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Nischk D, Gutschmidt R. Making Sense of Spiritual, Metaphysical, and Eschatological Elements in Delusions: A Qualitative Study Using Interpretative Phenomenological Analysis. Psychopathology 2024:1-10. [PMID: 39089226 DOI: 10.1159/000540120] [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: 01/02/2024] [Accepted: 06/25/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Spiritual, metaphysical, or eschatological elements in delusions (SMEDs) are frequent and often subjectively regarded as profound transformational experiences, similar to mystical experiences. This study aimed (1) to explore how SMEDs are experienced and in which aspects they are similar to mystical experiences and (2) to investigate how individuals make sense of SMED. METHODS Seven participants were interviewed, and their expressions were analyzed using interpretative phenomenological analysis. RESULTS We found that SMEDs were similar to mystical experiences with regard to alterations in perception of space, time, and unity. Furthermore, SMEDs were accompanied by a sense of enlightenment that however remained ineffable. SMEDs were interpreted from different viewpoints, i.e., as a source of ontological insight, as a mental health issue, as an inspiration for a new orientation in the world, and, for some participants, as an example of the limits of knowledge. Making sense of SMED appeared to follow a lively internal dialogue in which various, sometimes contradictory positions were reflected upon. Participants usually struggled to align the ostensible ontological significance of SMED to the dominating illness explanation. CONCLUSION SMEDs have similarities to mystical experiences, but integrating SMED into one's own life is challenging. We propose a philosophical, non-pathological interpretation of SMED derived from a novel perspective on mystical experience which may also have some therapeutic utility.
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Affiliation(s)
| | - Rico Gutschmidt
- Department of Philosophy, University of Konstanz, Konstanz, Germany
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2
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Connors MH, Gibbs J, Large MM, Halligan PW. Delusions in postpartum psychosis: Implications for cognitive theories. Cortex 2024; 177:194-208. [PMID: 38875734 DOI: 10.1016/j.cortex.2024.04.018] [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: 12/16/2023] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 06/16/2024]
Abstract
Postpartum psychosis is a rare but serious condition that can affect women after childbirth. We present a case study of an individual with no comorbidities or psychiatric history who developed postpartum psychosis characterised by prominent misidentification delusions whilst admitted to hospital. The woman recovered quickly with medication and showed no evidence of relapse over the following three years. Whilst still symptomatic and after recovery, the patient was able to provide a detailed description of her experiences. Contemporaneous interviews and observations during her hospital admission and a subsequent detailed retrospective account provide a unique, comprehensive window into her experience of these time-limited delusions. Her case reveals important insights including the triggers for her misidentification delusions, the role of social and contextual influences on delusional beliefs, and her recall of active involvement in evaluating and discarding delusional hypotheses. These insights highlight the complexity of delusional beliefs, challenge existing theories of delusions, and help inform broader theories of belief formation.
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Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia; Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia; Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Jessica Gibbs
- Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Matthew M Large
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia; Eastern Suburbs Mental Health Service, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Peter W Halligan
- School of Psychology, Cardiff University, Cardiff, Wales, United Kingdom
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3
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Denfield GH, Kyzar EJ. The Nested States Model: A Phenomenologically-Grounded Model of the Mind. Psychopathology 2024:1-15. [PMID: 39084192 DOI: 10.1159/000540319] [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: 04/16/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Subjective experience is central to the nature of mental illness, yet it has not played a central role in most empirical approaches to psychopathology. While phenomenological perspectives in psychiatry have seen a recent resurgence, there remains a need for more detailed models of psychopathological processes based on explicit phenomenological and enactive foundations. SUMMARY We present a framework derived from the Nested States Model (NSM) through which such phenomenologically-grounded models might be constructed. The NSM describes the dynamic structure of subjective experience as a system of nested states that reciprocally influence one another across hierarchical layers. Here, we show how the NSM provides a scheme for characterizing patterns of experience that comprise various psychopathological processes. We demonstrate the utility of this scheme both for clinical practice and for building our knowledge of psychopathological processes more broadly. KEY MESSAGES The NSM can advance three aims that we see as critical for the lasting integration of phenomenological approaches to psychopathology within psychiatry. First, we show that the NSM provides a means for constructing clinical formulations and treatment considerations that center squarely on an individual's subjective experiences. Second, the NSM supplies a framework for organizing findings from clinical-phenomenological research that can guide the construction of broader phenomenologically-grounded models of psychopathological processes. Lastly, the NSM aligns our perspective on subjective experience with emerging perspectives on brain dynamics, helping to bridge phenomenological work with ongoing neurophysiological research.
