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Cited by 157Schizophrenia research and treatmentMental Health and PsychiatryPsychology and Mental Health

The Diagnostic Status of First-Rank Symptoms

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Nordgaard, J., Arnfred, S. M., Handest, P., Parnas, J.·2007·Schizophrenia Bulletin
DOI 10.1093/schbul/sbm044PMC PMC2632385
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Abstract

OBJECTIVE: In the International Statistical Classification of Diseases, Tenth Revision(ICD-10) and Diagnostic and Statistical Manual of Mental Disorder, Third and Fourth Edition(DSM-III-IV), the presence of one of Schneider "first-rank symptoms" (FRS) is symptomatically sufficient for the schizophrenia diagnosis. Yet, it has been claimed that FRS may also be found in the nonschizophrenic conditions, and therefore, they are not specific or diagnostic for schizophrenia. This review was made to clarify the issue of diagnostic specificity. METHODS: (1) A critical review of FRS studies published in English between 1970 and 2005. (2) A highlight of the 5 most frequently cited studies identified in the Web of Science. (3) Theoretical implications of the epistemological issues of FRS. RESULTS: The reviewed studies do not allow for either a reconfirmation or a rejection of Schneider's claims about FRS. The sources of disagreement between the studies are (1) including or excluding acute patients with potential degradation of consciousness; (2) assessing or not the phenomenological context; (3) assessing patients in different stages of their illness evolution; and (4) differential emphasis on mood symptoms and history of psychiatric symptoms. CONCLUSION: Both DSM-IV and ICD-10 emphasize FRS to a degree that is not supported by the empirical evidence. Until the status of FRS is clarified in depth, we suggest that the FRS, as these are currently defined, should be de-emphasized in the next revisions of our diagnostic systems. Future studies aiming at validation of FRS as diagnostic features need to apply a phenomenological perspective and include a homogenous group of patients across a wide spectrum of diagnoses.

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  • Although first-rank symptoms are somewhat deemphasized, a diagnosis of schizophrenia requires at least two of seven symptom categories, including at least one core symptom.

    “Although first-rank symptoms are somewhat deemphasized [22], a diagnosis of schizophrenia requires the presence of at least two of seven symptom categories, including at least one ‘core’ symptom.”

    From Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies (2020) · cites this paper as [22]

    The Conclusion says first-rank symptoms should be de-emphasized in future diagnostic revisions, supporting the citation’s point about their reduced emphasis. It does not say that they had already been de-emphasized. The citation is attached to that clause, not to the subsequent two-of-seven diagnostic rule. (LLM, conf=0.83)

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Cites

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Research works printed but not linked: 8

  1. [1]Schneider K. Clinical Psychopathology. NY: Grune & Stratton; 1959. [Google Scholar]
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  7. [59]Parnas J, Zahavi D. The role of phenomenology in psychiatric classification and diagnosis. In: Golder MG, Maj M, Lopez-Ibor JJ, editors. World Psychiatric Association Series in Evidence and Experience in Psychiatry. Chichester, UK: John Wiley & Sons; 2002. pp. 137–162. [Google Scholar]
  8. [60]Jaspers K, Hoenig J, Hamilton MW. General Psychopathology. Manchester, UK: Manchester University Press; 1963. [Google Scholar]

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Authors
Nordgaard, J., Arnfred, S. M., Handest, P., & Parnas, J.
Affiliations
Hvidovre Hospital (DK)
ORCID
Venue
Schizophrenia Bulletin
Publisher
Oxford University Press (OUP)
Published
2007-10-27
Volume
34
Issue
1
Pages
137-154
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
DOI
10.1093/schbul/sbm044
PMC
PMC2632385
OpenAlex
W2119162345
Cited by
157
References
62
Citations by year
2026: 3 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 10 · 2021: 8 · 2020: 12 · 2019: 12 · 2018: 10 · 2017: 6 · 2016: 10 · 2015: 12 · 2014: 12 · 2013: 14 · 2012: 8
FWCI
4.44
Type
journal article
Language
en
Open access
Locations
  • Schizophrenia Bulletin (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders
  • Sundhed og Sygdom, Det Frie Forskningsråd
  • Danmarks Grundforskningsfond
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
Keywords
first-rank symptoms, schizophrenia diagnosis
MeSH terms
Diagnosis, Differential, Humans, Surveys and Questionnaires, Schizophrenia, Schizophrenic Psychology, Time Factors, Prevalence, Diagnostic and Statistical Manual of Mental Disorders

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