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Berge J, Nordgaard J, Lindstrom S. Excess mortality and suicide risk in treatment-seeking individuals with schizotypal disorder: A population-based study using Swedish national registers. Psychiatry Res 2024; 342:116223. [PMID: 39378537 DOI: 10.1016/j.psychres.2024.116223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 09/25/2024] [Accepted: 09/30/2024] [Indexed: 10/10/2024]
Abstract
This study investigates the excess mortality, both all-cause and due to suicide, among individuals with schizotypal disorder (SD) compared to the general population. Using individual-level data from the Swedish National Patient Register and the Cause of Death Register, we analyzed mortality in 998 patients diagnosed with SD from 2006 to 2017. Our primary outcomes were all-cause mortality and suicide mortality, with baseline variables including sex, age, and psychiatric comorbidities. Results indicated significantly elevated mortality rates for both all-cause mortality (Standardized Mortality Ratio (SMR) 5.2) and suicide (SMR 23.4). Substance use disorders, personality disorders, and ADHD were identified as significant predictors of increased all-cause mortality. Notably, having a personality disorder in conjunction with schizotypal disorder resulted in a markedly increased risk of suicide. The study underscores the urgent need for targeted interventions and improved diagnostic precision to reduce premature mortality in this vulnerable population. Additionally, the relatively low prevalence of SD diagnoses in Sweden highlights a potential underdiagnosis or misclassification issue. These findings have critical implications for clinical practice and public health efforts, emphasizing the necessity for comprehensive care strategies and suicide prevention interventions to improve outcomes for individuals with schizotypal disorder.
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Affiliation(s)
- J Berge
- Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden; Addiction Center Malmö, Malmö, Sweden
| | - J Nordgaard
- Psychiatry East Region Zealand, Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - S Lindstrom
- Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden.
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2
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Beño-Ruiz-de-la-Sierra RM, Arjona-Valladares A, Hernández-García M, Fernández-Linsenbarth I, Díez Á, Roig-Herrero A, Osorio-Iriarte E, Molina V. Corollary discharge and anomalous self-experiences in schizophrenia and bipolar disorder: A specificity analysis. Clin Neurophysiol 2024; 166:87-95. [PMID: 39137502 DOI: 10.1016/j.clinph.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE The Corollary Discharge (CD) mechanism inhibits self-generated speech sound perception, appearing disrupted in schizophrenia and potentially contributing to Anomalous Self-Experiences (ASEs). However, it remains unclear if this alteration and its correlation with ASEs extend to other psychotic disorders. METHODS Electroencephalography was used to study the N1 Event-Related Potential (ERP) as an index of CD-mediated suppression in the auditory cortex across thirty-five participants with schizophrenia, twenty-six with bipolar disorder, and thirty healthy controls. Auditory N1 was elicited by two conditions: real-time listening to self-pronounced vowels while speaking through connected microphone and earphones (listen/talk -or talk condition in previous literature-) and passive listening to the same previously recorded self-uttered vowels (listen/no talk -or listen condition-). RESULTS N1 ERP amplitude was lower in the listen/talk condition compared to listen/no talk across all groups. However, N1 suppression was significantly reduced in schizophrenia, with bipolar patients showing intermediate attenuation between both groups (i.e., non-significantly different from controls). Furthermore, N1 suppression inversely correlated with ASEs severity only in schizophrenia. CONCLUSIONS Dysfunction of the CD mechanism may be a defining feature of schizophrenia, where it is connected to ASEs. SIGNIFICANCE These results corroborate previous findings linking auditory N1 ERP suppression with disrupted CD mechanism in schizophrenia, but not in bipolar disorder.
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Affiliation(s)
| | | | | | | | - Álvaro Díez
- Psychiatry Department, School of Medicine, University of Valladolid, Spain
| | - Alejandro Roig-Herrero
- Psychiatry Department, School of Medicine, University of Valladolid, Spain; Imaging Processing Laboratory, University of Valladolid, Spain
| | | | - Vicente Molina
- Psychiatry Department, School of Medicine, University of Valladolid, Spain; Psychiatry Service, University Clinical Hospital of Valladolid, Spain.
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3
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Beño-Ruiz-de-la-Sierra RM, Arjona-Valladares A, Hernández-García M, Fernández-Linsenbarth I, Díez Á, Fondevila Estevez S, Castaño C, Muñoz F, Sanz-Fuentenebro J, Roig-Herrero A, Molina V. Corollary Discharge Dysfunction as a Possible Substrate of Anomalous Self-experiences in Schizophrenia. Schizophr Bull 2024; 50:1137-1146. [PMID: 37951230 PMCID: PMC11349017 DOI: 10.1093/schbul/sbad157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
BACKGROUND AND HYPOTHESIS Corollary discharge mechanism suppresses the conscious auditory sensory perception of self-generated speech and attenuates electrophysiological markers such as the auditory N1 Event-Related Potential (ERP) during Electroencephalographic (EEG) recordings. This phenomenon contributes to self-identification and seems to be altered in people with schizophrenia. Therefore, its alteration could be related to the anomalous self-experiences (ASEs) frequently found in these patients. STUDY DESIGN To analyze corollary discharge dysfunction as a possible substrate of ASEs, we recorded EEG ERP from 43 participants with schizophrenia and 43 healthy controls and scored ASEs with the 'Inventory of Psychotic-Like Anomalous Self-Experiences' (IPASE). Positive and negative symptoms were also scored with the 'Positive and Negative Syndrome Scale for Schizophrenia' (PANSS) and with the 'Brief Negative Symptom Scale' (BNSS) respectively. The N1 components were elicited by two task conditions: (1) concurrent listening to self-pronounced vowels (talk condition) and (2) subsequent non-concurrent listening to the same previously self-uttered vowels (listen condition). STUDY RESULTS The amplitude of the N1 component elicited by the talk condition was lower compared to the listen condition in people with schizophrenia and healthy controls. However, the difference in N1 amplitude between both conditions was significantly higher in controls than in schizophrenia patients. The values of these differences in patients correlated significantly and negatively with the IPASE, PANSS, and BNSS scores. CONCLUSIONS These results corroborate previous data relating auditory N1 ERP amplitude with altered corollary discharge mechanisms in schizophrenia and support corollary discharge dysfunction as a possible underpinning of ASEs in this illness.
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Affiliation(s)
| | | | | | | | - Álvaro Díez
- Psychiatry Department, School of Medicine, University of Valladolid, Valladolid, Spain
| | | | | | - Francisco Muñoz
- UCM-ISCIII Center for Human Evolution and Behaviour, Madrid, Spain
- Psychobiology and Behavioural Sciences Methods Department, Complutense University of Madrid, Madrid, Spain
| | | | - Alejandro Roig-Herrero
- Psychiatry Department, School of Medicine, University of Valladolid, Valladolid, Spain
- Imaging Processing Laboratory, University of Valladolid, Valladolid, Spain
| | - Vicente Molina
- Psychiatry Department, School of Medicine, University of Valladolid, Valladolid, Spain
- Psychiatry Service, University Clinical Hospital of Valladolid, Valladolid, Spain
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4
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Sandsten KE, Jensen MT, Saebye D, Null K, Northoff G, Parnas J. Altered cardiac autonomic functioning associates with self-disorders in schizophrenia. Schizophr Res 2024; 270:57-62. [PMID: 38865806 DOI: 10.1016/j.schres.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
Elevated resting heart rate (RHR) and reduced heart rate variability (HRV) are signs of autonomic nervous system dysfunction identified in schizophrenia (SCZ). This dysfunction has been found to manifest prior to the onset of the clinical diagnosis. Yet whether such autonomic dysfunction is associated with vulnerability to schizophrenia remains unknown. This case-control study included recent onset SCZ patients (n = 35) and healthy controls (HC) (n = 33). Patients were scored for self-disorders (SD's) using the EASE manual and all participants underwent a 5-minute resting state electrocardiogram (ECG) recording. Patients were included from outpatient clinics in Denmark. The main measures comprised EASE total scores (SDs), RHR (beats per minute) and three standard HRV measures usually included in testing autonomic nervous system dysfunction: root mean squared of successive differences (RMSSD), standard deviation of normal-to-normal interval (SDNN) and high-frequency/ low frequency ratio (HF/LF). Pearson correlations and linear regression models adjusted for age, sex and medication were used in the SCZ group. The main finding was a positive moderate association between SDs and RHR (r = 0.463; p = 0.005) and a negative association between SDs and HRV (RMSSD) (r = -0.440; p = 0.008) in the SCZ group. Linear regression models found SDs to explain 22 % of the variance of RHR and 19 % in RMSSD. SDs correlated with LF/HF (r = 0.434; p = 0.009), but non-significantly with SDNN. The study provides evidence of an intriguing link between SDs as a susceptibility trait for schizophrenia spectrum disorders and altered cardiac autonomic functioning.
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Affiliation(s)
| | - Magnus T Jensen
- William Harvey Research Institute, NIHR Bart's Biomedical Research Centre, Queen Mary University of London, United Kingdom; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark; Steno Diabetes Center Copenhagen, Denmark
| | - Ditte Saebye
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Kaylee Null
- Department of Psychology, University of California Los Angeles, United States of America
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, Ont., Canada
| | - Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, Denmark
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Sass L, Feyaerts J. Self-Disorder in Schizophrenia: A Revised View (2. Theoretical Revision-Hyperreflexivity). Schizophr Bull 2024; 50:472-483. [PMID: 38069907 PMCID: PMC10919789 DOI: 10.1093/schbul/sbad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
A growing body of research supports the role of self-disorders as core phenotypic features of schizophrenia-spectrum conditions. Self-disorders comprise various alterations of conscious experience whose theoretical understanding continues to present a challenge. This is the second of two articles that aim to clarify the nature of self-disorders in schizophrenia by considering the currently most influential, phenomenological model of schizophrenia: the basic-self-disturbance or ipseity-disorder model (IDM). The previous paper (article 1) presented a state-of-the-art overview of this model and critically assessed its descriptive adequacy with respect to the clinical heterogeneity and variability of the alterations in self- and world-awareness characteristic of schizophrenia. This paper (article 2) proposes a theoretical revision by considering how hyperreflexivity might form the crucial common thread or generating factor that unifies the heterogeneous, and sometimes even contradictory features of schizophrenic self-disorders. We outline implications of our revised model (IDMrevised) for explanatory research, therapeutic practice, and our general understanding of the abnormalities in question.
