Disintegration of the components of language as the path to a revision of Bleuler's and Schneider's concepts of schizophrenia

Abstract

BackgroundThe 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).AimsTo examine the relationships between linguistic deviations and symptoms in patients with acute psychosis.MethodWe 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.ResultsStrong positive correlations were found between the CLANG factor ‘poverty’ (of speech) and first-rank delusions of control and (‘delusional perceptions’) between semantic/phonemic paraphasias and verbal auditory hallucinations. Language disturbances were superior to nuclear symptoms in discriminating ICD–10 schizophrenia from other psychoses.ConclusionsEvaluating 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.