Cultural Relativety of First Rank Symptoms in Schizophrenia

This study aimed at assessing the extent and usefulness of Schneider's first rank symptoms in the diagnosis of schizophrenia from a cross-cultural point of view. Case notes of patients admitted to the mental health ward of the University of Benin Teaching Hospital, Benin City, Nigeria were analysed. Seventy eight schizophrenic patients form the basis of this study; 47 (60.3%) of them had first rank symptoms. Similarity was found with the results of Zarrouk, in that somatic passivity and 'made' phenomena predominated. First rank symptoms are becoming increasingly important in psychiatry. Psychiatrists in Nigeria frequently ask their patients during intake interviews about voices commenting, audible thoughts and thought insertion, in addition to the symptoms of somatic passivity and 'made' feelings reported by patients (Ayorinde, 1977; Okhomina and Ebie, 1973; Prince, 1960). The presence or absence of delusions are also frequently utilised as a basis for psychiatric diagnosis (Binitie, 1977). Thus, psychiatrists in Nigeria, perhaps inadvertently, make us of the first rank symptoms enumerated by Schneider. Mellor (1970) has given definitions and clinical illustrations of Kurt Schneider's first rank symptoms and carried out a comprehensive study of the subject. Zarrouk (1978) undertook a prospective study in which he attempted to replicate the findings of Mellor in a different culture. He found that somatised symptoms and 'made' feelings were prominent in his patient population. Zarrouk felt that this finding was not unexpected, 'since in that traditional Islamic and nomadic society beliefs in the devil and the supernatural are considered to be normal and are widely held by many intellectuual and highly educated people' - a situation not far removed from the Nigerian experience. The attempt in this retrospective study is to replicate the studies of Mellor and Zarrouk with the following questions and predictions in mind. 1. To what extent are first rank symptoms manifested by schizophrenic patients in Nigeria? 2. It was predicted that first rank symptoms are not of common occurrence in a Nigerian population. 3. It was also predicted that there would be a difference in occurrence of symptoms in the Nigerian population, compared with that examined by Mellor in Europe, there would be no difference from that studied by Zarrouk. 4. What is the cross-cultural validity of Schneider's first rank symptoms in the diagnosis of schizophrenia?