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Violeau L, Valery KM, Waintraub MO, Prouteau A, Lysaker P. [Promoting mental health recovery through metacognitive reflection and insight therapy (MERIT): A systematic literature review]. L'ENCEPHALE 2024:S0013-7006(24)00189-1. [PMID: 39368928 DOI: 10.1016/j.encep.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 10/07/2024]
Abstract
OBJECTIVES To demonstrate the effects of a metacognitive reflection and insight therapy (MERIT) in people suffering from psychiatric disorders. METHOD A systematic review was carried out on PubMed, PsychInfo, Psycharticles and Psychological and Behavioral Science Collection from 1980 to 2024. RESULTS The review included five randomized controlled studies, four observational group studies and 22 case studies with quantitative measures. Analyses indicated that MERIT significantly increases metacognitive abilities to reflect on oneself and others, as well as mastery of one's strategies. In addition, some studies found an improvement in insight and symptomatology. Most studies included participants with psychotic disorders. CONCLUSION MERIT is an effective therapy for promoting subjective recovery by improving metacognitive abilities in people with psychotic disorders. However, further studies are needed to generalize this result to other psychiatric disorders.
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Affiliation(s)
- Louis Violeau
- Unité de remédiation cognitive et d'évaluation, centre hospitalier Edouard-Toulouse, 13015 Marseille, France.
| | - Kévin-Marc Valery
- EA 4139, LabPsy, université de Bordeaux, 33000 Bordeaux, France; Association proSpairs, 33400 Talence, France
| | - Marc-Olivier Waintraub
- Unité de remédiation cognitive et d'évaluation, centre hospitalier Edouard-Toulouse, 13015 Marseille, France
| | - Antoinette Prouteau
- EA 4139, LabPsy, université de Bordeaux, 33000 Bordeaux, France; Union nationale de familles et amis de personnes malades et/ou handicapées psychiques, Paris, France
| | - Paul Lysaker
- Richard L. Roudbush VA Medical Center, Indianapolis, IN, États-Unis; Indiana University School of Medicine, Indianapolis, IN, États-Unis
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Cowan HR, McAdams DP, Ouellet L, Jones CM, Mittal VA. Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis. Schizophr Bull 2024; 50:848-859. [PMID: 37816626 PMCID: PMC11283199 DOI: 10.1093/schbul/sbad142] [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] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND HYPOTHESIS Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course. STUDY DESIGN Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning. STUDY RESULTS CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning. CONCLUSIONS This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.
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Affiliation(s)
- Henry R Cowan
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Dan P McAdams
- Psychology, Northwestern University, Evanston, IL, USA
| | - Leah Ouellet
- Human Development and Social Policy, Northwestern University, Evanston, IL, USA
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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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Kumazaki T, Hayashi N. Self-disorder explained: Yasunaga's "Phantom Space Theory" on schizophrenia. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e90. [PMID: 38868130 PMCID: PMC11114416 DOI: 10.1002/pcn5.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 06/14/2024]
Abstract
The present article revisits the theoretical model of schizophrenia by Hiroshi YASUNAGA (1929-2011). Yasunaga restated ego disturbance in schizophrenia as the "Pattern Reversal" between selfhood and otherness, based on British philosopher Wauchope's concept of "pattern." This concept is meant as asymmetrical relatedness (A/B) within a pair of concepts, such as life and death, quality and quantity, and self and other, prioritizing the former (A side) over the latter (B side). When applied to the pair of self and other, the pattern is vital for human experiences, and its disruption fundamentally alters every lived experience. Subsequently, Yasunaga extended the theory of pattern and invented his original "Phantom Space Theory," in which he postulated "Phantom Space," an experiential space that constitutes system a (A-side-led and consciously determined distance) and system a' (B-side-dominated and extra-consciously given distance). He then constructed a kind of neural system model composed of systems a and a', and thereby schematically presented a novel viewpoint on experiences of self and the outside world. The theory further illustrated how the hypothesized imbalance (Phantom Space shrinkage or diminished elasticity of system a') causes symptoms of schizophrenia, such as ego disturbances, auditory hallucinations, and other unspecific symptoms. This article then examines the clinical and theoretical implications of Yasunaga's psychiatric works. Phantom Space Theory is a non-stigmatizing account of schizophrenia because it does not presuppose personal or existential causes of psychosis. The relationship between Phantom Space Theory and dual-process theory is also explored.
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Affiliation(s)
- Tsutomu Kumazaki
- Health Service CenterTokyo University of Agriculture and TechnologyTokyoJapan
| | - Naoki Hayashi
- Department of PsychiatryNishigahara HospitalTokyoJapan
- Department of PsychiatryTeikyo University School of MedicineTokyoJapan
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Chan CC, Norel R, Agurto C, Lysaker PH, Myers EJ, Hazlett EA, Corcoran CM, Minor KS, Cecchi GA. Emergence of Language Related to Self-experience and Agency in Autobiographical Narratives of Individuals With Schizophrenia. Schizophr Bull 2023; 49:444-453. [PMID: 36184074 PMCID: PMC10016400 DOI: 10.1093/schbul/sbac126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND HYPOTHESIS Disturbances in self-experience are a central feature of schizophrenia and its study can enhance phenomenological understanding and inform mechanisms underlying clinical symptoms. Self-experience involves the sense of self-presence, of being the subject of one's own experiences and agent of one's own actions, and of being distinct from others. Self-experience is traditionally assessed by manual rating of interviews; however, natural language processing (NLP) offers automated approach that can augment manual ratings by rapid and reliable analysis of text. STUDY DESIGN We elicited autobiographical narratives from 167 patients with schizophrenia or schizoaffective disorder (SZ) and 90 healthy controls (HC), amounting to 490 000 words and 26 000 sentences. We used NLP techniques to examine transcripts for language related to self-experience, machine learning to validate group differences in language, and canonical correlation analysis to examine the relationship between language and symptoms. STUDY RESULTS Topics related to self-experience and agency emerged as significantly more expressed in SZ than HC (P < 10-13) and were decoupled from similarly emerging features such as emotional tone, semantic coherence, and concepts related to burden. Further validation on hold-out data showed that a classifier trained on these features achieved patient-control discrimination with AUC = 0.80 (P < 10-5). Canonical correlation analysis revealed significant relationships between self-experience and agency language features and clinical symptoms. CONCLUSIONS Notably, the self-experience and agency topics emerged without any explicit probing by the interviewer and can be algorithmically detected even though they involve higher-order metacognitive processes. These findings illustrate the utility of NLP methods to examine phenomenological aspects of schizophrenia.
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Affiliation(s)
- Chi C Chan
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raquel Norel
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Carla Agurto
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan J Myers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Erin A Hazlett
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cheryl M Corcoran
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
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Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis. SCHIZOPHRENIA 2022; 8:74. [PMID: 36114173 PMCID: PMC9481626 DOI: 10.1038/s41537-022-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.
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Humpston CS. Paradoxes in a prism: Reflections on the omnipotent passivity and omniscient oblivion of schizophrenia. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2078187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Clara S. Humpston
- Department of Psychology, University of York, York, UK
- School of Psychology, University of Birmingham, Birmingham, UK
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Damiani S, Donadeo A, Bassetti N, Salazar‐de‐Pablo G, Guiot C, Politi P, Fusar‐Poli P. Understanding source monitoring subtypes and their relation to psychosis: a systematic review and meta-analysis. Psychiatry Clin Neurosci 2022; 76:162-171. [PMID: 35124869 PMCID: PMC9313862 DOI: 10.1111/pcn.13338] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
AIMS Source monitoring (SM) is the metacognitive ability to determine the origin of one's experiences. SM is altered in primary psychiatric psychosis, although relationships between SM subtypes, other cognitive domains and symptoms are unclear. Our aims were to synthesize evidence comparing psychosis -with and without hallucinations- and healthy controls classifying SM subtypes by source discrimination (internal/external/reality monitoring) and stimulus modality (visual/auditory/imagined/performed). METHODS This systematic review adopted Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Meta-analyses Of Observational Studies in Epidemiology and Population, Intervention, Comparison and Outcomes guidelines. Core demographical and clinical parameters were extracted. Newcastle-Ottawa Scale was used as quality check. SM differences between (i) psychosis patients versus healthy controls and (ii) patients with versus without hallucinations were investigated via random-effect model meta-analysis. The primary effect size measure was standardized mean difference (SMD) in each SM subtype performance (error or accuracy). Heterogeneity, publication biases and meta-regressions were assessed. RESULTS Five thousand two hundred and fifty-six records were screened to finally include 44 studies (1566 patients, 1175 controls). Mean Newcastle-Ottawa score was 7.41 out of 9. Few studies measured SM associations with cognition (n = 9) and symptoms (n = 19), with heterogeneous findings. SM performance across all measures was reduced in psychosis versus healthy controls (SMD = 0.458). Internal SM (SMD: errors = 0.513; accuracy = 0.733) and imagined stimuli (SMD: errors = 0.688; accuracy = 0.978) were specifically impaired. Patients with versus without hallucinations showed SM deficits only for externalizing (SMD = 0.410) and imagined/auditory (SMD = 0.498/0.277) errors. CONCLUSION The proposed classifications highlight specific SM deficits for internal/imagined stimuli in psychosis, providing evidence-based indications to design and interpret future studies.
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Affiliation(s)
- Stefano Damiani
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Alberto Donadeo
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Nicola Bassetti
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Gonzalo Salazar‐de‐Pablo
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Child and Adolescent Mental Health ServicesSouth London and the Maudsley NHS Foundation TrustLondonUK
| | - Cecilia Guiot
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Pierluigi Politi
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Paolo Fusar‐Poli
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- OASIS service, South London and Maudsley NHS Foundation TrustLondonUK
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Gruber RP, Block RA, Montemayor C. Physical Time Within Human Time. Front Psychol 2022; 13:718505. [PMID: 35432085 PMCID: PMC9005802 DOI: 10.3389/fpsyg.2022.718505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
A possible solution is offered to help resolve the "two times problem" regarding the veridical and illusory nature of time. First it is recognized that the flow (passage) of time is part of a wider array of temporal experiences referred to as manifest time, all of which need to be reconciled. Then, an information gathering and utilizing system (IGUS) model is used as a basis for a view of manifest time. The model IGUS robot of Hartle that solves the "unique present" debate is enhanced with veridical and (corresponding) illusory components of not only the flow of time but also the larger entity of manifest time, providing a dualistic IGUS robot that represents all of the important temporal experiences. Based upon a variety of prior experiments, that view suggests that the veridical system is a reflection of accepted spacetime cosmologies and through natural selection begets the illusory system for functional purposes. Thus, there are not two opposing times, one outside and one inside the cranium. There is just one fundamental physical time which the brain developed, now possesses and is itself sufficient for adaption but then enhances. The illusory system is intended to provide a more satisfying experience of physical time, and better adaptive behavior. Future experiments to verify that view are provided. With a complete veridical system of temporal experiences there may be less need to reify certain temporal experiences so that the two times problem is less of a problem and more of a phenomenon.
