Resting state activity and the "stream of consciousness" in schizophrenia--neurophenomenal hypotheses

Identifying the difference in time perception between major depressive disorder and bipolar depression through a temporal bisection task

BACKGROUND

It is difficult to make a precise diagnosis to distinguish patients with Major Depressive Disorder (MDD) from patients with Bipolar Depressive Disorder (current depressive episode, BD). This study will explore the difference in time perception between MDD and BD using a temporal bisection task.

METHODS

In this temporal bisection task, 30 MDD patients, 30 BD patients, and 30 healthy controls (HC) had to categorize a signal duration, between 400 and 1600 milliseconds (ms), as either short or long. A repeated measurement analysis of variance with 3 (subject type) × 7 (time interval) was performed on the long response ratio with Bonferroni correction for multiple comparisons. Origin software was used to calculate the subjective bisection point (BP), difference limen (DL), and Weber ratio (WR). The Hamilton Depression Rating Scale for depression-17 was used to assess depressive symptoms in the patients.

RESULTS

The data showed that the interaction effect between subject type and duration was significant (F (6,498) = 4.656, p <0.001, η2p = 0.101). At 400 ms, and the long response of the MDD group was greater than HC group (p<0.017, Bonferroni-corrected). At 1200, 1400 and 1600 ms, the long response of BD group is smaller than HC group, (p<0.017, Bonferroni-corrected). The one-way ANOVA revealed significant difference among the HC, MDD and BD groups in the BP values WR values, F(2, 81) = 3.462, p = 0.036 vs. F(2, 81) = 3.311, p = 0.042. Post-hoc tests showed that the value of BP in the MDD group was less than BD group (p = 0.027) and the value of BP in the MDD group was less than HC group (p = 0.027), while there was not significant difference of BP values between BD group and HC group. The WR values in MDD group larger than the HC group (p = 0.022).

LIMITATIONS

Severity of depression not divided and analyzed according to the Hamilton Depression Rating Scale score.

CONCLUSION

The time perception of the MDD and BD groups was different from that of the HC group, they overestimated short time periods. Compared with the BD group, the MDD group had a smaller time bisector, and these patients felt that time passed more slowly. The time sensitivity of MDD group and BD group were less than the HC group. However, there was no statistical difference in time sensitivity between the MDD and BD groups.

A new path to mental disorders: Through gap junction channels and hemichannels

Behavioral disturbances related to emotional regulation, reward processing, cognition, sleep-wake regulation and activity/movement represent core symptoms of most common mental disorders. Increasing empirical and theoretical evidence suggests that normal functioning of these behavioral domains relies on fine graded coordination of neural and glial networks which are maintained and modulated by intercellular gap junction channels and unapposed pannexin or connexin hemichannels. Dysfunctions in these networks might contribute to the development and maintenance of psychopathological and neurobiological features associated with mental disorders. Here we review and discuss the evidence indicating a prominent role of gap junction channel and hemichannel dysfunction in core symptoms of mental disorders. We further discuss how the increasing knowledge on intercellular gap junction channels and unapposed pannexin or connexin hemichannels in the brain might lead to deeper mechanistic insight in common mental disorders and to the development of novel treatment approaches. We further attempt to exemplify what type of future research on this topic could be integrated into multidimensional approaches to understand and cure mental disorders.

From Shorter to Longer Timescales: Converging Integrated Information Theory (IIT) with the Temporo-Spatial Theory of Consciousness (TTC)