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Affiliation(s)
- George H Denfield
- Department of Psychiatry, Columbia University, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
- Creedmoor Psychiatric Center, Queens, New York, USA
| | - Evan J Kyzar
- Department of Psychiatry, Columbia University, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
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4
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Dijkstra SA, Rijkeboer J, Noordhof A, Boyette LL, Berendsen S, de Koning M, Bennen RLJ, Hofman T, de Haan L. Making Sense of Recovery From First Psychosis With Antipsychotic Medication: A Qualitative Phenomenological Study. Schizophr Bull 2024:sbae104. [PMID: 39004928 DOI: 10.1093/schbul/sbae104] [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] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND HYPOTHESIS Recovering from a first psychosis is a highly individual process and requires the person to make sense of their experiences. Clinicians, in turn, need to comprehend these first-person perspectives, creating a mutual sense-making dynamic. Antipsychotic medication is a substantial part of psychosis treatment. Providing insight in the lived experience of recovery with antipsychotics could improve the mutual understanding and help bridge the gap between the perspective of the clinician and that of the person recovering from psychosis. STUDY DESIGN 14 persons in recovery from a first psychosis with the use of antipsychotics were interviewed. Their narratives were analyzed using Interpretative Phenomenological Analysis (IPA). STUDY RESULTS Five overarching themes were found, representing important and meaningful experiences in recovering with antipsychotic medication. Theme 1: antipsychotics as external dampening (4 subthemes); Theme 2: shifting of realities; Theme 3: pace of recovery; Theme 4: antipsychotics' influence on identity; and Theme 5: is it truly the antipsychotics? CONCLUSIONS Our findings show that recovery from psychosis with antipsychotics is an all-encompassing, multi-faceted, and ambivalent experience. The themes found in this research could inspire clinicians to discuss less obvious aspects of the experience of recovering with antipsychotics. Even more so, paying attention to the first-person perspective could lead to a more thorough understanding and benefit therapeutic relationships.
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Affiliation(s)
- Stéphanie Astrid Dijkstra
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Jennifer Rijkeboer
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Arjen Noordhof
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven Berendsen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
- Dimence Mental Health Care, Deventer, The Netherlands
| | - Mariken de Koning
- Department of Research, Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Romy Liza Japien Bennen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Tim Hofman
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
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5
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Feyaerts J, Ritunnano R, Jensen G, Sass L. Predictive coding and phenomenological approaches of delusions: convergence and differences. Lancet Psychiatry 2024; 11:497-498. [PMID: 38705168 DOI: 10.1016/s2215-0366(24)00058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Jasper Feyaerts
- Department of Psychoanalysis & Clinical Consulting, Ghent University, Ghent 9000, Belgium.
| | - Rosa Ritunnano
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Gert Jensen
- University of Copenhagen, Copenhagen, Denmark
| | - Louis Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, New Brusnwick, NJ, USA
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6
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Sass L, Feyaerts J. Schizophrenia, the very idea: On self-disorder, hyperreflexivity, and the diagnostic concept. Schizophr Res 2024; 267:473-486. [PMID: 38693032 DOI: 10.1016/j.schres.2024.03.022] [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: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 05/03/2024]
Abstract
The purpose of the present article is to consider schizophrenia-the very idea-from the perspective of phenomenological psychopathology, with special attention to the problematic nature of the diagnostic concept as well as to the prospect and challenges inherent in focusing on subjective experience. First, we address historical and philosophical topics relevant to the legitimacy of diagnostic categorization-in general and regarding "schizophrenia" in particular. William James's pragmatist approach to categorization is discussed. Then we offer a version of the well-known basic-self or ipseity-disturbance model (IDM) of schizophrenia, but in a significantly revised form (IDMrevised). The revised model better acknowledges the diverse and even seemingly contradictory nature of schizophrenic symptoms while, at the same time, interpreting these in a more unitary fashion via the key concept of hyperreflexivity-a form of exaggerated self-awareness that tends to undermine normal world-directedness and the stability of self-experience. Particular attention is paid to forms of exaggerated "self-presence" that are sometimes neglected yet imbue classically schizophrenic experiences involving subjectivism or quasi-solipsism and/or all-inclusive or ontological forms of paranoia. We focus on the distinctively paradoxical nature of schizophrenic symptomatology. In concluding we consider precursors in the work of Klaus Conrad, Kimura Bin and Henri Grivois. Finally we defend the concept of schizophrenia by considering its distinctive way of altering certain core aspects of the human condition itself.
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Affiliation(s)
- Louis Sass
- Dept of Clinical Psychology, GSAPP-Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Jasper Feyaerts
- Dept of Psychoanalysis & Clinical Consulting, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.
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7
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Feyaerts J, Sass L. Self-Disorder in Schizophrenia: A Revised View (1. Comprehensive Review-Dualities of Self- and World-Experience). Schizophr Bull 2024; 50:460-471. [PMID: 38069912 PMCID: PMC10919772 DOI: 10.1093/schbul/sbad169] [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 disorders. Self-disorders comprise various alterations of conscious experience whose theoretical understanding continues to present a challenge. The following 2 articles aim to provide further clarification of the nature of self-disorders in schizophrenia by offering a comprehensive review (article 1) and theoretical revision (article 2) of the currently most influential model of altered selfhood in schizophrenia: the basic-self-disturbance or ipseity-disorder model (IDM). This article presents a state-of-the-art overview of the current self-disturbance model and critically assesses its descriptive adequacy with respect to the clinical variability and heterogeneity of the alterations in self- and world-awareness characteristic of schizophrenia. Special attention is paid to experiences of exaggerated basic self, increased "grip" or "hold" on the world, and paradoxical combinations. The next article proposes a theoretical revision of the self-disturbance model by considering how hyperreflexivity might form the crucial common thread or generating factor that unifies the phenomenologically heterogeneous, and sometimes even contradictory features of schizophrenic self-disorders. We outline the implications of our revised model for explanatory research, therapeutic practice, and our general understanding of the abnormalities in question.
