Aberrant salience relationship with first rank s ymptoms.

Background Aberrant salience is the incorrect assignment of salience, significance, or value to different innocuous stimuli that might precede the onset of psychotic symptoms. The present study study aimed to perform a preliminary evaluation of potentially different correlations between the Aberrant Salience Inventory (ASI) score and dimensional or categorical diagnostic approaches. Methods 168 adult outpatients with a current psychiatric diagnosis were consecutively enrolled. Patients were evaluated using different psychometric scales. ASI was used to evaluate aberrant salience, and to evaluate the association between ASI scores and First Rank Symptoms (FRS), and/or with a psychiatric diagnosis. Principal dichotomic clusters of ASI were identified using the Chi-square Automatic Interaction Detection (CHAID) method. Results Current (16.76 ± 6.02 vs 13.37 ± 5.76; p = 0.001), lifetime (15.74 ± 6.08 vs 13.16 ± 5.74; p = 0.005) and past (15.75 ± 6.01 vs 13.33 ± 5.80; p = 0.009) FRS were the main clusters dichotomizing ASI. The average ASI score did not significantly differ among patients with different diagnoses. Conclusions ASI could be used as a tool to identify psychopathological dimensions, rather the categorical diagnoses, in the schizophrenic spectrum.

Schneider's first-rank symptoms have neither diagnostic value for schizophrenia nor higher clinical validity than other delusions and hallucinations in psychotic disorders

The validity of studies on the diagnostic significance of first-rank symptoms (FRS) for schizophrenia has been put in doubt because of a poor compliance with Schneider's criterion for their definition and the lack of use of the phenomenological method for their assessment. In this study, using a rigorously phenomenological approach to elicit FRS, we examined (a) the degree to which unequivocally present FRS differentiated schizophrenia (n=513) from other psychotic disorders (n=633), and (b) the comparative validity between FRS and other reality-distortion symptoms against 16 external validators in the whole sample of psychotic disorders (n=1146). Diagnostic performance indices (with 95% CIs) of FRS for diagnosing schizophrenia were as follows: sensitivity=0.58 (0.54−0.61), specificity=0.65 (0.62−0.67), positive predictive value=0.57 (0.54−0.60) and negative predictive value=0.65 (0.63−0.68). While the overall association pattern of FRS and non-FRS scores with the validators was rather similar, three validators (premorbid social adjustment, number of hospitalizations and global assessment of functioning) were significantly related to non-FRS scores (p < 0.006) but not to FRS scores (p > 0.05). Furthermore, no validator was significantly related to FRS scores and unrelated to non-FRS scores, all of which indicates an overall better predictive validity for non-FRS delusions and hallucinations. These findings suggest that FRS do not have diagnostic value for diagnosing schizophrenia and that they do not meaningfully add to the external validity showed by other delusions and hallucinations. We believe that much of the misunderstanding about the diagnostic and clinical validity of FRS for schizophrenia is rooted in Schneider's confusing concept of the disorder.

A major flaw in the diagnosis of schizophrenia: what happened to the Schneider's first rank symptoms

Kurt Schneider introduced in the definition of the first-rank symptoms (FRS) the criterion that, where unequivocally present, the FRS are always psychological primaries and irreducible. This criterion, grounded on ‘phenomenology’ (description of subjective experiences), cannot be applied, according to Schneider, to delusions, either two-stage FRS delusional perception, or second-rank delusional notions. The Schneider's key criterion was neglected since the initial adoption of the ‘Schneider's FRS’ in the subsequent international literature (e.g. PSE, RDC, DSM, and ICD). The ‘Schneider's FRS’ (e.g. thought insertion, thought withdrawal, passivity, and influence) were persistently equivocated as ‘delusions’, in spite of the Schneider's FRS exclusion criterion. The internationally equivocated ‘Schneider's FRS’ (only homonymous of the original ‘Schneider's FRS’), were eliminated in the DSM-5 and de-emphasized in ICD-11. However, the diagnostic value of the original ‘Schneider's FRS’, assessed on the basis of the strict compliance with the Schneider's criterion for their definition, was never determined. The ‘damnatio memoriae’ of the original Schneider's FRS may be premature. The definition and assessment of the ‘experienced’ symptoms of schizophrenia, only directly observed and reported by the patients, represent a specific, crucial, irreplaceable domain of psychopathology, to be carefully distinguished from the domain of the ‘behavioral’ symptoms observed by the clinician. Contemporary psychopathology research is aware of the absolute need for psychiatry to enhance precision and exactness in the definition of the experienced symptoms of schizophrenia, through the formulation of unequivocal inclusion and exclusion criteria (descriptive micro-psychopathology), in order to determine their value in research and care.