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Affiliation(s)
- Ronald P. Gruber
- Stanford University Medical Center, Stanford University, Stanford, CA, United States
| | - Richard A. Block
- Department of Psychology, Montana State University, Bozeman, MT, United States
| | - Carlos Montemayor
- Department of Philosophy, San Francisco State University, San Francisco, CA, United States
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Wilkinson S, Green H, Hare S, Houlders J, Humpston C, Alderson-Day B. Thinking about hallucinations: why philosophy matters. Cogn Neuropsychiatry 2022; 27:219-235. [PMID: 34874242 PMCID: PMC9006978 DOI: 10.1080/13546805.2021.2007067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Hallucinations research is increasingly incorporating philosophy or the work of philosophically trained individuals. We present three different ways in which this is successfully implemented to the enhancement of knowledge and understanding of hallucinations and related phenomena.Method: We review contributions from phenomenology, philosophy of cognitive science, and philosophy of science and psychiatry.Results: We demonstrate that these areas of philosophy make significant contributions to hallucinations research. Phenomenology gives us a sophisticated and critical understanding of the lived experience of hallucinations. Philosophy of cognitive science enables big-picture theorising and synthesis of ideas, as well as a critical engagement with new paradigms. Philosophy of science and psychiatry raises valuable and theoretically informed questions about diagnosis and categorisation.Conclusions: These contributions reflect both the methodological variety within philosophy and its relevance to the hallucinations researcher.
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Affiliation(s)
- Sam Wilkinson
- Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK, Sam Wilkinson
| | - Huw Green
- Neuropsychology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stephanie Hare
- Neuroimaging, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Clara Humpston
- School of Psychology, University of Birmingham Institute for Mental Health, Birmingham, UK
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Nishiyama S, Kurachi M, Higuchi Y, Takahashi T, Sasabayashi D, Mizukami Y, Suzuki M. Development and validation of a scale of self-alienation-related attributes for the early diagnosis of schizophrenia. J Psychiatr Res 2022; 147:212-220. [PMID: 35065511 DOI: 10.1016/j.jpsychires.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The onset of schizophrenia is often preceded by a prodromal phase. However, it is difficult to predict the future transition to schizophrenia from the prodromal symptoms. Based on the diagnostic significance of Schneider's first rank symptoms (FRS), especially those representing "ego disorders (Ichstörungen)", we developed a scale of self-alienation-related attributes (Self-A) to assess the psychological characteristics associated with ego disorders for the early diagnosis of schizophrenia. METHODS In total, 153 schizophrenia (Sz) patients, 83 at-risk mental state (ARMS) subjects, and 154 healthy control (HC) subjects participated in this study. The Self-A scale was constructed by items from the Minnesota Multiphasic Personality Inventory (MMPI) based on the differences between schizophrenia patients with and without FRS representing ego-disorders designated as "self-alienation symptoms". The Self-A scale was tested for its reliability and validity in a different sample of schizophrenia patients, and was then applied to different cohorts including first-episode schizophrenia (FES) patients, ARMS individuals, and HC subjects. RESULTS The Self-A consisting of 27 items exhibited good internal consistency reliability. The validity was well demonstrated by the high correlation of the Self-A scores with the self-alienation symptom scores. The ARMS and FES groups had higher Self-A scores than the HC group. The Self-A score in the ARMS individuals who later developed schizophrenia was higher than that in the ARMS subjects who did not, and was comparable with that in the FES group. CONCLUSIONS This study suggests that the newly developed Self-A scale assessing the self-alienation-related attributes can improve the early diagnosis of schizophrenia.
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Affiliation(s)
- Shimako Nishiyama
- Centre for Health Care and Human Sciences, University of Toyama, Toyama, Japan; Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
| | - Masayoshi Kurachi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yuko Higuchi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Centre for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Centre for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Centre for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yuko Mizukami
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Centre for Idling Brain Science, University of Toyama, Toyama, Japan
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Wright AC, Moody E, Browne J, Cather C. Self-defining memories among persons with mental health, substance use, cognitive, and physical health conditions: a systematic review. Memory 2022; 30:823-844. [DOI: 10.1080/09658211.2022.2042565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Abigail C. Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Erin Moody
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Burgin S, Reniers R, Humpston C. Prevalence and assessment of self-disorders in the schizophrenia spectrum: a systematic review and meta-analysis. Sci Rep 2022; 12:1165. [PMID: 35064201 PMCID: PMC8782935 DOI: 10.1038/s41598-022-05232-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Self-disorders have been proposed as the "clinical core" of the schizophrenia spectrum. This has been explored in recent studies using self-disorder assessment tools. However, there are few systematic discussions of their quality and utility. Therefore, a literature search was performed on Medline, Embase, PsychINFO, PubMed and the Web of Science. Studies using these assessment tools to explore self-disorders within schizophrenia spectrum disorders (SSDs) were included. A meta-analysis was performed on the outcomes of total self-disorder score and odds ratios of self-disorders, using Comprehensive Meta-Analysis software. Weighted pooled effect sizes in Hedge's g were calculated using a random-effects model. 15 studies were included, giving a sample of 810 participants on the schizophrenia spectrum. Self-disorders showed a greater aggregation within schizophrenia spectrum groups compared to non-schizophrenia spectrum groups, as measured with the Bonn Scale for the Assessment of Basic Symptoms (Hedge's g = 0.774, p < 0.01) and Examination of Anomalous Self-Experiences (Hedge's g = 1.604, p < 0.01). Also, self-disorders had a greater likelihood of occurring within SSDs (odds ratio = 5.435, p < 0.01). These findings help to validate self-disorders as a core clinical feature of the broad schizophrenia spectrum.
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Affiliation(s)
- Sam Burgin
- University of Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK
| | - Renate Reniers
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK
| | - Clara Humpston
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.
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Klock L, Voss M, Weichenberger M, Kathmann N, Kühn S. The Thought From the Machine: Neural Basis of Thoughts With a Coherent and Diminished Sense of Authorship. Schizophr Bull 2021; 47:1631-1641. [PMID: 34387697 PMCID: PMC8530403 DOI: 10.1093/schbul/sbab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Patients with schizophrenia who experience inserted thoughts report a diminished sense of thought authorship. Based on its elusive neural basis, this functional neuroimaging study used a novel setup to convince healthy participants that a technical device triggers thoughts in their stream of consciousness. Self-reports indicate that participants experienced their thoughts as self-generated when they believed the (fake) device was deactivated, and attributed their thoughts externally when they believed the device was activated-an experience usually only reported by patients diagnosed with schizophrenia. Distinct activations in the medial prefrontal cortex (mPFC) were observed: ventral mPFC activation was linked to a sense of thought authorship and dorsal mPFC activation to a diminished sense of thought authorship. This functional differentiation corresponds to research on self- and other-oriented reflection processes and on patients with schizophrenia who show abnormal mPFC activation. Results thus support the notion that the mPFC might be involved in thought authorship as well as anomalous self-experiences.
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Affiliation(s)
- Leonie Klock
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Voss
- Department of Psychiatry and Psychotherapy, Charité University Medicine and St. Hedwig-Krankenhaus, Berlin, Germany
| | - Markus Weichenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Norbert Kathmann
- Department of Clinical Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Simone Kühn
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany.,Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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15
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Memory, Future Thinking, and the Self. In Honour of Martial Van Der Linden. Psychol Belg 2021; 61:274-283. [PMID: 34611494 PMCID: PMC8447971 DOI: 10.5334/pb.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
Over the past 20 years, much progress has been made in understanding the relations between memory and future thinking, and their role in shaping our sense of self and identity. My own interest in these research questions owes much to Martial Van der Linden, with whom I had the chance to interact closely for several years. The purpose of this article is to pay tribute to him by reviewing the work we initiated together on autobiographical memory and future-oriented thinking. I first review our early work on the relationship between memory and future thinking and discuss their role in self-representation. Then, I provide an overview of the underlying neural bases and describe the alterations of autobiographical thinking that characterize certain psychological disorders. Finally, I outline an integrative framework that I recently proposed to account for the cognitive structure of past and future autobiographical thinking.
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16
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Polner B, Hupuczi E, Kéri S, Kállai J. Adaptive and maladaptive features of schizotypy clusters in a community sample. Sci Rep 2021; 11:16653. [PMID: 34404855 PMCID: PMC8371157 DOI: 10.1038/s41598-021-95945-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
Schizotypal personality traits correlate with psychopathology and impaired functional outcome. Yet advantageous aspects of positive schizotypy may exist which could promote resilience and creativity, and several studies have identified a high positive but low negative schizotypy group with some signs of adaptation. The aim of our study was to clarify whether such individuals demonstrate only traits associated with well-being, or they also have traits that predict impairment. Participants (N = 643 students, 71.5% female) completed measures of schizotypy, resilience, self-esteem, self-concept clarity, and absorption. We identified four clusters: an overall low schizotypy, an overall high schizotypy, a disorganised-interpersonal schizotypy and a positive schizotypy cluster. The overall high schizotypy cluster seemed to be the most vulnerable as it was the least resilient and showed widespread maladaptation, whereas the high positive schizotypy cluster had intact self-esteem and high resilience and its elevated absorption may hold the promise for adaptive outcomes such as creativity and positive spirituality. However, the high positive schizotypy cluster lacked self-concept clarity. The results suggest that individuals showing high positive and low negative schizotypy demonstrate features promoting mental well-being to an extent that is higher than in all the other clusters, while their self-concept impairment is similar to that observed in the high and the disorganised-interpersonal schizotypy clusters. Better understanding of these factors could be informative for prevention and treatment of psychosis-spectrum disorders.