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Affiliation(s)
- Jasper Feyaerts
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Louis Sass
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, USA
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8
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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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9
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López-Silva P, Harrow M, Jobe TH, Tufano M, Harrow H, Rosen C. 'Are these my thoughts?': A 20-year prospective study of thought insertion, thought withdrawal, thought broadcasting, and their relationship to auditory verbal hallucinations. Schizophr Res 2024; 265:46-57. [PMID: 35945121 DOI: 10.1016/j.schres.2022.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022]
Abstract
The co-occurrence of delusions and other symptoms at the onset of psychosis is a challenge for theories about the aetiology of psychosis. This paper explores the relatedness of delusions about the experience of thinking (thought insertion, thought withdrawal, and thought broadcasting) and auditory verbal hallucinations by describing their trajectories over a 20-year period in individuals diagnosed with schizophrenia, affective and other psychosis, and unipolar depression nonpsychosis. The sample consisted of 407 participants who were recruited at index hospitalization and evaluated over six follow-ups over 20 years. The symptom structure associated with thought insertion included auditory verbal hallucinations, somatic hallucinations, other hallucinations, delusions of thought-dissemination, delusions of control, delusion of self-depreciation, depersonalization and anxiety. The symptom constellation of thought withdrawal included somatic hallucinations, other hallucinations, delusions of thought dissemination, delusions of control, sexual delusions, depersonalization, negative symptoms, depression, and anxiety. The symptom constellation of thought broadcasting included auditory verbal hallucinations, somatic hallucinations, delusions of thought-dissemination, delusion of self-depreciation, fantastic delusions, sexual delusions, and depersonalization. Auditory verbal hallucinations and delusions of self-depreciation were significantly associated with both thought insertion and thought broadcasting. Thought insertion and thought withdrawal were significantly associated with other hallucinations, delusions of control, and anxiety; thought withdrawal and thought broadcasting were significantly related to sexual delusions. We hypothesize that specific symptom constellations over time might be explained as the product of pseudo-coherent realities created to give meaning to the experience of the world and the self of individuals in psychosis based on both prior top-down and ongoing bottom-up elements.
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Affiliation(s)
- Pablo López-Silva
- Faculty of Social Sciences, School of Psychology, Universidad de Valparaíso, Chile
| | - Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Thomas H Jobe
- 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
| | - Helen Harrow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.
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10
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Kalman JL, Burkhardt G, Samochowiec J, Gebhard C, Dom G, John M, Kilic O, Kurimay T, Lien L, Schouler-Ocak M, Vidal DP, Wiser J, Gaebel W, Volpe U, Falkai P. Digitalising mental health care: Practical recommendations from the European Psychiatric Association. Eur Psychiatry 2023; 67:e4. [PMID: 38086744 PMCID: PMC10790232 DOI: 10.1192/j.eurpsy.2023.2466] [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: 06/08/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 01/06/2024] Open
Abstract
The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare providers and policymakers to navigate this rapidly evolving field. We provide an overview of the current scientific and implementation status across two major domains of digitalisation: i) digital mental health interventions and ii) digital phenotyping, discuss the potential of each domain to improve the accessibility and outcomes of mental health services, and highlight current challenges faced by researchers, clinicians, and service users. Furthermore, we make several recommendations meant to foster the widespread adoption of evidence-based digital solutions for mental health care in the member states of the EPA. To realise the vision of a digitalised, patient-centred, and data-driven mental health ecosystem, a number of implementation challenges must be considered and addressed, spanning from human, technical, ethical-legal, and economic barriers. The list of priority areas and action points our expert panel has identified could serve as a playbook for this process.