Time is a key element of consciousness as it includes multiple timescales from shorter to longer ones. This is reflected in our experience of various short-term phenomenal contents at discrete points in time as part of an ongoing, more continuous, and long-term ‘stream of consciousness.’ Can Integrated Information Theory (IIT) account for this multitude of timescales of consciousness? According to the theory, the relevant spatiotemporal scale for consciousness is the one in which the system reaches the maximum cause-effect power; IIT currently predicts that experience occurs on the order of short timescales, namely, between 100 and 300 ms (theta and alpha frequency range). This can well account for the integration of single inputs into a particular phenomenal content. However, such short timescales leave open the temporal relation of specific phenomenal contents to others during the course of the ongoing time, that is, the stream of consciousness. For that purpose, we converge the IIT with the Temporo-spatial Theory of Consciousness (TTC), which, assuming a multitude of different timescales, can take into view the temporal integration of specific phenomenal contents with other phenomenal contents over time. On the neuronal side, this is detailed by considering those neuronal mechanisms driving the non-additive interaction of pre-stimulus activity with the input resulting in stimulus-related activity. Due to their non-additive interaction, the single input is not only integrated with others in the short-term timescales of 100–300 ms (alpha and theta frequencies) (as predicted by IIT) but, at the same time, also virtually expanded in its temporal (and spatial) features; this is related to the longer timescales (delta and slower frequencies) that are carried over from pre-stimulus to stimulus-related activity. Such a non-additive pre-stimulus-input interaction amounts to temporo-spatial expansion as a key mechanism of TTC for the constitution of phenomenal contents including their embedding or nesting within the ongoing temporal dynamic, i.e., the stream of consciousness. In conclusion, we propose converging the short-term integration of inputs postulated in IIT (100–300 ms as in the alpha and theta frequency range) with the longer timescales (in delta and slower frequencies) of temporo-spatial expansion in TTC.

Altered Effective Brain Connectivity During Habituation in First Episode Schizophrenia With Auditory Verbal Hallucinations: A Dichotic Listening EEG Study

Background: Habituation is considered to have protective and filtering mechanisms. The present study is aim to find the casual relationship and mechanisms of excitatory-inhibitory (E/I) dysfunctions in schizophrenia (SCZ) via habituation. Methods: A dichotic listening paradigm was performed with simultaneous EEG recording on 22 schizophrenia patients and 22 gender- and age-matched healthy controls. Source reconstruction and dynamic causal modeling (DCM) analysis were performed to estimate the effective connectivity and casual relationship between frontal and temporal regions before and after habituation. Results: The schizophrenia patients expressed later habituation onset (p < 0.01) and hyper-activity in both lateral frontal-temporal cortices than controls (p = 0.001). The patients also showed decreased top-down and bottom-up connectivity in bilateral frontal-temporal regions (p < 0.01). The contralateral frontal-frontal and temporal-temporal connectivity showed a left to right decreasing (p < 0.01) and right to left strengthening (p < 0.01). Conclusions: The results give causal evidence for E/I imbalance in schizophrenia during dichotic auditory processing. The altered effective connectivity in frontal-temporal circuit could represent the trait bio-marker of schizophrenia with auditory hallucinations.

When the World Breaks Down: A 3-Stage Existential Model of Nihilism in Schizophrenia

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.

The neural correlates of the visual consciousness in schizophrenia: an fMRI study

In the current literature, two distinct and opposite models are suggested to explain the consciousness disorders in schizophrenia. The first one suggests that consciousness disorders rely on a low-level processing deficit, when the second model suggests that consciousness disorders rely on disruption in the ability to consciously access information, with preserved unconscious processing. The current study aims to understand the mechanisms associated with visual consciousness disorder in order to pave the road that will settle the debate regarding these hypotheses. During a functional magnetic resonance imaging session, 19 healthy participants (HC) and 15 patients with schizophrenia (SCZ) performed a visual detection task to compare the neural substrates associated with the conscious access to the visual inputs. The visual detection threshold was significantly higher in SCZ than in HC [t(32) = 3.37, p = 0.002]. Whole-brain ANOVA demonstrated that around the visual detection threshold patients with SCZ failed to activate a large network of brain areas compared to HC. (1) During conscious vision, HC engaged more the left cuneus and the right occipital cortex than patients with SCZ, (2) during unconscious vision, HC engaged a large network that patients with SCZ failed to activate, and finally, (3) during the access to consciousness process, patients with SCZ failed to activate the anterior cingulate cortex. These results suggest that the consciousness disorders in schizophrenia rely on specific dysfunctions depending on the consciousness stage. The disorders of the conscious vision are associated with dysfunction of occipital areas while the ones associated with unconscious vision rely on a large widespread network. Finally, the conscious access to the visual inputs is impaired by a dysfunction of the anterior cingulate cortex. The current study suggests that none of the two suggested models can explain consciousness disorders in schizophrenia. We suggest that there is an alternative model supporting that the conscious access to visual inputs is due to a disengagement of the supragenual anterior cingulate during the unconscious processing of the visual inputs associated with a sensory deficit.

