Schizophrenia

Kurt Schneider first rank symptoms

Audible thoughts ( thought echo- thoughts are heard as echo) auditory hallucination
3rd person auditory hallucination
Commentary auditory hallucination
Thought withdrawal
Thought insertion
Thought broadcasting
Made affect
Made impulse
Made action (volitions)
Delusional perception (interpret the false meaning/ delusional meaning rarely seen)
Somatic passivity ( sensation controlled by others

Clinical features
Positive dimension
Disorders of perception
Disorders of thought
Disorder of motor behaviour
Negative dimension
Affective flattening (unchanging facial expression)
Alogia (poverty of speech)
Avolition (lack of persistence/ impaired grooming hygiene)
Asociality
Attentional impairment (social inacttentiveness)
Positive dimension
Disorder of perception
Disorder of thought
Hallucination
- Disturbance in form (Formal thought
Auditory- command of 3rd
disorder)
person (classical), running
Derailment (loosing of
commentary, thought echo
association, - Ask A answer B)
(audible thought)
Tangentiality ( related answer/
Somatic tactile (people
topic but not actual/ correct /
punch, pinch, scratch)
exact answer
Olfactory
Incoherence ( unable to
Visual
understand the content of
Gustatory
speech at all)
Circumstantiality ( more in
mania, beat around the bushes
to answer the question)
Echolalia ( repeat the question
that is being asked and
continuously repeat it )
Neologism
Over inclusion ( wrong answers
are included in between the
correct answers
Disturbance in content
Delusion persecutory, reference,
grandiose, control, somatic
Disturbance in possession
Thought broadcast, thought insertion,
thought withdrawal ( schizophrenia
bizarre delusion)
Disorder of motor behaviour
Disorganized behaviour
Stereotype- repetitive behaviour
Aggressive agitated
Inappropriate sexual behaviour
Catatonic behaviour
Other features
Multiple somatic symptoms
Poor personal care
Poor insight
Poor judgement
Suicide (secondary to command hallucination
Neurological signs ( primitive reflexes, ticks, stereotypies, abnormal motor tone (rigidity)
Treatment
Pharmacotherapy: antipsychotic, block D2 receptors
Typical antipsychotic
Phenothiazine: Aliphatics: Chlorpromazine
Piperidine : Thioridazine
Piperazine: Fluphenazine
Butyrophenones: Haloperidol
Thioxanthine: Flupenthixol (depot preparation)
Diphenylbutylpiperidines: Pimozide (only for body dysmorphic disorders)
Atypical antipsychotics; serotonin- dopamine antagonist
Olanzapine, Risperidone, Aripriprazole, Quetiapine, Zisprasidone, Amisulpride
Clozapine (treatment resistant schizophrenia, serious adverse effect)
ECT (positive symptoms) used for maintenance purpose

Negative dimension
1.
2.
3.
4.
5.

Affecting flattening
Unchanging facial expression
Decreased spontaneous
movements
Poor eye contact ( blunt
expression)
Alogia
Poverty of speech
Poverty of content of speech
Avolition (motivationless)
Lack of persistence in work or
school
Impaired grooming and
hygiene
Asociality
Few recreational interest/
activities
Little sexual interest
Few relationships with friend/
peers
Attentional impairment
Social inattentiveness