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Affiliation(s)
- Janos L. Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Miriam John
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Ozge Kilic
- Department of Psychiatry, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| | - Tamas Kurimay
- North-Buda Saint John Central Hospital, Buda Family Centred Mental Health Centre, Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary
| | - Lars Lien
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Diego Palao Vidal
- Mental Health Service, Parc Taulí University Hospital, Unitat Mixta de Neurociència Traslacional I3PT-INc-UAB, Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jan Wiser
- CNWL NHS Foundation Trust, London, UK
| | - Wolfgang Gaebel
- WHO Collaborating Centre DEU-131, VR-Klinikum Düsseldorf, Department of Psychiatry and Psychotherapy, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
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11
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Northoff G, Daub J, Hirjak D. Overcoming the translational crisis of contemporary psychiatry - converging phenomenological and spatiotemporal psychopathology. Mol Psychiatry 2023; 28:4492-4499. [PMID: 37704861 PMCID: PMC10914603 DOI: 10.1038/s41380-023-02245-2] [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: 05/30/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
Despite all neurobiological/neurocomputational progress in psychiatric research, recent authors speak about a 'crisis of contemporary psychiatry'. Some argue that we do not yet know the computational mechanisms underlying the psychopathological symptoms ('crisis of mechanism') while others diagnose a neglect of subjectivity, namely first-person experience ('crisis of subjectivity'). In this perspective, we propose that Phenomenological Psychopathology, due to its focus on first-person experience of space and time, is in an ideal position to address the crisis of subjectivity and, if extended to the brain's spatiotemporal topographic-dynamic structure as key focus of Spatiotemporal Psychopathology, the crisis of mechanism. We demonstrate how the first-person experiences of space and time differ between schizophrenia, mood disorders and anxiety disorders allowing for their differential-diagnosis - this addresses the crisis of subjectivity. Presupposing space and time as shared features of brain, experience, and symptoms as their "common currency", the structure of abnormal space and time experience may also serve as template for the structure of the brain's spatiotemporal neuro-computational mechanisms - this may address the crisis of mechanism. Preliminary scientific evidence in our examples of schizophrenia, bipolar disorder, anxiety disorder, and depression support such clinically relevant spatiotemporal determination of both first-person experience (crisis of subjectivity) and the brain's neuro-computational structure (crisis of mechanism). In conclusion, converging Phenomenological Psychopathology with Spatiotemporal Psychopathology might help to overcome the translational crisis in psychiatry by delineating more fine-grained neuro computational and -phenomenal mechanisms; this offers novel candidate biomarkers for diagnosis and therapy including both pharmacological and non-pharmacological treatment.
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Affiliation(s)
- Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.
| | - Jonas Daub
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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12
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Pienkos E, Englebert J, Feyaerts J, Ritunnano R, Sass L. Editorial: Situating phenomenological psychopathology: subjective experience within the world. Front Psychol 2023; 14:1204174. [PMID: 37691804 PMCID: PMC10486011 DOI: 10.3389/fpsyg.2023.1204174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Elizabeth Pienkos
- Department of Psychology, Duquesne University, Pittsburgh, PA, United States
| | - Jérôme Englebert
- Centre de recherche interdisciplinaire sur la déviance et la pénalité, Université Catholique de Louvain, Louvain-la-Neuve, Walloon Brabant, Belgium
- Centre de recherches pénalité, sécurité et déviances (CRPSD), Université Libre de Bruxelles, Brussels, Belgium
| | - Jasper Feyaerts
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Rosa Ritunnano
- Centre for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Louis Sass
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, East Flanders, Belgium
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
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13
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Martin JC, Clark SR, Schubert KO. Towards a Neurophenomenological Understanding of Self-Disorder in Schizophrenia Spectrum Disorders: A Systematic Review and Synthesis of Anatomical, Physiological, and Neurocognitive Findings. Brain Sci 2023; 13:845. [PMID: 37371325 DOI: 10.3390/brainsci13060845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
The concept of anomalous self-experience, also termed Self-Disorder, has attracted both clinical and research interest, as empirical studies suggest such experiences specifically aggregate in and are a core feature of schizophrenia spectrum disorders. A comprehensive neurophenomenological understanding of Self-Disorder may improve diagnostic and therapeutic practice. This systematic review aims to evaluate anatomical, physiological, and neurocognitive correlates of Self-Disorder (SD), considered a core feature of Schizophrenia Spectrum Disorders (SSDs), towards developing a neurophenomenological understanding. A search of the PubMed database retrieved 285 articles, which were evaluated for inclusion using PRISMA guidelines. Non-experimental studies, studies with no validated measure of Self-Disorder, or those with no physiological variable were excluded. In total, 21 articles were included in the review. Findings may be interpreted in the context of triple-network theory and support a core dysfunction of signal integration within two anatomical components of the Salience Network (SN), the anterior insula and dorsal anterior cingulate cortex, which may mediate connectivity across both the Default Mode Network (DMN) and Fronto-Parietal Network (FPN). We propose a theoretical Triple-Network Model of Self-Disorder characterized by increased connectivity between the Salience Network (SN) and the DMN, increased connectivity between the SN and FPN, decreased connectivity between the DMN and FPN, and increased connectivity within both the DMN and FPN. We go on to describe translational opportunities for clinical practice and provide suggestions for future research.
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Affiliation(s)
- James C Martin
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Scott R Clark
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Basil Hetzel Institute, Woodville, SA 5011, Australia
| | - K Oliver Schubert
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Division of Mental Health, Northern Adelaide Local Health Network, SA Health, Adelaide, SA 5000, Australia
- Headspace Early Psychosis, Sonder, Adelaide, SA 5000, Australia
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14
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Stephensen H, Urfer-Parnas A, Parnas J. Double bookkeeping in schizophrenia spectrum disorder: an empirical-phenomenological study. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01609-7. [PMID: 37084145 DOI: 10.1007/s00406-023-01609-7] [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: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
Double bookkeeping is a term introduced by Eugen Bleuler to describe a fundamental feature of schizophrenia where psychotic reality can exist side by side with shared reality even when these realities seem mutually exclusive. Despite increasing theoretical interest in this phenomenon over the recent years, there are no empirical studies addressing this issue. We have, therefore, conducted a phenomenologically descriptive qualitative study of 25 patients with schizophrenia in which we addressed the following issues: (1) Experience of double reality; (2) Emergence and development of two realities; (3) Truth quality of psychotic or private reality; (4) Insight into illness; (5) Communication of psychotic experiences. The most important result was that most patients felt to be in contact with another dimension of reality. Hallucinatory and delusional experience pertained to this different reality, which patients most frequently kept separated from the shared reality. This other dimension was considered by the patients as being more profound and real. The pre-psychotic and psychotic experiences were difficult to verbalize and typically described as totally different than ordinary experience. Double reality was persistent across remissions. None of the patients considered their condition as an illness analogous to a somatic disorder. Most patients described a vague sense of duality preceding the crystallization of double bookkeeping. This emergence of doubleness was associated with a fundamental alienation from oneself, the world, and others stretching back to childhood or early adolescence. We discuss the results with a special emphasis on the concept of psychosis, clinical interview, treatment, and pathogenetic research.
