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Diagnostic Test Accuracy Protocol

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First-rank symptoms for schizophrenia

  1. Karla Soares-Weiser1,*,
  2. Nicola Maayan1,
  3. Clare Davenport2,
  4. Amanda J Kirkham2,
  5. Clive E Adams3

Editorial Group: Cochrane Schizophrenia Group

Published Online: 16 JUL 2013

DOI: 10.1002/14651858.CD010653


How to Cite

Soares-Weiser K, Maayan N, Davenport C, Kirkham AJ, Adams CE. First-rank symptoms for schizophrenia (Protocol). Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD010653. DOI: 10.1002/14651858.CD010653.

Author Information

  1. 1

    Enhance Reviews Ltd, Wantage, UK

  2. 2

    University of Birmingham, Department of Public Health, Epidemiology and Biostatistics, Birmingham, UK

  3. 3

    The University of Nottingham, Cochrane Schizophrenia Group, Nottingham, UK

*Karla Soares-Weiser, Enhance Reviews Ltd, Central Office, Cobweb Buildings, The Lane, Lyford, Wantage, OX12 0EE, UK. karla@enhance-reviews.com. ksoaresweiser@gmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 16 JUL 2013

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This is not the most recent version of the article. View current version (25 JAN 2015)

 
Table 1. Schneider first-rank symptoms

First-rank symptomDefinitionExample

Auditory hallucinationsAuditory perceptions with no cause

These auditory hallucinations have to be of particular types:

hearing thoughts spoken aloud"I hear my thoughts outside my head."

hearing voices referring to himself/herself made in the third person"The first voice says 'He used that fork in an odd way' and then the second replies 'Yes, he did'".

auditory hallucinations in the form of a commentary"They say 'He is sitting down now talking to the psychiatrist'".

Thought withdrawal, insertion and interruptionA person's thoughts are under control of an outside agency and can be removed, inserted (and felt to be alien to him/her) or interrupted by others"My thoughts are fine except when Michael Jackson stops them."

Thought broadcastingAs the person is thinking everyone is thinking in unison with him/her"My thoughts filter out of my head and everyone can pick them up if they walk past."

Somatic hallucinationsA hallucination involving the perception of a physical experience with the body"I feel them crawling over me."

Delusional perceptionA true perception, to which a person attributes a false meaningA perfectly normal event such as the traffic lights turning red may be interpreted by the patient as meaning that Martians are about to land

Feelings or actions experienced as made or influenced by external agentsWhere there is certainty that an action of the person or a feeling is caused not by themselves but by some others or other force"The CIA controlled my arm."

 
Table 2. ICD 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:

athought echo, thought insertion or withdrawal, and thought broadcasting; 

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

challucinatory 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; 

dpersistent 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); 

epersistent 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; 

fbreaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech, or neologisms; 

gcatatonic 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;

ia 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.

The normal requirement for a diagnosis of schizophrenia is that a minimum of 1 very clear symptom (and usually 2 or more if less clear-cut) belonging to any one of the groups listed as (a) to (d) above, or symptoms from at least 2 of the groups referred to as (e) to (h), should have been clearly present for most of the time during a period of 1 month or more. Conditions meeting such symptomatic requirements but of duration less than 1 month (whether treated or not) should be diagnosed in the first instance as acute schizophrenia-like psychotic disorder and are classified as schizophrenia if the symptoms persist for longer periods.

 
Table 3. DSM-IV criteria for schizophrenia

A*Characteristic symptoms: 2 or more of the following, each present for a significant portion of time during a 1-month period:

  • delusions
  • hallucinations
  • disorganised speech (e.g. frequent derailment or incoherence)
  • grossly disorganised or catatonic behaviour
  • negative symptoms (i.e. affective flattening, alogia or avolition).

BSocial/occupational dysfunction: since the onset of the disturbance, 1 or more major areas of functioning, such as work, interpersonal relations or self care, are markedly below the level previously achieved

CDuration: continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A

DExclusion of schizoaffective disorder and mood disorder with psychotic features

ESubstance/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

FRelationship 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)

* Only 1 Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behaviour or thoughts, or 2 or more voices conversing with each other

 
Table 4. Search strategies

DatabasePhase and dateSearch strategy

MEDLINE (OvidSP)Phase I

Date: 13-04-11
1          first-rank.mp.

2          first rank.mp.

3          first?rank.mp.

