Proximate and ultimate causes of ritual behavior

The Evolution of Symbolic Thought: At the Intersection of Schizophrenia Psychopathology, Ethnoarchaeology, and Neuroscience

The human capacity for symbolic representation arises, evolutionarily and developmentally, from the exploitation of a widespread sensorimotor network, along a fundamental continuity between embodied and symbolic modes of experience. In this regard, the fine balancing between constrained sensorimotor connections (responsible for self-embodiment processing) and more untethered neural associations (responsible for abstract and symbolic processing) is context dependent and plastically neuromodulated, thus intersubjectively constructed within a specific socio-cultural milieu. Instead, in the schizophrenia spectrum this system falls off catastrophically, due to an unbalance toward too unconstrained sensorimotor connectivity, leading to a profound distortion of self/world relation with a symbolic activity detached from its embodied ground. For this very reason, however, schizophrenia psychopathology may contribute to unveil, in a distorted or magnified way, ubiquitous structural features of human symbolic activity, beneath the various, historically determined cultural systems. In this respect, a comparative approach, linking psychopathology and ethnoarchaeology, allows highlight the following invariant formal characteristics of symbolic processing: (1) Emergence of salient perceptive fragments, which stand out from the perceptual field. (2) Spreading of a multiplicity of new significances with suspension of common-sense meaning. (3) Dynamic and passive character through which meaning proliferation is experienced. This study emphasizes the importance of fine-grained psychopathology to elucidate, within a cross-disciplinary framework, the evolutionarily and developmental pathways that shape the basic structures of human symbolization.

The relationship between obsessive-compulsive symptoms and real-life functioning in schizophrenia: New insights from the multicenter study of the Italian Network for Research on Psychoses

BACKGROUND

Although obsessive-compulsive disorder (OCD) is highly prevalent in schizophrenia, its relationship with patients' real-life functioning is still controversial.

METHODS

The present study aims at investigating the prevalence of OCD in a large cohort of non-preselected schizophrenia patients living in the community and verifying the relationship of OCD, as well as of other psychopathological symptoms, with real-life functioning along a continuum of OCD severity and after controlling for demographic variables.

RESULTS

A sample of 327 outpatients with schizophrenia was enrolled in the study and collapsed into three subgroups according to OCD severity (subclinical, mild-moderate, severe). A series of structural equation modeling (SEM) was performed to analyze in each subgroup the association of obsessive-compulsive symptoms with real-life functioning, assessed through the Specific Levels of Functioning Scale and the UCSD Performance-Based Skills Assessment. Moreover, latent profile analysis (LPA) was performed to infer latent subpopulations. In the subclinical OCD group, obsessive-compulsive symptoms (OCS) were not associated with functioning, whereas in the mild-moderate OCD group, they showed a positive relationship, particularly in the domains of work and everyday life skills. The paucity of patients with severe OCD did not allow performing SEM analysis in this group. Finally, LPA confirmed a subgroup with mild-moderate OCS and more preserved levels of functioning.

CONCLUSIONS

These findings hint at a positive association between mild-moderate OCD and real-life functioning in individuals with schizophrenia and encourage a careful assessment of OCD in personalized programs to sustain daily life activities.

An evolutionary analysis of the applicability and utility of the clinico-pathological method in psychiatry

Unlike other medical specialties, psychiatry has not been involved in the theoretical shift that replaced the syndromal approach with the clinico-pathological method, which consists in explaining clinical manifestations by reference to morbid anatomical and physiological changes. Past and present discussions on the applicability of the clinico-pathological method in psychiatry are based on a pre-Darwinian concept of biology as the study of proximate causation. Distinguishing between mediating mechanisms and evolved functions, an evolutionary perspective offers an original contribution to the debate by overcoming the opposite views of dualism (i.e., the clinico-pathological method is not applicable to disorders of the mind) and neuroessentialism (i.e., the definitive way of explaining psychiatric disorders is by reference to the brain and its activity). An evolutionary perspective offers original insights on the utility of the clinico-pathological method to solve critical questions of psychiatric research and clinical practice, including the distinction between mental health and illness, a better understanding of the etiology and pathophysiology, the classification and differential diagnosis of psychiatric disorders, and the development of more efficacious psychiatric treatments.

