Background: The aim of this study was to examine the prevalence of Schneider's first-rank symptoms (FRS) in Zulu patients diagnosed with paranoid schizophrenia and to ascertain the diagnostic and prognostic significance of Schneider's FRS in this group.

Methods: This descriptive study was done on 75 psychiatric Zulu in- and outpatients diagnosed with paranoid schizophrenia. A questionnaire was completed and included sociodemographic data, Schneider's FRS and a functional assessment.

Results: Fifty-three percent of the patients heard voices at some or other time. Most patients (90.7%) confirmed having experienced at least one of the five related symptoms of thought disturbances and 80% of the patients confirmed the presence of passivity phenomena. Most patients (87%) indicated that they had presented at least one type of primary delusion, at the time of the interview. Regarding functional assessment, some (12%) patients were still entirely productive (“no problems”), 28% rated “mild problems”, 45% “moderate problems” and 15% “severe problems”. With regard to social functioning, 8% of the patients scored “no problems”, 25% “mild problems”, 50% “moderate problems” and 17% “severe problems”.

Conclusions: The prevalence of Schneider's FRS in these patients is 100%, with a 95% confidence interval [95.2%; 100%]. Even though extremely sensitive for paranoid schizophrenia, the specificity of Schneider's FRS merits further study.