2. INTRODUCTION
Kurt Schneider (1939) set a high value on
certain symptoms in the diagnosis of
schizophrenia
He named them as ‘ First Rank Symptoms’.
Schneider listed these symptoms as follows:
1.Audible thoughts
2.Voices arguing
3.Voices commenting on once actions
4.Influence playing on the body, somatic
passivity
5.Thought withdrawal.
6.Thought ascribed to others
7.Diffusion or broadcasting of thoughts
8.Made feelings
9.Made impluses.
10.Made volitional acts.
11.Delusional perception
3. Audible Thoughts
Patient experiences auditory hallucinations with voices
speaking his thoughts aloud
A 32-year-old housewife complained of a man's voice,speaking
in an intense whisper from a point about 2 feet above her
head.The voice would repeat almost all the patient's goal
directed thinking even the most banal thoughts. The patient
would think ‘I must put the kettle on' and after a pause of not
more than one second the voice would say ‘ I must put the
kettle on'. It would often say the opposite ‘Don’t put the kettle
on'.
4. Voices Arguing
Two or more hallucinatory voices in disagreement or in
discussion
A 24-year-old male patient reported hearing voices coming from
the nurse's office. One voice, deep in pitch and roughly spoken,
repeatedly said ‘G.T is a bloody paradox', and another higher in
pitch said ‘ He is that ,he should be locked up'. A female voice
occasionally interrupted, saying ‘ He is not, he is a lovely man’.
5. Voices Commenting On One’s
Action
Content of auditory hallucinations is a description of the
patient’s activities as they occur.
A 41-year-old housewife heard a voice coming from the house
across the road. The voice went on incessantly in a flat
monotone describing everything she was doing, with an
admixture of critical comments. ‘Dhe is peeling potatoes, got
hold of the peeler, she does not want that potato, she is putting
it back, because she thinks it has a knobble like a penis, she
has a dirty mind, she is peeling potatoes, now she is washing
them...'
6. Influence Playing On The
Body,Somatic Passivity
Patient is a passive and invariably a reluctant recipient
of body sensations imposed upon him by external
agency.
A 38-year-old man had jumped from a bedroom
window, injuring his right knee which was very painful.
He described his physical experience as, ‘The sunrays
are directed by U.S. army satellite in an intense beam
which I can feel entering the centre of my knee and
then radiating outwards causing the pain’.
7. Thought Withdrawal
Patient describes his thought’s being taken from his
mind.
A 22-year-old woman said ‘ I am thinking about my
mother, and suddenly my thoughts are sucked out of
my mind by a phrenological vacuum extractor, and
there is nothing in my mind, it is empty...'
8. Thoughts Ascribed To Others
Thought insertion
A 29-year-old housewife said ‘I look out of the window
and I think the garden looks nice and the grass looks
cool, but the thoughts of Eamonn Andrews come into
my mind. There are no other thoughts there, only his...
He treats my mind like a screen and flashes his
thoughts on to it like you flash a picture.
9. Diffusion Or Broadcasting Of
Thoughts
Patient, during the process of thinking , has the experience
that his thoughts are not contained within his own mind.
A 21-year-old student said : ‘As I think , my thoughts leave
my head on a type of mental ticker-tape. Everyone around
has only pass the tape through their mind and they know my
thoughts.'
10. ‘Made’ Feelings
Patient experiences feelings which do not seem to be his
own.
A 23-year-old female patient reported, ‘I cry tears roll
down my cheeks and I look unhappy, but inside I have a
cold anger because they are using me in this way, and it is
not me who is unhappy, but they are projecting
unhappiness onto my brain. They project upon me
laughter, for no reason, and you have no idea how terrible
it is to laugh and look happy and know it is not you, but
their emotions’.
11. ‘Made’ Impulses (drives)
Powerful impulse overcomes the patient to which he
almost invariably gives away.
A 26-year-old engineer emptied the contents of a urine
bottle over the ward dinner trolley. He said, ‘The sudden
impulse came over me that I must do it. It was not my
feeling, it came into me from the X-ray department, that
was why I was sent there for implants yesterday. It was
nothing to do with me, they wanted it done. So I picked up
the bottle and poured it in. It seemed all I could do.’
12. ‘Made’ Volitional Act
Patient experiences his actions as being completely under
the control of an external influence.
A 29-year-old shorthand typist described her
actionsasfollows:’ when i reach my hand for the comb it is
my hand and arm which move, and my fingers pick up the
pen, but I don't control them. . . I sit there watching them
move, and they are quite independent, what they do is
nothing to do with me. .. I am just a puppet who is
manipulated by cosmic strings. When the strings are pulled
my body moves and I cannot prevent it.’
13. Delusional Perception
Two stage phenomenon.
The delusion arises from a perception which to the patient possesses all
the properties of a normal perception, and which he acknowledges
would be regarded as such by anyone else. This perception however
has a private meaning for him.
The second stage, which is the development of the delusion, follows
almost immediately.
The delusional perception is frequently preceded by a delusional
atmosphere.
