Bizarre delusions and DSM‐IV schizophrenia

Abstract

The present study investigated whether schizophrenia patients with and without DSM-IV bizarre delusions, categorized as bizarre delusions of Schneiderian first rank symptoms (SBD) and as non-Schneiderian bizarre delusions (non-SBD), differed on demographic or clinical features, in view of the weight given to bizarre delusions in the diagnosis of schizophrenia. One hundred and twenty-nine in-patients with schizophrenia were assessed systematically for both types of bizarre delusions on the five domains of psychopathology of the Positive and Negative Syndrome Scale (PANSS; delusions/hallucinations, thought disorder/disorganization, excitement, negative symptoms and depressive symptoms) and for extrapyramidal side-effects. Inter-rater reliabilities for SBD and non-SBD were assessed and were exceptionally high (kappa value 0.85 and 0.92, respectively). Neither SBD nor non-SBD were associated with any demographic or non-PANSS clinical characteristics tested. However, the presence of non-SBD was significantly associated with more severe psychopathology in all five domains of the PANSS, whereas the presence of SBD was significantly associated with more severe psychopathology in three domains only: delusions/hallucinations, thought disorder/disorganization and depressive symptoms. However, patients with only SBD did not differ from patients with only non-SBD on any demographic or clinical variables, including five psychopathological domains. These findings suggest that, despite showing more severe symptoms, patients with DSM-IV bizarre delusions do not constitute a clinically distinguishable subgroup.

More attention should be paid to schizophrenic patients with risk of violent offences

“…Patients with schizophrenia are more likely to be violent than the general population 2 . In particular, bizarre delusions are considered to be characteristic of schizophrenia related to aggressive behavior 3 . This case confirms that bizarre delusions in a patient with chronic schizophrenia resulted in severe violence due to a lack of public attention.…”

What is Bizarre in Bizarre Delusions? A Critical Review

“…FRS and BD also show similar profiles when jointly considered among schizophrenic patients. 3,39,40 ''Non Schneiderian bizarre delusions'' (BD without FRS) have been found to be infrequent: only 4% among clinical vignettes on delusion 3 and 12% among interviewed schizophrenic patients. 39 On the other hand, 11% of clinical vignettes with FRS were assessed as non-bizarre.…”

“…3,39,40 ''Non Schneiderian bizarre delusions'' (BD without FRS) have been found to be infrequent: only 4% among clinical vignettes on delusion 3 and 12% among interviewed schizophrenic patients. 39 On the other hand, 11% of clinical vignettes with FRS were assessed as non-bizarre. 3 It should be noted that the FRS comprise both delusions and hallucinations, whereas BD refer by definition only to delusional processes.…”

The special treatment of first rank auditory hallucinations and bizarre delusions in the diagnosis of schizophrenia

“…The inter-rater reliability for BD is variable, with kappa coefficients ranging from 0.28 to 0.92 (Flaum et al, 1991; Goldman et al, 1992; Kendler et al, 1983; Mojtabai and Nicholson, 1995; Nakaya et al, 2002; Spitzer et al, 1993; Tanenberg-Karant et al, 1995). The definition of BD is ambiguous, particularly regarding whether emphasis should be placed on form vs. content, and the validity of BD as currently operationalized in the DSM has been questioned (Cermolacce et al, 2010; Mullen, 2003).…”