The special treatment of first rank auditory hallucinations and bizarre delusions in the diagnosis of schizophrenia

Abstract

The presence of a single first-rank auditory hallucination (FRAH) or bizarre delusion (BD) is sufficient to satisfy the symptom criterion for a DSM-IV-TR diagnosis of schizophrenia. We queried two independent databases to investigate how prevalent FRAH and BD are in schizophrenia spectrum disorders and whether the diagnosis depends on them. FRAH was common in both datasets (42.2% and 55.2%) and BD was present in the majority of patients (62.5% and 69.7%). However, FRAH and BD rarely determined the diagnosis. In the first database, we found only seven cases among 325 patients (2.1%) and in the second database we found only one case among 201 patients (0.5%) who were diagnosed based on FRAH or BD alone. Among patients with FRAH, 96% had delusions, 14–42% had negative symptoms, 15–21% had disorganized or catatonic behavior, and 20–23% had disorganized speech. Among patients with BD, 88–99% had hallucinations, 17–49% had negative symptoms, 20–27% had disorganized or catatonic behavior, and 21–25% had disorganized speech. We conclude that FRAH and BD are common features of schizophrenia spectrum disorders, typically occur in the context of other psychotic symptoms, and very rarely constitute the sole symptom criterion for a DSM-IV-TR diagnosis of schizophrenia.

Aberrant cerebellar connectivity in motor and association networks in schizophrenia

“…Delusions of control can manifest as a loss of physical or bodily agency (e.g., an alien force controlling one's body, behavior, actions), or as a loss of mental or cognitive agency (e.g., thoughts being inserted, withdrawn, or broadcast aloud without one's control). Such “made” or “passivity” experiences, in which there is a blurring of the boundary between self and other, are common, occurring in 57–66% of SZ patients (Shinn et al, 2013b ). The default mode network is implicated in self-referential (e.g., reminiscences of autobiographical memories) as well as in undirected, spontaneous mental activity (e.g., daydreaming and mind-wandering) (Andreasen et al, 1995 ; Gusnard et al, 2001 ; Buckner et al, 2008 ).…”

Psychotic disorders in DSM-5 and ICD-11

“…5 Because of their unspecificity and questionable value for the diagnostic process, Schneiderian first rank symptoms, especially auditory hallucinations, lost their importance. 6,7 The heterogeneity and variety of schizophrenia, as well as the low lifetime stability of the symptoms, were given tribute by eliminating the subtypes described in DSM-IV. Subtypes were found to be of little to no clinical and scientific utility and did not show differences regarding sociodemographic parameters or cognitive outcome.…”

Current viewpoints on DSM‐5 in Japan

“…In addition, the subtypes of schizophrenia (e.g., paranoid and disorganized types) in the DSM‐IV‐TR have been eliminated because of their limited diagnostic stability, low reliability, and poor validity . Overall, these changes do not substantially affect the diagnosis of the disorder, which is made on the basis of the DSM‐IV‐TR . Furthermore, the criterion for delusional disorder in the DSM‐5 does not require non‐bizarre delusions; thus, a person with bizarre delusion(s) can be diagnosed as having delusional disorder.…”

“…32 Overall, these changes do not substantially affect the diagnosis of the disorder, which is made on the basis of the DSM-IV-TR. 33 Furthermore, the criterion for delusional disorder in the DSM-5 does not require non-bizarre delusions; thus, a person with bizarre delusion(s) can be diagnosed as having delusional disorder. The diagnostic stability of schizoaffective disorder would be improved by the changes in Criteria B and C for the disorder.…”