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Affiliation(s)
- Louis Sass
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, USA
| | - Jasper Feyaerts
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Krcmar M, Wannan CMJ, Lavoie S, Allott K, Davey CG, Yuen HP, Whitford T, Formica M, Youn S, Shetty J, Beedham R, Rayner V, Murray G, Polari A, Gawęda Ł, Koren D, Sass L, Parnas J, Rasmussen AR, McGorry P, Hartmann JA, Nelson B. The self, neuroscience and psychosis study: Testing a neurophenomenological model of the onset of psychosis. Early Interv Psychiatry 2024; 18:153-164. [PMID: 37394278 DOI: 10.1111/eip.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023]
Abstract
AIM Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self-disturbance model of psychosis by examining the relationship between specific clinical, neurocognitive, and neurophysiological variables in UHR patients, and (2) develop a prediction model using these neurophenomenological disturbances for persistence or deterioration of UHR symptoms at 12-month follow-up. METHODS SNAP is a longitudinal observational study. Participants include 400 UHR individuals, 100 clinical controls with no attenuated psychotic symptoms, and 50 healthy controls. All participants complete baseline clinical and neurocognitive assessments and electroencephalography. The UHR sample are followed up for a total of 24 months, with clinical assessment completed every 6 months. RESULTS This paper presents the protocol of the SNAP study, including background rationale, aims and hypotheses, design, and assessment procedures. CONCLUSIONS The SNAP study will test whether neurophenomenological disturbances associated with basic self-disturbance predict persistence or intensification of UHR symptomatology over a 2-year follow up period, and how specific these disturbances are to a clinical population with attenuated psychotic symptoms. This may ultimately inform clinical care and pathoaetiological models of psychosis.
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Affiliation(s)
- Marija Krcmar
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Cassandra M J Wannan
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher G Davey
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Whitford
- School of Psychology, University of New South Wales (UNSW), Kensington, New South Wales, Australia
| | - Melanie Formica
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Youn
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jashmina Shetty
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Beedham
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria Rayner
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Graham Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrea Polari
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Dan Koren
- Psychology Department, University of Haifa, Haifa, Israel
| | - Louis Sass
- Department of Clinical Psychology, GSAPP-Rutgers University, Piscataway, New Jersey, USA
| | - Josef Parnas
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Andreas R Rasmussen
- Orygen, Parkville, Parkville, Victoria, Australia
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Patrick McGorry
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica A Hartmann
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barnaby Nelson
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Gundersen KB, Rasmussen AR, Sandström KO, Albert N, Polari A, Ebdrup BH, Nelson B, Glenthøj LB. Treatment of schizotypal disorder: a protocol for a systematic review of the evidence and recommendations for clinical practice. BMJ Open 2023; 13:e075140. [PMID: 37977859 PMCID: PMC10660957 DOI: 10.1136/bmjopen-2023-075140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Schizotypal disorder is associated with a high level of disability at an individual level and high societal costs. However, clinical recommendations for the treatment of schizotypal disorder are scarce and based on limited evidence. This review aims to synthesise the current evidence on treatment for schizotypal disorder making recommendations for clinical practice. METHODS AND ANALYSIS This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search will be performed in PsychArticles, Embase, Medline and Cochrane Central Register of Controlled Trials. Additionally, we will search for relevant articles manually. Inclusion criteria are published studies including individuals diagnosed with schizotypal personality disorder according to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, or schizotypal disorder according to International Classification of Diseases (ICD) criteria. We will include interventional studies comprising any pharmacological and non-pharmacological treatment trials for patients with schizotypal disorder, and all relevant outcome measures will be reported. Risk of bias will be assessed by Cochrane risk-of-bias tools. Data will be synthesised using narrative or thematic analysis and, if suitable, through meta-analysis. ETHICS AND DISSEMINATION No original data will be collected as part of this study and ethics approval is, therefore, not applicable. The results will be disseminated through peer-reviewed publication and presented at international scientific meetings. We will aim at submitting the final paper for publication within 4 months of completion of analyses. Furthermore, this systematic review will inform clinicians and researchers on the current state of evidence on treatment for schizotypal disorder. Findings may guide proposals for further research and potentially guide recommendations for clinical practice using the Grading of Recommendations Assessment, Development and Evaluation. PROSPERO REGISTRATION NUMBER CRD42022375001.
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Affiliation(s)
- Kristina Ballestad Gundersen
- VIRTU research group, Copenhagen Research Centre for Mental Health, Hellerup, Denmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Rosén Rasmussen
- Mental Health Center Amager, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katharina Oravsky Sandström
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Nikolai Albert
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health (CORE), Hellerup, Denmark
| | - Andrea Polari
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen Specialist Program, Parkville, Victoria, Australia
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Louise Birkedal Glenthøj
- VIRTU research group, Copenhagen Research Centre for Mental Health, Hellerup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Mohn-Haugen CR, Møller P, Mohn C, Larøi F, Teigset CM, Øie MG, Rund BR. Anomalous self-experiences and neurocognitive functioning in adolescents at risk for psychosis: Still no significant associations found between these two vulnerability markers. Compr Psychiatry 2023; 125:152400. [PMID: 37451231 DOI: 10.1016/j.comppsych.2023.152400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Anomalous self-experiences (ASEs) and neurocognitive impairments are considered essential domains of vulnerability for developing psychotic disorders. However, little research exists of possible associations between ASEs and neurocognitive functions in individuals at-risk for psychosis. The interconnections between ASEs and neurocognitive impairments should therefore be clarified as much as possible, especially in young individuals at risk. No previous studies have investigated these two fundamental domains in non-help-seeking adolescents at risk for developing psychosis. METHODS This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). Adolescents (N = 48, 94% females, mean age = 15.3) were invited to participate after completing a 14-year-old survey distributed by MoBA. At-risk adolescents were selected based on the 0.4% highest scores on 19 items assessing both psychotic-like experiences and ASEs. Five specifically selected and formulated items measuring ASEs were computed to an ASEs total score. Neurocognitive functioning was assessed using the MATRICS Consensus Cognitive Battery. RESULTS Regression analyses revealed no significant relationships between ASEs and any neurocognitive domain. CONCLUSIONS We did not find any significant associations between ASEs and neurocognitive functions in non-help-seeking adolescents at risk for psychotic disorders, which is in line with reports from other types of cohorts. Thus, ASEs and neurocognitive functions may be understood as two relatively separate domains that co-exist in at-risk states. These results underline the need for a wider scope when making predictions about future trajectories, e.g. the development of psychotic disorders. Including both ASEs and neurocognitive functioning in at-risk populations may increase the specificity of vulnerability criteria in this population and enhance our understanding of early psychosis psychopathology.
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Affiliation(s)
- Caroline Ranem Mohn-Haugen
- Research Department, Vestre Viken Hospital Trust, 3004 Drammen, Norway; Department of Psychology, P. O. Box 1094 Blindern, University of Oslo, 0317, Oslo, Norway.
| | - Paul Møller
- Department of Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Christine Mohn
- Norment Centre, Institute of Clinical Medicine, University of Oslo, P. O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Frank Larøi
- Department of Psychology, P. O. Box 1094 Blindern, University of Oslo, 0317, Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, B-4000, Belgium
| | | | - Merete Glenne Øie
- Department of Psychology, P. O. Box 1094 Blindern, University of Oslo, 0317, Oslo, Norway
| | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust, 3004 Drammen, Norway; Department of Psychology, P. O. Box 1094 Blindern, University of Oslo, 0317, Oslo, Norway
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9
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Baklund L, Røssberg JI, Møller P. Linguistic markers and basic self-disturbances among adolescents at risk of psychosis. A qualitative study. EClinicalMedicine 2023; 55:101733. [PMID: 36386038 PMCID: PMC9661513 DOI: 10.1016/j.eclinm.2022.101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Language impairments are key features of schizophrenia spectrum disorders, and have also been suggested to signal enhanced psychosis risk. Incoherence, derailment, and monotonous speaking are however closely related to psychosis onset, and thus not very early markers. Recent phenomenologic-psychiatric studies claim that basic self-disturbance (BSD) may represent more useful early markers. Methods We searched for distinctive irregular linguistics of 30 CHR outpatient adolescents, aged 12-18 years. Standard instruments established psychosis risk and BSD. Participants chose three personal and well manifested BSD phenomena. Ninety verbatim statements were analyzed and grouped into higher order clusters of linguistic irregularities. Findings We identified five clusters of irregular language features: distinctive words, describing an atmosphere of unreality; irregular use of prepositions, indicating experiential detachment; shifts of personal pronouns, indicating identity confusion; near-literal use of metaphors and conjunctions indicating existential insecurity, and idiosyncratic use of adjectives indicating perceptual transcendence. Interpretation The adolescents provided naturalistic descriptions of experiences that were markedly twisted and almost ineffable. This unique irregular "BSD -language" was highly meaningful in its proper context, expressing informative characteristics of first-personal experiential alterations, essential for early detection. The features may additionally represent precursors of psychosis transition, useful for clinical decision-making. Funding Foundation Dam, Oslo, Norway (Grant Number 2017/FO143368).
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Affiliation(s)
- Lise Baklund
- Division of Mental Health and Addiction, Department of Mental Health Research and Development, Vestre Viken, Drammen, Norway
- Vestre Viken HF, FoU-avdelingen, P.O. Box 800, Drammen 3004, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo N-0424, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, Oslo 0318, Norway
| | - Paul Møller
- Division of Mental Health and Addiction, Department of Mental Health Research and Development, Vestre Viken, Drammen, Norway
- Vestre Viken HF, FoU-avdelingen, P.O. Box 800, Drammen 3004, Norway
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10
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Barattieri di San Pietro C, de Girolamo G, Luzzatti C, Marelli M. Agency of Subjects and Eye Movements in Schizophrenia Spectrum Disorders. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 2022; 51:1371-1391. [PMID: 35841496 PMCID: PMC9646601 DOI: 10.1007/s10936-022-09903-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
People with schizophrenia spectrum disorders (SSD) show anomalies in language processing with respect to "who is doing what" in an action. This linguistic behavior is suggestive of an atypical representation of the formal concepts of "Agent" in the lexical representation of a verb, i.e., its thematic grid. To test this hypothesis, we administered a silent-reading task with sentences including a semantic violation of the animacy trait of the grammatical subject to 30 people with SSD and 30 healthy control participants (HCs). When the anomalous grammatical subject was the Agent of the event, a significant increase of Gaze Duration was observed in HCs, but not in SSDs. Conversely, when the anomalous subject was a Theme, SSDs displayed an increased probability of go-back movements, unlike HCs. These results are suggestive of a higher tolerability for anomalous Agents in SSD compared to the normal population. The fact that SSD participants did not show a similar tolerability for anomalous Themes rules out the issue of an attention deficit. We suggest that general communication abilities in SSD might benefit from explicit training on deep linguistic structures.
