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A major flaw in the diagnosis of schizophrenia: what happened to the Schneider's first rank symptoms

Published online by Cambridge University Press:  11 June 2020

Massimo Moscarelli Open the ORCID record for Massimo Moscarelli [Opens in a new window]
Massimo Moscarelli*
Affiliation:
ICMPE, Via D.Crespi,7, I-20123MilanItaly
*
Author for correspondence: Massimo Moscarelli, E-mail: [email protected]
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Abstract

Kurt Schneider introduced in the definition of the first-rank symptoms (FRS) the criterion that, where unequivocally present, the FRS are always psychological primaries and irreducible. This criterion, grounded on ‘phenomenology’ (description of subjective experiences), cannot be applied, according to Schneider, to delusions, either two-stage FRS delusional perception, or second-rank delusional notions. The Schneider's key criterion was neglected since the initial adoption of the ‘Schneider's FRS’ in the subsequent international literature (e.g. PSE, RDC, DSM, and ICD). The ‘Schneider's FRS’ (e.g. thought insertion, thought withdrawal, passivity, and influence) were persistently equivocated as ‘delusions’, in spite of the Schneider's FRS exclusion criterion. The internationally equivocated ‘Schneider's FRS’ (only homonymous of the original ‘Schneider's FRS’), were eliminated in the DSM-5 and de-emphasized in ICD-11. However, the diagnostic value of the original ‘Schneider's FRS’, assessed on the basis of the strict compliance with the Schneider's criterion for their definition, was never determined. The ‘damnatio memoriae’ of the original Schneider's FRS may be premature. The definition and assessment of the ‘experienced’ symptoms of schizophrenia, only directly observed and reported by the patients, represent a specific, crucial, irreplaceable domain of psychopathology, to be carefully distinguished from the domain of the ‘behavioral’ symptoms observed by the clinician. Contemporary psychopathology research is aware of the absolute need for psychiatry to enhance precision and exactness in the definition of the experienced symptoms of schizophrenia, through the formulation of unequivocal inclusion and exclusion criteria (descriptive micro-psychopathology), in order to determine their value in research and care.

Keywords

First-rank symptomsphenomenologyschizophrenia
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 9 , July 2020 , pp. 1409 - 1417
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

American Psychiatric Association. (2004). DSM-IV-TR. Guidebook. Arlington, VA: American Psychiatric Publishing.Google Scholar
American Psychiatric Association. (2013). DSM-5. Arlington, VA: APA Press.Google Scholar
Aristotle (1984). Categories. In Barnes, J (Ed.), The complete works of Aristotle. Princeton: Princeton University Press.Google Scholar
Bleuler, E. (1950). Dementia praecox or the group of schizophrenias. New York: International University Press.Google Scholar
Bleuler, E. (1951). Textbook of psychiatry. New York: Dover Publications, Inc.Google Scholar
Carpenter, W. T. Jr (2006). The schizophrenia paradigm: A hundred-year challenge. Journal of Nervous and Mental Disease, 194(9),639–643. doi:10.1097/01.nmd.0000235484.45810.df.CrossRefGoogle ScholarPubMed
Carpenter, W. T., McGuffin, P., Mellor, C. S., Fuller Torrey, E., O'Grady, J., Geddes, J.D., & …Crow, T. J. (1996) Commentaries on ‘First-Rank Symptoms or Rank-and-File Symptoms?’ British Journal of Psychiatry, 169(5), 541–550. Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/commentaries-on-firstrank-symptoms-or-rankandfile-symptoms/CBE982E135D93A01D6FC05F18E805CAC .10.1192/S0007125000026313CrossRefGoogle Scholar
Carpenter, W. T. Jr, & Strauss, J. S. (1974). Cross-cultural evaluation of Schneider's first-rank symptoms of schizophrenia: A report from the International Pilot Study of Schizophrenia. American Journal of Psychiatry, 131(6),682–687. doi:10.1176/ajp.131.6.682.CrossRefGoogle ScholarPubMed