Speed, Accuracy, and Efficiency of Judgements of Coincidence between Speech Acts and Auditory Perception during a Delayed Auditory Feedback Paradigm: A Behavioral Study in Patients with Schizophrenia

The inability to differentiate between one’s actions and their consequences from sensory inputs originating from an alien source might cause classical first-rank symptoms in schizophrenia, such as audio-verbal hallucinations (AVH). We aimed to determine whether patients with or without AVH perform differently in a task challenging the audio-verbal self-monitoring system compared to controls. Controls (n = 21) and schizophrenia patients with (AH, n = 11) and without AVH (NH, n = 9) participated. Subjects had to discern whether they heard a sound they had just uttered with or without delay. Reaction time, accuracy as well as sensitivity and response bias were compared between groups. There were no group effects in reaction time. Controls were significantly more accurate in the detection of delays compared to AH and to NH. However, the most salient observation was that these deficits were not uniformly present, but were selectively elicited by the delay, reducing patients’ response accuracy to chance level. The analysis of the data based on signal detection theory revealed a significant drop in sensitivity in both patient groups compared to the controls, and a response bias: Particularly the patients with AVH seemed to be biased not to consider a delay, rather than falsely signaling a delay. Such a deficit may blur the distinction between external events and self-initiated actions, thus eventually interfering with the patients’ sense of agency.

S198. SELF-DISTURBANCES AND THEIR NEURAL SIGNATURES IN SCHIZOPHRENIA

Background The self-disturbances (SDs) concept is considered to be part of the Schneider’s first rank symptoms, i.e., thought-withdrawal, thought-insertion, thought-broadcasting, somatic-passivity experiences, mental/motor automatisms, disrupted unitary self-experience (Mishara et al., 2014). SDs were originally described by W. Mayer-Gross (1920), who observed them in psychotic patients. Methods We classified Mayer-Gross’ findings on SDs into the following categories: experience is new/compelling (aberrant salience), reduced access/importance of autobiographical past, cognitions/emotions occur independently from self’s volition, foreign agents have power over self and developed an SDs scale based on these categories and cognitive domains (perception, motor, speech, thinking etc.). Scale is applied as a measure of the frequency of the experiences. In our current study on phenomenology and neurobiology of psychotic symptoms, we administered the scale to a study group of patients with schizophrenia (N=84) and healthy volunteers (N=170). Further, the resting state fMRI was performed and the group was divided into two subgroups with (N=13) and without self-disturbances (N=10) and in healthy individuals (N=39). Results We found substantial differences in the frequency of self-disturbances in patients with schizophrenia compared to healthy controls (total score differences, Z=-5.83, p&lt; 0.001). On a neural level, patients with self-disturbances experienced a decreased functional brain connectivity of the default mode and salience networks as compared to the patients without self-disturbances and healthy controls. The differences were mainly explained by the factor ‘’foreign agents’’ and the novelty of the experience. Discussion The scale identifies self-disturbances in schizophrenia and confirms self-related processing in patients with schizophrenia to be associated with altered activation in the cortical midline structures. Supported by the grant projects MH CR AZV 17-32957A and MEYS NPU4NUDZ: LO1611.