Tanenberg-Karant M, Fennig S, Ram R, Krishna J, Jandorf L, Bromet E J
Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook USA.
Compr Psychiatry. 1995 Nov-Dec;36(6):428-34. doi: 10.1016/s0010-440x(95)90250-3.
This report examines the prevalence and correlates of bizarre delusions and Schneider's first-rank symptoms (FRS) in a first-admission sample with psychosis. A total of 196 patients were assessed with the Structured Clinical interview for DSM-III-R (SCID) and given a consensus diagnosis. Project psychiatrists blind to the consensus diagnoses coded each delusion and hallucination in the sample for both FRS and DSM-III-R bizarreness. Interrater reliability of bizarreness was lower than that of FRS (kappa = .681 v 861). The majority of symptoms (72%) were neither bizarre nor FRS, and of the remainder, bizarre delusions that were not also FRS were extremely uncommon. The prevalence of FRS was 70% in schizophrenia, 29% in psychotic bipolar disorder, and 18% in psychotic depression. For seven schizophrenic patients (7.45%), diagnosis of that disorder depended on the presence of a DSM-III-R bizarre delusion to meet criteria. There was a trend for FRS to be associated with poorer prognostic features in the schizophrenic sample. We concluded that although the constructs of bizarre delusions and FRS overlap, FRS were a more important feature in schizophrenia than bizarreness. The rarity of bizarre delusions that were not FRS, combined with the lower reliability of their assessment as compared with that of FRS, raises questions about the continued emphasis on this phenomenon in the definition of schizophrenia.
本报告调查了首次入院的精神病患者样本中怪异妄想及施奈德首级症状（FRS）的患病率及其相关因素。共有196名患者接受了《精神疾病诊断与统计手册第三版修订版》（DSM-III-R）的结构化临床访谈（SCID），并获得了一致性诊断。对共识诊断不知情的项目精神科医生对样本中的每一种妄想和幻觉进行编码，以确定其是否属于FRS及DSM-III-R怪异程度。怪异程度的评分者间信度低于FRS（kappa值分别为0.681和0.861）。大多数症状（72%）既不怪异也不属于FRS，在其余症状中，不属于FRS的怪异妄想极为罕见。FRS在精神分裂症中的患病率为70%，在双相情感障碍精神病性发作中的患病率为29%，在抑郁发作伴精神病性症状中的患病率为18%。对于7名精神分裂症患者（7.45%），该疾病的诊断取决于存在符合DSM-III-R标准的怪异妄想。在精神分裂症样本中，FRS有与预后较差特征相关的趋势。我们得出结论，虽然怪异妄想和FRS的概念有重叠，但FRS在精神分裂症中比怪异程度更重要。不属于FRS的怪异妄想罕见，且与FRS相比其评估的信度较低，这引发了对在精神分裂症定义中持续强调这一现象的质疑。
