Shall we really say goodbye to first rank symptoms?

Abstract

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.

Schneider’s first-rank symptoms as predictors of remission in antipsychotic-naive first-episode psychosis

“…As the importance of FRS for diagnosis and prognosis has been under discussion for decades, with consistent argumentation on both sides, 22,23,29 the results of this study provide additional evidence supporting FRS as an aspect to be considered. Clinical observation suggests that FRS can be found in a wide range of mental disorders where psychosis is present; this empirical view is supported by our heterogeneous sample, which included patients with schizophrenia, polymorphic psychosis, psychotic bipolar disorder, schizoaffective disorder, and even some mood disorders.…”

“…Those include passivity, pseudo-hallucinations, and primary interpretation delusion. This description was used in the DSM-III 22 under the vague designation of bizarre delusions, in criteria 1 to 6 for schizophrenia. The importance of FRS for this diagnosis remained in DSM-IV, 23 as long as criteria B and C were present.…”

Is there a symptomatic distinction between the affective psychoses and schizophrenia? A machine learning approach

“…In our study, nuclear syndrome (first rank symptoms -FRS), was almost 3 times more common in schizophrenia compared to affective psychosis (see Table 1). This is relevant, given renewed interest in presence of FRS; ICD 11 proposes to take this out (Heinz et al, 2016;Lawrie et al, 2016). Our findings contrast with other studies, notably Peralta and Cuesta (Peralta and Cuesta, 1999), who found small differences in FRS between schizophrenia, using Feighner, DSM III-R narrow and broad criteria and other psychotic disorders, with likelihood ratios of 1 to 3.…”

Neurobiologisch informierte Psychopathologie psychotischer Erkrankungen

“…Die Funktionseinschränkungen und prognostisch interessanten Marker der Schizophrenie hängen selten mit dem Gesamtschweregrad, sondern mit der Ausprägung einzelner Symptomdimensionen zusammen (46,47). Einzelne Symptome wie Ich-Störungen sind zwar weiterhin relevant, aber ihre Spezifität für die Schizophrenie wird klar durch empirische Studien infrage gestellt (48).…”