Carpenter, W. T. Jr, & Strauss, J. S. (2019) Ideology and scientific progress: First-rank symptoms. Schizophrenia Bulletin, 45(5),950–951. doi:10.1093/schbul/sbz072.CrossRefGoogle ScholarPubMed
Carpenter, W. T. Jr, Strauss, J. S., & Bartko, J. J. (1981). Beyond diagnosis: The phenomenology of schizophrenia. American Journal of Psychiatry, 138(7), 948–953. doi:10.1176/ajp.138.7.948.Google ScholarPubMed
Carpenter, W. T. Jr, Strauss, J. S., & Muleh, S. (1973). Are there pathognomonic symptoms in schizophrenia? An empiric investigation of Schneider's first-rank symptoms. Archives of General Psychiatry, 28(6), 847–852. doi:10.1001/archpsyc.1973.01750360069010.CrossRefGoogle ScholarPubMed
Cialdini, R. B. (2009). Influence: Science and practice. Boston: Pearson/Allyn and Bacon.Google Scholar
Cooper, J.E. (1985) The development of the Present State Examination (P.S.E.). In Pichot, P., Berner, P., Wolf, R. & Thau, K. (Eds.), Clinical psychopathology nomenclature and classification (pp. 133–139). Boston, MA: Springer.10.1007/978-1-4899-5049-9_20CrossRefGoogle Scholar
Crichton, P. (1996). First-rank symptoms or rank-and-file symptoms? British Journal of Psychiatry, 169(5), 537–540; discussion 541–550. doi:10.1192/bjp.169.5.537.CrossRefGoogle ScholarPubMed
Cutting, J. (2015). First rank symptoms of schizophrenia: Their nature and origin. History of Psychiatry, 26(2), 131–146. doi: 10.1177/0957154X14554369.CrossRefGoogle ScholarPubMed
Endicott, J., & Spitzer, R. L. (1978). A diagnostic interview: The schedule for affective disorders and schizophrenia. Archives of General Psychiatry, 35(7), 837–844. doi: 10.1001/archpsyc.1978.01770310043002.CrossRefGoogle Scholar
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A. Jr, Winokur, G., & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26(1), 57–63. doi:10.1001/archpsyc.1972.01750190059011.CrossRefGoogle ScholarPubMed
Frances, A. (2016). Robert Spitzer: The most influential psychiatrist of his time. The Lancet. Psychiatry, 3(2), 111. Retrieved from https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)00007-9/fulltext.CrossRefGoogle Scholar
Gaebel, W. (2012). Status of psychotic disorders in ICD-11. Schizophrenia Bulletin, 38(5), 895–898. doi: 10.1093/schbul/sbs104.CrossRefGoogle ScholarPubMed
Gurland, B. J., Fleiss, J. L., Cooper, J. E., Sharpe, L., Kendell, R. E., & Roberts, P. (1970). Cross-national study of diagnosis of mental disorders: Hospital diagnoses and hospital patients in New York and London. Comprehensive Psychiatry, 11(1), 18–25. doi: 10.1016/0010-440x(70)90200-2.CrossRefGoogle ScholarPubMed
Heinz, A., Voss, M., Lawrie, S. M., Mishara, A., Bauer, M., Gallinat, J., … Galderisi, S. (2016). Shall we really say goodbye to first rank symptoms? European Psychiatry, 37, 8–13. doi: 10.1016/j.eurpsy.2016.04.010.CrossRefGoogle ScholarPubMed
Hoenig, J. (1982). Kurt Schneider and Anglophone psychiatry. Comprehensive Psychiatry, 23(5), 391–400. doi: 10.1016/0010-440x(82)90152-3.CrossRefGoogle Scholar
Hoenig, J. (1983). The concept of schizophrenia. Kraepelin–Bleuler–Schneider. British Journal of Psychiatry, 142, 547–556. doi: 10.1192/bjp.142.6.547.CrossRefGoogle ScholarPubMed
Hoenig, J. (1984). Schneider's first rank symptoms and the tabulators. Comprehensive Psychiatry, 25(1), 77–87. doi: 10.1016/0010-440x(84)90025-7.CrossRefGoogle ScholarPubMed
Hyman, S. E. (2010). The diagnosis of mental disorders: The problem of reification. Annual Review of Clinical Psychology, 6, 155–179. doi: 10.1146/annurev.clinpsy.3.022806.091532.CrossRefGoogle Scholar
Jansson, L. (2018) First-rank symptoms of schizophrenia. In G. Stanghellini, M. Broome, A. Raballo, A. V. Fernandez, P. Fusar-Poli, and R. Rosfort (eds.) Oxford Handbook of Phenomenological Psychopathology. Oxford Handbooks online: Online publication May 2018. Retrieved from https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780198803157.001.0001/oxfordhb-9780198803157-e-70.Google Scholar
