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Shall we really say goodbye to first rank symptoms?

Published online by Cambridge University Press:  23 March 2020

A. Heinz ,
M. Voss ,
S.M. Lawrie ,
A. Mishara ,
M. Bauer ,
J. Gallinat ,
G. Juckel ,
U. Lang ,
M. Rapp  and
P. Falkai
...Show all authors
A. Heinz
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine, Saint-Hedwig Hospital, Humboldt University, Berlin, Germany
M. Voss*
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine, Saint-Hedwig Hospital, Humboldt University, Berlin, Germany
S.M. Lawrie
Affiliation:
Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, EdinburghEH10 5HF, UK
A. Mishara
Affiliation:
Department of Clinical Psychology, Chicago School of Professional Psychology, Los Angeles, USA
M. Bauer
Affiliation:
University Hospital Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
J. Gallinat
Affiliation:
University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
G. Juckel
Affiliation:
Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Ruhr-University, Bochum, Germany
U. Lang
Affiliation:
Psychiatric University Clinics (UPK), Basel, Switzerland
M. Rapp
Affiliation:
Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
P. Falkai
Affiliation:
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
W. Strik
Affiliation:
University Hospital of Psychiatry, University of Bern, Bern, Switzerland
J. Krystal
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
A. Abi-Dargham
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA
S. Galderisi
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
*
* Corresponding author. Department of Psychiatry and Psychotherapy, Charite´ University Medicine, Saint-Hedwig Hospital, Große Hamburger Str. 5-11, 10115 Berlin, Germany. E-mail address:[email protected]z (M. Voss).
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Abstract

Background

First rank symptoms (FRS) of schizophrenia have been used for decades for diagnostic purposes. In the new version of the DSM-5, the American Psychiatric Association (APA) has abolished any further reference to FRS of schizophrenia and treats them like any other “criterion A” symptom (e.g. any kind of hallucination or delusion) with regard to their diagnostic implication. The ICD-10 is currently under revision and may follow suit. In this review, we discuss central points of criticism that are directed against the continuous use of first rank symptoms (FRS) to diagnose schizophrenia.

Methods

We describe the specific circumstances in which Schneider articulated his approach to schizophrenia diagnosis and discuss the relevance of his approach today. Further, we discuss anthropological and phenomenological aspects of FRS and highlight the importance of self-disorder (as part of FRS) for the diagnosis of schizophrenia. Finally, we will conclude by suggesting that the theory and rationale behind the definition of FRS is still important for psychopathological as well as neurobiological approaches today.

Results

Results of a pivotal meta-analysis and other studies show relatively poor sensitivity, yet relatively high specificity for FRS as diagnostic marker for schizophrenia. Several methodological issues impede a systematic assessment of the usefulness of FRS in the diagnosis of schizophrenia. However, there is good evidence that FRS may still be useful to differentiate schizophrenia from somatic causes of psychotic states. This may be particularly important in countries or situations with little access to other diagnostic tests. FRS may thus still represent a useful aid for clinicians in the diagnostic process.

Conclusion

In conclusion, we suggest to continue a tradition of careful clinical observation and fine-grained psychopathological assessment, including a focus on symptoms regarding self-disorders, which reflects a key aspect of psychosis. We suggest that the importance of FRS may indeed be scaled down to a degree that the occurrence of a single FRS alone should not suffice to diagnose schizophrenia, but, on the other hand, absence of FRS should be regarded as a warning sign that the diagnosis of schizophrenia or schizoaffective disorder is not warranted and requires specific care to rule out other causes, particularly neurological and other somatic disorders. With respect to the current stage of the development of ICD-11, we appreciate the fact that self-disorders are explicitly mentioned (and distinguished from delusions) in the list of mandatory symptoms but still feel that delusional perceptions and complex hallucinations as defined by Schneider should be distinguished from delusions or hallucinations of “any kind”. Finally, we encourage future research to explore the psychopathological context and the neurobiological correlates of self-disorders as a potential phenotypic trait marker of schizophrenia.

