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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迈向 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，当前 DSM-5 中的精神分裂症诊断标准与克雷佩林（Kraepelin）曾经称为“早发性痴呆”和布洛伊勒（Bleuler）称为“精神分裂症”的诊断标准几乎没有相似之处。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 的后续版本是否应再次给予施奈德式一级症状（FRS；例如，思想广播）其在精神分裂症中的突出作用。 DSM-IV 以及 (b) DSM-5 中目前对幻觉的相当狭隘的定义，要求幻觉生动、清晰，并具有正常知觉的全部力量和影响力，是否应该扩大到纳入个人认为的类似知觉的现象。可以与正确的感知区分开来，但仍然感知为真实的和外部生成的。假设 调查的目的是了解专家的意见，但没有明确的假设。研究设计国际精神分裂症专家通过各种渠道招募，并受邀参加一项简短的在线调查。最终样本由 136 名专家组成，其中一个小组由 53 名专家组成，这些专家的身份经过验证，并具有至少 6 年的临床和/或研究经验。研究结果 赞成让 FRS 恢复其在 DSM 早期版本中的重要作用的专家 (49.3%) 比反对的专家 (34.6%) 略多。大约五分之四的专家同意应扩大 DSM 中幻觉的定义。根据结果​​，除了在现象学上与真实感知无法区分的内部症状之外，持有者确信是从另一个来源（即不是自我生成）插入的感觉入侵也应该包含在定义中。结论 尽管大多数专家建议改变幻觉的定义，但专家们对 FRS 的看法却较为复杂。我们希望本文能够促进未来针对这些症状的诊断相关性的研究，并鼓励关于核心精神病症状的定义和即将发布的 DSM 版本的诊断标准的讨论。