Basic symptom concept: Historical aspects in view of early detection of schizophrenia

The gradual development of the basic symptom concept (BSC) since the 50s is outlined in special consideration of its importance for the early recognition of schizophrenic and related disorders. The early detection of schizophrenia in the prepsychotic basic stages, the prodromes and outpost syndromes before the first psychotic episode, represent a main focus addressed by the basic symptom research. The basic symptoms (BS), unlike to negative symptoms experiential and not behavioral in kind, were differentiated in dynamic, thought, perception, motor, proprioception and vegetative BS, and in detail described and defined in the Bonn Scale for the Assessment of Basic Symptoms - BSABS. The BS as self-experienced, troublesome disturbances, typically, first not yet observable in expression and behavior, occur in the prodromes, that continuously pass over in the psychosis, 3 until 4 years, in the phasically remitting outpost syndromes 10 years before the first psychotic manifestation. It is shown that the BSC proceeded from two observations of the early 50 s. the first description of the pure defect and the cenesthetic schizophrenia, which became in view of its dominating non-psychotic, pre- and postpsychotic basic stages, a model for the development of the BSC and the identification of substrateclose BS and transition-relevant cognitive BS as psychopathological predictors of an imminent first rank psychosis.The empirical data of the BS research were the presupposition for the recognition of the proper initial phases of schizophrenia and by realizing the possibilities for early pharmacological and cognitive-behavioral psychological intervention a starting point for the improvement of the prognosis of the disorder. The article discusses similar approaches of the anglophone and swiss psychiatry for early detection and intervention of schizophrenia. Combining the BSC with the vulnerability-stress-model by placing BS in the latter makes sense, because the BS of the BSABS are not only more precise, expended and detailed defined, but are also experiential in kind, i.e. perceived and reported complaints what is decisive for the clinical and therapeutic utility. Already today a primary prevention of schizophrenic psychoses by pharmacological intervention, e.g. time limited low dose neuroleptics in the prodromal stages, identifiable with the help of the BSABS, is possible and indispensable. Not psychiatrists who do so, but those advocating delays in therapeutic intervention in prepsychotic patients, should provide evidence that this reserve cam be clinically and ethically justified. The basic symptom concept (BSC) has been developed since the 50s by clinical psychiatrists and, independently of this group, in the 70s by clinical psychologists [63, 64]. A comprehensive synopsis of the concept of basic symptoms (BS) and basic stages has been given a.o. in the book of Sullwold and Huber [65], in the six editions of Huber's textbook of psychiatry since 1974 [48] and in the papers of 1966 Pure defect syndromes and basic stages of endogenous psychoses[31] and 1983 The concept of substrateclose basic symptoms and its meaning for theory and therapy of schizophrenic disorders [38], furtheron in the reports on the eleven Weissenauer Schizophrenia Symposia 1971-1988 [a.o. 32, 33, 36, 37, 40, 41, 43]. The individual BS were described in the manual of the Bonn Scale for the Assessment ofBS (BSABS - 15) of1987 (Italian edition 1992, danish edition 1994, spanish edition 1995). The BSC originated with two observations which we made in the early 50s as a pupil of Kurt Schneider in his University Hospital in Heidelberg. The one concerned the so-called pure defect syndromes [29, 31], the other the cenesthetic type schizophrenia [28] with its long lasting prodomes, preceding the first psychotic episode.