P01-397 - Clinical Relevance of Self-disorders (Ich-Störungen) in Schizophrenia: a Review of Studies on Diagnosis, Factor Structure and Outcome

Abstract

Objective

The 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.

Methods

We 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. (1) neurobiological and neuropsychological studies based on phenomenological or neurocognitive paradigms;

2. (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.

Results

Several 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.

Conclusions

Self-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.