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Affiliation(s)
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Claudio Luzzatti
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
- Milan Center for Neuroscience, Milan, Italy
| | - Marco Marelli
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
- Milan Center for Neuroscience, Milan, Italy
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11
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Eckstein KN, Rosenbaum D, Zehender N, Pleiss S, Platzbecker S, Martinelli A, Herrmann ML, Wildgruber D. Induced feelings of external influence during instructed imaginations in healthy subjects. Front Psychol 2022; 13:1005479. [PMID: 36389532 PMCID: PMC9664387 DOI: 10.3389/fpsyg.2022.1005479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/14/2022] [Indexed: 01/25/2023] Open
Abstract
The psychopathological phenomenon of delusions of influence comprises variable disturbances of the self-environment-border leading to the feeling of external influence on thoughts, feelings, impulses or behaviors. Delusions of influence are a hallmark in psychotic illness, but nevertheless, attenuated forms can also appear in healthy individuals. Here we present a newly developed paradigm to induce and assess feelings of external influence during instructed imaginations in healthy individuals. In the current study, we asked 60 healthy individuals to visually imagine different objects. To induce feelings of external influence, we applied one of three different physical setups (low-amplitude transcranial direct current stimulation, eye contact, or skin-to-skin hand touch), and informed the participants whether or not an external influence was attempted during the respective trial. The physical setup (setup vs. no setup, Z = -3.847, p < 0.001, r = 0.497) as well as the information given to the participants (confirmation vs. negation, Z = -5.218, p < 0.001, r = 0.674) alone were able to modulate the feeling of external influence in all three interventions. The impact of information (whether influence was attempted or not attempted) significantly exceeded the impact of the physical setup on the ratings of experienced external influence (Z = -2.394, p = 0.016, r = 0.310). Moreover, the response latency correlated with the estimated feeling of external influence (r S = 0.392, p = 0.002). Additional analyses addressed the influence of the emotional content of imagined objects and examined the intensity and emotional valence of the imaginations. Further supplemental analyses correlated external influence estimation of the participants with other psychopathological measures (trait markers for supernatural beliefs, proneness to hallucinations, and delusions and attributional style). In conclusion, this study endorses a quantitative model of psychopathological characteristics, in this case feelings of external influence that can be induced by external cues.
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Affiliation(s)
- Kathrin N. Eckstein
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany,*Correspondence: Kathrin N. Eckstein,
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
| | - Nadine Zehender
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany,Department of Psychiatry and Psychotherapy, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sonja Pleiss
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
| | - Sharon Platzbecker
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
| | - Anne Martinelli
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany,School of Psychology, Fresenius University of Applied Sciences, Frankfurt am Main, Germany
| | - Matthias L. Herrmann
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany,Department of Neurology and Neuroscience, Medical Center, University of Freiburg, Freiburg, Germany
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
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12
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Sandsten KE, Wainio‐Theberge S, Nordgaard J, Kjaer TW, Northoff G, Parnas J. Relating self-disorders to neurocognitive and psychopathological measures in first-episode schizophrenia. Early Interv Psychiatry 2022; 16:1202-1210. [PMID: 35081668 PMCID: PMC9786869 DOI: 10.1111/eip.13269] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/27/2021] [Accepted: 01/18/2022] [Indexed: 12/30/2022]
Abstract
AIM The notion of a disturbed self as the core feature of schizophrenia dates back to the founding texts on the illness. Since the development of the psychometric tool for examination of anomalous self-experience (EASE), self-disorders have become accessible to empirical research. Empirical studies have shown that EASE measured self-disorders predict schizophrenia spectrum in prospective studies and consistently show a selective hyper aggregation of self-disorder in schizophrenia and schizotypal disorders. The aim of this study is to investigate the relationship between self-disorders cognitive deficits and symptoms in schizophrenia. METHODS Thirty-five non-acute first-episode patients with schizophrenia and 35 matched healthy controls were evaluated with EASE, cognitive deficits, and symptoms (PANSS positive, negative and general). [Correction added on 28 January 2022, after first online publication: the words, 'evaluated with' were missing and have now been added to the preceding sentence.] RESULTS: The results show that self-disorders and symptoms are correlated among patients with schizophrenia, but not with cognitive deficits. Moreover, with the exception of attentional deficits, neurocognitive impairment was not significantly higher among patients with schizophrenia compared to healthy controls. CONCLUSIONS We argue that this adds support to a view of schizophrenia as being characterized by specific traits of pre-reflective self-disturbance, which are related to the severity of symptoms, whereas neurocognitive impairment reflects a separate or distinct aspect of schizophrenia.
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Affiliation(s)
| | | | - Julie Nordgaard
- Mental Health Center AmagerUniversity Hospital of CopenhagenCopenhagenDenmark
| | | | - Georg Northoff
- University of Ottawa Institute of Mental Health ResearchOttawaOntarioCanada
| | - Josef Parnas
- Mental Health Center GlostrupUniversity Hospital of CopenhagenCopenhagenDenmark
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13
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Tonna M, Lucarini V, Lucchese J, Presta V, Paraboschi F, Marsella F, Daniel BD, Vitale M, Marchesi C, Gobbi G. Posture, gait and self‐disorders: An empirical study in individuals with schizophrenia. Early Interv Psychiatry 2022; 17:447-461. [PMID: 37156494 DOI: 10.1111/eip.13340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/17/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
AIM In schizophrenia, subjectively perceived disruptions of the sense of the Self (also referred to as "self-disorders") seem to be intimately associated with a perturbation of the implicit awareness of one's own body. Indeed, an early impairment of the motor system, including posture and gait, is now considered a marker of schizophrenia neurodevelopmental substrate and appears more pronounced in early-onset schizophrenia. Therefore, the present study was aimed at: (1) investigating a possible relationship between self-disorders, symptom dimensions and postural and gait profile in schizophrenia; (2) identifying a specific motor profile in early-onset conditions. METHODS A total of 43 schizophrenia outpatients and 38 healthy controls underwent an exhaustive investigation of posture and gait pattern. The positive and negative syndrome scale (PANSS), the examination of anomalous self experience scale (EASE) and the abnormal involuntary movement scale (AIMS) were administered to the schizophrenia group. Subsequently, schizophrenia patients were divided into early and adult-onset subgroups and compared with respect to their motor profile. RESULTS We found an association between specific postural patterns (impaired sway area), a general disruption of the gait cycle and subjective bodily experiences (concerning the loss of bodily integrity, cohesion and demarcation). Only motor parameters (increased sway area and gait cadence reduction) differentiated between early and adult-onset patients. CONCLUSION The results of the present study hint at a link between motor impairment and self-disturbances in schizophrenia and candidate a specific motor profile as a possible marker of early-onset forms.
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Affiliation(s)
- Matteo Tonna
- Department of Medicine and Surgery, Psychiatry Unit, University of Parma, Parma, Italy
- Department of Mental Health, Local Health Service, Parma, Italy
| | | | - Jacopo Lucchese
- Department of Medicine and Surgery, Psychiatry Unit, University of Parma, Parma, Italy
| | - Valentina Presta
- Department of Medicine and Surgery, Human Anatomy, University of Parma, Parma, Italy
| | | | - Filippo Marsella
- Department of Mental Health, Local Health Service, Reggio Emilia, Italy
| | | | - Marco Vitale
- Department of Medicine and Surgery, Human Anatomy, University of Parma, Parma, Italy
- Department of Medicine and Surgery, Movement Analysis Laboratory (LAM), University of Parma, Parma, Italy
| | - Carlo Marchesi
- Department of Medicine and Surgery, Psychiatry Unit, University of Parma, Parma, Italy
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Giuliana Gobbi
- Department of Medicine and Surgery, Human Anatomy, University of Parma, Parma, Italy
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14
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Mitchell J, Meehan T. How art-as-therapy supports participants with a diagnosis of schizophrenia: A phenomenological lifeworld investigation. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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15
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Pelizza L, Leuci E, Maestri D, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Examining disorganization in patients with first episode psychosis: Findings from a 1-year follow-up of the 'Parma early psychosis' program. Early Interv Psychiatry 2022; 16:552-560. [PMID: 34279049 DOI: 10.1111/eip.13198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/09/2021] [Accepted: 07/04/2021] [Indexed: 12/22/2022]
Abstract
AIM Disorganization has been considered as a clinical domain close to the core of psychosis. However, it has received poor attention, especially at the illness onset. Moreover, most of the studies examining disorganized symptoms have been conducted in patients with chronic psychosis and research in the early stages of illness is still relatively scarce. Thus, the aims of this study were (a) to longitudinally monitor the stability of disorganization in patients with first episode psychosis (FEP) across a 1-year follow-up period, and (b) to investigate any relevant association of disorganized symptoms with functioning, psychopathology and the specific treatment components of an 'early intervention in psychosis' (EIP) program along the 1 year of follow-up. METHODS At baseline, 312 FEP participants (aged 12-35 years) completed the positive and negative syndrome scale (PANSS) and the global assessment of functioning (GAF). Spearman's correlations and multiple linear regression analysis were used. RESULTS At baseline, disorganization showed significant associations with all PANSS subscores, and a relevant negative correlation with GAF score. Across the follow-up, FEP individuals showed a significant improvement in disorganization severity. This decrease was specifically related to both baseline antipsychotic dosage and the number of individual cognitive-behavioural therapy sessions offered across the 1-year follow-up period. CONCLUSIONS Disorganization is clinically relevant in FEP patients, already ate the enrollment in an EIP program. However, it tends to improve over time together with the delivery of specialized, person-tailored FEP interventions within a specific EIP protocol.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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16
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Basic self-disturbance trajectories in clinical high risk for psychosis: a one-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2022; 272:1007-1019. [PMID: 34783878 PMCID: PMC9388413 DOI: 10.1007/s00406-021-01349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
Basic self-disturbance (BSD) has been proposed as a driver of symptom development in schizophrenia spectrum disorders (SSDs). In a one-year follow-up of 32 patients (15-30 years) at putative risk for psychosis, we investigated trajectories of BSD levels from baseline to follow-up, and associations between clinical characteristics at baseline and follow-up, including follow-up levels of BSD (assessed with the EASE). Clinical high risk (CHR) for psychosis status and symptom severity were assessed with the SIPS/SOPS scales and also according to the cognitive basic symptoms high-risk criteria (COGDIS). DSM-IV diagnoses, functioning and other clinical characteristics were assessed with standard clinical instruments. Higher severity of negative symptoms and meeting COGDIS criteria at baseline were associated with higher BSD levels at follow-up. All measured at follow-up, higher BSD levels correlated with higher severity of positive, negative, disorganization and general symptoms, and with a lower level of global functioning. We found higher BSD levels at follow-up in subjects with schizotypal personality disorder (SPD) at baseline (n = 5) and in SSDs at follow-up (n = 12, including nine with SPD). Mean BSD levels decreased significantly from baseline to follow-up, but individual trajectories varied considerably. Increased BSD levels were associated with higher baseline BSD levels, non-remission of positive symptoms and functional decline. Overall, the current study indicates that subgroups in the CHR population with a higher risk of non-remission or deterioration may be identified by supplementing CHR criteria with assessment of BSD and negative symptoms.