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Affiliation(s)
- Bertalan Polner
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Ernő Hupuczi
- Cognitive Neuroscience Research Group, Medical Faculty, Institute of Behavioral Sciences, University of Pécs, Pecs, Hungary
| | - Szabolcs Kéri
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary.,National Institute of Psychiatry and Addictions, Budapest, Hungary.,Department of Physiology, University of Szeged, Szeged, Hungary
| | - János Kállai
- Cognitive Neuroscience Research Group, Medical Faculty, Institute of Behavioral Sciences, University of Pécs, Pecs, Hungary
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17
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Hamilton A, Northoff G. Abnormal ERPs and Brain Dynamics Mediate Basic Self Disturbance in Schizophrenia: A Review of EEG and MEG Studies. Front Psychiatry 2021; 12:642469. [PMID: 33912085 PMCID: PMC8072007 DOI: 10.3389/fpsyt.2021.642469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/11/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Interest in disordered sense of self in schizophrenia has recently re-emerged in the literature. It has been proposed that there is a basic self disturbance, underlying the diagnostic symptoms of schizophrenia, in which the person's sense of being a bounded individual continuous through time loses stability. This disturbance has been documented phenomenologically and at the level of cognitive tasks. However, the neural correlates of basic self disorder in schizophrenia are poorly understood. Methods: A search of PubMed was used to identify studies on self and schizophrenia that reported EEG or MEG data. Results: Thirty-three studies were identified, 32 using EEG and one using MEG. Their operationalizations of the self were divided into six paradigms: self-monitoring for errors, proprioception, self-other integration, self-referential processing, aberrant salience, and source monitoring. Participants with schizophrenia were less accurate on self-referential processing tasks and had slower response times across most studies. Event-related potential amplitudes differed across many early and late components, with reduced N100 suppression in source monitoring paradigms being the most replicated finding. Several studies found differences in one or more frequency band, but no coherent overall finding emerged in this area. Various other measures of brain dynamics also showed differences in single studies. Only some of the study designs were adequate to establish a causal relationship between the self and EEG or MEG measures. Conclusion: The broad range of changes suggests a global self disturbance at the neuronal level, possibly carried over from the resting state. Further studies that successfully isolate self-related effects are warranted to better understand the temporal-dynamic and spatial-topographic basis of self disorder and its relationship to basic self disturbance on the phenomenological level.
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Affiliation(s)
- Arthur Hamilton
- Department of Cognitive Science, Carleton University, Ottawa, ON, Canada
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
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18
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Kállai J, Vincze G, Török IA, Hargitai R, Rózsa S, Hartung I, Tamás I, Láng A, Herold R. Cognitive Gain or Handicap: Magical Ideation and Self-Absorption in Clinical and Non-clinical Participants. Front Psychol 2021; 12:613074. [PMID: 33716876 PMCID: PMC7952430 DOI: 10.3389/fpsyg.2021.613074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/18/2021] [Indexed: 11/22/2022] Open
Abstract
Background: This study aimed to examine magical ideation and absorption traits across non-clinical and clinical groups to determine their potential adaptive and maladaptive functions. Method: We enrolled 760 healthy participants from neighboring communities (female = 53.2%). Moreover, we recruited 318 patients (female = 66.5%), which included 25, 183, and 110 patients with schizophrenia spectrum disorders, anxiety disorders, and mood disorders, respectively. Potentially adaptive and maladaptive sociocognitive functions were measured to determine the role of magical ideation and self-absorption in patients with psychiatric disorders. Results: The degree of magical ideation and absorption gradually increased in the following order: anxiety disorders, mood disorders, and schizophrenia spectrum disorders. Furthermore, enhanced self-absorption-related enhanced consciousness traits were essential indicators of the presence of self-integration weakness in patients with schizophrenia spectrum disorders. Conclusion: Magical ideation and psychological absorption may be considered as mental model construction functions, which result in both gains and handicaps in social adaptation.
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Affiliation(s)
- János Kállai
- Department of Behavioural Sciences, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Vincze
- Pándy Kálmán Division, Department of Psychiatry, Békés Country Hospital Center, Gyula, Hungary
| | - Imre András Török
- Pándy Kálmán Division, Department of Psychiatry, Békés Country Hospital Center, Gyula, Hungary
| | - Rita Hargitai
- Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary
| | - Sándor Rózsa
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - István Hartung
- Department of Behavioural Sciences, Medical School, University of Pécs, Pécs, Hungary
| | - István Tamás
- Department of Behavioural Sciences, Medical School, University of Pécs, Pécs, Hungary
| | - András Láng
- Institute of Psychology, Faculty of Humanities, University of Pécs, Pécs, Hungary
| | - Róbert Herold
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
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19
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Herbener ES, Harrow M. Course and symptom and functional correlates of passivity symptoms in schizophrenia: an 18-year multi-follow-up longitudinal study. Psychol Med 2021; 51:503-510. [PMID: 31839019 DOI: 10.1017/s0033291719003428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Change in the experience of oneself may lay the groundwork for the development of additional hallucinations and delusions in individuals with schizophrenia. However, to date, the course and symptom and functioning correlates of passivity symptoms (cf. thought insertion, thought withdrawal) have not been measured consistently over long periods of time. Information on the course and correlates of passivity symptoms is essential for developing models of their contribution to schizophrenic illness. METHOD Eighty-two individuals diagnosed with schizophrenia or schizoaffective disorder were recruited at an index hospitalization and reassessed at three or more follow-ups over the following 18 years. RESULTS The results indicate that a small group of participants report passivity symptoms at all follow-ups, many reported passivity symptoms at some follow-ups, and the majority of individuals never reported passivity symptoms. The prevalence of passivity symptoms was similar to that for delusions of reference and persecutory delusions. Notably, when individuals did experience passivity symptoms, they also had a greater number of additional psychotic symptoms than individuals without passivity symptoms. Further, the presence of passivity symptoms was associated with work impairment at some assessments. CONCLUSIONS Passivity symptoms present episodically, at a similar rate as delusions of reference and persecutory delusions, and when present, they are associated with having a higher number of additional psychotic symptoms, as well as having some impact on work functioning. These results suggest that passivity symptoms may increase vulnerability to additional psychotic symptoms and greater work impairment.
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Affiliation(s)
- Ellen S Herbener
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St., Chicago, IL60607, USA
- Department of Psychiatry, University of Illinois at Chicago, 1601 W Taylor St., Chicago, IL60612, USA
| | - Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, 1601 W Taylor St., Chicago, IL60612, USA
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20
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Klar P, Northoff G. When the World Breaks Down: A 3-Stage Existential Model of Nihilism in Schizophrenia. Psychopathology 2021; 54:169-192. [PMID: 34198308 PMCID: PMC8619772 DOI: 10.1159/000516814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
The existential crisis of nihilism in schizophrenia has been reported since the early days of psychiatry. Taking first-person accounts concerning nihilistic experiences of both the self and the world as vantage point, we aim to develop a dynamic existential model of the pathological development of existential nihilism. Since the phenomenology of such a crisis is intrinsically subjective, we especially take the immediate and pre-reflective first-person perspective's (FPP) experience (instead of objectified symptoms and diagnoses) of schizophrenia into consideration. The hereby developed existential model consists of 3 conceptualized stages that are nested into each other, which defines what we mean by existential. At the same time, the model intrinsically converges with the phenomenological concept of the self-world structure notable inside our existential framework. Regarding the 3 individual stages, we suggest that the onset or first stage of nihilistic pathogenesis is reflected by phenomenological solipsism, that is, a general disruption of the FPP experience. Paradigmatically, this initial disruption contains the well-known crisis of common sense in schizophrenia. The following second stage of epistemological solipsism negatively affects all possible perspectives of experience, that is, the first-, second-, and third-person perspectives of subjectivity. Therefore, within the second stage, solipsism expands from a disruption of immediate and pre-reflective experience (first stage) to a disruption of reflective experience and principal knowledge (second stage), as mirrored in abnormal epistemological limitations of principal knowledge. Finally, the experience of the annihilation of healthy self-consciousness into the ultimate collapse of the individual's existence defines the third stage. The schizophrenic individual consequently loses her/his vital experience since the intentional structure of consciousness including any sense of reality breaks down. Such a descriptive-interpretative existential model of nihilism in schizophrenia may ultimately serve as input for future psychopathological investigations of nihilism in general, including, for instance, its manifestation in depression.
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Affiliation(s)
- Philipp Klar
- Medical Faculty, C. & O. Vogt-Institute for Brain Research, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Georg Northoff
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, China.,Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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21
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Eeles E, Ward S, Teodorczuk A, Dissanayaka N, Burianová H. Consciousness and the rabbit holes of delirium. Med Hypotheses 2020; 144:110260. [PMID: 33254566 DOI: 10.1016/j.mehy.2020.110260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 11/24/2022]
Abstract
Delirium is a common disorder in hospitalized older adults and the defining characteristic is a disturbance of consciousness. Unfortunately, there are currently no testable measures of consciousness as pertains to its disruption in delirium. Not surprisingly rates of recognition of delirium suffer. Arguably, a greater understanding of the quantum of consciousness may improve delirium diagnosis through better diagnostic tools. Candidate dimensions of consciousness derived from fields of psychology, psychiatry, and philosophy are discussed and relevance to delirium explored. Based upon existing literature in the field of consciousness we identify the pre-reflective state, experiential awareness, and functional networks as candidate sites that may be affected in delirium. Opportunities for clinical instrument development and how these tools can be tested are discussed. We conclude that consciousness content may not hold to a unitary measurement, but facets of its integrity that are impacted in delirium are open to further exploration. Disorders in pre-reflective status, experiential awareness, and functional networks may represent the measurable "rabbit holes" of consciousness disturbance.
