The document summarizes Kurt Schneider's concept of first-rank symptoms (FRS) of schizophrenia. Schneider was a German psychiatrist who studied schizophrenia in the early 20th century. He identified 11 symptoms that he believed were pathognomonic of schizophrenia, including auditory hallucinations, thought broadcasting, and somatic passivity. The document outlines each of Schneider's 11 proposed FRS and provides examples. It discusses the evolution of concepts of schizophrenia from Kraepelin to Bleuler. Overall, the summary focuses on Schneider's influential work defining first-rank symptoms to aid in the diagnosis of schizophrenia.

1. SCHENIDER FIRST RANK
SYMPTOMS
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN.

2. • Kurt Schneider was a German psychiatrist known largely for
his writing on the diagnosis and understanding of
schizophrenia, as well as personality disorders then known
as psychopathic personalities.
• Schneider was born in Crailsheim, Kingdom of Württemberg,
and trained in medicine in Berlin and Tübingen. He was
drafted for and completed military service in World War I
and later obtained a postgraduate qualification in
psychiatry.
• In 1931 he became director of the German Psychiatric
Research Institute in Munich, which was previously founded
by Emil Kraepelin.

3. • Disgusted by the developing tide of psychiatric eugenics
championed by the Nazi Party, Schneider left the institute,
but did serve as a doctor for the german armed forces
during World War II.
• After the war, academics who hadn't taken part in the Nazi
eugenics policies were appointed to serve in, and rebuild
Germany's medical institutions and Schneider was given the
post of Dean of the Medical School at Heidelberg University.
Schneider kept this post until his retirement in 1955.

4. INTRODUCTION
• Schneider accepted Kraepelin’s system of classification
and distinguished between “abnormal personalities”,
“abnormal reactions”, “organic psychosis”, “schizophrenia and
cyclothymia”.
• He had taken a group of psychotic patients, excluded
those with clear organic psychosis, reactive psychosis,
obvious cyclothymia, and then performed a statistical analysis
of the symptom of the remaining psychotic patients, who
were presumed to have schizophrenia.
• In those patients he termed the most frequently found
symptoms as ‘First Rank Symptoms [FRS]’(Schneider 1959).
• As per Schneider, FRS is mostly found in schizophrenia
(Crichton, 1996).

5. EVOLUTION OF CONCEPT
• Morel, in 1852 reported a series of cases of severe
intellectual deterioration starting in adolescence and he
called this illness demence precoce.
• In 1874, Kahlbaum drew attention to a mental illness in
which stupor occurred in the absence of disease of nervous
system, he called this illness tension insanity or catatonia.
• In 1893, Kraepelin brought together the syndromes of
demence precoce, hebephrenia, catatonia, and dementia
paranoides in the 4th edition of his textbook and called this
group of illness ‘psychological degeneration process’. In
1899, he used the term dementia praecox to designate this
group of illnesses because intellectual deterioration was a
common feature and the illness usually occurred in young
people (Hamilton,1984).

6. • Bleuler coined the term schizophrenia in 1911.
• According to him, the disease is characterized by a specific
type of alteration of thinking, feeling, and relation to
external world, which appears nowhere else in this
particular fashion. He said that certain symptoms of
schizophrenia are present at all times and in every case.
Here he is referring to the so-called basic symptoms.
Accessory symptoms on the other had may also occur in
other illnesses (Bleuler, 1950). The basic symptoms were
characterized by the four A’s
• Ambivalence
• Autism
• Affect disturbances
• Association disturbances

7. • Schneider wrote that the presence of delusional
perception excludes a reactive experience and always
indicates a true psychosis, which in practical terms is a
schizophrenic illness. If the symptom is present in a non-
organic psychosis, then we call that psychosis as
schizophrenia as opposed to cyclothymic psychosis or
reactive psychosis in abnormal personality (Hamilton,
1984).

8. EVOLUTION OF THE CONCEPT OF FRS
• Schneider reported that the presence of FRS always signifies
schizophrenia but first rank symptoms need not always be
present in schizophrenia. The search for pathognomic
symptoms among positive phenomena is the hallmark of
Schneider’s clinical psychopathology (Monti, 1996).
• However Schneider had given few statistics to demonstrate,
not how he arrived at his choice of FRS but how the use of
FRS led to clear cut diagnosis in most cases (Schneider,
1980).
• In FRS, the use of the term ‘symptoms’ is somewhat
idiosyncratic (Boyle, 1990). Patients do not complain it as a
symptom of illness (Crichton, 1996). FRS is referred to a
more or less characteristic but invariably detectable feature
of a purely psychopathological ‘state course complex’
(Schneider, 1980).

9. • According to some authors (Huber, 1994), Schneider’s
personal prestige also contributed to the success of his
concept of FRS. In 1931, Schneider became Director of
German Research Institute for Psychiatry in Munich founded
by Kraepelin and led the honorary professorship at the
University of Munich 1934 onward (Huber 1994).

10. CONCEPTS AND DEFINITION
• FRS deals with mainly delusions and hallucinations. First
rank symptoms were regarded as primary symptoms.
Schneider said, “From the standpoint of psychopathology,
primary symptoms are final and irreducible” (Sims, 1991).
• According to Jasper (1968) “If we try to get some closer
understanding of these primary experiences of delusion,
we soon find we cannot really appreciate these quite alien
modes of experience. They remain largely
incomprehensible, unreal and beyond our understanding.