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17
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Lindhardt L, Nilsson LS, Munk-Jørgensen P, Mortensen OS, Simonsen E, Nordgaard J. Unrecognized schizophrenia spectrum and other mental disorders in youth disconnected from education and work-life. Front Psychiatry 2022; 13:1015616. [PMID: 36386963 PMCID: PMC9645021 DOI: 10.3389/fpsyt.2022.1015616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Schizophrenia spectrum disorders typically emerge during adolescence or early adulthood. Often the symptomatology is vague initially, while a marked functional decline and social withdrawal can be seen. A group of young people with such social and functional impairments is the so-called "Not in Education, Employment or Training" (NEET), i.e., a youth population that is socially disconnected from education and work-life. Despite the NEET group's disconnection from important parts of social life and a rising concern of an intersection with mental health problems, a psychopathological perspective on the problems experienced by this group remains underexplored. AIM To examine a NEET sample for psychopathology and if relevant allocate psychiatric diagnoses. METHODS We performed an interview study comprising 40 participants from youth job-counseling services. All underwent a comprehensive psychiatric evaluation. Inclusion criteria were 18-29 years of age and a welfare benefit history of minimum 6 months. RESULTS Diagnostic criteria of any mental disorder were fulfilled by 95% of the sample; half of whom were diagnosed with a schizophrenia spectrum disorder. The participants with schizophrenia spectrum disorders had lower global functioning, were more often in contact with the mental health services and had higher PANSS and Examination of Anomalous Self-Experiences (EASE) scores compared to those with non-schizophrenia spectrum disorders. The participants fulfilling the criteria for schizophrenia spectrum disorders had lower EASE and PANSS scores than usually reported in the literature, suggesting more "symptom-poor" presentations. CONCLUSION Psychiatric illness and particularly schizophrenia spectrum disorders affecting social interaction and the ability to take part in educational and work-life were grossly overrepresented in the NEET sample. Our findings suggest that pronounced social disconnection in youth in and of itself should lead to suspect the presence of a severe mental disorder.
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Affiliation(s)
- Line Lindhardt
- Early Psychosis Intervention Center, Mental Health Services East, Psychiatry Region Zealand, Roskilde, Denmark
| | - Lars Siersbæk Nilsson
- Mental Health Center Amager, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
| | | | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbæk Hospital, Holbæk, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Mental Health Services East, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Nordgaard
- Mental Health Center Amager, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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18
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Pionke-Ubych R, Frydecka D, Cechnicki A, Krężołek M, Nelson B, Gawęda Ł. Integrating trauma, self-disturbances, cognitive biases, and personality into a model for the risk of psychosis: a longitudinal study in a non-clinical sample. Eur Arch Psychiatry Clin Neurosci 2022; 272:1073-1085. [PMID: 34859297 PMCID: PMC9388435 DOI: 10.1007/s00406-021-01355-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
The hypothesis of the psychosis continuum enables to study the mechanisms of psychosis risk not only in clinical samples but in non-clinical as well. The aim of this longitudinal study was to investigate self-disturbances (SD), a risk factor that has attracted substantial interest over the last two decades, in combination with trauma, cognitive biases and personality, and to test whether SD are associated with subclinical positive symptoms (PS) over a 12-month follow-up period. Our study was conducted in a non-clinical sample of 139 Polish young adults (81 females, age M = 25.32, SD = 4.51) who were selected for frequent experience of subclinical PS. Participants completed self-report questionnaires for the evaluation of SD (IPASE), trauma (CECA.Q), cognitive biases (DACOBS) and personality (TCI), and were interviewed for subclinical PS (CAARMS). SD and subclinical PS were re-assessed 12 months after baseline measurement. The hypothesized model for psychosis risk was tested using path analysis. The change in SD and subclinical PS over the 12-month period was investigated with non-parametric equivalent of dependent sample t-tests. The models with self-transcendence (ST) and harm avoidance (HA) as personality variables were found to be well-fitted and explained 34% of the variance in subclinical PS at follow-up. Moreover, we found a significant reduction of SD and subclinical PS after 12 months. Our study suggests that combining trauma, cognitive biases, SD and personality traits such as ST and HA into one model can enhance our understanding of appearance as well as maintenance of subclinical PS.
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Affiliation(s)
- Renata Pionke-Ubych
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza 1, 00-378 Warsaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College Jagiellonian University, Krakow, Poland
| | - Martyna Krężołek
- II Department of Psychiatry, The Medical University of Warsaw, Warszaw, Poland
| | - Barnaby Nelson
- Orygen, Parkville, VIC Australia ,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC Australia
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza 1, 00-378, Warsaw, Poland.
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19
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Henriksen MG, Raballo A, Nordgaard J. Self-disorders and psychopathology: a systematic review. Lancet Psychiatry 2021; 8:1001-1012. [PMID: 34688345 DOI: 10.1016/s2215-0366(21)00097-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 01/01/2023]
Abstract
In foundational texts on schizophrenia, the mental disorder was constitutively linked to a specific disintegration of subjectivity (often termed a self-disorder). Apart from Scharfetter's work on ego-pathology, research on self-disorders generally faded into oblivion, and self-disorders were only rediscovered as notable psychopathological features of the schizophrenia spectrum nearly two decades ago. Subsequently, the Examination of Anomalous Self-Experience (EASE) scale was constructed to allow systematic assessment of non-psychotic self-disorders. This Review is the first systematic review of empirical studies on self-disorders based on the EASE or other related scales. The results consistently show that self-disorders hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders; that self-disorders are found in individuals at a clinical risk of developing psychosis; that self-disorders show a high degree of temporal stability; that self-disorders predict the later development of schizophrenia spectrum disorders; and that self-disorders correlate with the canonical dimensions of the psychopathology of schizophrenia, impaired social functioning, and suicidality. Issues with the methods of the reviewed literature are critically discussed and the role of self-disorders in clinical psychiatry and future research is outlined.
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Affiliation(s)
- Mads Gram Henriksen
- Centre for Subjectivity Research, Department of Communication, University of Copenhagen, Copenhagen, Denmark; Mental Health Centre Amager, University Hospital of Copenhagen, Copenhagen, Denmark; Mental Health Centre Glostrup, University Hospital of Copenhagen, Copenhagen, Denmark.
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy; Centre for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| | - Julie Nordgaard
- Mental Health Centre Amager, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Nordgaard J, Henriksen MG, Jansson L, Handest P, Møller P, Rasmussen AR, Sandsten KE, Nilsson LS, Zandersen M, Zahavi D, Parnas J. Disordered Selfhood in Schizophrenia and the Examination of Anomalous Self-Experience: Accumulated Evidence and Experience. Psychopathology 2021; 54:275-281. [PMID: 34384082 PMCID: PMC8686724 DOI: 10.1159/000517672] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
Disordered selfhood in schizophrenia was rediscovered at the turn of the millennium. In 2005, Psychopathology published the psychometric instrument, the Examination of Anomalous Self-Experience (EASE). In this article, we summarize the historical background of the creation of the EASE, explicate the notion of the disorder of basic or minimal self with the help of phenomenological philosophy, and provide a brief description of clinical manifestations targeted by the EASE. We also present our personal experience using and teaching the EASE and summarize the empirical evidence obtained so far. We conclude that the basic self-disorder represents a crucial phenotype of schizophrenia spectrum disorders and that this phenotype offers a potential avenue to empirical pathogenetic research and psychotherapeutic treatment.
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Affiliation(s)
- Julie Nordgaard
- Mental Health Center Amager, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mads Gram Henriksen
- Mental Health Center Amager, Copenhagen, Denmark
- Mental Health Center Glostrup, Broendby, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Lennart Jansson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Center Glostrup, Broendby, Denmark
| | | | - Paul Møller
- Division of Mental Health and Addicition, Department of Mental Health Research and Development, Vestre Viken Hospital Trust, Drammen, Norway
| | - Andreas Rosen Rasmussen
- Mental Health Center Amager, Copenhagen, Denmark
- Mental Health Center Glostrup, Broendby, Denmark
| | | | - Lars Siersbæk Nilsson
- Mental Health Center Glostrup, Broendby, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Maja Zandersen
- Mental Health Center Glostrup, Broendby, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Dan Zahavi
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Josef Parnas
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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21
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Donati FL, Fecchio M, Maestri D, Cornali M, Derchi CC, Casetta C, Zalaffi M, Sinigaglia C, Sarasso S, D'Agostino A. Reduced readiness potential and post-movement beta synchronization reflect self-disorders in early course schizophrenia. Sci Rep 2021; 11:15044. [PMID: 34294767 PMCID: PMC8298598 DOI: 10.1038/s41598-021-94356-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/06/2021] [Indexed: 02/05/2023] Open
Abstract
Disturbances of conscious awareness, or self-disorders, are a defining feature of schizophrenia. These include symptoms such as delusions of control, i.e. the belief that one's actions are controlled by an external agent. Models of self-disorders point at altered neural mechanisms of source monitoring, i.e. the ability of the brain to discriminate self-generated stimuli from those driven by the environment. However, evidence supporting this putative relationship is currently lacking. We performed electroencephalography (EEG) during self-paced, brisk right fist closures in ten (M = 9; F = 1) patients with Early-Course Schizophrenia (ECSCZ) and age and gender-matched healthy volunteers. We measured the Readiness Potential (RP), i.e. an EEG feature preceding self-generated movements, and movement-related EEG spectral changes. Self-disorders in ECSCZ were assessed with the Examination of Anomalous Self-Experience (EASE). Patients showed a markedly reduced RP and altered post-movement Event-Related Synchronization (ERS) in the beta frequency band (14-24 Hz) compared to healthy controls. Importantly, smaller RP and weaker ERS were associated with higher EASE scores in ECSCZ. Our data suggest that disturbances of neural correlates preceding and following self-initiated movements may reflect the severity of self-disorders in patients suffering from ECSCZ. These findings point towards deficits in basic mechanisms of sensorimotor integration as a substrate for self-disorders.
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Affiliation(s)
- Francesco Luciano Donati
- Department of Health Sciences, University of Milan, Ospedale San Paolo, Blocco A, Piano 9. Via Antonio di Rudinì, 8, 20142, Milan, MI, Italy.