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Affiliation(s)
- Eamonn Eeles
- Internal Medicine Service, The Prince Charles Hospital, Brisbane, QLD, Australia; School of Medicine, Northside Clinical School, The University of Queensland, The Prince Charles Hospital, QLD, Australia; UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, QLD.
| | - S Ward
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, QLD; Redcliffe Hospital, Redcliffe, QLD, Australia
| | - A Teodorczuk
- School of Medicine, Griffith University, Gold Coast, Australia; Metro North Mental Health, The Prince Charles Hospital, Brisbane, Australia
| | - N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, QLD; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Brisbane, QLD, Australia; School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - H Burianová
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset UK
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22
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Humpston CS, Broome MR. Thinking, believing, and hallucinating self in schizophrenia. Lancet Psychiatry 2020; 7:638-646. [PMID: 32105619 DOI: 10.1016/s2215-0366(20)30007-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 01/01/2023]
Abstract
In this Personal View, we discuss the history and concept of self-disturbance in relation to the pathophysiology and subjective experience of schizophrenia in terms of three approaches: the perceptual anomalies approach of the early Heidelberg School of Psychiatry, the ipseity model, and the predictive coding framework. Despite the importance of these approaches, there has been a notable absence of efforts to compare them and consider how they might be integrated. This Personal View compares the three approaches and offers suggestions as to how they might work together, which represents a novel position. We view self-disturbances as transformations of self that form the inseparable background against which psychotic symptoms emerge. Integrating computational psychiatric approaches with those used by phenomenologists in the first two listed approaches, we argue that delusions and hallucinations are inferences produced under extraordinary conditions and are both statistically and experientially as real for patients as other mental events. Such inferences still approximate Bayes-optimality, given the personal, neurobiological, and environmental circumstances, and might be the only ones available to minimise prediction error. The added contribution we hope to make focuses on how the dialogue between neuroscience and phenomenology might improve clinical practice. We hope this Personal View will act as a timely primer and bridging point for the different approaches of computational psychiatry and phenomenological psychopathology for interested clinicians.
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Affiliation(s)
- Clara S Humpston
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
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23
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Frewen P, Schroeter ML, Riva G, Cipresso P, Fairfield B, Padulo C, Kemp AH, Palaniyappan L, Owolabi M, Kusi-Mensah K, Polyakova M, Fehertoi N, D’Andrea W, Lowe L, Northoff G. Neuroimaging the consciousness of self: Review, and conceptual-methodological framework. Neurosci Biobehav Rev 2020; 112:164-212. [DOI: 10.1016/j.neubiorev.2020.01.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
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24
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Kéri S. Self-Transformation at the Boundary of Religious Conversion and Psychosis. JOURNAL OF RELIGION AND HEALTH 2020; 59:584-597. [PMID: 28914403 DOI: 10.1007/s10943-017-0496-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The relationship between religious conversion, as a form of spiritual emergency, and psychosis is one of the fundamental issues at the meeting point of theology and clinical psychology. In the present study, we assessed 53 individuals referred to a psychiatry center with the initial diagnosis of a psychotic episode by focusing on the clinical diagnosis (psychosis vs. spiritual emergency), subjective experiences (basic symptoms), and neuropsychological functions. Twenty-nine individuals meet the diagnosis of schizophrenia-spectrum disorders, but 24 persons experienced only religious and spiritual problems (religious conversion). Both groups reported similar levels of perplexity (e.g., ambivalence, inability to discriminate between own feelings, and hyperreflectivity) and self-disorder (e.g., depersonalization, impression of a change in one's mirror image, and experience of discontinuity in own action). Diminished affectivity, disturbed contact, and perceptual/cognitive disorders were pronounced in psychosis, whereas anxiety and depressive symptoms were more severe in people with spiritual and religious problems. These results indicate that perplexity, self-disorder, and emotional turmoil are common features of turbulent religious conversion and psychosis, but a broader emergence of anomalous subjective experiences and cognitive deficits are detectable only in psychosis.
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Affiliation(s)
- Szabolcs Kéri
- Katharina Schütz Zell Center, Nyírő Gyula Hospital - National Institute of Psychiatry and Addictions, Budapest, Hungary.
- Department of Cognitive Science, Budapest University of Technology and Economics, Egry J. Str. 1, Budapest, 1111, Hungary.
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25
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Kéri S, Kelemen O. Christianity and Schizophrenia Redux: An Empirical Study. JOURNAL OF RELIGION AND HEALTH 2020; 59:452-469. [PMID: 27062727 DOI: 10.1007/s10943-016-0227-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper explores the relationship among schizophrenia, spirituality, and Christian religiosity. We interviewed 120 patients with schizophrenia and 120 control individuals (74.2 % of individuals with self-reported Christian religions). Patients with schizophrenia showed increases in positive spirituality and decreases in positive congregational support, as measured by the Brief Multidimensional Measure of Religiousness/Spirituality. There was no significant difference in Christian religiosity. Higher positive spirituality was predicted by more severe self-disorder, perceptual disorder, and positive clinical symptoms. Schizophrenia patients with religious delusions did not exhibit enhanced Christian beliefs and rituals. These results do not confirm the hypothesis of general hyper-religiosity in schizophrenia.
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Affiliation(s)
- Szabolcs Kéri
- Nyírő Gyula Hospital - National Institute of Psychiatry and Addictions, Budapest, Hungary.
- Department of Cognitive Science, Budapest University of Technology and Economics, Egry J. str. 1, Budapest, 1111, Hungary.
- Katharina Schütz Zell Center, Budapest, Hungary.
| | - Oguz Kelemen
- Department of Behavioral Sciences, University of Szeged, Szeged, Hungary
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26
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Savostyanov A, Tamozhnikov S, Bocharov A, Saprygin A, Matushkin Y, Lashin S, Kolpakova G, Sudobin K, Knyazev G. The Effect of Meditation on Comprehension of Statements About One-Self and Others: A Pilot ERP and Behavioral Study. Front Hum Neurosci 2020; 13:437. [PMID: 31998096 PMCID: PMC6962228 DOI: 10.3389/fnhum.2019.00437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/28/2019] [Indexed: 11/23/2022] Open
Abstract
The main goal of this study was to examine the effect of long-term meditation practice on behavioral indicators and ERP peak characteristics during an error-recognition task, where participants were presented with emotionally negative (evoking anxiety or aggression) written sentences describing self-related or non-self-related emotional state and personality traits. In total, 200 sentences written in Russian with varying emotional coloring were presented during the task, with half of the sentences containing a grammatical error that the participants were asked to identify. The EEG was recorded in age-matched control individuals (n = 17) and two groups of Samatha meditators with relatively short- (3–5 years’ experience, n = 18) and long-term (10–30 years’ experience, n = 18) practice experience. Task performance time (TPT) and accuracy of error detection (AED) were chosen as behavioral values. Amplitude, time latency and cortical distribution of P300 and P600 peaks of ERP were used as a value of speech-related brain activity. All statistical effects of meditation were estimated, controlling for age and sex. No behavioral differences between two groups of meditators were found. General TPT was shorter for both groups of meditators compared to the control group. Non-meditators reacted significantly slower to sentences about aggression than to sentences about anxiety or non-emotional sentences, whereas no significance was found between meditator groups. Non-meditators had better AED for the sentences about one-self than for the sentences about other people, whereas the meditators did not show any significant difference. The amplitude of P300 peak in frontal and left temporal scalp regions was higher for long-term meditators in comparison with both intermediate and control groups. The latency of P300 and P600 in left frontal and temporal regions positively correlated with TPT, whereas the amplitude of P300 in these regions had a negative correlation with TPT. We demonstrate that long-term meditation practice increases the ability of an individual to process negative emotional stimuli. The differences in behavioral reactions after onset of negative information that was self-related and non-self-related, which is typical for non-meditators, disappeared due to the influence of meditation. ERP results could be interpreted as a value of increase in voluntary control over emotional state during meditational practice.
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Affiliation(s)
- Alexander Savostyanov
- Laboratory of Psychological Genetics, Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences (SB RAS), Novosibirsk, Russia.,Laboratory Differential Psychophysiology, State-Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia.,Laboratory of Biological Markers of Human Social Behavior, Humanitarian Institution at the Novosibirsk State University, Novosibirsk, Russia
| | - Sergey Tamozhnikov
- Laboratory Differential Psychophysiology, State-Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
| | - Andrey Bocharov
- Laboratory Differential Psychophysiology, State-Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia.,Laboratory of Biological Markers of Human Social Behavior, Humanitarian Institution at the Novosibirsk State University, Novosibirsk, Russia
| | - Alexander Saprygin
- Laboratory Differential Psychophysiology, State-Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
| | - Yuriy Matushkin
- Laboratory of Psychological Genetics, Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences (SB RAS), Novosibirsk, Russia
| | - Sergey Lashin
- Laboratory of Psychological Genetics, Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences (SB RAS), Novosibirsk, Russia.,Laboratory of Biological Markers of Human Social Behavior, Humanitarian Institution at the Novosibirsk State University, Novosibirsk, Russia
| | - Galina Kolpakova
- Laboratory of Biological Markers of Human Social Behavior, Humanitarian Institution at the Novosibirsk State University, Novosibirsk, Russia
| | - Klimenty Sudobin
- Laboratory of Biological Markers of Human Social Behavior, Humanitarian Institution at the Novosibirsk State University, Novosibirsk, Russia
| | - Gennady Knyazev
- Laboratory Differential Psychophysiology, State-Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
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27
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Lynn SJ, Maxwell R, Merckelbach H, Lilienfeld SO, Kloet DVHVD, Miskovic V. Dissociation and its disorders: Competing models, future directions, and a way forward. Clin Psychol Rev 2019; 73:101755. [DOI: 10.1016/j.cpr.2019.101755] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/20/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
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28
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Valle R, Perales A. Self-disorders in Early Stages of the Schizophrenia Spectrum. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2019; 48:244-251. [PMID: 31779875 DOI: 10.1016/j.rcp.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/04/2018] [Accepted: 02/08/2018] [Indexed: 06/10/2023]
Abstract
The pathogenic nucleus of schizophrenia has varied according to the different eras and influences of distinguished clinical researchers. Self-disorders have also been recognised to be at the heart of this disorder, although they have seldom been studied due to their subjective nature. Recently, due to the growing interest in the study of the early stages of schizophrenia, the study of self-disorders has been resumed. The self-disorders in schizophrenia model, developed by Sass and Parnas, proposes that in this disorder the person suffers loss of the first-person perspective and experiences hyperreflexibility, diminished self-affection and disturbance of the field of awareness. Therefore, the person experiences feelings of strangeness about him/herself, difficulty in understanding the common sense of things and difficulty interacting with his/her environment. Based on this model, self-disorder evaluation instruments have been developed and empirical studies have been conducted to evaluate people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in prepsychotic stages and that their manifestation may predict the transition to schizophrenia spectrum disorders. These results have important clinical implications as they enable people in the early stages of the disorder to be identified and create the opportunity to apply early therapeutic interventions.
