizophrenia, leading to inadequate management, delayed appropriate treatment, and poor prognosis.

First-rank symptoms in Bipolar disorder: A case report.

Despite their description as characteristic symptoms of schizophrenia, first-rank symptoms (FRS) are also seen in other conditions.[1] The prevalence of FRS was 70% in schizophrenia, 29% in psychotic bipolar disorder, and 18% in psychotic depression.[2] Manic hyperactivity may at times be confused with psychotic agitation and excitement. Amidst debate on the diagnostic utility of FRS, they continue to be relevant from prognostication and treatment planning point of view.[3] The presence of FRS in bipolar affective disorder (BPAD) may be predictor of poor short-term outcome and decompensating the course of illness.[4] BPAD patients with mania or mixed episodes are more likely to be females. Younger patients had a higher prevalence of FRS.[5] The presence of FRS in psychiatric illness is associated with poor long-term residential status and poorer psychosocial functioning.[6] We present a case of bipolar affective disorder who at presentation had florid psychotic symptoms with FRS. A 19-year-old female, BA LLB student, with no family history of psychiatric illness, premorbidly stable extrovert with past history of an insidious onset gradually progressive persistent and pervasive depressed mood, loss of interest and enjoyment, reduced concentration and attention, reduced self-esteem and self-confidence, disturbed sleep and diminished appetite in September 2019 remitted gradually without treatment over 3–4 months. She manifested in November 2020 with acute onset and progressive elevated and expansive mood, increased physical restlessness, and over-talkativeness. She was suspicious as she was unable to upload video on Instagram and believed that unknown people are jealous of her celebrity status and has hacking her mobile and network. General physical and systemic examinations were within normal limits. Mental status examination revealed her to be well-groomed, wearing colorful clothes with matching mask, and nail polish. She entered the chamber without seeking permission with air of confidence around her. She briskly shook the hand with examiner and sat on chair without asking as if in casual conversation. She was suspicious that the wall clock had monitoring device and there was someone behind the curtain. She was easily distractible by people entering the room. She was over-familiar, jocular, distractible, and had increased motor activity. She had elated affect, flight of ideas, delusion of grandiosity and persecution, intermittent auditory hallucination giving a running commentary on her action, ill sustained concentration, impaired judgment and insight, and decreased need for sleep and increased energy. Her hematological, biochemical parameters (including thyroid profile), and NCCT head were within normal limits. Young Mania Rating Scale score was 32/60, suggestive of moderate mania. Rorschach psychodiagnostic test revealed an increased number of responses, decreased initial and total reaction time, high number of color, sexual, and movement responses. New and additional responses in inquiry were suggestive of mania. She was provisionally diagnosed as a case of bipolar affective disorder, current episode manic with psychotic symptoms. She was started on tablet risperidone 2 mg/day and tablet lithium 900 mg/day. Psychoeducation about the illness and relapse prevention was taught to which she responded well. Schizophrenia is often difficult to diagnose, and it is important not to give a label of Schizophrenia to those who do not suffer from it.[7] In the index case, there was a diagnostic dilemma in view of the initial presentation with widespread persecutory delusions obscuring the disturbance of affect. The presence of FRS further complicated the clinical picture. However, history suggestive of a depressive episode which remitted without medications over 4 months compelled us to consider a diagnosis of BPAD with psychotic symptoms as more likely. She responded well to antipsychotic and mood stabilizer and supportive psychotherapy with improvement in mood, social and academic functioning. The index case underscores the importance of being aware of overlapping nature of symptoms in various psychiatric disorders, the need for close serial monitoring of patients for evolution of new symptoms of changing psychopathology and the utility of Rorschach psychodiagnostic test in difficult cases. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Borderline personality disorder and auditory verbal hallucinations.

Auditory verbal hallucinations (AVH) frequently co-occur with borderline personality disorder (BPD) and can lead to misdiagnosis with schizophrenia (SCZ) or other primary psychotic disorders. Misdiagnosis is more common when AVH meet criteria for Schneiderian first rank symptoms (FRS). This paper's objective is to improve diagnostic accuracy by outlining particular clinical features that can assist the distinction between BPD and psychotic disorders in these cases. The overall clinical presentation when AVH occur in BPD can assist in determining a primary diagnosis of BPD when frank psychotic disorder is absent. AVH in BPD cannot be distinguished phenomenologically from AVH in SCZ. Clinical experience and increasing research suggest that AVH in BPD are often dissociative in origin and highly correlated with the presence of FRS, elevated levels of dissociation and a history of childhood trauma. When AVH occur in BPD in the absence of co-occurring psychotic disorder, formal thought disorder is usually absent, negative symptoms minimal or absent, bizarre symptoms absent, affect reactive and the patient retains sociability. Psychotropic medication may be less effective for the AVH in these cases, while they may improve or remit during psychotherapy for BPD.

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 in mania: An indistinct diagnostic strand

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.ObjectiveTo determine the frequency of first rank symptoms in manic patients.MethodThe cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty 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.ResultThe mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. In total, 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.ConclusionThe 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.Disclosure of interestThe authors have not supplied their declaration of competing interest.