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Matteo Fecchio
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Padiglione 'LITA', Piano 5, Via Gian Battista Grassi, 74, 20157, Milan, MI, Italy
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Davide Maestri
- Department of Health Sciences, University of Milan, Ospedale San Paolo, Blocco A, Piano 9. Via Antonio di Rudinì, 8, 20142, Milan, MI, Italy
| | - Mattia Cornali
- Department of Health Sciences, University of Milan, Ospedale San Paolo, Blocco A, Piano 9. Via Antonio di Rudinì, 8, 20142, Milan, MI, Italy
| | | | - Cecilia Casetta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Maristella Zalaffi
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Padiglione 'LITA', Piano 5, Via Gian Battista Grassi, 74, 20157, Milan, MI, Italy
| | | | - Simone Sarasso
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Padiglione 'LITA', Piano 5, Via Gian Battista Grassi, 74, 20157, Milan, MI, Italy.
| | - Armando D'Agostino
- Department of Health Sciences, University of Milan, Ospedale San Paolo, Blocco A, Piano 9. Via Antonio di Rudinì, 8, 20142, Milan, MI, Italy
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Anomalous self-experiences are related to general cognition deficits in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:707-712. [PMID: 33221938 DOI: 10.1007/s00406-020-01213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/07/2020] [Indexed: 12/29/2022]
Abstract
Anomalous self-experiences (ASEs) are prevalent in schizophrenia, but its underpinnings are not completely understood. Given the likely complex substrate of the experience of the self, neurocognitive functions requiring coordinate cerebral activity may relate to ASEs. Moreover, cognitive deficits functioning may be involved in the link between self-experience disturbances and some aspects of social dysfunction in schizophrenia. We have assessed ASEs in 41 schizophrenia patients (11 first episodes) using the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE), and the general cognition using the Brief Assessment of Cognition in Schizophrenia (BACS). Besides, social cognition was assessed using two complementary tools Meyer, Salovey and Caruso Emotional Intelligence Test (MSCEIT) and GEOPTE (Grupo Español para la Optimización del Tratamiento de la Esquizofrenia). The results revealed that Self-awareness/presence and Somatization IPASE scores were inversely explained by motor speed in the BACS; Consciousness IPASE scores were inversely explained by problem solving performance in the BACS. These data reveal a significant relationship between certain domains of general cognition and anomalous self-experiences, that may be useful in further investigation on the substrates of ASEs.
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23
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Salice A, Henriksen MG. Disturbances of Shared Intentionality in Schizophrenia and Autism. Front Psychiatry 2021; 11:570597. [PMID: 33643078 PMCID: PMC7902514 DOI: 10.3389/fpsyt.2020.570597] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia and autism are today considered complex spectrum disorders characterized by difficulties in social behavior. Drawing on recent advances in collective or shared intentionality studies, we present a novel theoretical approach to these social difficulties by exploring them from the angle of shared intentionality. We begin by describing two forms of shared intentionality: joint intentionality and we-intentionality. Joint intentionality crucially relies on the agents' mentalizing abilities such as mind reading and the ability to factor in (or "to be moved" by) their partner's intentions in deliberation and action planning. By contrast, we-intentionality relies on the agents' capacity to understand themselves as group members and to adopt the group's perspective. In schizophrenia spectrum disorders, we propose that joint intentionality remains unaffected, but we-intentionality may be impaired. In severe autism spectrum disorder (i.e., infantile autism), we propose that both forms of shared intentionality are impaired. We suggest that the source of the problems affecting we-intentionality in schizophrenia spectrum disorders lies primarily in trait-like, anomalous self-experiences. In severe autism spectrum disorder, we suggest that problems with mind reading, the ability to "be moved" by others' intentions, and with the capacity for perspective-taking impede both forms of shared intentionality.
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Affiliation(s)
- Alessandro Salice
- Department of Philosophy, University College Cork, Cork, Ireland
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Mads Gram Henriksen
- Department of Communication, Center for Subjectivity Research, University of Copenhagen & Mental Health Center Amager/Glostrup, Copenhagen, Denmark
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24
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Klar P, Northoff G. When the World Breaks Down: A 3-Stage Existential Model of Nihilism in Schizophrenia. Psychopathology 2021; 54:169-192. [PMID: 34198308 PMCID: PMC8619772 DOI: 10.1159/000516814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
The existential crisis of nihilism in schizophrenia has been reported since the early days of psychiatry. Taking first-person accounts concerning nihilistic experiences of both the self and the world as vantage point, we aim to develop a dynamic existential model of the pathological development of existential nihilism. Since the phenomenology of such a crisis is intrinsically subjective, we especially take the immediate and pre-reflective first-person perspective's (FPP) experience (instead of objectified symptoms and diagnoses) of schizophrenia into consideration. The hereby developed existential model consists of 3 conceptualized stages that are nested into each other, which defines what we mean by existential. At the same time, the model intrinsically converges with the phenomenological concept of the self-world structure notable inside our existential framework. Regarding the 3 individual stages, we suggest that the onset or first stage of nihilistic pathogenesis is reflected by phenomenological solipsism, that is, a general disruption of the FPP experience. Paradigmatically, this initial disruption contains the well-known crisis of common sense in schizophrenia. The following second stage of epistemological solipsism negatively affects all possible perspectives of experience, that is, the first-, second-, and third-person perspectives of subjectivity. Therefore, within the second stage, solipsism expands from a disruption of immediate and pre-reflective experience (first stage) to a disruption of reflective experience and principal knowledge (second stage), as mirrored in abnormal epistemological limitations of principal knowledge. Finally, the experience of the annihilation of healthy self-consciousness into the ultimate collapse of the individual's existence defines the third stage. The schizophrenic individual consequently loses her/his vital experience since the intentional structure of consciousness including any sense of reality breaks down. Such a descriptive-interpretative existential model of nihilism in schizophrenia may ultimately serve as input for future psychopathological investigations of nihilism in general, including, for instance, its manifestation in depression.
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Affiliation(s)
- Philipp Klar
- Medical Faculty, C. & O. Vogt-Institute for Brain Research, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Georg Northoff
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, China.,Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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25
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Rasmussen AR, Raballo A, Preti A, Sæbye D, Parnas J. Anomalies of Imagination, Self-Disorders, and Schizophrenia Spectrum Psychopathology: A Network Analysis. Front Psychiatry 2021; 12:808009. [PMID: 35111092 PMCID: PMC8801416 DOI: 10.3389/fpsyt.2021.808009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anomalies of imagination encompass disturbances of the basic experiential structure of fantasies and imagery that can be explored in a semi-structured way with the Examination of Anomalous Fantasy and Imagination (EAFI). We aimed (1) to examine the distribution of anomalies of imagination among different diagnostic groups and a group of healthy controls, and (2) to examine their relation with disorders of basic self, perceptual disturbances and canonical state psychopathology of the schizophrenia-spectrum (positive, negative and general symptoms). METHODS The 81 participants included patients with schizophrenia or other non-affective psychosis (N = 32), schizotypal personality disorder (N = 15) or other mental illness (N = 16) and healthy controls (N = 18). The assessment encompassed EAFI, Examination of Anomalous Self-Experience (EASE), parts of Bonn Scale for the Assessment of Basic Symptoms (BSABS) and Positive and Negative Syndrome Scale (PANSS). For network analysis, the associations of EAFI with the other psychopathological variables were tested by Pearson's correlation coefficient and graphically represented using multidimensional clustering. Comparisons between correlations in the network were tested with Steiger's test. RESULTS Anomalies of imagination aggregated significantly in schizophrenia-spectrum disorders compared to other mental illness and healthy controls with no difference between schizophrenia and schizotypal disorder. In the network analysis, anomalies of imagination were closely inter-connected with self-disorders. Although, the anomalies of imagination correlated moderately with perceptual disturbance and positive, negative and general state symptomatology, these dimensions aggregated separately and relatively distant in the network. CONCLUSIONS The results support that anomalies of imagination are highly characteristic of schizophrenia-spectrum disorders and closely related to self-disorders.
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Amager, University of Copenhagen, Copenhagen, Denmark.,Mental Health Center Glostrup, University of Copenhagen, Broendby, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Raballo
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Ditte Sæbye
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Josef Parnas
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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26
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Rosen C, Tufano M, Humpston CS, Chase KA, Jones N, Abramowitz AC, Franco Chakkalakal A, Sharma RP. The Sensory and Perceptual Scaffolding of Absorption, Inner Speech, and Self in Psychosis. Front Psychiatry 2021; 12:649808. [PMID: 34045979 PMCID: PMC8145281 DOI: 10.3389/fpsyt.2021.649808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/09/2021] [Indexed: 12/05/2022] Open
Abstract
This study examines the interconnectedness between absorption, inner speech, self, and psychopathology. Absorption involves an intense focus and immersion in mental imagery, sensory/perceptual stimuli, or vivid imagination that involves decreased self-awareness and alterations in consciousness. In psychosis, the dissolution and permeability in the demarcation between self and one's sensory experiences and perceptions, and also between self-other and/or inter-object boundaries alter one's sense of self. Thus, as the individual integrates these changes new "meaning making" or understanding evolves as part of an ongoing inner dialogue and dialogue with others. This study consisted of 117 participants: 81 participants with psychosis and 36 controls. We first conducted a bivariate correlation to elucidate the relationship between absorption and inner speech. We next conducted hierarchical multiple regressions to examine the effect of absorption and inner speech to predict psychopathology. Lastly, we conducted a network analysis and applied extended Bayesian Information Criterion to select the best model. We showed that in both the control and psychosis group dialogic and emotional/motivational types of inner speech were strongly associated with absorption subscales, apart from the aesthetic subscale in the control group which was not significant, while in psychosis, condensed inner speech was uniquely associated with increased imaginative involvement. In psychosis, we also demonstrated that altered consciousness, dialogic, and emotional/motivational inner speech all predicted positive symptoms. In terms of network associations, imaginative involvement was the most central, influential, and most highly predictive node in the model from which all other nodes related to inner speech and psychopathology are connected. This study shows a strong interrelatedness between absorption, inner speech and psychosis thus identifying potentially fertile ground for future research and directions, particularly in the exploration into the underlying construct of imaginative involvement in psychotic symptoms.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Michele Tufano
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Clara S Humpston
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Kayla A Chase
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Nev Jones
- Department of Psychiatry, University of South Florida, Tampa, FL, United States
| | - Amy C Abramowitz
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
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27
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Nordgaard J, Gravesen-Jensen M, Buch-Pedersen M, Parnas J. Formal Thought Disorder and Self-Disorder: An Empirical Study. Front Psychiatry 2021; 12:640921. [PMID: 33897496 PMCID: PMC8060494 DOI: 10.3389/fpsyt.2021.640921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Formal thought disorder was constitutively linked to the original concept of schizophrenia and has since been one of central features supporting its diagnosis. Bleuler considered formal thought disorder as a fundamental symptom of schizophrenia among other fundamental symptoms, including ego disorders. The contemporary concept of self-disorder represents a more developed, nuanced, and systematic approach to disturbances of self-experience than the Bleulerian concept of ego disorders. As fundamental symptoms, on Bleuler's account, are persistently present in every case, an association between these symptoms could be expected. The purpose of this study was to examine the association between self-disorder and formal thought disorder. Methods: A sample of 94 diagnostically heterogeneous patients was examined for formal thought disorder using clinical rating and a proverb test. The proverb test was analyzed for two different aspects of formal thought disorder: literal responses and bizarre responses. The sample was comprehensively assessed for psychopathology, including self-disorder as measured with the Examination of Anomalous Self-Experience scale. Results: The patients, who provided bizarre responses, had a higher level of self-disorder, more negative symptoms, lower level of social functioning, and lower level of intelligence. Bizarre answers aggregated in patients diagnosed within the schizophrenia spectrum compared with patients outside the schizophrenia spectrum. We found moderate correlations between the two measures of formal thought disorder (clinically rated and bizarre responses) and self-disorder (0.454 [p < 0.01] and 0.328 [p < 0.01]). Literal responses did not differ between diagnostic groups and also did not correlate with bizarre responses. Specificity of bizarre responses for a diagnosis within schizophrenia spectrum was 86.89%, whereas sensitivity was 40.85%. Conclusion: The close relation between formal thought disorder and self-disorder further adds to the notion of self-disorder as a unifying psychopathological core beneath the apparently heterogeneous symptoms of schizophrenia.