Keywords

First rank symptomsSchizophreniaICDDSMSelf-disorder
Type
Review
Information
European Psychiatry , Volume 37 , September 2016 , pp. 8 - 13
Copyright
Copyright © European Psychiatric Association 2016

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References

Diagnostic and Statistical Manual of Mental Disorders – (DSM-IV) 4th ed.Washington D.C.: American Psychiatric Association;1994Google Scholar
Tandon, RGaebel, WBarch, DMBustillo, JGur, REHeckers, Set al.Definition and description of schizophrenia in the DSM-5 Schizophr Res 2013; 150: 3–10CrossRefGoogle ScholarPubMed
World Health Organization The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines 1992Google Scholar
Peralta, VCuesta, MJDiagnostic significance of Schneider’s first-rank symptoms in schizophrenia. Comparative study between schizophrenic and non-schizophrenic psychotic disorders. Br J Psychiatry 1999; 174: 243–248CrossRefGoogle ScholarPubMed
Ihara, KMorgan, CFearon, PDazzan, PDemjaha, ALloyd, Tet al.The prevalence, diagnostic significance and demographic characteristics of Schneiderian first-rank symptoms in an epidemiological sample of first-episode psychoses Psychopathology 2009; 42: 81–91CrossRefGoogle Scholar
Schneider, KPsychischer Befund und psychiatrische Diagnose Thieme: Leipzig; 1942Google Scholar
Schneider, KClinical Psychopathology (translation by M Hamilton of Klinische Psychopathologie)5th ed.New York: Grune and Stratton; 1958Google Scholar
Mellor, CSFirst rank symptoms of schizophrenia. I. The frequency in schizophrenics on admission to hospital. II. Differences between individual first rank symptoms. Br J Psychiatry 1970; 117: 15–23CrossRefGoogle Scholar
Cutting, JFirst rank symptoms of schizophrenia: their nature and origin. Hist Psychiatry 2015; 26: 131–146CrossRefGoogle ScholarPubMed
Bobon, DPThe AMDP-system in Pharmacopsychiatry AG (Switzerland): S. Karger; 1983Google Scholar
Ichstörung Spitzer, MIn Search of a TheorySpitzer, MUehlein, FAOepen, GPsychopathology and philosophy Berlin, Heidelberg:Springer; 1988.167–183CrossRefGoogle Scholar
Jaspers, KHoenig, JHamilton, MWGeneral Psychopathology JHU Press; 1997Google Scholar
Bell, VHalligan, PWEllis, HDDiagnosing delusions: a review of inter-rater reliability. Schizophr Res 2006; 86: 76–79CrossRefGoogle ScholarPubMed
Flaum, MArndt, SAndreasen, NCThe reliability of “bizarre” delusions. Compr Psychiatry 1991; 32: 59–65CrossRefGoogle ScholarPubMed
Andreasen, NCCarpenter, WTDiagnosis and classification of schizophrenia. Schizophr Bull 1993; 19: 199–214CrossRefGoogle ScholarPubMed
Oliva, FDalmotto, MPirfo, EFurlan, PMPicci, RLA comparison of thought and perception disorders in borderline personality disorder and schizophrenia: psychotic experiences as a reaction to impaired social functioning. BMC Psychiatry 14 2014 239CrossRefGoogle ScholarPubMed
McGrath, JJSaha, SAl-Hamzawi, AAlonso, JBromet, EJBruffaerts, Ret al.Psychotic experiences in the general population JAMA Psychiatry 2015 1–9Google Scholar
Rössler, WAjdacic-Gross, VHaker, HRodgers, SMüller, MHengartner, MPSubclinical psychosis syndromes in the general population: results from a large-scale epidemiological survey among residents of the canton of Zurich, Switzerland. Epidemiol Psychiatr Sci 2015; 24: 69–77CrossRefGoogle ScholarPubMed
van Os, JLinscott, RJMyin-Germeys, IDelespaul, PKrabbendam, LA systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 2009; 39: 179–195CrossRefGoogle ScholarPubMed
Lambo, TThe role of cultural factors in paranoid psychosis among the Yoruba tribe. J Ment Sci 1955; 101: 239–266CrossRefGoogle Scholar
Heinz, ABermpohl, FFrank, MConstruction and interpretation of self-related function and dysfunction in Intercultural Psychiatry. Eur Psychiatry 2012; 27(Suppl. 2):S32–S43CrossRefGoogle ScholarPubMed
