Hello. Kurt Schneider was a German psychiatrist.
He pointed out certain symptoms that he said were characteristic of schizophrenia,
and he named these the First Rank Symptoms of Schizophrenia.
However, as psychiatrists we need to be cautious,
as these symptoms may occur in other conditions, such as mania and delirium.
I'm Dr Beth Colby, a psychiatrist in London.
In this video I'm going to outline the First Rank Symptoms of Schizophrenia into groups,
to make them easier to remember,
and I'm also going to give examples of questions you can ask your patients,
either in a clinical or examination setting.
The first group of First Rank Symptoms are auditory hallucinations.
These include thought echo, where the patient hears his thoughts out loud.
The second one is two or more voices talking together or arguing about the patient in the third person,
and the third is the patient hearing a running commentary on his actions or thoughts, also in the third person.
So, for thought echo you could ask, 'Do you ever hear your thoughts out loud?'
and then you could expand it, saying 'as if you're hearing your thoughts with your ears,
and the thoughts are outside of your head?' So, for the voices talking or arguing about
the patient, you could ask, 'Do you ever hear any voices
talking about you or arguing about you, and saying it about you, not to you?
So one voice may say, 'He seems quite angry today,' rather than
'You are very angry today, yes you are.' So it's using the term 'he' or 'she', not 'you'.
Then on the running commentary on a person's actions or thoughts,
'Do you ever hear a voice talking about what you're doing or thinking, sort of like a running
commentary on what's happening?' So they may say, 'Oh, Tom's sitting down to the table now.
He's picked up his cutlery and is going to eat a piece of his cheese and onion pie.'
So they're talking about you, what you're doing.' The second group of First Rank Symptoms I've
grouped under 'Delusions of thought interference.' These include thought insertion,
thought withdrawal, thought broadcast and thought blocking.
As a broad question to start with, you could ask, 'Oh, have you found that your thoughts
are being interfered with at the moment?' Or 'Is there any telepathy or hypnosis going on?'
Then you could hone it down, saying 'Do you ever feel as though thoughts are
being put into your head, say for instance from an outside force or somebody else?'
Then for withdrawal, 'Do you ever feel as though thoughts are being taken
out of your head by a force or a person?' Broadcast, 'Do you think that other people
know what you're thinking?' And then you say, 'Well,
how do they know, do you think they do?' and then thought block, 'Do you ever feel as though when
you're thinking, your thoughts suddenly stop, as if somebody's stopped your thoughts coming
or as if you've run out of thoughts?' The third group is delusions of control,
or passivity phenomena. Patients believe that their feelings, actions and impulses
are not their own, but that they're being controlled by something or someone else.
So the question for this could be, 'Do you ever feel as though you're being
controlled by something or someone? What's that like? Tell me about it.'
Or if they say, 'What do you mean?' you could say, 'Well, do you ever feel as though what you're
doing is outside your control, that you're being made to do it,
that it's not you moving your arm, it's being moved for you,
or that the feelings you have aren't yours, they've been placed inside you,
or do you ever feel as though you've been touched or attacked
when there's been nobody there, or have the feeling of insects or something under your skin?'
This last one is called somatic passivity. The last symptom is delusional perception.
This is where somebody has a real perception like seeing something,
hearing something, tasting something, but then they attribute a different
meaning to it, a special meaning. So, for instance, I could see a red car going by,
and because a red car has gone by, that's told me that I'm going to be the next
Queen of England or the next Prime Minister. So, I'm actually seeing the red car, it's
not in my imagination it's not a hallucination, but the meaning that I've put on it is delusional.
I hope this has been helpful. I'll just sum up the groups of symptoms.
So, the First Rank Symptoms of Schizophrenia are auditory hallucinations, which are thought echo,
voices discussing or arguing about the patient in the third person,
and a voice or voices doing a running commentary in the
third person on somebody's thoughts or actions. The second group is delusions of thought control,
where a patient may experience thought insertion, withdrawal, broadcast or thought blocking.
The third group is delusions of control or passivity phenomena, where a patient believes that
their impulses, actions and feelings are not their own but they're under the control of something or
someone else, and also includes somatic passivity, where a patient feels a bodily sensation that's
been put there by someone else. And then the last one is delusional perception, where somebody
has a perception, but then misinterprets the meaning of it in a delusional way.
Thank you very much. 'Bye for now.