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Affiliation(s)
- Julie Nordgaard
- Mental Health Centre Amager, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Josef Parnas
- Mental Health Centre Glostrup, Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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28
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Zandersen M, Parnas J. Exploring schizophrenia spectrum psychopathology in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:969-978. [PMID: 31289925 PMCID: PMC7599140 DOI: 10.1007/s00406-019-01039-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
We have previously argued that the current borderline personality disorder (BPD) diagnosis is over-inclusive and clinically and conceptually impossible to distinguish from the schizophrenia spectrum disorders. This study involves 30 patients clinically diagnosed with BPD as their main diagnosis by three BPD dedicated outpatient treatment facilities in Denmark. The patients underwent a careful and time-consuming psychiatric evaluation involving several senior level clinical psychiatrists and researchers and a comprehensive battery of psychopathological scales. The study found that the vast majority of patients (67% in DSM-5 and 77% in ICD-10) in fact met the criteria for a schizophrenia spectrum disorder, i.e., schizophrenia (20%) or schizotypal (personality) disorder (SPD). The schizophrenia spectrum group scored significantly higher on the level of disorders of core self as measured by the Examination of Anomalous Self-Experiences Scale (EASE). The BPD criterion of "identity disturbance" was significantly correlated with the mean total score of EASE. These findings are discussed in the light of changes from prototypical to polythetic diagnostic systems. We argue that the original prototypes/gestalts informing the creation of BPD and SPD have gone into oblivion during the evolution of polythetic criteria.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark.
| | - Josef Parnas
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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29
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Möller HJ. The place of comorbidity and of subtle psychopathological evaluation. Eur Arch Psychiatry Clin Neurosci 2020; 270:939-940. [PMID: 33095370 DOI: 10.1007/s00406-020-01198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, München, Germany.
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30
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Conneely M, McNamee P, Gupta V, Richardson J, Priebe S, Jones JM, Giacco D. Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis. Schizophr Bull 2020; 47:309-322. [PMID: 32989443 PMCID: PMC7965068 DOI: 10.1093/schbul/sbaa124] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature. METHODS Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis. RESULTS Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss. CONCLUSIONS Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.
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Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,To whom correspondence should be addressed; Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK; tel: +44 020 7540 4380 (ext.: 2308), fax: +44 020 7540 4380, e-mail:
| | - Philip McNamee
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Veenu Gupta
- Department of Primary Care and Mental health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - John Richardson
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Janelle M Jones
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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31
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Rasmussen AR, Reich D, Lavoie S, Li E, Hartmann JA, McHugh M, Whitford TJ, Nelson B. The relation of basic self-disturbance to self-harm, eating disorder symptomatology and other clinical features: Exploration in an early psychosis sample. Early Interv Psychiatry 2020; 14:275-282. [PMID: 31264785 DOI: 10.1111/eip.12850] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/30/2019] [Accepted: 06/09/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS The notion of basic self-disturbance has been proposed as a core feature of schizophrenia-spectrum disorders and as an indicator of future transition to psychosis in high-risk populations. However, the relation of this notion to many clinical characteristics has not been explored. The aim of this study was: (a) to investigate the distribution of self-disturbance and other symptoms dimensions in ultra-high risk (UHR), first-episode psychosis (FEP) and healthy control groups; and (b) to explore the association of self-disturbance with a history of self-harm, suicidal attempt, eating disorder symptomatology, school bullying victimization and sexual or physical abuse. METHODS Patients with UHR status (n = 38) or FEP (n = 26) and healthy controls (n = 33) were assessed with the Examination of Anomalous Self-Experience (EASE) and the Comprehensive Assessment of at Risk Mental States (CAARMS). The clinical-historical variables were assessed through medical records. RESULTS The FEP group scored significantly higher on the EASE than the UHR group, which scored significantly higher than the healthy control group, which had a very low score. Multivariate logistic regression analyses revealed that higher EASE score was significantly associated with a history of self-harm, disordered eating and bullying victimization (but not with suicide attempts or sexual/physical abuse) after controlling for positive, negative and depressive symptoms. CONCLUSION These novel findings suggest that self-disturbance may be related to a history of school bullying victimization, self-harm and eating disorder symptomatology in patients with or at-risk of psychosis. If further confirmed, these findings are potentially relevant to clinical risk assessment and therapy.
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Affiliation(s)
- Andreas R Rasmussen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Mental Health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Reich
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Emily Li
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Meredith McHugh
- Health Care for the Homeless, Baltimore, Maryland.,Youth Empowered Society, Baltimore, Maryland
| | - Thomas J Whitford
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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32
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Well-Being and Self-Disorders in Schizotypal Disorder and Asperger Syndrome/Autism Spectrum Disorder. J Nerv Ment Dis 2020; 208:418-423. [PMID: 31977719 DOI: 10.1097/nmd.0000000000001145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We explored subjective well-being in two groups of young adult participants diagnosed with either schizotypal disorder (Sd) (n = 29) or Asperger syndrome/autism spectrum disorder (As/ASD) (n = 22). Well-being was impaired in both groups and was lower in the Sd group than in the As/ASD group. Furthermore, there was a negative correlation between well-being and the presence of self-disorders. The negative effect of self-disorders on well-being was still significant when adjusted for diagnosis, age and gender, and level of function. The present findings point toward clinically important disorder-specific differences in the nature of impaired well-being between the Sd group and the As/ASD group, as there seems to be a self-disorder-driven additional contribution to impaired subjective well-being within the schizophrenia spectrum. These findings further nuance the understanding of fundamental and clinically important qualitative differences between the schizophrenia spectrum and the autism spectrum.
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33
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Svendsen IH, Øie MG, Møller P, Nelson B, Melle I, Haug E. Basic self-disturbances are associated with Sense of Coherence in patients with psychotic disorders. PLoS One 2020; 15:e0230956. [PMID: 32294097 PMCID: PMC7159222 DOI: 10.1371/journal.pone.0230956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Sense of Coherence (SOC) theory gives a possible explanation of how people can experience subjective good health despite severe illness. Basic self-disturbances (BSDs) are subtle non-psychotic disturbances that may destabilize the person’s sense of self, identity, corporeality, and the overall ‘grip’ of the world. Aim Our objective was to investigate associations between BSDs and SOC in patients with psychotic disorders. Design This is a cross-sectional study of 56 patients diagnosed with psychotic disorders inside and outside the schizophrenia spectrum (35 schizophrenia, 13 bipolar, and eight other psychoses). SOC was measured using Antonovsky’s 13-item SOC questionnaire, and BSDs were assessed using the Examination of Anomalous Self-Experience (EASE) manual. Diagnosis, symptoms, and social and occupational performance were assessed using standardized clinical instruments. Results We found a statistically significant correlation (r = ) between high levels of BSDs and low levels of SOC (r = -0.64/p<0.001). This association was not influenced by diagnostics, clinical symptoms or level of functioning in follow-up multivariate analyses. Conclusion A statistically significant association between BSDs and SOC indicates that the presence and level of self-disturbances may influence the person's ability to experience life as comprehensive, manageable and meaningful. However, the cross-sectional nature of the study precludes conclusions regarding the direction of this association.
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Affiliation(s)
- Ingrid Hartveit Svendsen
- Department of Acute Psychiatry and Psychosis Treatment, Division of Mental Health, Innlandet Hospital Trust, Reinsvoll, Norway
- Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- * E-mail:
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo, Norway
- Division of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Paul Møller
- Department of Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Ingrid Melle
- NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Haug
- Department of Acute Psychiatry and Psychosis Treatment, Division of Mental Health, Innlandet Hospital Trust, Reinsvoll, Norway
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34
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Pionke R, Gidzgier P, Nelson B, Gawęda Ł. Prevalence, dimensionality and clinical relevance of self-disturbances and psychotic-like experiences in Polish young adults: a latent class analysis approach. Int J Methods Psychiatr Res 2020; 29:e1809. [PMID: 31808220 PMCID: PMC7051838 DOI: 10.1002/mpr.1809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/23/2019] [Accepted: 09/20/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES We aimed to investigate latent classes of psychotic-like experiences (PLEs) and self-disturbances (SD) and to explore mutual overlapping between derived subgroups. Further, our goal was to investigate class membership relationship with an exposure to childhood trauma and different psychopathological factors such as cognitive biases, depression, insomnia, psychiatric diagnosis and lifetime suicidality. METHODS Participants consist of 3167 non-clinical adults. We performed two latent class analyses (LCA), for PLEs and SD separately, to identify subgroups of individuals with different profiles on PLEs and SD. Associations between psychopathological factors and latent class membership were examined using multinomial logistic regression analysis. RESULTS LCA produced 5 classes within SD and 3 classes within PLEs. Class of the highest endorsement of SD showed 53% overlap with class of the highest endorsement of PLEs. The highest risk of belonging to High Class for both SD and PLEs was associated in particular with depression, cognitive biases and insomnia. Trauma emerged as a significant predictor only for PLEs classes. CONCLUSIONS Our findings confirm that high PLEs and SD co-occur and are concentrated in a relatively small number of individuals, at least in the general population. Their combination may capture the highest risk of psychosis in the general population.