11. Schneider formulated what he considered to be
pathognomic of first rank symptoms of
schizophrenia (Schneider, 1959).
1.Audible thoughts (voices speaking out his thoughts aloud).
2.Voices arguing (Referring to the patient in 3rd person)
3.Voices commenting on one’s actions.
4.Thought withdrawal
5.Thought insertion
6.Thought broadcasting
7.Made volition.
8.Made affect
9.Made impulse
10.Somatic passivity (experiencing externally controlled body
changes)
11.Delusional perception (a real percept elaborated in a
delusional way)

12. First rank symptoms of schizophrenia and symptoms
from the Present State Examination

13. 1.Audible thoughts - is the patient’s experience of hearing his
own thoughts said out loud.
The patient may hear people repeating his thoughts out loud
just after he has thought them, answering his thoughts,
talking about them having said them audibly or saying aloud
what he is about to think so that his thoughts repeat the
voices.
A 35-year-old painter heard a quiet voice with ‘an Oxford
accent’, which he attributed to the BBC. The volume was
slightly lower than that of normal conversation and could be
heard equally well with either ear. He could locate its source
at the right mastoid process. The voice would say, ‘I can’t
stand that man, the way he holds his hand he looks like a
poof’…..

14. He immediately experienced whatever the voice was
saying as his own thoughts, to the exclusion of all other
thoughts. When he read the newspaper the voice would
speak aloud whatever his eyes fell on. He had not time to
think of what he was reading before it was uttered aloud.
(Mellor, 1970: 16)

15. 2.Voices arguing - Voices heard arguing with each other
implies two or more hallucinatory voices quarrelling or
discussing with each other.
The patient usually features in the third person in the content
of these arguing voices.
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.’ (Mellor, 1970: 16)

16. 3.Voices commenting - Hallucinatory voices giving a running
commentary on the patient’s activities occur and are of first
rank. The time sequence of the commentary may be such
that it takes place just before, during or after the patient’s
activities.
The patient does not know that his particular perception is
unique, that other people do not share his perceptual
experience.
The abnormal thing about voices commenting is that they
should be experienced as perceptions and as coming from
outside the self.

17. 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. ‘She 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.’ (Mellor, 1970: 16)

18. 4.Thought withdrawal- In thought withdrawal, it is believed
by the patient that his thoughts are in some way being taken
out of his mind; he has some feeling of loss resulting from this
process. It may be coupled with other thought passivity
experiences.
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.’ (Mellor, 1970: 16)

19. 5.Thought insertion- experiences thoughts that do not have
the feeling of familiarity, of being his own, but he feels that
they have been put in his mind, without his volition, from
outside himself.
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 onto it like you flash a
picture.’ (Mellor, 1970: 17)

20. 6.Thought broadcasting-the patient experiences his thoughts
withdrawn from his mind and then, in some way, made public
and projected over a wide area.
The explanation he gives for how this can occur will, as usual
for the content of a delusion, depend on his background
culture and predominant interests.
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 to pass the tape through their mind and they know my
thoughts.’ (Mellor, 1970: 17)

21. 7.Made volition-passivity of volition the patient feels that it is
not his will that carried out the action.
A 29-year-old shorthand typist described her actions as
follows, ‘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 wanting them to 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 can’t prevent it.’
(Mellor, 1970: 17)

22. 8.Made affect-Passivity of emotion occurs when the affect
that the patient experiences does not seem to him to be his
own. He believes that he has been made to feel it.
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 your, but their reaction.’(Mellor, 1970: 17)

23. 9.Made impulse-the patient experiences a drive, which he
feels is alien, to carry out some motor activity.
The impulse may be experienced without the subject carrying
out the behaviour.
The action is admitted to be the patient’s own, but he feels
that the impulse that precipitated him into doing it was not
his own.
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 and 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.’ (Mellor, 1970: 17)

24. 10.Somatic passivity – Somatic passivity is the belief that
outside influences are playing on the body.
It is not the same as haptic hallucination, but it is a delusional
belief that the body is being influenced from outside the self.
May occur in association with various somatic hallucinations.
The event is experienced as alien by the patient in that it is
not experienced by the patient as his own but inserted into
the self from outside.
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 sun-rays are directed by US
army satellites in an intense beam which I can feel entering
the centre of my knee and then radiating outwards causing
the pain.’ (Mellor, 1970: 16)

25. The terms
disorders of passivity
made experiences
delusions of control
disorders of personal activity
Are in practice synonymous and interchangeable.
Passivity experiences are those events in the realm of
sensation, feeling, drive and volition that are experienced as
made or influenced by others.
They have been well described as delusions of control,
because the patient’s experience of the event being made to
occur takes the form of delusion.

26. 11.Delusional perception - The only type of delusion that is
regarded as of first rank is a delusional perception.
A normal perception delusionally interpreted and regarded as
being highly significant to the patient.
A woman said, ‘every night blood is being injected out of my
arms [sic]’. When asked for her evidence, she explained that
she had little brown spots on her arms and therefore knew
that she was being injected. The interviewer looked at the
spots on her arms, rolled up his sleeve and showed her spots
identical in appearance on his own arm. He said that they had
been on his arm as long as he could remember and were
called ‘freckles’. She agreed that both sets of spots looked
similar and accepted his explanation of his own spots, but she
still insisted that her freckles proved that she was being
injected in her sleep.

27. As per Schneider, there were less important criteria for the
diagnosis of schizophrenia other than FRS and he termed
them as second rank symptoms. Those are:
Other hallucinations
Delusional notions
Perplexity
Depressed or elated mood,
Experiences of flattened feelings.
Other abnormal modes of expression eg., disorder of speech
and other motor manifestations were known as third rank
symptoms.

28. THANK YOU