"Common Currency" Between Experience and Brain: Spatiotemporal Psychopathology of the Resting State in Depression

The aim of this contribution is to introduce Spatiotemporal Psychopathology and the way it may complement and extent Phenomenological Psychopathology by bridging the methodological gap between the brain and experience. In the first part, I will provide examples for spatiotemporal correspondence between neuronal and psychopathological features. Specifically, I will discuss how spatial changes in the brain's spontaneous activity translate into abnormal experience of the self in major depressive disorder (MDD). Finally, I will briefly discuss the method of such Spatiotemporal Psychopathology and distinguish it from the methods relied on in other forms of Psychopathology with a special focus on showing the continuity between Spatiotemporal and Phenomenological Psychopathology.

Aberrant static and dynamic functional patterns of frontoparietal control network in antipsychotic-naïve first-episode psychosis subjects

Psychotic disorders are disabling clinical syndromes characterized by widespread alterations in cortical information processing. Disruption of frontoparietal network (FPN) connectivity has emerged as a common footprint across the psychosis spectrum. Our goal was to characterize the static and dynamic resting‐state functional connectivity (FC) of the FPN in antipsychotic‐naïve first‐episode psychosis (FEP) subjects. We compared the static FC of the FPN in 40 FEP and 40 healthy control (HC) subjects, matched on age, sex, and socioeconomic status. To study the dynamic FC, we measured quasiperiodic patterns (QPPs) that consist of infraslow spatioemporal patterns embedded in the blood oxygen level‐dependent signal that repeats over time, exhibiting alternation of high and low activity. Relative to HC, we found functional hypoconnectivity between the right middle frontal gyrus and the right middle temporal gyrus, as well as the left inferior temporal gyrus and the left inferior parietal gyrus in FEP (p < .05, false discovery rate corrected). The correlation of the QPP with all functional scans was significantly stronger for FEP compared to HC, suggesting a greater impact of the QPPs to intrinsic brain activity in psychotic population. Regressing the QPP from the functional scans erased all significant group differences in static FC, suggesting that abnormal connectivity in FEP could result from altered QPP. Our study supports that alterations of cortical information processing are not a function of psychotic chronicity or antipsychotic medication exposure and may be regarded as trait specific. In addition, static connectivity abnormality may be partly related to altered brain network temporal dynamics.

The self in art therapy - Brain-based assessment of the drawing process

Art therapy plays important role in classical psychological assessment as it allows expressing the subject's sense of self. However, its effectiveness and validity could be impeded by lack of relationship to the patients' neuronal changes in their brain. The aim of our theoretical-empirical paper is to propose a novel brain-based quantitative objective measurement of the self and how it shapes the drawing process. We discuss recent data that how the autocorrelation window (ACW) is related to the temporal continuity of self in current neuroscience and further develop a method to use ACW to measure the temporal continuity of the drawing process, probing it in two case studies. As expected, the schizophrenic subject shows lower ACW values compared to the healthy subject and reflects the well-known deficit in the temporal continuity of the self in schizophrenia. We concluded that ACW and eventually other measures of the brain's spatiotemporal structure might be able to serve as objective markers of the self in the drawing process. As our approach connects brain, self, and drawing process, it provides the theoretical basis for the future development of a brain-based assessment of the self in the drawing process and art therapy.

Why context matters? Divisive normalization and canonical microcircuits in psychiatric disorders

Neural activity on cellular, regional, and behavioral levels shows context-dependence. Here we suggest the processing of input-output relationships in terms divisive normalization (DN), including (i) summing/averaging inputs and (ii) normalizing output against input stages, as a computational mechanism to underlie context-dependence. Input summation and output normalization are mediated by input-output relationships in canonical microcircuits (CM). DN/CM are altered in psychiatric disorders like schizophrenia or depression whose various symptoms can be characterized by abnormal context-dependence.

NMDA Receptor Antagonist Effects on Speech-Related Mismatch Negativity and Its Underlying Oscillatory and Source Activity in Healthy Humans

Background: Previous studies in schizophrenia have consistently shown that deficits in the generation of the auditory mismatch negativity (MMN) – a pre-attentive, event-related potential (ERP) typically elicited by changes to simple sound features – are linked to N-methyl-D-aspartate (NMDA) receptor hypofunction. Concomitant with extensive language dysfunction in schizophrenia, patients also exhibit MMN deficits to changes in speech but their relationship to NMDA-mediated neurotransmission is not clear. Accordingly, our study aimed to investigate speech MMNs in healthy humans and their underlying electrophysiological mechanisms in response to NMDA antagonist treatment. We also evaluated the relationship between baseline MMN/electrocortical activity and emergent schizophrenia-like symptoms associated with NMDA receptor blockade.

