Disintegration of the components of language as the path to a revision of Bleuler's and Schneider's concepts of schizophrenia. Linguistic disturbances compared with first-rank symptoms in acute psychosis.

BACKGROUND

The 20th century ended without a resolution of the debate about the supremacy of Schneider's psychopathological conceptualisation of schizophrenia (the first-rank symptoms) over Bleuler's 'four As' (disorders of association and affect, ambivalence and autism).

AIMS: To examine the relationships between linguistic deviations and symptoms in patients with acute psychosis.

METHOD: We assessed language disturbances and first-rank symptoms with the Clinical Language Disorder Rating Scale (CLANG) in 30 consecutive patients with acute psychosis, selected for the presence of at least one active first-rank symptom, and 15 control participants with depression but no psychotic symptoms.

RESULTS

Strong positive correlations were found between the CLANG factor 'poverty' and first-rank delusions of control and between semantic/phonemic paraphasias and verbal auditory hallucinations [corrected]. Language disturbances were superior to nuclear symptoms in discriminating ICD-10 schizophrenia from other psychoses.

CONCLUSIONS

Evaluating the features of psychosis as deviations in the cerebral organisation of language paves the way to a concept of psychosis that supersedes these traditional but competing categorical concepts.