Impact of Benzodiazepines and Illness Duration on Obsessive-Compulsive Disorder during COVID-19 in Italy: Exploring Symptoms' Evolutionary Benefits

Obsessive-compulsive disorder (OCD) is believed to follow a waxing and waning course, often according to environmental stressors. During the COVID-19 pandemic, pre-existing OCD symptoms were reported to increase and to change from checking to washing behaviors, while new-onset symptoms were predominantly of the hoarding type. In the present study, we followed the evolution of OCD symptoms, anxiety, depression, and insights of illness in forty-six OCD patients throughout the pandemic. Clinical measures were collected at four different time points before and during the COVID-19 pandemic in Italy. Within-subject comparisons were used to compare clinical scale scores across time, and correlations were examined between patients' baseline characteristics and changes in clinical scores. We found that all clinical measures increased during the first Italian lockdown with respect to the pre-pandemic values. Anxiety decreased during the temporary elimination of restriction provisions, whereas the severity of OCD symptoms and insight returned to pre-pandemic values during the second mandatory lockdown. These results were observed only in two sub-groups of patients: those taking benzodiazepines and those with shorter illness duration. Our findings suggest the need for additional clinical attention to these specific sub-groups of OCD patients in case of particularly distressing circumstances while pointing to a possible adaptive role of their OCD symptoms when the environment requires a higher care of hygiene and an extraordinary supply of essential resources.

An investigation of the experience of control through the sense of agency in people with obsessive-compulsive disorder: a review and meta-analysis

The construct of sense of agency (SoA) has proven useful for understanding mechanisms underlying obsessive-compulsive disorder (OCD) phenomenology, especially in explaining the apparent dissociation in OCD between actual and perceived control over one's actions. Paradoxically, people with OCD appear to experience both diminished SoA (feeling unable to control their actions) and inflated SoA (having "magical" control over events). The present review investigated the extent to which the SoA is distorted in OCD, in terms of both implicit (ie, inferred from correlates and outcomes of voluntary actions) and explicit (ie, subjective judgment of one's control over an outcome) measures of SoA. Our search resulted in 15 studies that met the criteria for inclusion in a meta-analysis, where we also examined the potential moderating effects of the type of measure (explicit versus implicit) and of the actual control participants had over the outcome. We found that participants with OCD or with high levels of OCD symptoms show lower implicit measures of SoA and at the same time tend to overestimate their control in situations where they do not actually have it. Together, these findings support the hypothesized dissociation in OCD between actual and perceived control over one's actions.

A clinical investigation of psychotic vulnerability in early-onset Obsessive-Compulsive Disorder through Cognitive-Perceptive basic symptoms

Childhood-onset Obsessive-Compulsive Disorder (OCD) shows distinct comorbidity patterns and developmental pathways, as well as an increased risk of psychosis with respect to adult-onset forms. Nevertheless, little is known about the prodromal symptoms of psychosis in children and adolescents with a primary diagnosis of OCD. The present study was aimed at evaluating the occurrence of Cognitive-Perceptual basic symptoms (COPER) and high- risk criterion Cognitive Disturbances (COGDIS) in pediatric and adults OCD patients, verifying if they might vary according to the age of onset of OCD. The study included 90 outpatients with a primary diagnosis of obsessive-compulsive disorder. The study sample was collapsed into three groups according to the age at onset: 1) very early onset group (< 10 years); 2) early onset group (11-18 years); 3) adult-onset group (> 18 years). All patients were administered the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), the Schizophrenia Proneness Instrument-Adult (SPIA) and its Child and Adolescent version (SPI-CY) and the Social and Occupational Functioning Assessment Scale (SOFAS). COPER and COGDIS symptoms were positively associated with OCD severity and detectable, respectively, in 28.9 and 26.7% of our study sample. The very early onset group significantly had higher COPER and COGDIS symptoms than the adult-onset group. Our data suggest that COPER and COGDIS symptoms are frequent in obsessive patients, in particular in those with earlier onset; therefore, their detection in childhood-onset OCD may represent an early and specific indicator of psychotic vulnerability.