Jaspers, K. (1974). General psychopathology. Baltimore, MD: The John Hopkins University Press.Google Scholar
Katschnig, H. (2018). Psychiatry's contribution to the public stereotype of schizophrenia: Historical considerations. Journal of Evaluation in Clinical Practice, 24(5), 1093–1100. doi: 10.1111/jep.13011.CrossRefGoogle ScholarPubMed
Keller, W.R., Fischer, B.A., & Carpenter, W.T. Jr. (2011). Revisiting the diagnosis of schizophrenia: Where have we been and where are we going? CNS Neuroscience & Therapeutics, 17(2), 83–88. doi:10.1111/j.1755-5949.2010.00229.x.CrossRefGoogle Scholar
Kendell, R. E., Cooper, J. E., Gourlay, A. J., Copeland, J. R., Sharpe, L., & Gurland, B. J. (1971). Diagnostic criteria of American and British psychiatrists. Archives of General Psychiatry, 25(2), 123–130. doi: 10.1001/archpsyc.1971.01750140027006.CrossRefGoogle ScholarPubMed
Kendler, K. S. (2009). An historical framework for psychiatric nosology. Psychological Medicine, 39(12), 1935–1941. doi: 10.1017/S0033291709005753.CrossRefGoogle ScholarPubMed
Kendler, K. S. (2016). Phenomenology of schizophrenia and the representativeness of modern diagnostic criteria. JAMA Psychiatry, 173(10), 1082–1092. doi: 10.1001/jamapsychiatry.2016.1976.CrossRefGoogle Scholar
Kendler, K. S., & Mishara, A. (2019). The prehistory of Schneider's first-rank symptoms: Texts from 1810 to 1932. Schizophrenia Bulletin, 45(5), 971–990. doi: 10.1093/schbul/sbz047.CrossRefGoogle ScholarPubMed
Koehler, K. (1979). First rank symptoms of schizophrenia: Questions concerning clinical boundaries. British Journal of Psychiatry, 134, 236–248. doi: 10.1192/bjp.134.3.236.CrossRefGoogle ScholarPubMed
Koehler, K., Guth, W., & Grimm, G. (1977). First-rank symptoms of schizophrenia in Schneider-oriented German centers. Archives of General Psychiatry, 34(7), 810–813. doi: 10.1001/archpsyc.1977.01770190072007.CrossRefGoogle ScholarPubMed
Koehler, K., & Seminario, I. (1978). ‘First rank’ schizophrenia and research diagnosable schizophrenic and affective illness. Comprehensive Psychiatry, 19(5), 401–406. doi: 10.1016/0010-440x(78)90068-8.CrossRefGoogle Scholar
Kraepelin, E. (1989). Dementia praecox and paraphrenia. Birmingham, AL: Griphon Editions.Google Scholar
Mayer-Gross, W., Slater, E., & Roth, M. (1977). Clinical psychiatry. Third Edition by Eliot Slater and Martin Roth. London: Bailliere Tindall.Google Scholar
Mellor, C. S. (1970). First rank symptoms of schizophrenia. I. The frequency in schizophrenics on admission to hospital. II. Differences between individual first rank symptoms. British Journal of Psychiatry, 117(536), 15–23.CrossRefGoogle Scholar
Moscarelli, M. (2009). Passive and active schizophrenia: Toward a new descriptive micropsychopathology. Schizophrenia Bulletin, 35(6), 1183–1196. doi: 10.1093/schbul/sbn057.CrossRefGoogle Scholar
Nordgaard, J., Arnfred, S. M., Handest, P., & Parnas, J. (2008). The diagnostic status of first-rank symptoms. Schizophrenia Bulletin, 34(1), 137–154. doi: 10.1093/schbul/sbm044.CrossRefGoogle ScholarPubMed
Nordgaard, J., Henriksen, M. G., Berge, J., & Nilsson, L. S. (2019). First-rank symptoms and self-disorders in schizophrenia. Schizophrenia Research, 210, 306–307. doi: 10.1016/j.schres.2019.06.027.CrossRefGoogle Scholar
Peralta, V., & Cuesta, M. J. (1999). Diagnostic significance of Schneider's first-rank symptoms in schizophrenia. Comparative study between schizophrenic and non-schizophrenic psychotic disorders. British Journal of Psychiatry, 174, 243–248. doi: 10.1192/bjp.174.3.243.CrossRefGoogle ScholarPubMed
Picardi, A. (2019). The two faces of first-rank symptoms. Psychopathology, 52(4), 221–231. doi: 10.1159/000503152CrossRefGoogle ScholarPubMed
Reed, G. M., First, M. B., Kogan, C. S., Hyman, S. E., Gureje, O., Gaebel, W., … Saxena, S. (2019). Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry, 18(1), 3–19. doi: 10.1002/wps.20611.CrossRefGoogle ScholarPubMed
