the definition of schizophrenia

2022.4.10: psy/schiz/the definition of schizophrenia

summary:

. schizophrenia as defined by psychiatrists

for diagnostic purposes.

. a bizarre delusion is a belief in something

that the dominant theorists consider impossible,

such as telepathy or magical abilities.

Review Schizophr Bull . 2010

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879682/

First-rank symptoms in schizophrenia: 

reexamining mechanisms of self-recognition.

Flavie A V Waters, Johanna C Badcock

First-rank symptoms (FRS) are considered to be at the 

core of schizophrenia psychopathology.

FRS play a key role in the diagnosis of schizophrenia

and feature prominently in current diagnostic systems. 

The growing literature on FRS reflects the

renewed interest in their cognitive and neural processes

and their diagnostic significance.

FRS, however, are not easily explained in terms of

traditional neuropsychological dysfunction,

and the pathophysiological mechanisms underlying these symptoms

continue to elude researchers.

First-Rank Symptoms (Passivity Symptoms)  in Schizophrenia:

Third-person auditory verbal hallucinations

Voices which the patients regard as

separate from their own mental processes. 

"The voice of God says to me ..."

Loud (audible) thoughts [involuntary telepathy]

Thought insertion

[thoughts that come from non-self]

Thought broadcast

[involuntary thought broadcasting

defying one's need for privacy.]

Thought withdrawal

[eg, by a demon or the god 

trying to suppress self-defense.]

[loss of free will]:

Actions, intentions, and/or feelings are experienced to be 

under the control of some other force. 

Cochrane Database Syst Rev. 2015

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079421/

First rank symptoms for schizophrenia

Karla Soares-Weiser. et al.

There is widespread uncertainty about the

diagnostic accuracy of First Rank Symptoms (FRS); 

we examined whether they are a useful diagnostic tool

to differentiate schizophrenia 

from other psychotic disorders.

. studies showed that 

for people who actually have schizophrenia, 

FRS as defined by Schneider,

would only correctly diagnose  60% of them as schizophrenic. 

For people who do not have schizophrenia, 

almost 20% would be incorrectly diagnosed with schizophrenia. 

Therefore, if a person is experiencing a FRS, 

schizophrenia is a possible diagnosis, 

but there is also a chance that it is 

another mental health disorder

such as mood disorders with psychotic symptoms.

We do not recommend that FRS alone

can be used to diagnose schizophrenia. 

The index test being evaluated in this review are

Schneider’s 1959 First Rank Symptoms (FRS):

auditory hallucinations of particular types:  

hearing [one's private] thoughts spoken aloud [by others or by spirits]

hearing voices referring to self made in the third person

auditory hallucinations in the form of a commentary about self.

Thought withdrawal, insertion and interruption

Thought broadcasting [involuntary telepathy]

Somatic hallucinations

A hallucination involving the perception of a physical experience with the body

"I feel them crawling over me."

Delusional perception

A true perception, to which a person attributes a false meaning.

Feelings or actions experienced as made or influenced by external agents

Where there is certainty that

an action of the person or a feeling

is caused not by themselves but by others [eg, the supernatural]

"The CIA controlled my arm."

Schneider’s 1959 First Rank Symptoms (FRS)

are currently incorporated into the major 

operationalised diagnostic systems of the

International Statistical Classification of Diseases‐10 (ICD‐10) (Table 4) 

and Diagnostic and Statistical Manual of Mental Disorder‐III‐IV (DSM‐III‐IV) (Table 5). 

These systems, however, go beyond the relatively simple list produced by Schneider.

ICD‐10 criteria for schizophrenia:

Although no strictly pathognomonic symptoms can be identified, 

for practical purposes it is useful to divide symptoms into

groups that have special importance for the

diagnosis and often occur together, 

such as:

a) thought echo, thought insertion or withdrawal, and thought broadcasting; 

b) delusions of control, influence, or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception; 

c) hallucinatory voices giving a running commentary on the patient's behaviour, 

or discussing the patient among themselves, or other types of hallucinatory voices coming from some part of the body; 

d) persistent delusions of other kinds that are

culturally inappropriate and completely impossible, 

such as religious or political identity, or superhuman powers and abilities

(e.g. being able to control the weather, 

or being in communication with aliens from another world); 

e) persistent hallucinations in any modality, 

when accompanied either by fleeting or half‐formed delusions without clear affective content, 

or by persistent over‐valued ideas, 

or when occurring every day for weeks or months on end; 

f) breaks or interpolations in the train of thought, 

resulting in incoherence or irrelevant speech, or neologisms; 

g) catatonic behaviour, such as excitement, posturing, 

or waxy flexibility, negativism, mutism, and stupor; 

h) "negative" symptoms such as marked apathy, paucity of speech, 

and blunting or incongruity of emotional responses, 

usually resulting in social withdrawal and lowering of social performance; 

it must be clear that these are not due to depression or to neuroleptic medication; 

i) a significant and consistent change in the overall quality

of some aspects of personal behaviour, 

manifest as loss of interest, aimlessness, idleness,

a self‐absorbed attitude, and social withdrawal.

DSM‐IV criteria for schizophrenia:

Characteristic symptoms: 

Two or more of the following, each present for a significant portion of time

during a one‐month period:

Criterion A*

delusions

hallucinations

disorganised speech (e.g. frequent derailment or incoherence)

grossly disorganised or catatonic behaviour

negative symptoms (i.e. affective flattening, alogia, or avolition).

* Only one Criterion A symptom is required 

if delusions are bizarre

or hallucinations consist of a voice that is 

keeping up a running commentary

on the person's behaviour or thoughts, 

or two or more voices conversing with each other.

Criterion B

Social/occupational dysfunction: 

Since the onset of the disturbance, 

one or more major areas of functioning, 

such as work, interpersonal relations, or self‐care, 

are markedly below the level previously achieved.

Criterion C

Duration: Continuous signs of the disturbance persist for at least six months. 

This six‐month period must include at least one month of symptoms

(or less if successfully treated) that meet Criterion A.

Criterion D

Exclusion of schizoaffective disorder

and mood disorder with psychotic features.

Criterion E

Substance/general medical condition exclusion: 

the disturbance is not due to the direct physiological effects of a substance

(e.g. a drug of abuse, a medication) 

or a general medical condition.

Criterion F

Relationship to a pervasive developmental disorder: 

If there is a history of autistic disorder 

or another pervasive development disorder, 

the diagnosis of schizophrenia is made only if 

prominent delusions or hallucinations 

are also present for at least a month

(or less if successfully treated).