First rank symptoms in Mania: An indistinct diagnostic strand

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.

Structural MRI Differences between Patients with and without First Rank Symptoms: A Delusion?

It has been suggested that specific psychotic symptom clusters may be explained by patterns of biological abnormalities. The presence of first rank symptoms (FRS) has been associated with cognitive abnormalities, e.g., deficits in self-monitoring or in the experience of agency, suggesting that a specific network of neural abnormalities might underlie FRS. Here, we investigate differences in cortical and subcortical brain volume between patients with and without FRS. Three independent patient samples (referred to as A, B, and C) with different mean ages and in different illness stages were included, leading to a total of 348 patients within the schizophrenia-spectrum. All underwent magnetic resonance imaging of the brain. In addition, the presence of FRS was established using a diagnostic interview. Patients with (FRS+, A: n = 63, B: n = 129, and C: n = 96) and without FRS (FRS-, A: n = 35, B: n = 17, and C: n = 8) were compared on global and local cortical volumes as well as subcortical volumes, using a whole brain (cerebrum) approach. Nucleus accumbens volume was significantly smaller in FRS+ as compared with FRS- in sample A (p < 0.005). Furthermore, FRS+ showed a smaller volume of the pars-opercularis relative to FRS- in sample B (p < 0.001). No further significant differences were found in cortical and subcortical volumes between FRS+ and FRS- in either one of the three samples after correction for multiple comparison. Brain volume differences between patients with and without FRS are, when present, subtle, and not consistent between three independent samples. Brain abnormalities related to FRS may be too subtle to become visible through structural brain imaging.

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.

Prevalence, Factorial Structure, and Clinical Correlates of First Rank Symptoms in Urban, African-American Patients with First-Episode Nonaffective Psychosis

Rationale: Given the dearth of research on the prevalence and clinical correlates of first rank symptoms in first-episode psychosis samples, this study focused on a relatively homogenous sample of hospitalized, first-episode, urban, African-American patients.Objective: To determine frequencies of eleven first rank symptoms based on previously published definitions, to conduct correlations and an exploratory factor analysis to reveal any potential latent structure of the eleven symptoms, and to assess associations between first rank symptoms and several select clinical variables.Methods: The sample included seventy-three African-American patients hospitalized for a first episode of nonaffective psychosis. A structured inventory was used to rate the presence of first rank symptoms. Additionally, positive, negative, and general psychopathology symptoms were assessed; duration of the prodrome and duration of untreated psychosis were estimated; and depression, insight, and social functioning were rated.Results...

Prognostic value of initial subtype in schizophrenic disorders

The prognostic value of the subtype diagnosis at the initial episode was investigated in 148 narrowly defined schizophrenic patients. Every initial episode was classified according to multiple criteria: DSM-III-R, ICD-10, the positive/negative dichotomy, and Schneider's first rank symptoms. Patients were followed up on average 23 years later (range 10–50 years). Different aspects of long-term outcome were evaluated (global functioning, social adjustment, negative social consequences). In 93% of the patients persisting alterations were found at the end of the observation time. The influence of the predominant clinical features at the initial episode on various aspects of long-term outcome was found to differ depending on which of the four diagnostic systems was used. The highest power for discrimination was found for the subtypes of DSM-III-R, while the presence of first rank symptoms had no prognostic value. It was found that patients with an initial paranoid or positive episode had a significantly better long-term outcome than patients initially having a disorganised/hepephrenic or catatonic episode. The frequency of negative social consequences was not influenced by the initial subtype, with the exception of permanent hospitalisation.

A study of Schneider's first-rank symptoms of schizophrenia in Nigerian patients.

A prospective evaluation of Schneider's first-rank symptoms in 56 Nigerians with RDC schizophrenia gave a prevalence of 73%. The presence of first-rank symptoms was unrelated to schizophrenic subtypes, duration or severity of illness. While some of the symptoms correlate with age of patients, the pattern of inter-correlations among them supports previous views about their empirical heterogeneity.

Schneider's first rank symptoms--prevalence, diagnostic use and prognostic implications.

An evaluation of the prevalence of Schneiderian first-rank symptoms, and their diagnostic and prognostic value is described. 35.2 per cent of schizophrenic patients had first-rank symptoms. The presence of first-rank symptoms did not indicate either chronicity of illness or a poor outcome.

Schizophrenia: Schneider's first-rank symptoms and outcome.

The files of a narrowly defined group fo schizophrenic patients, admitted to hospital for the first time in their lives in 1963, and who were representative of cases from a large un-selected population, were examined for Schneider's first-rank symptoms. Forty-three such patients were followed-up in 1977. Using stepwise regression, it was found that Schneider's first-rank symptoms relate to outcome such that they can "explain" from 17 per cent of 26 per cent of the variance on four outcome measures. The presence of some first-rank symptoms correlated positively with good outcome, others negatively, whilst some correlated differently with different outcome measures. Thus, assessment of only the presence, absence or number of first-rank symptoms is unlikely to relate to outcome.