Diagnostic validity of basic symptoms

  • Joachim Klosterkötter
  • Hermann Ebel
  • Frauke Schultze-Lutter
  • Eckhard Michael Steinmeyer
Original Paper


Although the Bonn Scale for the Assessment of Basic Symptoms (BSABS) [13] has come into use in several European countries, its diagnostic validity has not yet been sufficiently examined. That is why we have assessed BSABS items on a sample of 243 consecutive admissions to the Department of Psychiatry at the RWTH University, Aachen, and 79 psychologically healthy persons. Then, a cluster analysis was calculated to identify the empirical item-grouping. Five well-interpretable BSABS subsyndromes were found. In addition, uni- and multivariate analyses were computed to evaluate the diagnostic validity of these subsyndromes. We were able to show that every BSABS subsyndrome separates at least schizophrenic, organic mental and affective disorders from personality, neurotic and substance-induced disorders, as well as from psychological health. Furthermore, the subsyndrome “information processing disturbances” differentiates between schizophrenic and organic mental disorders, on the one hand, and affective disorders, on the other, and additionally, the subsyndrome “interpersonal irritation” between schizophrenics and all other persons examined.

Key words

Schizophrenia Basic symptoms Diagnostic validity Bonn Scale for the Assessment of Basic Symptoms (BSABS) 