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Affiliation(s)
- Renata Pionke
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Poland
| | - Piotr Gidzgier
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Łukasz Gawęda
- Clinical Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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Rasmussen AR, Nordgaard J, Parnas J. Schizophrenia-spectrum psychopathology in obsessive-compulsive disorder: an empirical study. Eur Arch Psychiatry Clin Neurosci 2020; 270:993-1002. [PMID: 31129700 PMCID: PMC7599137 DOI: 10.1007/s00406-019-01022-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/15/2019] [Indexed: 12/29/2022]
Abstract
The differential diagnosis of obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession ('with resistance') and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizophrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive-compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Glostrup, University of Copenhagen, Broendbyostervej 160, 2605, Broendby, Denmark.
| | - Julie Nordgaard
- grid.5254.60000 0001 0674 042XMental Health Center Amager, University of Copenhagen, Gl. Kongevej 33, 1610 Copenhagen V, Denmark
| | - Josef Parnas
- grid.5254.60000 0001 0674 042XMental Health Center Glostrup, University of Copenhagen, Broendbyostervej 160, 2605 Broendby, Denmark ,grid.5254.60000 0001 0674 042XCenter for Subjectivity Research, University of Copenhagen, Karen Blixens Plads 8, 2300 Copenhagen S, Denmark
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Svendsen IH, Øie MG, Møller P, Nelson B, Haug E, Melle I. Basic self-disturbances independently predict recovery in psychotic disorders: A seven year follow-up study. Schizophr Res 2019; 212:72-78. [PMID: 31420200 DOI: 10.1016/j.schres.2019.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recovery is the ultimate goal of psychosis treatment. Basic self-disturbances (BSDs) are non-psychotic phenomena associated with clinical outcome, present in prodromal, psychotic and residual phases of psychotic disorders. AIM To investigate the relationship between BSDs and recovery seven years after first treatment in patients with psychotic disorders. METHOD Prospective longitudinal study of 56 patients recruited during first adequate treatment for schizophrenia (n = 35) and other psychotic disorders (n = 21) (psychotic bipolar disorder, delusional disorder, psychotic disorder NOS). At baseline and follow-up BSDs were assessed using the Examination of Anomalous Self-Experience (EASE) manual, while standard clinical instruments were used to ascertained diagnosis, clinical symptom severity, and functioning. Recovery was defined as absence of psychotic symptoms and regaining of functioning that persisted the last two years before follow-up. RESULTS At follow up, 34% achieved recovery (5 (14%) with schizophrenia and 14 (67%) with other psychoses at baseline). Recovery was predicted by an absence of a schizophrenia diagnosis, low baseline level of BSDs and further reductions in BSDs from baseline to follow-up. Change in BSDs was the strongest predictor, also after adjusting for premorbid adjustment and duration of untreated psychosis, and was not confounded by diagnosis. CONCLUSION Low baseline levels of basic self-disturbances and further reductions over time independently predict recovery seven years later in first treated psychosis patients.
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Affiliation(s)
- Ingrid Hartveit Svendsen
- Innlandet Hospital Trust, Department of Acute Psychiatry and Psychosis Treatment, Presteseter 1, 2840 Reinsvoll, Norway; University of Oslo, Faculty of Medicine, P. B. 1018 Blindern, 0315 Oslo, Norway.
| | - Merete G Øie
- Department of Psychology, University of Oslo, Pb 1094 Blindern, Norway; Division of Research, Innlandet Hospital Trust, Norway.
| | - Paul Møller
- Vestre Viken Hospital Trust, Division of Mental Health and Addiction, Department of Mental Health Research and Development, Norway.
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd (Locked Bag 10), Parkville, Victoria 3052, Australia.
| | - Elisabeth Haug
- Innlandet Hospital Trust, Department of Acute Psychiatry and Psychosis Treatment, Presteseter 1, 2840 Reinsvoll, Norway.
| | - Ingrid Melle
- NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, P.O. Box 1039 Blindern, 0315 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 1039 Blindern, 0315 Oslo, Norway.
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37
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Værnes TG, Røssberg JI, Møller P. Anomalous self-experiences are strongly associated with negative symptoms in a clinical high-risk for psychosis sample. Compr Psychiatry 2019; 93:65-72. [PMID: 31351243 DOI: 10.1016/j.comppsych.2019.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/01/2019] [Accepted: 07/10/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Anomalous self-experiences (ASE) are considered as central features of the schizophrenia spectrum disorders and prodromal schizophrenia. We investigated total and single-item prevalence of these phenomena in a clinical high-risk (CHR) for psychosis sample, and associations with conventional psychosis-risk symptoms, present and childhood global/psychosocial functioning, and childhood trauma. METHODS The sample (n = 38) included 31 CHR, according to ultra-high risk or cognitive basic symptoms (COGDIS) criteria, and seven with non-progressive attenuated positive symptoms. Psychopathological evaluations included the Examination of Anomalous Self-Experience (EASE), Structured Clinical Interview for Prodromal Syndromes (SIPS), Schizophrenia Proneness Instrument - Adult (SPI-A) (only the COGDIS-criteria), a diagnostic interview (SCID-I), Global Assessment of Functioning - Split version (S-GAF), Premorbid Adjustment Scale (PAS) and Childhood Trauma Questionnaire (CTQ). RESULTS The mean total EASE score was in line with reports from other CHR samples, and was particularly enhanced in schizotypal personality disorder and in subjects fulfilling COGDIS-criteria. The four most frequent EASE-items were present in two-thirds or more of the participants. EASE total was significantly associated with negative and disorganization symptoms. A multiple regression analysis revealed that the level of negative symptoms explained most of the variance in EASE total. CONCLUSIONS These results corroborates other findings that anomalous self-experiences are frequent and important features in CHR conditions and in the schizophrenia spectrum. The strong associations with negative symptoms and cognitive disturbances (COGDIS) should be investigated in longitudinal studies to address causality, psychopathological pathways and schizophrenia spectrum specificity. The weaker correlation between EASE total and positive symptoms may partly be related to a restricted range of positive symptoms.
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Affiliation(s)
- Tor Gunnar Værnes
- Early Intervention in Psychosis Advisory Unit for South-East Norway, TIPS Sør-Øst, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.; NORMENT, Norwegian Centre for Mental Disorders Research, University of Oslo, Norway..
| | - Jan Ivar Røssberg
- Division of Psychiatric Treatment Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Paul Møller
- Dept. for Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Norway
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38
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Martin B, Franck N, Giersch A. A reflection upon methods to explore timing in patients with schizophrenia. Psych J 2019; 8:82-89. [PMID: 30912627 DOI: 10.1002/pchj.268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023]
Abstract
Phenomenologists have provided a detailed description of the disorders of the subjective experience associated with minimal-self disorders in patients with schizophrenia. Those patients report a range of distortions of their conscious experiences, including a sense of inner void, confusion between self and others, and, sometimes, a disruption of the sense of time. These reports have been interpreted as distortion of the first-person perspective and a lack of immersion in the world, associated with a breakdown of the temporal structure of consciousness, and especially a disruption of the sense of time continuity. Further, it has been proposed that these disruptions are based on a difficulty to retain past information and to predict future information, that is, the mechanisms that help to relate events with one another and to reach a sense of time continuity. Experimental psychology results seem to converge to similar conclusions, inasmuch as some results in patients with schizophrenia suggest a deficient ability to predict sequences of events at the millisecond level. Several studies have underlined this convergence. Here we reflect on the limits of both the phenomenological and experimental psychology approaches, and of the convergence of their hypotheses. We think that this reflection is necessary to avoid premature conclusions on the mechanisms underlying the impairments in patients, but also to enrich our understanding of schizophrenia.
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Affiliation(s)
- Brice Martin
- Ressource Center for Psychosocial Rehabilitation and Cognitive Remediation, Le Vinatier Hospital UMR 5229 CNRS & Université Lyon 1, Université de Lyon, Lyon, France
| | - Nicolas Franck
- Ressource Center for Psychosocial Rehabilitation and Cognitive Remediation, Le Vinatier Hospital UMR 5229 CNRS & Université Lyon 1, Université de Lyon, Lyon, France
| | - Anne Giersch
- INSERM U1114, Psychiatric Center, University of Strasbourg, Regional University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
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39
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Damme KSF, Pelletier-Baldelli A, Cowan HR, Orr JM, Mittal VA. Distinct and opposite profiles of connectivity during self-reference task and rest in youth at clinical high risk for psychosis. Hum Brain Mapp 2019; 40:3254-3264. [PMID: 30941844 DOI: 10.1002/hbm.24595] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
Self-reference is impaired in psychotic disorders such as schizophrenia, associated with disability, and closely related to characteristic patterns of aberrant brain connectivity. However, at present, it is unclear whether self-reference is impacted in pathogenesis of the disorder. Alterations in connectivity during a self-reference task or resting-state in the psychosis risk (i.e., prodromal) period may yield important clues for biomarker development, as well as for novel treatment targets. This study examined a task-based and resting-state functional magnetic resonance imaging in individuals at clinical high risk (CHR) for psychosis (n = 22) and healthy control unaffected peers (n = 20). The self-reference task comprised three task conditions where subjects were asked if an adjective was relevant to themselves (self), a designated other individual (other), or to evaluate the word's spelling (letter). Connectivity analyses examined medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC), regions commonly found in conjunction analyses of self-reference, during both the self-reference task and rest. In task connectivity analyses, CHR individuals exhibited decreased mPFC-PCC connectivity when compared to controls. In resting-state analyses, CHR participants showed greater mPFC-PCC connectivity. Taken together, results suggest that psychosis-like alterations in mPFC-PCC connectivity is present prior to psychosis onset across both task and rest.
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Affiliation(s)
| | | | - Henry R Cowan
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Joseph M Orr
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas.,Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois.,Department of Psychiatry, Northwestern University, Chicago, Illinois.,Medical Social Sciences, Northwestern University, Chicago, Illinois.,Institute for Policy Research (IPR), Northwestern University, Chicago, Illinois.,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston, Illinois
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40
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Spanlang B, Nierula B, Haffar M, Debruille JB. Mimicking Schizophrenia: Reducing P300b by Minimally Fragmenting Healthy Participants' Selves Using Immersive Virtual Reality Embodiment. Front Hum Neurosci 2019; 12:504. [PMID: 30662398 PMCID: PMC6328438 DOI: 10.3389/fnhum.2018.00504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
The most robust and clear biological index differentiating persons with schizophrenia from healthy controls is the drastic reduction of the amplitude of their P300b event-related brain potential (ERP). However, the cause of that reduction remains obscure. Nevertheless, the P300b belongs to the family of the late posterior positivities (LPPs) which are closely related to the consciousness of the meaning of the stimulus in the task for the participants themselves (e.g., the: I am seeing the target stimulus for which I have to respond). The fragmentation of the self present in schizophrenia, could thus be the cause. If this were true, then P300bs should be somewhat reduced in healthy participants when their self representations are temporarily and minimally fragmented. We tested this hypothesis by using the innocuous fragmentation of the self that occurs in virtual reality (VR). There, participants can have a fragment of their self in an avatar they feel embodied in, within a VR room, while having another fragment of their self in their real body in the real room where they know they are. Our participants were thus equipped with a head mounted display in which they viewed a virtual room where a female humanoid avatar was facing them. She was lifting her right hand in synchrony with the participants, in order to induce in them a feeling of embodiment. Stimuli were a frequent green- and a rare red-disk, the oddball stimulus, occurring over the right hand of the avatar. Participants had to perform a Go/NoGo task, lifting their right hand to the frequent green disk and repressing this action for the oddball red disk. In the syncMove block of trials the avatar was lifting her right hand synchronously with the participant, disturbing her self representation as confirmed by the debriefing session. In the noMove block, the avatar remained immobile. In the classic block, only the red and the green disk were displayed on a monochrome background, neither the room nor the avatar were shown. As predicted, P300bs were found to be smaller in the syncMove block than in the noMove- and the classic-block in participants who had the classically large P300b oddball effect between ERPs to the frequent and those to the rare stimuli. Reduced P300bs of schizophrenia could thus be partly due to self fragmentation. Results may also open an avenue of research to the functional significance of LPPs and the content of the consciousness indexed by these potentials.