4          FRS$.mp.

5          Schneiderian.mp

6          1 or 2 or 3 or 4 or 5

Phase II

Date: 01-06-11
1          exp "International Classification of Diseases"/ (3305)

2          exp "Diagnostic and Statistical Manual of Mental Disorders"/ (9349)

3          "Research Diagnostic Criteria".mp. (1325)

4          Feighner.mp. (147)

5          ICD.mp. (13774)

6          DSM.mp. (29660)

7          RDC.mp. (1143)

8          schneider.mp. (1529)

9          bleuler.mp. (215)

10        kraepelin.mp. (495)

11        "international pilot study of schizophrenia".mp. (47)

12        IPSS.mp. (1436)

13        "new haven schizophrenia index".mp. (13)

14        NHSI.mp. (14)

15        "present state examination".mp. (412)

16        PSE.mp. (1394)

17        "operational criteria".mp. (431)

18        (operation$ adj3 criteri$).mp. [mp=protocol supplementary concept, rare disease supplementary concept, title, original title, abstract, name of substance word, subject heading word, unique identifier] (1077)

19        "Sensitivity and Specificity"/ (233760)

20        Diagnosis/ (15703)

21        1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 (303793)

22        exp Schizophrenia/ (74720)

23        schizophren$.mp. (93319)

24        22 or 23 (93528)

25        21 and 24 (7401)

26        (animals not (humans and animals)).sh. (3503422)

27        25 not 26 (7398)

Phase III

Date: 17-07-11
1          *schizophrenia/di [Diagnosis]

EMBASE (OvidSP)Phase I

Date: 13-04-11
1          first-rank.mp.

2          first rank.mp.

3          first?rank.mp.

4          FRS$.mp.

5          Schneiderian.mp

6          1 or 2 or 3 or 4 or 5

Phase II

Date: 01-06-11
1          exp "International Classification of Diseases"/ (5070)

2          exp "Diagnostic and Statistical Manual of Mental Disorders"/ (17196)

3          "Research Diagnostic Criteria".mp. (1436)

4          Feighner.mp. (161)

5          ICD.mp. (20919)

6          DSM.mp. (38725)

7          RDC.mp. (1310)

8          schneider.mp. (2302)

9          bleuler.mp. (293)

10        kraepelin.mp. (661)

11        "international pilot study of schizophrenia".mp. (40)

12        IPSS.mp. (2881)

13        "new haven schizophrenia index".mp. (12)

14        NHSI.mp. (22)

15        "present state examination".mp. (447)

16        PSE.mp. (1625)

17        "operational criteria".mp. (557)

18        (operation$ adj3 criteri$).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] (1358)

19        "Sensitivity and Specificity"/ (139513)

20        Diagnosis/ (544275)

21        1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 (755543)

22        exp Schizophrenia/ (110049)

23        schizophren$.mp. (120515)

24        22 or 23 (121863)

25        21 and 24 (12378)

26        Human/ (12332237)

27        nonhuman/ (3642333)

28        26 and 27 (656673)

29        27 not 28 (2985660)

30        25 not 29 (12368)

Phase III

Date: 17-07-11
1          *schizophrenia/di [Diagnosis]

PsycINFO (OvidSP)Phase I

Date: 13-04-11
1          first-rank.mp.

2          first rank.mp.

3          first?rank.mp.

4          FRS$.mp.

5          Schneiderian.mp

6          1 or 2 or 3 or 4 or 5

Phase II

Date: 01-06-11
1          exp "International Classification of Diseases"/ (747)

2          "Research Diagnostic Criteria".mp. (1393)

3          Feighner.mp. (169)

4          ICD.mp. (4427)

5          DSM.mp. (42426)

6          RDC.mp. (392)

7          schneider.mp. (1283)

8          bleuler.mp. (464)

9          kraepelin.mp. (736)

10        "international pilot study of schizophrenia".mp. (68)

11        IPSS.mp. (53)

12        "new haven schizophrenia index".mp. (20)

13        NHSI.mp. (7)

14        "present state examination".mp. (811)

15        PSE.mp. (440)

16        "operational criteria".mp. (462)

17        (operation$ adj3 criteri$).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures] (810)

18        Diagnosis/ (25820)

19        "Research Diagnostic Criteria".mp. (1393)

20        exp "Diagnostic and Statistical Manual"/ (4184)

21        exp Research Diagnostic Criteria/ (122)

22        1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 (72691)

23        exp SCHIZOPHRENIA/ (62498)

24        schizophren$.mp. (88734)

25        23 or 24 (88734)

26        22 and 25 (10364)

27        limit 26 to human (10180)

MEDIONDate: 24-02-11(schizophrenia or schizophrenic or schizophreniform in title or abstract) or (psychosis or psychoses or psychotic in title or abstract)

 All databases searched from inception.
All searches were undertaken, added to a common database and duplicates deleted.
 
Table 5. Study characteristics

Study detailsFirst author, year, publication status, country, aim of study

Patient characteristics and setting Number of participants included in study and number in analysis

Description of participants in the study (age, gender, ethnicity, comorbid disorders, duration of symptoms and concurrent medications used)

Predefined inclusion and exclusion criteria

Study aim

Previous treatment for schizophrenia

Clinical setting

Country

Index testDescription of first-rank symptoms used

Professionals performing test

Resolution of discrepancies

How first-rank symptoms used in study

Target condition and reference standard(s)Reference standard

Target condition(s)

Professionals performing test

Resolution of discrepancies

Flow and timingStudy process

Follow-up