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Affiliation(s)
- Helene Stephensen
- Center for Subjectivity Research, University of Copenhagen, Karen Blixens Plads 8, 2300, Copenhagen S, Denmark.
- Mental Health Centre Glostrup, University Hospital of Copenhagen, 2605, Brøndby, Denmark.
| | - Annick Urfer-Parnas
- Mental Health Centre Amager, University Hospital of Copenhagen, 1610, Copenhagen V, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, Karen Blixens Plads 8, 2300, Copenhagen S, Denmark
- Mental Health Centre Glostrup, University Hospital of Copenhagen, 2605, Brøndby, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen N, Denmark
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15
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Grunfeld G, Lemonde AC, Gold I, Iyer SN, Malla A, Lepage M, Joober R, Boksa P, Shah JL. "The more things change…"? Stability of delusional themes across 12 years of presentations to an early intervention service for psychosis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:35-41. [PMID: 35907013 DOI: 10.1007/s00127-022-02324-9] [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: 09/12/2021] [Accepted: 06/20/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE While the prevalence of delusional themes appears to be consistent across geographic contexts, little is known about the relative prevalence of such themes within a given setting over periods of time. We therefore investigated delusional themes across 12 years of presentation to a catchment-based early intervention service for first episode psychosis (FEP). METHODS Systematically collected data from 500 patients at an early intervention service for FEP were analyzed. Four cohorts of 3 years each, from 2006 to 2017, were used to compare the frequency of delusion themes across cohorts. We also integrated into the analysis baseline sociodemographic factors such as gender, age, and highest level of education and clinical factors such as anxiety, depression, suicidality, hallucinations, and primary diagnosis (affective or non-affective psychosis). RESULTS Sex and education level were stable across cohorts, while patient age varied (p = 0.047). Clinical anxiety, depression, and suicidality at entry were also stable. Across cohorts, the proportion of patients with affective versus non-affective diagnosis differed (p = 0.050), with no differences in global rating of delusion severity or theme prevalence except for delusions of guilt or sin (p = 0.001). This single theme difference was not correlated with age or diagnosis. CONCLUSION Our study suggests relatively stable prevalence of delusion themes across cohorts of individuals experiencing FEP. This demonstrates the potential utility of studying thematic content both for understanding delusions in clinical populations and in research. Future explorations of the relationships between delusion themes and across individual patient episodes should be conducted.
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Affiliation(s)
- Gil Grunfeld
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ann-Catherine Lemonde
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ian Gold
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Department of Philosophy, Faculty of Arts, McGill University, Montréal, QC, Canada
| | - Srividya N Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Martin Lepage
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ridha Joober
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Patricia Boksa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Jai L Shah
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada. .,Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada.
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16
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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
- Corresponding author.
| | - 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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17
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Kyzar EJ, Denfield GH. Taking subjectivity seriously: towards a unification of phenomenology, psychiatry, and neuroscience. Mol Psychiatry 2023; 28:10-16. [PMID: 36460728 PMCID: PMC10130907 DOI: 10.1038/s41380-022-01891-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
Nearly all psychiatric diseases involve alterations in subjective, lived experience. The scientific study of the biological basis of mental illness has generally focused on objective measures and observable behaviors, limiting the potential for our understanding of brain mechanisms of disease states and possible treatments. However, applying methods designed principally to interpret objective behavioral measures to the measurement and extrapolation of subjective states presents a number of challenges. In order to help bridge this gap, we draw on the tradition of phenomenology, a philosophical movement concerned with elucidating the structure of lived experience, which emerged in the early 20th century and influenced philosophy of mind, cognitive science, and psychiatry. A number of early phenomenologically-oriented psychiatrists made influential contributions to the field, but this approach retreated to the background as psychiatry moved towards more operationalized disease classifications. Recently, clinical-phenomenological research and viewpoints have re-emerged in the field. We argue that the potential for phenomenological research and methods to generate productive hypotheses about the neurobiological basis of psychiatric diseases has thus far been underappreciated. Using specific examples drawing on the subjective experience of mania and psychosis, we demonstrate that phenomenologically-oriented clinical studies can generate novel and fruitful propositions for neuroscientific investigation. Additionally, we outline a proposal for more rigorously integrating phenomenological investigations of subjective experience with the methods of modern neuroscience research, advocating a cross-species approach with a key role for human subjects research. Collaborative interaction between phenomenology, psychiatry, and neuroscience has the potential to move these fields towards a unified understanding of the biological basis of mental illness.
