Background Diagnostic criteria for mental disorders are subject to change. This is particularly true for schizophrenia, whose diagnostic criteria in the current DSM-5 bear little resemblance to what Kraepelin once named “dementia praecox” and Bleuler termed “the schizophrenias.” The present study reports results from a survey of experts on two core topics of schizophrenia: (a) whether subsequent editions of the DSM should once again give the Schneiderian first-rank symptoms (FRS; eg, thought broadcasting) the prominent role they had in the DSM-IV and (b) whether the currently quite narrow definition of hallucinations in the DSM-5 requiring them to be vivid and clear and have the full force and impact of normal perceptions should be broadened to incorporate perceptual-like phenomena that the individual can differentiate from proper perceptions but still perceives as real and externally generated. Hypothesis The aim of the survey was to learn about experts’ opinions with no clear hypotheses. Study Design International experts on schizophrenia were recruited via various sources and invited to participate in a short online survey. The final sample comprised 136 experts with a subgroup of 53 experts with verified identity and at least 6 years of clinical and/or research experience. Study Results Slightly more experts voted in favor (49.3%) of returning FRS to the prominent role they had in earlier versions of the DSM than against (34.6%). Approximately four out of five experts agreed that the definition of hallucinations in the DSM should be expanded. According to the results, alongside internal symptoms that are phenomenologically indistinguishable from true perceptions, sensory intrusions that the holder is convinced were inserted from another source (ie, not self-generated) should be included in the definition. Conclusions While a large majority of experts recommend a change in the definition of hallucinations, the experts’ opinions on FRS are more mixed. We hope that this article will stimulate future studies targeting the diagnostic relevance of these symptoms and encourage discussion about the definition of core psychotic symptoms and the diagnostic criteria for the upcoming edition of the DSM.

中文翻译：

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走向 DSM-6：关于重新引入一级症状作为精神分裂症核心标准和重新定义幻觉的专家调查结果


背景 精神障碍的诊断标准可能会发生变化。对于精神分裂症来说尤其如此，其当前DSM-5中的诊断标准与Kraepelin曾经命名的“痴呆症praecox”和Bleuler所说的“精神分裂症”几乎没有相似之处。本研究报告了对精神分裂症两个核心主题的专家调查的结果：（a） DSM 的后续版本是否应该再次给予 Schneiderian 一级症状 （FRS;例如，思想广播） 它们在 DSM-IV 中发挥的突出作用，以及 （b） DSM-5 中目前相当狭隘的幻觉定义要求它们生动清晰，并具有正常感知的全部力量和影响是否应该是扩大到包含类似感知的现象，个人可以从适当的感知中区分出来，但仍然认为是真实的和外部生成的。假设 调查的目的是了解没有明确假设的专家的意见。研究设计 通过各种来源招募了国际精神分裂症专家，并被邀请参加一项简短的在线调查。最终样本包括 136 名专家，其中 53 名专家具有经过验证的身份和至少 6 年的临床和/或研究经验。研究结果：赞成 （49.3%） 的专家投票赞成将 FRS 恢复到它们在早期版本的 DSM 中的突出作用 （34.6%） 略多于反对 （34.6%）。大约五分之四的专家同意 DSM 中幻觉的定义应该扩大。 根据结果，除了现象学上与真实感知无法区分的内部症状外，持有者确信是从其他来源（即，不是自我产生的）插入的感觉侵入应包括在定义中。结论虽然绝大多数专家建议改变幻觉的定义，但专家对 FRS 的看法更加复杂。我们希望本文将激发针对这些症状的诊断相关性的未来研究，并鼓励讨论核心精神病症状的定义和即将发布的 DSM 的诊断标准。