Methods: In a sample of 18 healthy volunteers, a multi-feature Finnish language paradigm incorporating changes in syllables, vowels and consonant stimuli was used to assess the acute effects of the NMDA receptor antagonist ketamine and placebo on the MMN. Further, measures of underlying neural activity, including evoked theta power, theta phase locking and source-localized current density in cortical regions of interest were assessed. Subjective symptoms were assessed with the Clinician Administered Dissociative States Scale (CADSS).

Results: Participants exhibited significant ketamine-induced increases in psychosis-like symptoms and depending on temporal or frontal recording region, co-occurred with reductions in MMN generation in response to syllable frequency/intensity, vowel duration, across vowel and consonant deviants. MMN attenuation was associated with decreases in evoked theta power, theta phase locking and diminished current density in auditory and inferior frontal (language-related cortical) regions. Baseline (placebo) MMN and underlying electrophysiological features associated with the processing of changes in syllable intensity correlated with the degree of psychotomimetic response to ketamine.

Conclusion: Ketamine-induced impairments in healthy human speech MMNs and their underlying electrocortical mechanisms closely resemble those observed in schizophrenia and support a model of dysfunctional NMDA receptor-mediated neurotransmission of language processing deficits in schizophrenia.

Indication of Disrupted Temporal Structure in the Case of Thought Blocks in Schizophrenia: The Role of the Metastable Balance

This study is aimed at investigating probable disruption of the metastable balance relevant to a disruption of the mental processes observed in the neurophenomenal level. This disruption was found to occur under dense auditory verbal hallucinations (AVHs) which are accompanied by thought blocking (TB) phenomena. The entropy that quantifies the complexity of the spontaneous coupling has been used to describe the observed transitions. According to our findings, the high synchrony-derived entropy (SE) defines a metastable state, where formations of cortical areas are able to coordinate transiently under the demands of stimulus-oriented processes or other internal cognitive associations. It was also found that the disruption of the sensitive balance to the side of oversynergy (overconnectedness) rather than the side of independence (coincidental coupling) is relevant with functional fixations under the specific symptom of schizophrenia. An introduced measure relative to the persistence of coupling indicated that the overcoupled brain areas exhibit a kind of “stiffness” in processing incoherent phasic components. Our consideration enhances the understanding of the role the metastability plays in the interpretation of deeply subjective phenomena, such as AVHs and TBs that affect the normal information routing in the brain.

Varieties of Self Disorder: A Bio-Pheno-Social Model of Schizophrenia

The self-disorder model offers a unifying way of conceptualizing schizophrenia's highly diverse symptoms (positive, negative, disorganized), of capturing their distinctive bizarreness, and of conceiving their longitudinal development. These symptoms are viewed as differing manifestations of an underlying disorder of ipseity or core-self: hyper-reflexivity/diminished-self-presence with accompanying disturbances of "grip" or "hold" on reality. Recent revision to this phenomenological theory, in particular distinguishing primary-vs-secondary factors, offers a bio-pheno-social model that is consistent with recent empirical findings and offers several advantages: (1) It helps account for the temporal variations of the symptoms or syndrome, including longitudinal progression, but also the shorter-term, situationally reactive, and sometimes defensive or quasi-intentional variability of symptom-expression that can occur in schizophrenia (consistent with understanding some aspects of ipseity-disturbance as dynamic and mutable, involving shifting attitudes or experiential orientations). (2) It accommodates the overlapping of some key schizophrenic symptoms with certain nonschizophrenic conditions involving dissociation (depersonalization, derealization), including depersonalization disorder and panic disorder, thereby acknowledging both shared and distinguishing symptoms. (3) It integrates recent neurocognitive and neurobiological as well as psychosocial (eg, influence of trauma and culture) findings into a coherent but multi-factorial neuropsychological account. An adequate model of schizophrenia will postulate shared disturbances of core-self experiences that nevertheless can follow several distinct pathways and occur in various forms. Such a model is preferable to uni-dimensional alternatives-whether of schizophrenia or ipseity-disturbance-given its ability to account for distinctive yet varying experiential and neurocognitive abnormalities found in research on schizophrenia, and to integrate these with recent psychosocial and neurobiological findings.