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Affiliation(s)
- Rubén Valle
- Centro de Investigación en Epidemiología Clínica y Medicina Basada en Evidencias, Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Perú; Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; DEIDAE de Adultos y Adultos Mayores, Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Perú.
| | - Alberto Perales
- Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; Instituto de Ética en Salud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
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Potvin S, Gamache L, Lungu O. A Functional Neuroimaging Meta-Analysis of Self-Related Processing in Schizophrenia. Front Neurol 2019; 10:990. [PMID: 31572296 PMCID: PMC6749044 DOI: 10.3389/fneur.2019.00990] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/30/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Schizophrenia is characterized by self-disturbances, including impaired self-evaluation abilities and source monitoring. The cortical midline structures (e.g., medial prefrontal cortex, anterior and posterior cingulate cortex, and precuneus) and the temporoparietal junction are known to play a key role in self-related processing. In theory, self-disturbances in schizophrenia may arise from impaired activity in these regions. We performed a functional neuroimaging meta-analysis to verify this hypothesis. Methods: A literature search was performed with PubMed and Google Scholar to identify functional neuroimaging studies examining the neural correlates of self-processing in schizophrenia, using self-other or source monitoring paradigms. Fourteen studies were retrieved, involving 245 patients and 201 controls. Using peak coordinates to recreate an effect-size map of contrast results, a standard random-effects variance weighted meta-analysis for each voxel was performed with the Seed-based d Mapping software. Results: During self-processing, decreased activations were observed in schizophrenia patients relative to controls in the bilateral thalamus and the left dorsal anterior cingulate cortex (dACC) and dorso-medial prefrontal cortex. Importantly, results were homogeneous across studies, and no publication bias was observed. Sensitivity analyses revealed that results were replicable in 93-100% of studies. Conclusion: The current results partially support the hypothesized impaired activity of cortical midline brain regions in schizophrenia during self-processing. Decreased activations were observed in the dACC and dorsomedial prefrontal cortex, which are involved in cognitive control and/or salience attribution, as well as decision-making, respectively. These alterations may compromise patients' ability to direct their attention toward themselves and/or others and to make the decision whether a certain trait applies to one's self or to someone else. In addition, decreased activations were observed in the thalamus, which is not a core region of the default-mode network, and is involved in information integration. These thalamic alterations may compromise self-coherence in schizophrenia.
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Affiliation(s)
- Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Lydia Gamache
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Ovidiu Lungu
- Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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30
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Kamens SR. Extreme States and Extreme Conditions: On Homelessness and the Ontico-ontological Difference. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167818763734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article briefly examines the intersections between extreme psychological states and extreme structural conditions of the world. Drawing on the work of Martin Heidegger and Louis Sass, I argue that heightened focus on ontological–existential matters during extreme states often comprises (rather than eschews) a meaningful and humanistic response to extreme worldly conditions. At the center of this article are the stories of two persons who offered generosity and hospitality toward the everyday community of other humans while experiencing both extreme psychological states and extreme structural conditions.
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31
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García-Mieres H, Niño-Robles N, Ochoa S, Feixas G. Exploring identity and personal meanings in psychosis using the repertory grid technique: A systematic review. Clin Psychol Psychother 2019; 26:717-733. [PMID: 31412423 DOI: 10.1002/cpp.2394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 01/25/2023]
Abstract
Current research and clinical practice in person-centred approaches highlight the importance of self, identity, and personal meanings in psychosis. Previous research has focused on dimensions of self, but less attention has been paid to the personal meanings involved in identity. The personal construct theory framework and the repertory grid technique (RGT) allow the study of identity and personal meanings within person-centred approaches of psychopathology and treatment in psychosis, as suggested by studies that began more than 40 years ago. However, their contributions have not yet been reviewed. We aimed to systematically review the evidence for the role of identity and personal meanings in psychotic disorders. We performed a systematic search using personal construct and RGT terms in PsycINFO, Web of Science, PubMed, EBSCO, Scopus, and Google Scholar. After identifying 2,574 articles, 15 were included. Nine studies followed an idiographic assessment, and six were nomothetic. Patients reported their subjective experience of isolation in terms of high self-ideal discrepancy and high perceived discrepancy with their significant others, which some studies associated with a lower degree of recovery or with the way in which positive symptoms were construed. Self-fragmentation either decreased with interventions or was associated with recovery. Evidence regarding interpersonal construing was less consistent, but there was a tendency for patients to show a more rigid cognitive structure than controls. To conclude, we found some evidence that self-discrepancies, fragmentation of self, and interpersonal construing are affected in psychosis and potentially modifiable through psychotherapy.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Noelia Niño-Robles
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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van Schuppen L, van Krieken K, Sanders J. Deictic Navigation Network: Linguistic Viewpoint Disturbances in Schizophrenia. Front Psychol 2019; 10:1616. [PMID: 31396125 PMCID: PMC6668655 DOI: 10.3389/fpsyg.2019.01616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022] Open
Abstract
This paper introduces the Deictic Navigation Network, a cognitive-linguistic framework to analyze and clarify the nature of viewpoint disturbances in language, applied to schizophrenia. We argue that such disturbances have linguistic counterparts in the use of deixis: linguistic elements of which the interpretation relies on the situational context of the discourse and their connection to a subject-bound perspective. The DNN connects such linguistic phenomena to three viewpoint disturbances, which can manifest in different degrees of extremity: (i) the reduced capacity to recognize one's own subjective perspective and the subjective perspectives of others; (ii) the reduced capacity to separate present perspectives from distinct past, future, and hypothetical perspectives; and (iii) the reduced capacity to integrate projected viewpoint structures into the actual here-and-now. We explain how application of the DNN to language in schizophrenia enables the localization of perspectivization disturbances and helps to clarify the nature of disturbances in the ability to build complex viewpoint structures in language as well as cognition.
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33
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Keromnes G, Chokron S, Celume MP, Berthoz A, Botbol M, Canitano R, Du Boisgueheneuc F, Jaafari N, Lavenne-Collot N, Martin B, Motillon T, Thirioux B, Scandurra V, Wehrmann M, Ghanizadeh A, Tordjman S. Exploring Self-Consciousness From Self- and Other-Image Recognition in the Mirror: Concepts and Evaluation. Front Psychol 2019; 10:719. [PMID: 31133909 PMCID: PMC6524719 DOI: 10.3389/fpsyg.2019.00719] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/15/2019] [Indexed: 12/03/2022] Open
Abstract
A historical review of the concepts of self-consciousness is presented, highlighting the important role of the body (particularly, body perception but also body action), and the social other in the construction of self-consciousness. More precisely, body perception, especially intermodal sensory perception including kinesthetic perception, is involved in the construction of a sense of self allowing self-other differentiation. Furthermore, the social other, through very early social and emotional interactions, provides meaning to the infant's perception and contributes to the development of his/her symbolization capacities. This is a necessary condition for body image representation and awareness of a permanent self in a time-space continuum (invariant over time and space). Self-image recognition impairments in the mirror are also discussed regarding a comprehensive developmental theory of self-consciousness. Then, a neuropsychological and neurophysiological approach to self-consciousness reviews the role of complex brain activation/integration pathways and the mirror neuron system in self-consciousness. Finally, this article offers new perspectives on self-consciousness evaluation using a double mirror paradigm to study self- and other- image and body recognition.
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Affiliation(s)
- Gaëlle Keromnes
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1, Rennes, France
| | - Sylvie Chokron
- Laboratoire de Psychologie de la Perception (LPP), Université Paris Descartes, CNRS UMR 8242, Paris, France
| | - Macarena-Paz Celume
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1, Rennes, France
- Laboratoire de Psychologie et d’Ergonomie Appliquées (LaPEA), Université Paris Descartes, UMR T7708, Boulogne Billancourt, France
| | - Alain Berthoz
- Laboratoire de Physiologie de la Perception et de l’Action, Collège de France, CNRS UMR 7152, Paris, France
| | - Michel Botbol
- CHU de Brest – Service Hospitalo-Universitaire de Psychiatrie, CHU de Brest, Hôpital de Bohars, Bohars, France
| | - Roberto Canitano
- Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - Foucaud Du Boisgueheneuc
- Département de Neurologie, Centre de Mémoire de Ressource et de Recherche, CHU de Poitiers, Poitiers, France
| | - Nemat Jaafari
- Université de Poitiers, Unité de Recherche Clinique Intersectorielle en Psychiatrie à Vocation Régionale Pierre-Deniker du Centre Hospitalier Henri Laborit, Poitiers, France
- INSERM U 1084, Experimental and Clinical Neurosciences Laboratory, Groupement de Recherche, CNRS 3557, Poitiers, France
| | - Nathalie Lavenne-Collot
- CHU de Brest – Service Hospitalo-Universitaire de Psychiatrie, CHU de Brest, Hôpital de Bohars, Bohars, France
| | - Brice Martin
- Service Universitaire de Réhabilitation, Hôpital du Vinatier, Université Lyon 1, CNRS UMR 5229, Lyon, France
| | - Tom Motillon
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1, Rennes, France
| | - Bérangère Thirioux
- Laboratoire de Physiologie de la Perception et de l’Action, Collège de France, CNRS UMR 7152, Paris, France
- Université de Poitiers, Unité de Recherche Clinique Intersectorielle en Psychiatrie à Vocation Régionale Pierre-Deniker du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Valeria Scandurra
- Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - Moritz Wehrmann
- International Research Institute for Cultural Techniques and Media Philosophy, Bauhaus-Universität Weimar, Weimar, Germany
| | - Ahmad Ghanizadeh
- Department of Neuroscience, Research Center for Psychiatry and Behavioral Sciences, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sylvie Tordjman
- Pôle Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1, Rennes, France
- Laboratoire de Psychologie de la Perception (LPP), Université Paris Descartes, CNRS UMR 8242, Paris, France
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Reframing schizophrenia and autism as bodily self-consciousness disorders leading to a deficit of theory of mind and empathy with social communication impairments. Neurosci Biobehav Rev 2019; 103:401-413. [PMID: 31029711 DOI: 10.1016/j.neubiorev.2019.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/11/2019] [Accepted: 04/14/2019] [Indexed: 12/24/2022]
Abstract
Prior observations and studies suggest self-consciousness disorders in schizophrenia and Autism Spectrum Disorder (ASD), two neurodevelopmental disorders sharing social communication impairments. First, the relationships between schizophrenia and autism are explored regarding social communication impairments. Then, self-consciousness disorders in schizophrenia and autism are described and discussed in relation with impairments of body self leading to impairments of self-other differentiation, a deficit of theory of mind and empathy, and their consequences on social communication. Also, neurological dysfunction involved possibly in self-consciousness disorders in schizophrenia and autism is presented. In conclusion, a new model is proposed integrating results of studies presented here and stating the existence of bodily self-consciousness disorders in schizophrenia and autism associated with altered/absent intermodal sensory integration (especially visual-kinesthetic-tactile integration). This would result in problems of self-other differentiation, leading in turn to a deficit of theory of mind and empathy as well as social communication impairments. This model opens new perspectives to understand better self-consciousness disorders and social communication impairments in schizophrenia and ASD and to develop therapeutic strategies.
