Schneiderian first-rank symptoms of schizophrenia are pathognomonic according to Kurt Schneider. Which of the following is NOT a first-rank symptom?

• A Persecutory delusions without passivity phenomena ✓
• B Thought insertion
• C Somatic passivity
• D Auditory hallucinations of two or more voices arguing

Explanation

Schneiderian first-rank symptoms include: audible thoughts (running commentary, voices discussing the patient, voices arguing), thought insertion, thought withdrawal, thought broadcasting, passivity of feelings/impulses/actions (made experiences), somatic passivity, and delusional perception. Simple persecutory delusions without passivity phenomena are second-rank symptoms. The first-rank symptoms are highly specific for schizophrenia but not pathognomonic as they can occur in bipolar disorder with psychosis.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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