The Relationship between Childhood Trauma Experiences and Psychotic Vulnerability in Obsessive Compulsive Disorder: An Italian Cross-Sectional Study

People with obsessive compulsive disorder (OCD) are at increased risk of developing psychotic disorders; yet little is known about specific clinical features which might hint at this vulnerability. The present study was aimed at elucidating the pathophysiological mechanism linking OCD to psychosis through the investigation of childhood trauma experiences in adolescents and adults with OCD. One hundred outpatients, aged between 12 and 65 years old, were administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), as well as the Childhood Trauma Questionnaire (CTQ); Cognitive-Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS) were assessed in the study sample. Greater childhood trauma experiences were found to predict psychotic vulnerability (p = 0.018), as well as more severe OCD symptoms (p = 0.010) and an earlier age of OCD onset (p = 0.050). Participants with psychotic vulnerability reported higher scores on childhood trauma experiences (p = 0.02), specifically in the emotional neglect domain (p = 0.01). In turn, emotional neglect and psychotic vulnerability were found higher in the pediatric group than in the adult group (p = 0.01). Our findings suggest that childhood trauma in people with OCD may represent an indicator of psychotic vulnerability, especially in those with an earlier OCD onset. Research on the pathogenic pathways linking trauma, OCD, and psychosis is needed.

Nocturnal selective pressures on the evolution of human musicality as a missing piece of the adaptationist puzzle

Human musicality exhibits the necessary hallmarks for biological adaptations. Evolutionary explanations focus on recurrent adaptive problems that human musicality possibly solved in ancestral environments, such as mate selection and competition, social bonding/cohesion and social grooming, perceptual and motor skill development, conflict reduction, safe time-passing, transgenerational communication, mood regulation and synchronization, and credible signaling of coalition and territorial/predator defense. Although not mutually exclusive, these different hypotheses are still not conceptually integrated nor clearly derived from independent principles. I propose The Nocturnal Evolution of Human Musicality and Performativity Theory in which the night-time is the missing piece of the adaptationist puzzle of human musicality and performing arts. The expansion of nocturnal activities throughout human evolution, which is tied to tree-to-ground sleep transition and habitual use of fire, might help (i) explain the evolution of musicality from independent principles, (ii) explain various seemingly unrelated music features and functions, and (iii) integrate many ancestral adaptive values proposed. The expansion into the nocturnal niche posed recurrent ancestral adaptive challenges/opportunities: lack of luminosity, regrouping to cook before sleep, imminent dangerousness, low temperatures, peak tiredness, and concealment of identity. These crucial night-time features might have selected evening-oriented individuals who were prone to acoustic communication, more alert and imaginative, gregarious, risk-taking and novelty-seeking, prone to anxiety modulation, hedonistic, promiscuous, and disinhibited. Those night-time selected dispositions may have converged and enhanced protomusicality into human musicality by facilitating it to assume many survival- and reproduction-enhancing roles (social cohesion and coordination, signaling of coalitions, territorial defense, antipredatorial defense, knowledge transference, safe passage of time, children lullabies, and sexual selection) that are correspondent to the co-occurring night-time adaptive challenges/opportunities. The nocturnal dynamic may help explain musical features (sound, loudness, repetitiveness, call and response, song, elaboration/virtuosity, and duetting/chorusing). Across vertebrates, acoustic communication mostly occurs in nocturnal species. The eveningness chronotype is common among musicians and composers. Adolescents, who are the most evening-oriented humans, enjoy more music. Contemporary tribal nocturnal activities around the campfire involve eating, singing/dancing, storytelling, and rituals. I discuss the nocturnal integration of musicality's many roles and conclude that musicality is probably a multifunctional mental adaptation that evolved along with the night-time adaptive landscape.

Psychotic Vulnerability and its Associations with Clinical Characteristics in Adolescents with Obsessive-Compulsive Disorder

Compared to peers, children and adolescents with obsessive-compulsive disorder (OCD) are at increased risk of developing psychotic disorders. Yet very few studies have examined early indicators of psychosis in pediatric OCD. In the present study, 52 youth with a primary diagnosis of OCD (Mage = 15.66 [SD = 2.33], 59.6% girls) were interviewed using the Schizophrenia Proneness Instrument Child and Adolescent version (SPI-CY), which is a comprehensive clinical interview assessing both Cognitive-Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS). Associations between COPER/COGDIS symptoms and demographic and clinical characteristics were examined. Findings showed that COPER or COGDIS symptoms were present in 44% of participants, with no significant difference between girls and boys. Psychotic vulnerability was associated with an earlier age of OCD onset, greater OCD severity, poorer insight, and more contamination/cleaning symptoms. Psychotic vulnerability was also strongly associated with worse psychosocial functioning. Findings suggest that early indicators of psychosis are frequent in pediatric OCD and associated with more severe OCD and poorer functioning. Research examining how psychotic vulnerability is associated with short- and long-term outcomes for youth with OCD is needed.