Salvador-Carulla, L., Bertelli, M., & Martinez-Leal, R. (2018). The road to 11th edition of the International Classification of Diseases: Trajectories of scientific consensus and contested science in the classification of intellectual disability/intellectual developmental disorders. Current Opinion in Psychiatry, 31, 79–87. doi: 10.1097/YCO.0000000000000396CrossRefGoogle ScholarPubMed
Salvador-Carulla, L., Fernandez, A., Madden, R., Lukersmith, S., Colagiuri, R., Torkfar, G., & Sturmberg, J. (2014). Framing of scientific knowledge as a new category of health care research. Journal of Evaluation in Clinical Practice, 20(6), 1045–1055. doi: 10.1111/jep.12286.CrossRefGoogle ScholarPubMed
Schneider, K. (1959). Clinical psychopathology. New York: Grune & Stratton.Google Scholar
Sextus Empiricus (1933). Outlines of pyrrhonism. Cambridge and London: Harvard University Press. Loeb Classical Library.Google Scholar
Shapiro, C. (1982). Consumer information, product quality, and seller reputation. Bell Journal of Economics, 13(1), 20–35. doi:10.2307/3003427. Retrieved from https://www.jstor.org/stable/3003427.CrossRefGoogle Scholar
Silverstein, M. L., & Harrow, M. (1981). Schneiderian first-rank symptoms in schizophrenia. Archives of General Psychiatry, 38(3), 288–293. doi: 10.1001/archpsyc.1981.01780280056006.CrossRefGoogle Scholar
Soares-Weiser, K., Maayan, N., Bergman, H., Davenport, C., Kirkham, A. J., Grabowski, S., & Adams, C. E. (2015). First rank symptoms for schizophrenia (Cochrane Diagnostic Test Accuracy Review). Schizophrenia Bulletin, 41(4), 792–794. doi: 10.1093/schbul/sbv061.CrossRefGoogle Scholar
Spitzer, R.L. (1989). The development of diagnostic criteria in psychiatry. Current Contents, V.32, #19. May 8, Retrieved from http://garfield.library.upenn.edu/classics1989/A1989U310000002.pdf.Google Scholar
Spitzer, R. L., Andreasen, N. C., & Endicott, J. (1978a). Schizophrenia and other psychotic disorders in DSM-III. Schizophrenia Bulletin, 4(4), 489–510. doi: 10.1093/schbul/4.4.489.CrossRefGoogle Scholar
Spitzer, R. L., Endicott, J., & Robins, E. (1975). Clinical criteria for psychiatric diagnosis and DSM-III. American Journal of Psychiatry, 132(11), 1187–1192. doi: 10.1176/ajp.132.11.1187.Google ScholarPubMed
Spitzer, R. L., Endicott, J., & Robins, E. (1978b). Research diagnostic criteria: Rationale and reliability. Archives of General Psychiatry, 35(6), 773–782. doi: 10.1001/archpsyc.1978.01770300115013.CrossRefGoogle Scholar
Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., … Carpenter, W. (2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia Research, 150(1), 3–10. doi: 10.1016/j.schres.2013.05.028.CrossRefGoogle ScholarPubMed
Taylor, M. A. (1972). Schneiderian first-rank symptoms and clinical prognostic features in schizophrenia. Archives of General Psychiatry, 26(1), 64–67. doi: 10.1001/archpsyc.1972.01750190066012.CrossRefGoogle Scholar
Wing, J. K. (1961). A simple and reliable sub-classification of chronic schizophrenia. Journal of Mental Science, 107, 862–875. doi: 10.1192/bjp.107.450.862.CrossRefGoogle Scholar
Wing, J. K., Birley, J. L., Cooper, J. E., Graham, P., & Isaacs, A. D. (1967). Reliability of a procedure for measuring and classifying ‘present psychiatric state’. British Journal of Psychiatry, 113(498), 499–515. doi: 10.1192/bjp.113.498.499.CrossRefGoogle Scholar
Wing, J.K., Cooper, J.E., & Sartorius, N. (1974). Measurement and classification of psychiatric symptoms – An instructional manual for the PSE and Catego program. Cambridge: Cambridge University Press.Google Scholar
Wing, J., & Nixon, J. (1975). Discriminating symptoms in schizophrenia. A report from the international pilot study of schizophrenia. Archives of General Psychiatry, 32(7), 853–859. doi: 10.1001/archpsyc.1975.01760250045004.CrossRefGoogle ScholarPubMed
World Health Organisation (1973). The international pilot study of schizophrenia. Geneva: WHO Press.Google Scholar