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Affiliation(s)
- Evan J Kyzar
- Department of Psychiatry, Columbia University, New York, NY, USA. .,Research Foundation for Mental Hygiene, Menands, NY, USA. .,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, USA.
| | - George H Denfield
- Department of Psychiatry, Columbia University, New York, NY, USA. .,Research Foundation for Mental Hygiene, Menands, NY, USA. .,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, USA.
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18
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Vanheule S. The father, the Wager, and the question of psychosis in Lacan’s work. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2159797] [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: 12/30/2022]
Affiliation(s)
- Stijn Vanheule
- Department of Psychoanalysis, Ghent University, Ghent Belgium
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19
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Miceli McMillan R, Fernandez AV. Understanding subjective experience in psychedelic-assisted psychotherapy: The need for phenomenology. Aust N Z J Psychiatry 2022; 57:783-788. [PMID: 36384307 DOI: 10.1177/00048674221139962] [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] [Indexed: 11/18/2022]
Abstract
Psychedelic-assisted psychotherapy is being investigated as a treatment for a range of psychiatric illnesses. Current research suggests that the kinds of subjective experiences induced by psychedelic compounds play key roles in producing therapeutic outcomes. To date, most knowledge of therapeutic psychedelic experiences are derived from psychometric assessments with scales such as the Mystical Experience Questionnaire. While these approaches are insightful, more nuanced and detailed descriptions of psychedelic-induced changes to subjective experience are required. Drawing on recent advancements in qualitative methods arising from the interdisciplinary field of phenomenological psychopathology, we propose a systematic and comprehensive investigation into how psychedelic-assisted psychotherapy alters subjective experience. This research programme aims to characterise the nature of therapeutic psychedelic experiences by drawing on concepts from philosophical phenomenology. Such characterisations should, moreover, contribute to our understanding of the mechanisms of psychedelic therapy, the role of integration therapy, and related philosophical debates.
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Affiliation(s)
| | - Anthony Vincent Fernandez
- Danish Institute for Advanced Study and Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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20
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Kusters W. On understanding madness: A paradoxical view. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2146491] [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: 11/16/2022]
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21
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Stanghellini G, Aragona M, Gilardi L, Ritunnano R. The person’s position-taking in the shaping of schizophrenic phenomena. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2144192] [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: 11/13/2022]
Affiliation(s)
- Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- “Diego Portales” University, Santiago, Chile
| | | | | | - Rosa Ritunnano
- Institute for Mental Health, University of Birmingham, Birmingham, UK
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22
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Rosen C, Harrow M, Humpston C, Tong L, Jobe TH, Harrow H. 'An experience of meaning': A 20-year prospective analysis of delusional realities in schizophrenia and affective psychoses. Front Psychiatry 2022; 13:940124. [PMID: 35990079 PMCID: PMC9388349 DOI: 10.3389/fpsyt.2022.940124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Delusions are transdiagnostic and heterogeneous phenomena with varying degrees of intensity, stability, and dimensional attributes where the boundaries between everyday beliefs and delusional beliefs can be experienced as clearly demarcated, fuzzy, or indistinguishable. This highlights the difficulty in defining delusional realities. All individuals in the current study were evaluated at index and at least one of six subsequential follow-ups over 20 years in the Chicago Longitudinal Study. We assessed 16 distinct delusions categorized as thought or thematic delusions. We also examined the probability of recurrence and the relationships between delusions and hallucinations, depression, anxiety, and negative symptoms. The sample consisted of 262 individuals with schizophrenia vs. affective psychosis. Thought delusions were significantly different between groups at all follow-up evaluations except the 20-year timepoint. Thematic delusions were more common than thought delusions and show a significant decreasing pattern. In general, delusional content varied over time. Referential, persecutory, and thought dissemination delusions show the highest probability of recurrence. Hallucinations were the strongest indicator for thought, thematic, and overall delusions. The formation and maintenance of delusions were conceptualized as a multimodal construct consisting of sensory, perceptual, emotional, social, and somatic embodiment of an "experience of meanings". Given the significant associations between delusions and hallucinations, future work incorporating participatory research is needed to better define and align subjective and objective perspectives. Our research also points to the need for future clinical interventions that specifically evaluate and target the coexistence and entanglement of delusions and hallucinations.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Clara Humpston
- Department of Psychology, University of York, York, United Kingdom
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Liping Tong
- Advocate Aurora Health, Downers Grove, IL, United States
| | - Thomas H. Jobe
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
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23
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Affiliation(s)
- Louis Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional PsychologyRutgers UniversityPiscatawayNJUSA
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24