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35
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Pienkos E, Giersch A, Hansen M, Humpston C, McCarthy-Jones S, Mishara A, Nelson B, Park S, Raballo A, Sharma R, Thomas N, Rosen C. Hallucinations Beyond Voices: A Conceptual Review of the Phenomenology of Altered Perception in Psychosis. Schizophr Bull 2019; 45:S67-S77. [PMID: 30715544 PMCID: PMC6357976 DOI: 10.1093/schbul/sby057] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Recent psychiatric research and treatment initiatives have tended to move away from traditional diagnostic categories and have focused instead on transdiagnostic phenomena, such as hallucinations. However, this emphasis on isolated experiences may artificially limit the definition of such phenomena and ignore the rich, complex, and dynamic changes occurring simultaneously in other domains of experience. This article reviews the literature on a range of experiential features associated with psychosis, with a focus on their relevance for hallucinations. Phenomenological research on changes in cognition, perception, selfhood and reality, temporality, interpersonal experience, and embodiment are discussed, along with their implications for traditional conceptualizations of hallucinations. We then discuss several phenomenological and neurocognitive theories, as well as the potential impact of trauma on these phenomena. Hallucinations are suggested to be an equifinal outcome of multiple genetic, neurocognitive, subjective, and social processes; by grouping them together under a single, operationalizable definition, meaningful differences in etiology and phenomenology may be ignored. It is suggested that future research efforts strive to incorporate a broader range of experiential alterations, potentially expanding on traditional definitions of hallucinations. Relevance for clinical practice, including emphasizing phenomenologically responsive techniques and developing targeted new therapies, is discussed.
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Affiliation(s)
- Elizabeth Pienkos
- Graduate Institute of Professional Psychology, University of Hartford, West Hartford, CT
| | - Anne Giersch
- INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Centre Hospitalier Régional Universitaire of Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Marie Hansen
- Department of Clinical Psychology, Long Island University Brooklyn, Brooklyn, NY
| | - Clara Humpston
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Aaron Mishara
- Clinical Psychology Department, The Chicago School of Professional Psychology, Los Angeles, CA
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN
- Kyung Hee University, Seoul, Korea
| | - Andrea Raballo
- Department of Psychology, Psychopathology and Development Research Unit, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
| | - Rajiv Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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Kállai J, Rózsa S, Hupuczi E, Hargitai R, Birkás B, Hartung I, Martin L, Herold R, Simon M. Cognitive fusion and affective isolation: Blurred self-concept and empathy deficits in schizotypy. Psychiatry Res 2019; 271:178-186. [PMID: 30481696 DOI: 10.1016/j.psychres.2018.11.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/30/2018] [Accepted: 11/18/2018] [Indexed: 01/23/2023]
Abstract
This is a cross-sectional nonclinical sample study to examine the different levels of the Ipsiety Disturbance Model (IDM) for schizophrenia spectrum disorders (introduced by Sass and Parnas, 2003). Three faces of schizotypy were studied: diminished self-presence, hyper-reflexivity, and distortion in experience of own self and another person's self-discrimination. A sample of college students (N = 1312) was provided a questionnaire packet that contained the Schizotypy Personality Questionnaire Brief-Revisited (SPQ-BR), the Self-Concept Clarity Sale, the Tellegen Absorption Scale, and Interpersonal Reactivity Index measures. Results: higher absorption capabilities predict higher scores on both the SPQ-BR cognitive and SPQ-BR disorganization factors. High scores in cognitive empathy predicted a low score on both SPQ-BR cognitive and SPQ-BR interpersonal scores. In contrast, higher affective empathy predicted high scores on the SPQ-BR interpersonal factor. The deficiency in self-concept clarity predicted an elevated score on the SPQ-BR cognitive, interpersonal, and disorganization schizotypy symptoms. We argue that a lack of self-concept clarity manifested in both the hyperreflexivity level (measured by absorption) and the metallization level (measured by empathy). We argue that the IDM is a reliable way to interpret functioning with different levels of schizotypy.
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Affiliation(s)
- János Kállai
- Institute of Behavioral Sciences, Medical School, University of Pécs, Szigeti út 12, Pécs 7625, Hungary.
| | - Sándor Rózsa
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Ernő Hupuczi
- Institute of Behavioral Sciences, Medical School, University of Pécs, Szigeti út 12, Pécs 7625, Hungary.
| | - Rita Hargitai
- Department of Personality and Clinical Psychology, Pázmány Péter Catholic University, Budapest, Hungary.
| | - Béla Birkás
- Institute of Behavioral Sciences, Medical School, University of Pécs, Szigeti út 12, Pécs 7625, Hungary.
| | - István Hartung
- Institute of Behavioral Sciences, Medical School, University of Pécs, Szigeti út 12, Pécs 7625, Hungary.
| | - László Martin
- Department of Pedagogy and Psychology, Kaposvári University, Kaposvár, Hungary.
| | - Róbert Herold
- Department of Psychiatry and Psychotherapy, Medical School, Universi of Pécs, Pécs, Hungary.
| | - Mária Simon
- Department of Psychiatry and Psychotherapy, Medical School, Universi of Pécs, Pécs, Hungary.
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Nischk D, Rusch J. What Makes Soteria Work? On the Effect of a Therapeutic Milieu on Self-Disturbances in the Schizophrenia Syndrome. Psychopathology 2019; 52:213-220. [PMID: 31390648 DOI: 10.1159/000501816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/27/2019] [Indexed: 11/19/2022]
Abstract
Soteria represents an alternative approach to the treatment of acute psychosis providing a community-based social milieu, personal relationships ("being-with"), and meaningful shared activities ("doing-with") along with minimal neuroleptic medication. In this review article, we analyze Soteria's potential to adapt to and restore self-disturbances, a central element of phenomenological conceptions of the schizophrenia syndrome. Based on typical difficulties of psychotic patients in responding adequately to situational demands, in relating to others, and in utilizing skills, we analyze how the architectural and social context, being-with, and doing-with take account of self-disturbances. The central elements of the Soteria approach all appear to carry the potential to adjust to self-disturbances and even offer opportunities for their relief. We suggest that it is precisely this property of the Soteria paradigm that induces sustained relaxation in patients, allowing for symptom relief, thereby specifying a central claim of "affect-logic" to explain the antipsychotic effect of Soteria.
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Affiliation(s)
- Daniel Nischk
- Centre for Psychiatry Reichenau, Reichenau, Germany,
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38
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Keromnes G, Motillon T, Coulon N, Berthoz A, Du Boisgueheneuc F, Wehrmann M, Martin B, Thirioux B, Bonnot O, Ridereau R, Bellissant E, Drapier D, Levoyer D, Jaafari N, Tordjman S. Self-other recognition impairments in individuals with schizophrenia: a new experimental paradigm using a double mirror. NPJ SCHIZOPHRENIA 2018; 4:24. [PMID: 30487540 PMCID: PMC6261962 DOI: 10.1038/s41537-018-0065-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/14/2018] [Indexed: 11/08/2022]
Abstract
Clinical observations suggest early self-consciousness disturbances in schizophrenia. A double mirror combining the images of two individuals sitting on each side of the mirror was used to study self-other differentiation in 12 individuals with early onset schizophrenia (EOS) and 15 individuals with adult onset schizophrenia (AOS) compared to 27 typically developing controls (TDC) matched on age and sex. The effects of intermodal sensory perception (visual-tactile and visual-kinesthetic) on self-other recognition were also studied. The results showed that EOS and AOS individuals, independently of age and schizophrenia severity, were centered on their own image compared to TDC, with both significant earlier self-recognition and delayed other-recognition during the visual recognition task. In addition, there was no significant effect of intermodal sensory stimulation on self-other recognition in EOS and AOS patients, whereas self-centered functioning was significantly increased by visual-tactile stimulation and decreased by visual-kinesthetic stimulation in TDC. The findings suggest that self-other recognition impairments might be a possible endophenotypic trait of schizophrenia.
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Affiliation(s)
- Gaelle Keromnes
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 and Centre Hospitalier Guillaume Régnier, 154 rue de Châtillon, Rennes, France.
| | - Tom Motillon
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 and Centre Hospitalier Guillaume Régnier, 154 rue de Châtillon, Rennes, France
| | - Nathalie Coulon
- Laboratoire Psychologie de la Perception, Université Paris Descartes and CNRS UMR 8242, Paris, France
- CHU de Brest - Department of Psychiatry, UBO and Hôpital de Bohars, Bohars, France
| | - Alain Berthoz
- Laboratoire de Physiologie de la Perception et de l'Action UMR 7152 CNRS, Collège de France, Paris, France
| | - Foucaud Du Boisgueheneuc
- Département de Neurologie, Centre de Mémoire de Ressource et de Recherche, CHU de Poitiers, Poitiers, France
| | - Moritz Wehrmann
- Laboratoire de Physiologie de la Perception et de l'Action UMR 7152 CNRS, Collège de France, Paris, France
- Bauhaus-Universität Weimar, Weimar, Germany
| | - Brice Martin
- Centre Référent Lyonnais en Réhabilitation et en Remédiation Cognitive - Service Universitaire de Réhabilitation, Hôpital du Vinatier, Université Lyon 1, et UMR, 5229, Lyon, France
| | - Bérangère Thirioux
- Laboratoire de Physiologie de la Perception et de l'Action UMR 7152 CNRS, Collège de France, Paris, France
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, Nantes University Hospital, Nantes, France
| | - Romain Ridereau
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 and Centre Hospitalier Guillaume Régnier, 154 rue de Châtillon, Rennes, France
| | - Eric Bellissant
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France
| | - Dominique Drapier
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Adulte, Université de Rennes 1 and Centre Hospitalier Guillaume Régnier, Rennes, France
| | - David Levoyer
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Adulte, Université de Rennes 1 and Centre Hospitalier Guillaume Régnier, Rennes, France
| | - Nemat Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers - INSERM CIC 1402, CHU de Poitiers - INSERM U 1084, Experimental and Clinical Neuroscience Laboratory - Groupement de Recherche CNRS 3557, Poitiers, France
| | - Sylvie Tordjman
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 and Centre Hospitalier Guillaume Régnier, 154 rue de Châtillon, Rennes, France.
