First rank symptoms in mania: An indistinct diagnostic strand

Abstract

First rank symptoms (FRS) are considered to be pathognomic for schizophrenia. However, FRS is not distinctive feature of schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. Its existence in the first episode of bipolar disorder may be predictor of poor short-term outcome and decompensating course of illness.ObjectiveTo determine the frequency of first rank symptoms in manic patients.MethodThe cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty manic patients were recruited from November 2014 to May 2015.FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool.ResultThe mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. In total, 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a P value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness, 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity, 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception.ConclusionThe study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

First-rank symptoms in Bipolar disorder

“…Amidst debate on the diagnostic utility of FRS, they continue to be relevant from prognostication and treatment planning point of view. [ 3 ] The presence of FRS in bipolar affective disorder (BPAD) may be predictor of poor short-term outcome and decompensating the course of illness. [ 4 ] BPAD patients with mania or mixed episodes are more likely to be females.…”