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11/13/24, 8\:09 PM Guide | Exploring first rank symptoms

Exploring

Table of contents
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Introduction

Kurt Schneider, a German psychiatrist, pointed out certain symptoms as being characteristic of schizophrenia and therefore
exhibiting a “
¹ However
other disorders such as mania or delirium which is why their isolated presence is not su
This guide provides examples of questions that may be useful in exploring
history.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain that you’d like to take a history from the patient\:
“ I h a v e t o a s k y o u s o m e q u e s t i o n s t h a t m a y s e e m a l i t t l e b i z a r r e a n d
m a y n o t m a k e s e n s e . T h e s e a r e q u e s t i o n s w e a s k o f e v e r y o n e . W o u l d t h a t b e o k ?”
Gain consent to proceed with history taking.

Hallucinations

A hallucination is a perception in the absence of an external stimulus that has qualities of real perception.
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Auditory hallucination

An auditory hallucination might involve a patient hearing voices despite the absence of any actual sound.
Questions which may be useful to explore auditory hallucinations include\:
" D o y o u e v e r h e a r n o i s e s o r v o i c e s w h e n t h e r e i s n o b o d y e l s e t h e r e ?"
" C a n y o u h e a r t h e m i n y o u r e a r s , o r a r e t h e y i n y o u r m i n d ?"
" H o w m a n y v o i c e s a r e t h e r e ?"
" D o y o u r e c o g n i s e t h e v o i c e s ?"
" W h a t d o t h e y s a y ?"
" D o t h e y t e l l y o u t o d o t h i n g s a n d d o y o u o b e y ?"
" D o t h e y t e n d t o c o m m e n t o n w h a t y o u a r e d o i n g o r t h i n k i n g ?"
" A r e t h e v o i c e s p r e s e n t a l l t h e t i m e ?"
" D o e s a n y t h i n g m a k e t h e m b e t t e r o r w o r s e ?"
" D o y o u e v e r
" D o y o u s m e l l o r s e e a n y t h i n g a t t h e s a m e t i m e t h a t y o u h e a r t h e s e v o i c e s ?"

Somatic hallucinations

A perception of being touched in the absence of a sensory stimulus is termed a somatic hallucination. This may result in
hallucinations of being touched, assaulted or that insects are beneath the skin.
Questions which may be useful to explore somatic hallucinations include\:
" D o y o u e v e r f e e l t h a t s o m e o n e o r s o m e t h i n g i s t o u c h i n g y o u w h e n t h e r e i s n o b o d y t h e r e ?"
" H a v e y o u e v e r f e l t l i k e y o u' v e b e e n a s s a u l t e d d e s p i t e n o b o d y b e i n g p r e s e n t ?"
" H a v e y o u e v e r f e l t l i k e i n s e c t s a r e c r a w l i n g b e n e a t h y o u r s k i n ?"

Thought abnormalities

Thought blocking

Thought blocking involves sudden cessation of thought, typically mid-sentence, with the patient being unable to recover
what was previously said.
Questions which may be useful to explore thought blocking include\:
" D o y o u f e e l a b l e t o t h i n k c l e a r l y ?"
" D o y o u e v e r e x p e r i e n c e y o u r t h o u g h t s s u d d e n l y s t o p p i n g a s t h o u gh t h e r e w e r e n o t h o u gh t s l e f t ?"
" W h a t i s i t l i k e ? H o w d o y o u e x p l a i n i t ?"

Thought withdrawal

Thought withdrawal refers to a patient's belief that thoughts can be removed from their mind by others.
Questions which may be useful to explore thought withdrawal include\:
" I s t h e r e a n y t h i n g l i k e h y p n o s i s o r t e l e p a t h y go i n g o n ?"
" I s t h e r e a n y o n e o r a n y t h i n g t a k i n g t h o u g h t s o u t o f y o u r h e a d ?"

Thought insertion

Thought insertion refers to a patient's belief that thoughts can be inserted into their mind by others.
Questions which may be useful to explore thought insertion include\:
" A r e y o u r t h o u g h t s y o u r o w n ?"
" I s t h e r e a n y o n e / a n y t h i n g p u t t i n g t h o u g h t s i n t o y o u r h e a d t h a t y o u k n o w a r e n o t y o u r o w n ?"
" H o w d o y o u k n o w t h e y a r e n’ t y o u r s ? W h e r e d o t h e y c o m e f r o m ?"

Thought broadcasting

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Thought broadcasting refers to a patient's belief that others can hear their thoughts.
Questions which may be useful to explore thought broadcasting include\:
" C a n a n y o n e h e a r y o u r t h o u g h t s ? F o r e x a m p l e , c a n I h e a r w h a t y o u a r e t h i n k i n g r i gh t n o w ?"
" D o y o u e v e r h e a r y o u r o w n t h o u g h t s e c h o e d o r r e p e a t e d ?"

Delusional perception

Delusions are
contrary and not in sync with regional and cultural norms. These may include persecutory delusions, in which the patient
erroneously believes another individual or group is trying to harm them or ideas of reference, in which the individual
incorrectly believes speci
Questions which may be useful to explore delusional perception include\:
" D o y o u s o m e t i m e s h a v e t h o u g h t s t h a t o t h e r s t e l l y o u a r e f a l s e ?"
" D o y o u h a v e a n y b e l i e f s t h a t a r e n' t s h a r e d b y o t h e r s y o u k n o w ?"
" D o y o u e v e r f e e l t h a t p e o p l e a r e o u t t o d o y o u h a r m ?"
" D o y o u e v e r f e e l t h a t s p e c i
" W h e n y o u w a t c h t h e t e l e v i s i o n / l i s t e n t o t h e r a d i o / h e a r s o m e t h i n g, d o y o u f e e l t h a t t h e s t o r i e s a r e r e f e r r i n g t o y o u o r
s o m e t h i n g t h a t y o u h a v e d o n e ?"

Passivity

People who experience passivity do not feel in control of their actions, thoughts and perceptions, believing them to in
by an external agent.
Questions which may be useful to explore passivity include\:
" D o y o u e v e r f e e l a s t h o u g h y o u a r e b e i n g c o n t r o l l e d b y s o m e o n e o r s o m e t h i n g?"
" D o y o u e v e r t h i n k t h a t s o m e o n e o r s o m e b o d y i s c o n t r o l l i n g y o u ?"
" A r e y o u r t h o u g h t s / m o o d / a c t i o n s u n d e r y o u r c o n t r o l o r i s s o m e o n e f o r c i n g y o u t o b e h a v e i n t h i s w a y ?"

Closing the consultation

Ask the patient if they have any questions or concerns that have not been addressed.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Summarise your mental state examination structure).

References

1. Nordgaard J, Arnfred SM, Handest P, Parnas J. The Diagnostic Status of First-Rank Symptoms. Schizophrenia Bulletin.
2008;34(1)\:137-154. doi\:10.1093/schbul/sbm044.
Source\: geekymedics.com
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