Carpenter, WTStrauss, JSMuleh, SAre there pathognomonic symptoms in schizophrenia? An empiric investigation of Schneider’s first-rank symptoms. Arch Gen Psychiatry 1973; 28: 847–852CrossRefGoogle ScholarPubMed
Kraepelin, EPsychiatrie – Ein Lehrbuch für Studierende und Ärzte 5th Ed.Barth: Leipzig; 1896Google Scholar
Cross-Disorder Group of the Psychiatric Genomics Consortium Lee, SHRipke, SNeale, BMFaraone, SVPurcell, SMet al.Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs Nat Genet 2013; 45: 984–994Google ScholarPubMed
Cross-Disorder Group of the Psychiatric Genomics Consortium Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis Lancet 2013; 381: 1371–1379CrossRefGoogle Scholar
Ruderfer, DMFanous, AHRipke, SMcQuillin, AAmdur, RLSchizophrenia Working Group of Psychiatric Genomics Consortium Polygenic dissection of diagnosis and clinical dimensions of bipolar disorder and schizophrenia Mol Psychiatry 2014; 19: 1017–1024CrossRefGoogle Scholar
Frith, CDBlakemore, SWolpert, DMExplaining the symptoms of schizophrenia: abnormalities in the awareness of action. Brain Res Brain Res Rev 2000; 31: 357–363CrossRefGoogle ScholarPubMed
Nelson, BFornito, AHarrison, BJYücel, MSass, LAYung, ARet al.A disturbed sense of self in the psychosis prodrome: linking phenomenology and neurobiology Neurosci Biobehav Rev 2009; 33: 807–817CrossRefGoogle ScholarPubMed
Insel, TRThe NIMH Research Domain Criteria (RDoC) Project: precision medicine for psychiatry. Am J Psychiatry 2014; 171: 395–397CrossRefGoogle ScholarPubMed
Hägele, CSchlagenhauf, FRapp, MSterzer, PBeck, ABermpohl, Fet al.Dimensional psychiatry: reward dysfunction and depressive mood across psychiatric disorders Psychopharmacology (Berl) 2014; 232: 331–341CrossRefGoogle ScholarPubMed
Wang, X.-J.Krystal, JHComputational psychiatry. Neuron 2014; 84: 638–654CrossRefGoogle ScholarPubMed
Vosgerau, GVoss, MAuthorship and control over thoughts Mind & Language 2014 http://dx.doi.org/10.1111/mila.12065/full.CrossRefGoogle Scholar
Wakefield, JCThe concept of mental disorder: diagnostic implications of the harmful dysfunction analysis. World Psychiatry 2007; 6: 149–156Google ScholarPubMed
Heinz, ADer Begriff der psychischen Krankheit Suhrkamp Verlag; 2014Google Scholar
Sartorius, NMeta effects of classifying mental disorders. The Conceptual Evolution of DSM-5 2011Google Scholar
Nordgaard, JArnfred, SMHandest, PParnas, JThe diagnostic status of first-rank symptoms. Schizophr Bull 2008; 34: 137–154CrossRefGoogle ScholarPubMed
Soares-Weiser, KMaayan, NBergman, HDavenport, CKirkham, AJGrabowski, Set al.First rank symptoms for schizophrenia Cochrane Database Syst Rev 2015 CD010653CrossRefGoogle Scholar
Marneros, ASchizophrenic first-rank symptoms in organic mental disorders. Br J Psychiatry 1988; 152: 625–628CrossRefGoogle ScholarPubMed
Heinz, APrzuntek, HWinterer, GPietzcker, A[Clinical aspects and follow-up of dopamine-induced psychoses in continuous dopaminergic therapy and their implications for the dopamine hypothesis of schizophrenic symptoms]. Nervenarzt 1995; 66: 662–669Google Scholar
Sass, LAMadness and modernism Basic Books; 1992Google Scholar
Zarrouk, ETThe usefulness of first-rank symptoms in the diagnosis of schizophrenia in a Saudi Arabian population. Br J Psychiatry 1978; 132: 571–573CrossRefGoogle Scholar
Coffey, GJMackinnon, AMinas, IHInterethnic variations in the presence of Schneiderian first rank symptoms. Aust N Z J Psychiatry 1993; 27: 219–227CrossRefGoogle ScholarPubMed
Hutchinson, GTakei, NSham, PHarvey, IMurray, RMFactor analysis of symptoms in schizophrenia: differences between White and Caribbean patients in Camberwell. Psychol Med 1999; 29: 607–612CrossRefGoogle ScholarPubMed
Napo, FHeinz, AAuckenthaler, AExplanatory models and concepts of West African Malian patients with psychotic symptoms. Eur Psychiatry 2012; 27(Suppl. 2):S44–S49CrossRefGoogle ScholarPubMed