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Affiliation(s)
- Bernhard Spanlang
- Event-Lab, Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Birgit Nierula
- Event-Lab, Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maud Haffar
- Department of Neuroscience, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Center, Montreal, QC, Canada
| | - J. Bruno Debruille
- Department of Neuroscience, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Center, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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41
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Škodlar B, Henriksen MG. Toward a Phenomenological Psychotherapy for Schizophrenia. Psychopathology 2019; 52:117-125. [PMID: 31163426 DOI: 10.1159/000500163] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/03/2019] [Indexed: 11/19/2022]
Abstract
During the last decades, research in phenomenological psychopathology has provided a vast array of insights that are invaluable for understanding the experiential worlds of patients with schizophrenia. Precisely, knowledge of patients' experiences is a necessary basis for a sound and thoughtful psychotherapy. This is especially important in psychotherapy for schizophrenia, where patients' experiences may not always be easily accessible or understandable. In the available literature, we found only scattered suggestions for a translation of insights from phenomenological psychopathology into psychotherapeutic practice. The aim of this article is to offer a preliminary translation. First, we outline characteristics of the experiential worlds in schizophrenia, highlighting what we call "core experiences" and "experience-near concepts." Then we explore the psychotherapeutic methods and strategies that can be developed and elaborated on the basis of the accumulated research in phenomenological psychopathology, drawing also on experiences from a phenomenologically informed psychotherapy unit at the University Psychiatric Hospital of Ljubljana. Here, we propose principles of a phenomenological psychotherapy for schizophrenia, dividing them into the following subgroups: (1) overall goals, (2) general attitudes, (3) main domains, and (4) therapeutic strategies. The unique value of phenomenological psychotherapy seems to lie in its ability to capture the heart of the patients' experiences and their inherent vulnerabilities and then use these insights to inform psychotherapeutic interventions.
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Affiliation(s)
- Borut Škodlar
- University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia, .,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia,
| | - Mads Gram Henriksen
- Center for Subjectivity Research, Philosophy Section, Department of Media, Communication and Cognition, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark.,Mental Health Centre Amager, University Hospital of Copenhagen Mental Health Centre Glostrup, University Hospital of Copenhagen, Copenhagen, Denmark.,Mental Health Centre Amager, University Hospital of Copenhagen Mental Health Centre Glostrup, University Hospital of Copenhagen, Copenhagen, Denmark
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42
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Nischk D, Rusch J. What Makes Soteria Work? On the Effect of a Therapeutic Milieu on Self-Disturbances in the Schizophrenia Syndrome. Psychopathology 2019; 52:213-220. [PMID: 31390648 DOI: 10.1159/000501816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/27/2019] [Indexed: 11/19/2022]
Abstract
Soteria represents an alternative approach to the treatment of acute psychosis providing a community-based social milieu, personal relationships ("being-with"), and meaningful shared activities ("doing-with") along with minimal neuroleptic medication. In this review article, we analyze Soteria's potential to adapt to and restore self-disturbances, a central element of phenomenological conceptions of the schizophrenia syndrome. Based on typical difficulties of psychotic patients in responding adequately to situational demands, in relating to others, and in utilizing skills, we analyze how the architectural and social context, being-with, and doing-with take account of self-disturbances. The central elements of the Soteria approach all appear to carry the potential to adjust to self-disturbances and even offer opportunities for their relief. We suggest that it is precisely this property of the Soteria paradigm that induces sustained relaxation in patients, allowing for symptom relief, thereby specifying a central claim of "affect-logic" to explain the antipsychotic effect of Soteria.
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Affiliation(s)
- Daniel Nischk
- Centre for Psychiatry Reichenau, Reichenau, Germany,
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Abstract
Historical and current research on borderline personality disorder reveal certain affinities with schizophrenia spectrum psychopathology. This is also the case for the borderline criteria of "identity disturbance" and "feelings of emptiness," which reflect symptomatology frequently found in schizophrenia and schizotypal personality disorder. Unfortunately, the diagnostic manuals offer limited insight into the nature of these criteria, including possible deviations and similarities with schizophrenia spectrum symptomatology. In this article, we attempt to clarify the concepts of identity disturbance and feelings of emptiness with an emphasis on the criteria's differential diagnostic significance. Drawing on contemporary philosophy, we distinguish between a "narrative" self and a "core" self, suggesting that this distinction may assist differential diagnostic efforts and contribute to mark the psychopathological boundaries of these disorders.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendby, Denmark
| | - Josef Parnas
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendby, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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44
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Nilsson LS, Urfer Parnas A, Nordgaard J. Social Life in the Schizophrenia Spectrum: A Phenomenological Study of Five Patients. Psychopathology 2019; 52:232-239. [PMID: 31390645 DOI: 10.1159/000501833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Social difficulties are a hallmark of schizophrenia spectrum conditions, yet their background and exact nature remain contested. Previous pivotal studies on chronically ill patients have suggested that a position of "positive withdrawal" is associated with a decreased tendency to rehospitalization. This concept designates an essentially withdrawn but not negatively experienced position balanced by elements relating the individual to the social world. OBJECTIVES To explore a less ill subgroup of schizophrenia spectrum patients' ways of navigating the social world and examine potential links to anomalous self-experiences by applying key insights from phenomenology and anthropology. METHOD The present study was part of a 5-year follow-up on a group of first-admission schizophrenia spectrum patients. From this sample of 48 patients, 5 were selected for qualitative evaluation following the principles of thematic analysis. RESULTS A "positively withdrawn" position characterizes a wider group of patients than originally reported. Further, we identified a preference for partaking in social activities in particular circumstances with clearly circumscribed goals or social roles and rules. This alleviated social discomfort and helped patients stay embedded in a social milieu. All patients experienced high levels of self-disorders. CONCLUSIONS We suggest that certain aspects of social impairment may, in fact, reflect meaningful compensatory mechanisms, and argue that this conceptualization of social difficulties is relevant to various psychotherapeutic interventions.
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Affiliation(s)
- Lars Siersbæk Nilsson
- Psychiatric Center North Zealand, University Hospital of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Annick Urfer Parnas
- Psychiatric Center Amager, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Julie Nordgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, .,Psychiatric Center Amager, University Hospital of Copenhagen, Copenhagen, Denmark,
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45
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Raballo A, Monducci E, Ferrara M, Fiori Nastro P, Dario C. Developmental vulnerability to psychosis: Selective aggregation of basic self-disturbance in early onset schizophrenia. Schizophr Res 2018; 201:367-372. [PMID: 29804931 DOI: 10.1016/j.schres.2018.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/06/2018] [Accepted: 05/12/2018] [Indexed: 11/29/2022]
Abstract
Trait-like anomalies of subjective experience (aka, Basic Self-disturbance or Self-disorder, SD) have been empirically identified as schizophrenia-specific markers of vulnerability in several clinical and genetic high-risk populations. However, such specificity is still to be tested in developmental years, where emerging psychopathology is less crystallized and diagnostic boundaries more blurred. Thus, the current study explores the distribution of SD in adolescent help-seekers (age range 14 to 18) and tests the specificity of SD with respect to the severity of their diagnostic staging (Early Onset schizophrenia-spectrum psychosis [EOP], ultra high-risk [UHR] and clinical help-seeking controls [CHSC]). For this purpose, 96 help-seeking adolescents consecutively referred to specialized Child and Adolescent Units for diagnostic evaluation, underwent a comprehensive psychopathological examination including the specific interview for SD (i.e. the Examination of Anomalous Self-Experience, EASE). One-way ANOVA was used to test the diagnostic distribution of SD (EASE score), whereas multinomial logistic regression was used to test the effect of SD on the diagnostic outcome. SD frequency (both in terms of EASE total score and domain sub-scores) was decreasing progressively from EOP to CHSC, with intermediate levels in UHR. The EASE total score increased the risk of belonging to the more severe diagnostic stages (i.e, UHR and EOP vs CHSC as reference class) and allowed the correct reclassification of the 75% of the sample. The results confirm the schizophrenia-spectrum specificity of SD in adolescence, highlighting their potential value for early differential diagnosis and risk stratification.
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Affiliation(s)
- Andrea Raballo
- Psychodiagnostic and Clinical Psychopharmacology Unit, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy; Psychopathology and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Elena Monducci
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Mauro Ferrara
- Pediatrics and Paediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Claudia Dario
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy; Psychiatric Center Hvidovre, University of Copenhagen, Denmark; Center for Subjectivity Research, University of Copenhagen, Denmark
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46
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Raballo A, Preti A. The Self in the Spectrum: A Closer Look at the Temporal Stability of Self-Disorders in Schizophrenia. Psychopathology 2018; 51:285-289. [PMID: 29734188 DOI: 10.1159/000488645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/21/2018] [Indexed: 11/19/2022]
Abstract
Self-disorders are temporally persisting, experiential anomalies of subjective experiences that index liability to schizophrenia. They impact on the temporal unfolding of concomitant, diagnostic symptoms and can be suitably characterized through the Examination of Anomalous Self Ex periences (EASE). Capitalizing on the results of a recent longitudinal study, we explored the relevant patterns of interaction within self-disorders' descriptive dimensions (i.e., stream of consciousness, presence, corporeality, demarcation, and solipsism). The results indicated that after a 5-year follow-up the interconnection across SD dimensions tightened, confirming that EASE domains are interdependent aspects of an overarching structural change of subjectivity.
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Affiliation(s)
- Andrea Raballo
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Section of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonio Preti
- Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy.,Psychiatry Branch, Centro Medico Genneruxi, Cagliari, Italy
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