- Laboratoire Psychologie de la Perception, Université Paris Descartes and CNRS UMR 8242, Paris, France.
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France.
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Forgione FA. Diagnostic Dissent: Experiences of Perceived Misdiagnosis and Stigma in Persons Diagnosed With Schizophrenia. JOURNAL OF HUMANISTIC PSYCHOLOGY 2018. [DOI: 10.1177/0022167818777151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is not uncommon for individuals to disagree with their psychiatric diagnosis. The experience of perceived misdiagnosis can be challenging for service users, as mainstream psychiatric theory often views this disagreement as an indication of “poor insight” into their putative illness. Some researchers have suggested that labeling a service user as lacking insight can be detrimental to the service user’s recovery. Regardless of whether a person agrees with his or her diagnosis, persons labeled with “mental illness” sometimes internalize the discrimination and stigma that they encounter. However, few studies have examined the lived experience of disagreeing with a diagnosis. The present study investigated the first-person experiences of three individuals who believed that they were misdiagnosed with a psychotic disorder. As part of a larger study, participants completed in-depth interviews about their life history and experiences in psychiatric hospitals. Data were analyzed using phenomenological methods. Participants felt that their clinicians assigned an erroneous and stigmatizing label that did not match their self-experience. Diagnostic dissent, a form of perceived misdiagnosis, was a way for individuals to assert their self-experience against perceived invalidation and stigmatizing labels.
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Rosen C, McCarthy-Jones S, Chase KA, Humpston C, Melbourne JK, Kling L, Sharma RP. The tangled roots of inner speech, voices and delusions. Psychiatry Res 2018; 264:281-289. [PMID: 29660570 PMCID: PMC5972053 DOI: 10.1016/j.psychres.2018.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023]
Abstract
The role of inner speech in the experience of auditory verbal hallucinations (AVH) and delusions remains unclear. This exploratory study tested for differences in inner speech (assessed via self-report questionnaire) between 89 participants with psychosis and 37 non-clinical controls. We also tested for associations of inner speech with, i) state/trait AVH, ii) AVH-severity; iii) patients' relations with their voices, and; iv) delusion-severity. Persons with psychosis had greater levels of dialogic inner speech, other people in inner speech, and evaluative/motivational inner speech than non-clinical controls. Those with state, but not trait AVH had greater levels of dialogic and evaluative/motivational inner speech than non-clinical controls. After controlling for delusions, there was a positive relation between AVH-severity and both evaluative/motivational inner speech and other people in inner speech. Participants with greater levels of dialogic inner speech reported better relations both with and between their voices. There was no association between delusion-severity and inner speech. These results highlight the importance of better understanding relations between inner speech and AVH, provide avenues for future research, and underscore the need for research into the interrelatedness of inner speech, voices and delusions, and the complexities involved in disentangling these experiences.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor, Suite 489, Chicago, IL 60612, United States.
| | | | - Kayla A. Chase
- Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, United States,Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United
States
| | - Clara Humpston
- School of Psychology, Cardiff University, United Kingdom
| | - Jennifer K. Melbourne
- Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, United States
| | - Leah Kling
- Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, United States
| | - Rajiv P. Sharma
- Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, United States,Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United
States
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41
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Martin B, Franck N, Cermolacce M, Coull JT, Giersch A. Minimal Self and Timing Disorders in Schizophrenia: A Case Report. Front Hum Neurosci 2018; 12:132. [PMID: 29686612 PMCID: PMC5900747 DOI: 10.3389/fnhum.2018.00132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
For years, phenomenological psychiatry has proposed that distortions of the temporal structure of consciousness contribute to the abnormal experiences described before schizophrenia emerges, and may relate to basic disturbances in consciousness of the self. However, considering that temporality refers mainly to an implicit aspect of our relationship with the world, disturbances in the temporal structure of consciousness remain difficult to access. Nonetheless, previous studies have shown a correlation between self disorders and the automatic ability to expect an event in time, suggesting timing is a key issue for the psychopathology of schizophrenia. Timing disorders may represent a target for cognitive remediation, but this requires that disorders can be demonstrated at an individual level. Since cognitive impairments in patients with schizophrenia are discrete, and there is no standardized timing exploration, we focused on timing impairments suggested to be related to self disorders. We present the case report of AF, a 22 year old man suffering from schizophrenia, with no antipsychotic intake. Although AF shows few positive and negative symptoms and has a normal neurocognitive assessment, he shows a high level of disturbance of Minimal Self Disorders (SDs) (assessed with the EASE scale). Moreover, AF has a rare ability to describe his self and time difficulties. An objective assessment of timing ability (variable foreperiod task) confirmed that AF had temporal impairments similar to those previously described in patients, i.e., a preserved ability to distinguish time intervals, but a difficulty to benefit from the passage of time to expect a visual stimulus. He presents additional difficulties in benefitting from temporal cues and adapting to changes in time delays. The impairments were ample enough to yield significant effects with analyses at the individual level. Although causal relationships between subjective and objective impairments cannot be established, the results show that exploring timing deficits at the individual level is possible in patients with schizophrenia. Besides, the results are consistent with hypotheses relating minimal self disorders (SDs) to timing difficulties. They suggest that both subjective and objective timing investigations should be developed further so that their use at an individual level can be generalized in clinical practice.
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Affiliation(s)
- Brice Martin
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Référent Lyonnais en Réhabilitation et en Remédiation Cognitive Hôpital du Vinatier, Centre National de la Recherche Scientifique UMR 5229, Lyon, France
| | - Nicolas Franck
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Référent Lyonnais en Réhabilitation et en Remédiation Cognitive Hôpital du Vinatier, Centre National de la Recherche Scientifique UMR 5229, Lyon, France
| | - Michel Cermolacce
- Service Universitaire de Psychiatrie, Hôpital Ste Marguerite, Marseille, France
| | - Jennifer T Coull
- Laboratoire des Neurosciences Cognitives (UMR 7291), Aix-Marseille Université & Centre National de la Recherche Scientifique, Marseille, France
| | - Anne Giersch
- Institut National de la Santé et de la Recherche Médicale U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire of Strasbourg, Université de Strasbourg, Paris, France
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Gawęda Ł, Pionke R, Krężołek M, Prochwicz K, Kłosowska J, Frydecka D, Misiak B, Kotowicz K, Samochowiec A, Mak M, Błądziński P, Cechnicki A, Nelson B. Self-disturbances, cognitive biases and insecure attachment as mechanisms of the relationship between traumatic life events and psychotic-like experiences in non-clinical adults - A path analysis. Psychiatry Res 2018; 259:571-578. [PMID: 29195191 DOI: 10.1016/j.psychres.2017.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/28/2017] [Accepted: 11/03/2017] [Indexed: 01/04/2023]
Abstract
Although traumatic life events have been linked to psychotic-like experiences, the mechanisms of the relationship remain unclear. We investigated whether insecure (anxious and avoidant) attachment styles, cognitive biases and self-disturbances serve as significant mediators in the relationship between traumatic life events and psychotic-like experiences in non-clinical sample. Six-hundred and ninety healthy participants (522 females) who have not ever been diagnosed with psychiatric disorders took part in the study. Participants completed self-report scales that measure traumatic life events, psychotic-like experiences, cognitive biases, attachment styles and self-disturbances. Our model was tested with path analysis. Our integrated model fit to the data with excellent goodness-of-fit indices. The direct effect was significantly reduced after the mediators were included. Significant pathways from traumatic life events to psychotic-like experiences were found through self-disturbances and cognitive biases. Traumatic life events were associated with anxious attachment through cognitive biases. Self-disturbances, cognitive biases and anxious attachment had a direct effect on psychotic-like experiences. The results of our study tentatively suggest that traumatic life events are related with psychotic-like experiences through cognitive biases and self-disturbances. Further studies in clinical samples are required to verify our model.
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Affiliation(s)
- Łukasz Gawęda
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany; II Department of Psychiatry, Medical University of Warsaw, Poland.
| | - Renata Pionke
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Martyna Krężołek
- II Department of Psychiatry, Medical University of Warsaw, Poland
| | | | - Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Poland
| | - Błażej Misiak
- Department of Geneticts, Wroclaw Medical University, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Poland
| | - Agnieszka Samochowiec
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, Poland
| | - Monika Mak
- Department of Psychiatry, Pomeranian Medical University, Poland
| | - Piotr Błądziński
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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43
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Berkovitch L, Dehaene S, Gaillard R. Disruption of Conscious Access in Schizophrenia. Trends Cogn Sci 2017; 21:878-892. [DOI: 10.1016/j.tics.2017.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/25/2017] [Accepted: 08/21/2017] [Indexed: 12/13/2022]
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Maurage P, Philippot P, Grynberg D, Leleux D, Delatte B, Mangelinckx C, Belge JB, Constant E. Imbalance between abstract and concrete repetitive thinking modes in schizophrenia. Compr Psychiatry 2017; 78:61-66. [PMID: 28806606 DOI: 10.1016/j.comppsych.2017.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/12/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Repetitive thoughts can be divided in two modes: abstract/analytic (decontextualized and dysfunctional) and concrete/experiential (problem-focused and adaptive). They constitute a transdiagnostic process involved in many psychopathological states but have received little attention in schizophrenia, as earlier studies only indexed increased ruminations (related to dysfunctional repetitive thoughts) without jointly exploring both modes. This study explored the two repetitive thinking modes, beyond ruminations, to determine their imbalance in schizophrenia. METHODS Thirty stabilized patients with schizophrenia and 30 matched controls completed the Repetitive Response Scale and the Mini Cambridge-Exeter Repetitive Thought Scale, both measuring repetitive thinking modes. Complementary measures related to schizophrenic symptomatology, depression and anxiety were also conducted. RESULTS Compared to controls, patients with schizophrenia presented an imbalance between repetitive thinking modes, with increased abstract/analytic and reduced concrete/experiential thoughts, even after controlling for comorbidities. Schizophrenia is associated with stronger dysfunctional repetitive thoughts (i.e. abstract thinking) and impaired ability to efficiently use repetitive thinking for current problem-solving (i.e. concrete thinking). CONCLUSION This imbalance confirms the double-faced nature of repetitive thinking modes, whose influence on schizophrenia's symptomatology should be further investigated. The present results also claim for evaluating these processes in clinical settings and for rehabilitating the balance between opposite repetitive thinking modes.