The effects of model age and familiarity on children's reproduction of ritual behaviour

Rituals are fundamental social acts that structure relationships and enable the filtering of important cognitive attributes (e.g. working memory and inhibitory control) that make humans what they are today. This study investigated the influence of model age and familiarity on the reproduction of ritual behaviour in five-year-old children. Through an exploration of these factors, this study sheds light on the cognitive mechanisms children use to comprehend and replicate rituals. Ninety-eight five-year-old children were divided into two groups: an experimental group, which observed an adult or child model, either familiar or unfamiliar to them, demonstrating eight ritual acts; and a control group, which received no video demonstration. The results revealed that children who observed an adult reproduced more ritual acts than those who observed a child, and children who observed unfamiliar models reproduced ritual acts more frequently than those who observed familiar ones. Additionally, when exposed to unfamiliar models, children's reproductive fidelity was higher. These findings suggest that children have the ability to address new adaptation challenges by participating in rituals at an early age and that they generate suitable solutions depending on the model's characteristics. This provides evidence for the adaptive bias in children's cultural learning from a ritual perspective.

Disembodiment and Language in Schizophrenia: An Integrated Psychopathological and Evolutionary Perspective

Different hypotheses have flourished to explain the evolutionary paradox of schizophrenia. In this contribution, we sought to illustrate how, in the schizophrenia spectrum, the concept of embodiment may underpin the phylogenetic and developmental pathways linking sensorimotor processes, the origin of human language, and the construction of a basic sense of the self. In particular, according to an embodied model of language, we suggest that the reuse of basic sensorimotor loops for language, while enabling the development of fully symbolic thought, has pushed the human brain close to the threshold of a severe disruption of self-embodiment processes, which are at the core of schizophrenia psychopathology. We adopted an inter-disciplinary approach (psychopathology, neuroscience, developmental biology) within an evolutionary framework, to gain an integrated, multi-perspectival model on the origin of schizophrenia vulnerability. A maladaptive over-expression of evolutionary-developmental trajectories toward language at the expense of embodiment processes would have led to the evolutionary "trade-off" of a hyper-symbolic activity to the detriment of a disembodied self. Therefore, schizophrenia psychopathology might be the cost of long-term co-evolutive interactions between brain and language.

The motor profile of obsessive-compulsive rituals: psychopathological and evolutionary implications

BACKGROUND

Studies investigating obsessive-compulsive disorder from an ethological approach have highlighted a specific motor pattern of compulsive rituals with respect to corresponding ordinary behaviors. Particularly, compulsive motor profile is built through the repetition of acts, with prevalence of nonfunctional ones and redirection of attention to its basic structural units. These formal features would characterize ritual behavior throughout evolution, from nonhuman animals to human cultures. However, no study to date has investigated a possible relationship between such motor profile and underlying psychopathology. Therefore, the first objective of the study was to confirm previous findings on a larger sample size of obsessive patients; the second objective was to elucidate whether motor profile might be associated with obsessive-compulsive psychopathology and/or prepsychotic symptoms of schizophrenia.

METHODS

Twenty-one obsessive-compulsive outpatients provided a videotape of their rituals. An equal number of healthy controls, matched for sex and age, were registered for corresponding ordinary acts. Obsessive patients were administered the Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Hamilton Rating Scale for Depression, and the Frankfurt Complaint Questionnaire.

RESULTS

The results of the present study confirm that ritual compulsions present a specific motor structure characterized by repetition of both functional and nonfunctional acts and their longer duration. Such a motor pattern is independent from obsessive-compulsive psychopathology, whereas it results specifically associated with prepsychotic symptoms of schizophrenia.

CONCLUSIONS

We argue that this association may reflect the adaptive significance of ritual behavior across evolution, that is, its homeostatic function in conditions of unpredictability.