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Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis. Lancet Psychiatry 2022; 9:458-476. [PMID: 35523211 DOI: 10.1016/s2215-0366(22)00104-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delusions are a common transdiagnostic feature of psychotic disorders, and their treatment remains suboptimal. Despite the pressing need to better understand the nature, meaning, and course of these symptoms, research into the lived experience of delusional phenomena in psychosis is scarce. Thus, we aimed to explore the lived experience and subjective apprehension of delusions in help-seeking individuals with psychosis, regardless of diagnosis and thematic content of the delusion. METHODS In our systematic review and qualitative evidence synthesis, we searched MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science for qualitative studies published in English from database inception, with the last search on Sept 9, 2021. Grey literature search and hand-searching of relevant journals were also done. Studies were eligible if they provided an analysis of lived experience of delusions or predelusional phenomena presented from the perspective of individuals (age 14-65 years) who had developed a clinical high-risk stage of psychosis, or a diagnosable affective or non-affective psychotic disorder (as clinically defined, self-reported, or assessed within the primary study). Studies with only a subset of relevant participants were eligible only if data for the population of interest were reported separately. Studies that did not discriminate between the experience of delusion and other positive symptoms (eg, hallucinations) were included only if data for delusions were reported separately or could be extracted. First-person accounts (and author interpretations) discussing changes in the sense of self, lived world, and meaning in relation to delusions were extracted and synthesised using a novel thematic synthesis approach informed by a critical realist stance and a phenomenological theoretical framework. Analytic themes were developed into a new overarching framework for understanding the emergence of delusional phenomena. The study was registered with PROSPERO, CRD42020222104. FINDINGS Of the 3265 records screened, 2115 were identified after duplicate removal. Of these, 1982 were excluded after title and abstract screening and 106 after full-text eligibility assessment. Of the 27 studies entering quality assessment, 24 eligible studies were included in the qualitative evidence synthesis, representing the perspectives of 373 help-seeking individuals with lived experience of delusions in the context of psychosis. Gender was reported as male (n=210), female (n=110), transgender (n=1), or not reported (n=52). Only 13 studies reported ethnicity, with White being predominant. The age of most participants ranged from 15 to 65 years. We found no eligible studies investigating subclinical or predelusional experiences in at-risk mental state populations through qualitative methods. Most studies were undertaken in western, educated, industrialised, rich, and democratic (WEIRD) societies, and most included participants had received or self-reported a diagnosis within the schizophrenia spectrum. Studies differed in relation to whether they focused on one kind or theme of delusion or delusional phenomena more generally as a unified category. Three superordinate themes relating to experiential changes and meanings in delusion were identified: (1) a radical rearrangement of the lived world dominated by intense emotions; (2) doubting, losing, and finding oneself again within delusional realities; and (3) searching for meaning, belonging, and coherence beyond mere dysfunction. Based on the review findings and thematic synthesis, we propose the Emergence Model of Delusion to advance understanding of delusional phenomena in psychosis. INTERPRETATION Delusions are best understood as strongly individualised and inherently complex phenomena emerging from a dynamic interplay between interdependent subpersonal, personal, interpersonal, and sociocultural processes. Integrative approaches to research on delusion, which consider their potential adaptiveness and favour explanatory pluralism, might be advantageous. Effective clinical care for individuals with psychosis might need adapting to match more closely, and take account of, the subjective experience and meaning of delusions as they are lived through, which might also help redress power imbalances and enduring epistemic injustices in mental health. FUNDING Priestley Scholars, Wellcome Trust.
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25
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Beals K, Sperry SH, Sheffield JM. Empathy, Emotion Recognition, and Paranoia in the General Population. Front Psychol 2022; 13:804178. [PMID: 35282255 PMCID: PMC8908382 DOI: 10.3389/fpsyg.2022.804178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background Paranoia is associated with a multitude of social cognitive deficits, observed in both clinical and subclinical populations. Empathy is significantly and broadly impaired in schizophrenia, yet its relationship with subclinical paranoia is poorly understood. Furthermore, deficits in emotion recognition - a very early component of empathic processing - are present in both clinical and subclinical paranoia. Deficits in emotion recognition may therefore underlie relationships between paranoia and empathic processing. The current investigation aims to add to the literature on social cognition and paranoia by: (1) characterizing the relationship between paranoia and empathy, and (2) testing whether there is an indirect effect of emotion recognition on the relationship between empathy and paranoia. Methods Paranoia, empathy, and emotion recognition were assessed in a non-clinical sample of adults (n = 226) from the Nathan Kline Institute-Rockland (NKI-Rockland) dataset. Paranoia was measured using the Peters Delusions Inventory-21 (PDI-21). Empathy was measured using the Interpersonal Reactivity Index (IRI), a self-report instrument designed to assess empathy using four subscales: Personal Distress, Empathic Concern, Perspective Taking, and Fantasy. Emotion recognition was assessed using the Penn Emotion Recognition Test (ER-40). Structural equation modeling (SEM) was used to estimate relationships between paranoia, the four measures of empathy and emotion recognition. Results Paranoia was associated with the Fantasy subscale of the IRI, such that higher Fantasy was associated with more severe paranoia (p < 0.001). No other empathy subscales were associated with paranoia. Fantasy was also associated with the emotion recognition of fear, such that higher Fantasy was correlated with better recognition of fear (p = 0.008). Paranoia and emotion recognition were not significantly associated. The Empathic Concern subscale was negatively associated with emotion recognition, with higher empathic concern related to worse overall emotion recognition (p = 0.002). All indirect paths through emotion recognition were non-significant. Discussion These results suggest that imaginative perspective-taking contributes to paranoia in the general population. These data do not, however, point to robust global relationships between empathy and paranoia or to emotion recognition as an underlying mechanism. Deficits in empathy and emotion recognition observed in schizophrenia may be associated with the broader pathology of schizophrenia, and therefore not detectable with subclinical populations.