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Affiliation(s)
- Pierre Maurage
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Place C. Mercier 10, B-1348 Louvain-la-Neuve, Belgium.
| | - Pierre Philippot
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Place C. Mercier 10, B-1348 Louvain-la-Neuve, Belgium
| | - Delphine Grynberg
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Dominique Leleux
- Psychiatric Hospital Sanatia, Rue du Moulin 27, B-1210 Brussels, Belgium
| | - Benoît Delatte
- Beau Vallon Psychiatric Hospital, Rue de Bricgniot 205, B-5002 Namur, Belgium
| | - Camille Mangelinckx
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Place C. Mercier 10, B-1348 Louvain-la-Neuve, Belgium
| | - Jan-Baptist Belge
- Department of Psychiatry, Saint-Luc University Hospital and Institute of Neuroscience (IoNS), Université catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Eric Constant
- Department of Psychiatry, Saint-Luc University Hospital and Institute of Neuroscience (IoNS), Université catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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45
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Giersch A, Mishara AL. Is Schizophrenia a Disorder of Consciousness? Experimental and Phenomenological Support for Anomalous Unconscious Processing. Front Psychol 2017; 8:1659. [PMID: 29033868 PMCID: PMC5625017 DOI: 10.3389/fpsyg.2017.01659] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/08/2017] [Indexed: 12/27/2022] Open
Abstract
Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients' conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious and conscious level. We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness.
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Affiliation(s)
- Anne Giersch
- INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire of Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Aaron L. Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, Los Angeles, CA, United States
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46
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Voss M, Chambon V, Wenke D, Kühn S, Haggard P. In and out of control: brain mechanisms linking fluency of action selection to self-agency in patients with schizophrenia. Brain 2017; 140:2226-2239. [DOI: 10.1093/brain/awx136] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 04/26/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Martin Voss
- Department of Psychiatry and Psychotherapy, Charité University Medicine and St. Hedwig Hospital, Berlin Center for Advanced Neuroimaging, Humboldt University Berlin, Germany
| | - Valérian Chambon
- Institut Jean Nicod (ENS – EHESS – CNRS), Département d’Etudes Cognitives, Ecole Normale Supérieure – PSL Research University, Paris, France
- Department of Neuroscience, Biotech Campus-University of Geneva, Geneva, Switzerland
| | - Dorit Wenke
- Department of Psychology, Humboldt University, Berlin, Germany
- Department of Psychology, Private University of Applied Sciences, Göttingen, Germany
| | - Simone Kühn
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
- Department of Psychiatry, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, UK
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Kocsis-Bogár K, Kotulla S, Maier S, Voracek M, Hennig-Fast K. Cognitive Correlates of Different Mentalizing Abilities in Individuals with High and Low Trait Schizotypy: Findings from an Extreme-Group Design. Front Psychol 2017. [PMID: 28634459 PMCID: PMC5460341 DOI: 10.3389/fpsyg.2017.00922] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mentalizing or Theory of Mind (ToM) deficits in schizophrenia have been studied to great extent, but studies involving samples of trait schizotypy yield ambiguous results. Executive functions like cognitive inhibition, cognitive flexibility, and agency are all prerequisites of mentalizing, and it is assumed that the impairment of these functions contributes to ToM deficits in schizophrenia. Whether these impairments influence the ToM performance of people with high trait schizotypy remains unclear. Although impaired self-agency has repeatedly been identified in people with schizotypy, its role in mentalizing is yet to be investigated. The main aim of this study was to explore whether deficits in cognitive and affective ToM can be found in high trait schizotypy, and to identify in what way these deficits are related to the positive and negative dimensions of schizotypy. The secondary aim was to examine whether these deficits correlate with executive functions. Based on the dimensional view of the schizophrenia spectrum, an extreme-group design was applied to non-clinical volunteers demonstrating high (N = 39) and low (N = 47) trait schizotypy. Affective and cognitive ToM were investigated using the Movie for Assessment of Social Cognition, a sensitive and video-based measurement. Cognitive inhibition was assessed using the Stroop Test, and cognitive flexibility was analyzed using the Trail-Making Test. Agency was measured using a computerized self-agency paradigm. Participants in the high-schizotypy group performed significantly worse in the affective ToM task (d = 0.79), and their overall ToM performance was significantly impaired (d = 0.60). No between-group differences were found with regards to cognitive ToM, executive functions, and self-agency. Cognitive flexibility correlated negatively with positive schizotypy, and contributed to a worse overall and affective ToM. Impaired cognitive inhibition contributed to undermentalizing-type errors. It was found that non-clinical participants with high trait (positive) schizotypy - especially those with slight executive-function deficits - may have difficulties in understanding the emotional state of others and consequently in functioning in social situations.
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Affiliation(s)
- Krisztina Kocsis-Bogár
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of ViennaVienna, Austria
| | - Simone Kotulla
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of ViennaVienna, Austria
| | - Susanne Maier
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of ViennaVienna, Austria
| | - Martin Voracek
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of ViennaVienna, Austria
| | - Kristina Hennig-Fast
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of ViennaVienna, Austria.,Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus BielefeldBielefeld, Germany
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48
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Millière R. Looking for the Self: Phenomenology, Neurophysiology and Philosophical Significance of Drug-induced Ego Dissolution. Front Hum Neurosci 2017; 11:245. [PMID: 28588463 PMCID: PMC5441112 DOI: 10.3389/fnhum.2017.00245] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/25/2017] [Indexed: 12/17/2022] Open
Abstract
There is converging evidence that high doses of hallucinogenic drugs can produce significant alterations of self-experience, described as the dissolution of the sense of self and the loss of boundaries between self and world. This article discusses the relevance of this phenomenon, known as “drug-induced ego dissolution (DIED)”, for cognitive neuroscience, psychology and philosophy of mind. Data from self-report questionnaires suggest that three neuropharmacological classes of drugs can induce ego dissolution: classical psychedelics, dissociative anesthetics and agonists of the kappa opioid receptor (KOR). While these substances act on different neurotransmitter receptors, they all produce strong subjective effects that can be compared to the symptoms of acute psychosis, including ego dissolution. It has been suggested that neuroimaging of DIED can indirectly shed light on the neural correlates of the self. While this line of inquiry is promising, its results must be interpreted with caution. First, neural correlates of ego dissolution might reveal the necessary neurophysiological conditions for the maintenance of the sense of self, but it is more doubtful that this method can reveal its minimally sufficient conditions. Second, it is necessary to define the relevant notion of self at play in the phenomenon of DIED. This article suggests that DIED consists in the disruption of subpersonal processes underlying the “minimal” or “embodied” self, i.e., the basic experience of being a self rooted in multimodal integration of self-related stimuli. This hypothesis is consistent with Bayesian models of phenomenal selfhood, according to which the subjective structure of conscious experience ultimately results from the optimization of predictions in perception and action. Finally, it is argued that DIED is also of particular interest for philosophy of mind. On the one hand, it challenges theories according to which consciousness always involves self-awareness. On the other hand, it suggests that ordinary conscious experience might involve a minimal kind of self-awareness rooted in multisensory processing, which is what appears to fade away during DIED.
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Affiliation(s)
- Raphaël Millière
- Faculty of Philosophy, University of OxfordOxford, United Kingdom
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49
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Seeman MV. Identity and schizophrenia: Who do I want to be? World J Psychiatry 2017; 7:1-7. [PMID: 28401044 PMCID: PMC5371169 DOI: 10.5498/wjp.v7.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/07/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
Many individuals with schizophrenia have occasional difficulty defining both to themselves and to others who they truly are. Perhaps for this reason they make attempts to change core aspects of themselves. These attempts may be delusional, but are too often unjustly dismissed as delusional before the potential value of the change is considered. Instead of facilitation, obstacles are placed in the way of hoped-for body modifications or changes of name or of religious faith. This paper discusses the various changes of identity sometimes undertaken by individuals with schizophrenia who may or may not be deluded. Ethical and clinical ramifications are discussed. The recommendation is made that, when clinicians respond to requests for help with identity change, safety needs to be the main consideration.
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50
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Ferri F, Ambrosini E, Costantini M. Spatiotemporal processing of somatosensory stimuli in schizotypy. Sci Rep 2016; 6:38735. [PMID: 27934937 PMCID: PMC5146666 DOI: 10.1038/srep38735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/14/2016] [Indexed: 12/26/2022] Open
Abstract
Unusual interaction behaviors and perceptual aberrations, like those occurring in schizotypy and schizophrenia, may in part originate from impaired remapping of environmental stimuli in the body space. Such remapping is contributed by the integration of tactile and proprioceptive information about current body posture with other exteroceptive spatial information. Surprisingly, no study has investigated whether alterations in such remapping occur in psychosis-prone individuals. Four hundred eleven students were screened with respect to schizotypal traits using the Schizotypal Personality Questionnaire. A subgroup of them, classified as low, moderate, and high schizotypes were to perform a temporal order judgment task of tactile stimuli delivered on their hands, with both uncrossed and crossed arms. Results revealed marked differences in touch remapping in the high schizotypes as compared to low and moderate schizotypes. For the first time here we reveal that the remapping of environmental stimuli in the body space, an essential function to demarcate the boundaries between self and external world, is altered in schizotypy. Results are discussed in relation to recent models of 'self-disorders' as due to perceptual incoherence.
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Affiliation(s)
- Francesca Ferri
- Centre for Brain Science, Department of Psychology, University of Essex, Colchester, UK
| | | | - Marcello Costantini
- Centre for Brain Science, Department of Psychology, University of Essex, Colchester, UK.,Laboratory of Neuropsychology and Cognitive Neuroscience, Department of Neuroscience and Imaging, University G. d'Annunzio &Institute for Advanced Biomedical Technologies - ITAB, Foundation University G. d'Annunzio, Chieti, Italy
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