Chandrasena, RSchneider’s first rank symptoms: an international and interethnic comparative study. Acta Psychiatr Scand 1987; 76: 574–578CrossRefGoogle ScholarPubMed
Klee, EDokumente zur » Euthanasie « im NS-Staat 6th ed.Frankfurt am Main: Fischer Taschenbuch Verlag; 2006Google Scholar
Levine, SZLevav, IGoldberg, YPugachova, IBecher, YYoffe, RExposure to genocide and the risk of schizophrenia: a population-based study. Psychol Med 2016; 46: 855–863CrossRefGoogle ScholarPubMed
Bleuler, EDementia praecox oder Gruppe der Schizophrenien Handbuch der psychiatrie 1911Google Scholar
Swiney, LSousa, PWhen our thoughts are not our own: investigating agency misattributions using the mind-to-mind paradigm. Conscious Cogn 2013; 22: 589–602CrossRefGoogle Scholar
Blakemore, SJWolpert, DMFrith, CDAbnormalities in the awareness of action. Trends Cogn Sci 2002; 6: 237–242CrossRefGoogle ScholarPubMed
Voss, MMoore, JWHauser, MGallinat, JHeinz, AHaggard, PAltered awareness of action in schizophrenia: a specific deficit in predicting action consequences. Brain 2010; 133: 3104–3112CrossRefGoogle ScholarPubMed
Plessner, HDie Stufen des Organischen und der Mensch. Einleitung in die philosophische Anthropologie (3. Unveränd.) Berlin: Walter de Gruyter; 1975CrossRefGoogle Scholar
Sass, LAParnas, JSchizophrenia, consciousness, and the self. Schizophr Bull 2003; 29: 427–444CrossRefGoogle ScholarPubMed
Mishara, ALLysaker, PHSchwartz, MASelf-disturbances in schizophrenia: history, phenomenology, and relevant findings from research on metacognition. Schizophr Bull 2014; 40: 5–12CrossRefGoogle ScholarPubMed
Spiegel, DLoewenstein, RJLewis-Fernandez, RSar, VSimeon, DVermetten, Eet al.Dissociative disorders in DSM-5. Depression Anxiety 2011; 28(12):CrossRefGoogle ScholarPubMed
Frith, CDThe Cognitive Neuropsychology of Schizophrenia (Classic Edition) 2015 Psychology PressGoogle Scholar
Parnas, JHandest, PPhenomenology of anomalous self-experience in early schizophrenia. Compr Psychiatry 2003; 44: 121–134CrossRefGoogle ScholarPubMed
Pankow, AKatthagen, TDiner, SDeserno, LBoehme, RKathmann, Net al.Aberrant salience is related to dysfunctional self-referential processing in psychosis Schizophr Bull 2015 http://dx.doi.org/10.1093/schbul/sbv098.CrossRefGoogle Scholar
Nelson, BWhitford, TJLavoie, SSass, LAWhat are the neurocognitive correlates of basic self- disturbance in schizophrenia?: integrating phenomenology and neurocognition. Part 1 (source monitoring deficits). Schizophr Res 2013; 152(1): 12–19CrossRefGoogle Scholar
Nelson, BWhitford, TJLavoie, SSass, LAWhat are the neurocognitive correlates of basic self-disturbance in schizophrenia?: integrating phenomenology and neurocognition: part 2 (aberrant salience). Schizophr Res 2013; 152(1): 20–27CrossRefGoogle Scholar
Frith, CDThe Cognitive Neuropsychology of Schizophrenia East Sussex, England: Erlbaum/Taylor and Francis; 1992Google Scholar
Synofzik, MVosgerau, GVoss, MThe experience of agency: an interplay between prediction and postdiction. Front Psychol 4 2013 127CrossRefGoogle ScholarPubMed
Hauser, MKnoblich, GRepp, BHLautenschlager, MGallinat, JHeinz, Aet al.Altered sense of agency in schizophrenia and the putative psychotic prodrome. Psychiatry Res 2010; 186(2-3):170–6CrossRefGoogle ScholarPubMed
Bonhoeffer, KDie exogenen reaktionstypen. Archiv für Psychiatrie und Nervenkrankheiten 1917; 58: 58–70CrossRefGoogle Scholar
Gaebel, WZielasek, JCleveland, H.-R.Classifying psychosis – challenges and opportunities. Int Rev Psychiatry 2012; 24: 538–548CrossRefGoogle ScholarPubMed
Tandon, RBruijnzeel, DRankupalli, BDoes change in definition of psychotic symptoms in diagnosis of schizophrenia in DSM-5 affect caseness?. Asian J Psychiatr 2013; 6: 330–332CrossRefGoogle ScholarPubMed
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