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Affiliation(s)
- Kendall Beals
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah H. Sperry
- Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Julia M. Sheffield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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26
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Kovács A, Ladányi B, Farkas N, Stempel L, Kiss D, Bittermann É, Rácz J. The recovery of homicidal people diagnosed with schizophrenia and schizoaffective disorder-An interpretative phenomenological analysis. Front Psychiatry 2022; 13:951678. [PMID: 36741576 PMCID: PMC9892903 DOI: 10.3389/fpsyt.2022.951678] [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: 05/24/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Identity recovery in people diagnosed with schizophrenia who have committed homicide poses several difficulties. Premorbid mental illnesses, the experience of psychosis, and the absence of cohesive ego functions may result in the inability to integrate the homicidal act into self-identity. Problems with integration increase the risk of recidivism and further mental problems. The aim of the present research was to explore how homicidal people diagnosed with schizophrenia make sense of their actions, and how they identify with the homicide. METHOD Six semi-structured interviews were conducted at a long-term psychiatric home with people who had committed homicide and who had been diagnosed with schizophrenia. The interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA), an idiographic method rooted in phenomenologist traditions that focuses on how participants experience and make sense of events in their lives, and how those events affect their identity and sense of self. RESULTS Three personal experiential themes were established as a result of the analysis: (1) homicide and responsibility; (2) homicide and self; and (3) control over threats to self and self-evaluation. (1) Homicide was often reported to have been committed in a non-conscious, delusional state that may have led to the loss of self-determination. (2) Our interviewees struggled to integrate their acts into their identities. They distanced themselves from the crime or held multiple, parallel interpretations of the act. (3) Recovering patients experienced the constant threat of entering into a delusional reality and losing control. The importance of control was central to their self-evaluation. The patients appeared to distance themselves from the homicidal act and to regard their delusional selves as a threat to their lives. CONCLUSION Therapy aimed at bolstering self-control, supporting the integration of the fragmented self, and raising awareness of the connections between delusional reality and standard, intersubjective reality may be helpful in reducing the instability of the self. Therapy aimed at processing complex grief and loss of family is also needed.
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Affiliation(s)
- Asztrik Kovács
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Bence Ladányi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Criminal Investigation, Hungarian National Police Headquarters, Budapest, Hungary
| | - Noémi Farkas
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Laura Stempel
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Kiss
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | | | - József Rácz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Addictology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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27
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Leendertse P, Hirzalla F, van den Berg D, Castelein S, Mulder CL. Facilitating and hindering factors of personal recovery in the context of Soteria-A qualitative study among people with (early episode) psychosis. Front Psychiatry 2022; 13:1051446. [PMID: 36683984 PMCID: PMC9848445 DOI: 10.3389/fpsyt.2022.1051446] [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: 09/22/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The objective of this study was to gain insight into patients' experiences of how personal recovery (PR) is facilitated or hindered in the context of an early episode psychosis setting (Soteria). We thereby aimed to contribute to the understanding of how care settings may promote or hinder the process of PR in people with (acute) psychosis. METHOD This study used a qualitative method, consisting of semi-structured in-depth interviews with people who had been admitted to a Soteria house in the Netherlands. Interview transcripts were analyzed following the Grounded Theory approach. RESULTS Five themes emerged from the data illustrating how Soteria facilitated or impeded PR. The experience of togetherness in contact with staff and peers, feeling at home, and being active facilitated PR, while the emphasis put on medication by staff was experienced as hindering, and attention to spirituality was missed. CONCLUSION In addition to the literature that identified factors associated with PR in psychosis, the current study gives a sense of how this can be put into practice. By offering treatment within a normalizing, holding environment, with emphasis on equality, close contact, optimism, active structured days, open-mindedness toward spirituality, and the role of medication, PR can be facilitated without detracting from guideline-based treatment aimed at symptomatic recovery. Similarities with existing concepts are discussed.
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Affiliation(s)
- Pien Leendertse
- Emergis, Institute for Mental Healthcare, Kloetinge, Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Fadi Hirzalla
- Department of Public Administration and Sociology, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, Netherlands.,Faculty of Behavioral and Social Sciences, Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Cornelis Lambert Mulder
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands.,Antes, Institute for Mental Healthcare, Parnassia Psychiatric Institute, Rotterdam, Netherlands
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Connors MH, Halligan PW. Delusions and disorders of self-experience. Lancet Psychiatry 2021; 8:740-741. [PMID: 34358476 DOI: 10.1016/s2215-0366(21)00244-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia; Dementia Centre for Research Collaboration, University of New South Wales, Sydney, NSW 2052, Australia.
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