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  1. 1.
    Andreasen NC (1982) Negative symptoms in schizophrenia: definition and reliability. Arch Gen Psychiatry 39:784–788Google Scholar
  2. 2.
    Andreasen NC, Flaum M (1991) Schizophrenia: the characteristic symptoms. Schizophr Bull 17:27–49Google Scholar
  3. 3.
    Angst J, Stassen HH, Woggon B (1989) Effect of neuroleptics on positive and negative symptoms and the defect state. Psychopharmacology 99:41–46Google Scholar
  4. 4.
    Birchwood M, Smith J, McMillan F, Hogg B, Prasad R, Harvey C, Bering S (1989) Predicting relapse in schizophrenia: the development and implementation of an early signs monitoring system using patients and families as observers, a preliminary investigation. Psychol Med 19:649–656Google Scholar
  5. 5.
    Chapmah JP (1966) The early symptoms of schizophrenia. Br J Psychiatry 112:225–251Google Scholar
  6. 6.
    Chapman LJ, Chapman JP (1987) The search for symptoms predictive of schizophrenia. Schizophr Bull 13:497–504Google Scholar
  7. 7.
    Chapman LJ, Edwell WS, Chapman JP (1980) Physical anhedonia, perceptual aberration and psychosis proneness. Schizophr Bull 6:639–653Google Scholar
  8. 8.
    David AS, Appleby L (1992) Diagnostic criteria in schizophrenia: accentuate the positive. Schizophr Bull 18:551–557Google Scholar
  9. 9.
    Dilling H, Mombour W, Schmidt MH (eds) (1991) Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V-(F). H. Huber, BernGoogle Scholar
  10. 10.
    Ebel H, Klosterkötter J, Gross G, Huber G (1989) Basic symptoms in schizophrenic and affective psychoses. Psychopathology 22:224–232Google Scholar
  11. 11.
    Gross G, Huber G, Klosterkötter J (1992) Early diagnosis of schizophrenia. Neurol Psychiatr Brain Res 1:17–22Google Scholar
  12. 12.
    Gross G, Huber G, Klosterkötter J, Gnad M (1990) Früherkennung idiopathischer Psychosyndrome. In: Huber G (ed) Idiopathische Psychosen: Psychopathologie — Neurobiologie —Therapie. Schattauer, Stuttgart, pp 157–173Google Scholar
  13. 13.
    Gross G, Huber G, Klosterkötter J, Linz M (1987) Bonner Skala für die Beurteilung von Basissymptomen (BSABS: Bonn Scale for the Assessment of Basic Symptoms). Springer, Berlin Heidelberg New YorkGoogle Scholar
  14. 14.
    Gross G, Huber G, Klosterkötter J, Linz M (1992a) Scala di Bonn per la valutazione dei sintomi di base. Edizione italiana a cura di Maggini C & Dalle Luche R. ETS Editrice, PisaGoogle Scholar
  15. 15.
    Gross G, Huber G, Klosterkötter J, Linz M (1992b) Escala de Bonn para Evaluation de Sintomas Basicos. Moringio Escalante JC (ed). Universidad Nacional de Asuncion, AsuncionGoogle Scholar
  16. 16.
    Gross G, Huber G, Klosterkötter J, Linz M (1995) Bonnskalaen til vurdering af basissymptomer. Mogens Handest, CopenhagenGoogle Scholar
  17. 17.
    Gross G, Stassen HH, Huber G, Klosterkötter J (1990) Reliability of the psychopathological documentation scheme BSABS. In: Stefanis CN, Rabavilas AD, Soldatos CR (eds) Psychiatry a world perspective, vol 1. Excerpta Medica, Amsterdam, pp 199–203Google Scholar
  18. 18.
    Häfner H, Maurer K, Löffler W, Riecher-Rössler A (1991) Schizophrenie und Lebensalter. Nervenarzt 62:536–548Google Scholar
  19. 19.
    Häfner H, Riecher A, Maurer K, Meissner S, Schmidtke A, Fätkenheuer B, Löffler W, Heiden W an der (1990) Ein Instrument zur retrospektiven Einschätzung des Erkrankungsbeginns bei Schizophrenie (Instrument for the retrospective assessment of the onset of schizophrenia, “IRAOS”) — Entwicklung und erste Ergebnisse. Z Klin Psychol 12:230–255Google Scholar
  20. 20.
    Hager W (1987) Grundlagen einer Versuchsplanung zur Prüfung empirischer Hypothesen in der Psychologie. In: Lüer G (ed) Allgemeine Experimentelle Psychologie. Fischer, Stuttgart; pp 43–267Google Scholar
  21. 21.
    Herz MI, Szymanski MV, Simon JC (1992) Intermitted medication of stable schizophrenic outpatients: an alternative to maintenance medication. Am J Psychiatry 139:918–922Google Scholar
  22. 22.
    Huber G (1986) Psychiatrische Aspekte des Basisstörungskonzepts. In: Süllwold L, Huber G (1986) Schizophrene Basisstörungen. Springer, Berlin Heidelberg New York, pp 39–143Google Scholar
  23. 23.
    Huber G (1990) Advances in schizophrenia research. From neuron to action. In: Deecke L, Eccles JC, Mountcastle VB (eds) Springer, Berlin Heidelberg New York, pp 471–477Google Scholar
  24. 24.
    Janzarik W (1993) Basisstörungen: Eine Revision mit struktur-dynamischen Mitteln. Nervenarzt 54:122–130Google Scholar
  25. 25.
    Klosterkötter J (1992) The meaning of basic symptoms for the development of schizophrenic psychoses. Neurol Psychiatr Brain Res 1:30–41Google Scholar
  26. 26.
    Klosterkötter J (1994) Warning signs and symptoms in schizophrenia. In: Saugstad LF (ed) Psychiatry and mental health —the legacy of Ørnulv Ødegård. LFSF, Oslo, pp 113–135Google Scholar
  27. 27.
    Klosterkötter J, Gross G, Huber G, Gnad M (1990) Basissymptomorientierte Diagnostik schizophrener Vulnerabilität. In: Huber G (ed) Idiopathische Psychosen: Psychopathologie — Neurobiologie — Therapie. Schattauer, Stuttgart, pp 137–148Google Scholar
  28. 28.
    Klosterkötter J, Albers M, Steinmeyer EM, Hensen A, Sass H (1994) The diagnostic validity of positive, negative, and basic symptoms. Neurol Psychiatr Brain Res 2:232–238Google Scholar
  29. 29.
    Klosterkötter J, Albers M, Steinmeyer EM, Hensen A, Sass H (1995) Positive or negative symptoms — which are more appropriate as diagnostic criteria for schizophrenia. Acta Psychiatr-Scand 92:321–326Google Scholar
  30. 30.
    Klosterkötter J, Schultze-Lutter F, Gross G, Steinmeyer EM, Huber G (1995) Are subsequent schizophrenic diseases predictable? Br J Psychiatry (submitted)Google Scholar
  31. 31.
    Klosterkötter J, Breuer H, Gross G, Huber G, Gnad M, Steinmeyer EM (1992) New approach to early recognition of idiopathic psychoses. In: Ferrero FP, Haynal AE, Sartorius N (ed) Schizophrenia and affective psychoses. Nosology in contemporary psychiatry. John Libbey, Rome, pp 105–110Google Scholar
  32. 32.
    Kojoh K, Hirasawa S (1990) The Bonn scale for the assessment of basic symptoms (BSABS). Arch Psychiatr Diagn Clin Evaluation 4:587–597Google Scholar
  33. 33.
    Kulhara P, Chadda R (1987) Study of negative symptoms in schizophrenia and depression. Compr Psychiatry 28:229–235Google Scholar
  34. 34.
    McGhie A, Chapman J (1961) Disorders of attention and perception in early schizophrenia. Br J Med Psychol 34:103–116Google Scholar
  35. 35.
    Rösler M, Bellaire W, Hengesch G, Kiesling-Muck H, Carls W (1985) Die uncharakteristischen Basissymptome des Frankfurter Beschwerdefragebogens und ihre Beziehung zu psychopathologischen Syndromen. Nervenarzt 56:259–264Google Scholar
  36. 36.
    Scharfetter Ch (1985) Allgemeine Psychopathologie. 2. Aufl. Thieme, StuttgartGoogle Scholar
  37. 37.
    Schouten HJA (1982) Measuring pairwise agreement among many observers. Some improvements and additions. Biometric J 24:431–435Google Scholar
  38. 38.
    Süllwold L, Huber G (1986) Schizophrene Basisstörungen. Springer, Berlin Heidelberg New YorkGoogle Scholar
  39. 39.
    Teusch L (1985) Substratnahe Basisstörungen oder nosologisch vieldeutige subjektive kognitive Störbarkeit? Nervenarzt 56:265–269Google Scholar
  40. 40.
    Waller RA, Duncan DB (1969) A Bayes rule for the symmetric multiple comparison problem. J Am Stat Assoc 64:1484–1499Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Joachim Klosterkötter
    • 1
  • Hermann Ebel
    • 1
  • Frauke Schultze-Lutter
    • 1
  • Eckhard Michael Steinmeyer
    • 1
  1. 1.Department of PsychiatryRWTH AachenAachenGermany

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