Disrupted relationship between "resting state" connectivity and task-evoked activity during social perception in schizophrenia

Schizophrenia has been described as a self-disorder, whereas social deficits are key features of the illness. Changes in "resting state" activity of brain networks involved in self-related processing have been consistently reported in schizophrenia, but their meaning for social perception deficits remains poorly understood. Here, we applied a novel approach investigating the relationship between task-evoked neural activity during social perception and functional organization of self-related brain networks during a "resting state". "Resting state" functional MRI was combined with task-related functional MRI using a social perception experiment. Twenty-one healthy control participants (HC) and 21 out-patients with a diagnosis of schizophrenia (SCH) were included. There were no significant differences concerning age, IQ, education and gender between the groups. Results showed reduced "resting state" functional connectivity between ventromedial prefrontal cortex and dorsal posterior cingulate cortex in SCH, compared to HC. During social perception, neural activity in dorsal posterior cingulate cortex and behavioral data indicated impaired congruence coding of social stimuli in SCH. Task-evoked activity during social perception in dorsal posterior cingulate cortex co-varied with dorsal posterior cingulate cortex-ventromedial prefrontal cortex functional connectivity during a "resting state" in HC, but not in SCH. Task-evoked activity also correlated with negative symptoms in SCH. These preliminary findings, showing disrupted prediction of social perception measures by "resting state" functioning of self-related brain networks in schizophrenia, provide important insight in the hypothesized link between self and social deficits. They also shed light on the meaning of "resting state" changes for tasks such as social perception.

The brain's spontaneous activity and its psychopathological symptoms - "Spatiotemporal binding and integration"

Neuroimaging provided much insight into the neural activity of the brain and its alterations in psychiatric disorders. However, despite extensive research, the exact neuronal mechanisms leading to the various psychopathological symptoms remain unclear, yet. In addition to task-evoked activity during affective, cognitive, or other challenges, the brain's spontaneous or resting state activity has come increasingly into the focus. Basically all psychiatric disorders show abnormal resting state activity with the relation to psychopathological symptoms remaining unclear though. I here suggest to conceive the brain's spontaneous activity in spatiotemporal terms that is, by various mechanisms that are based on its spatial, i.e., functional connectivity, and temporal, i.e., fluctuations in different frequencies, features. I here point out two such spatiotemporal mechanisms, i.e., "spatiotemporal binding and integration". Alterations in the resting state's spatial and temporal features lead to abnormal "spatiotemporal binding and integration" which results in abnormal contents in cognition as in the various psychopathological symptoms. This, together with concrete empirical evidence, is demonstrated in depression and schizophrenia. I therefore conclude that we need to develop a spatiotemporal approach to psychopathology, "spatiotemporal psychopathology:" as I call it.

Too Fast or Too Slow? Time and Neuronal Variability in Bipolar Disorder-A Combined Theoretical and Empirical Investigation

Time is an essential feature in bipolar disorder (BP). Manic and depressed BP patients perceive the speed of time as either too fast or too slow. The present article combines theoretical and empirical approaches to integrate phenomenological, psychological, and neuroscientific accounts of abnormal time perception in BP. Phenomenology distinguishes between perception of inner time, ie, self-time, and outer time, ie, world-time, that desynchronize or dissociate from each other in BP: inner time speed is abnormally slow (as in depression) or fast (as in mania) and, by taking on the role as default-mode function, impacts and modulates the perception of outer time speed in an opposite way, ie, as too fast in depression and too slow in mania. Complementing, psychological investigation show opposite results in time perception, ie, time estimation and reproduction, in manic and depressed BP. Neuronally, time speed can be indexed by neuronal variability, ie, SD. Our own empirical data show opposite changes in manic and depressed BP (and major depressive disorder [MDD]) with abnormal SD balance, ie, SD ratio, between somatomotor and sensory networks that can be associated with inner and outer time. Taken together, our combined theoretical-empirical approach demonstrates that desynchronization or dissociation between inner and outer time in BP can be traced to opposite neuronal variability patterns in somatomotor and sensory networks. This opens the door for individualized therapeutic "normalization" of neuronal variability pattern in somatomotor and sensory networks by stimulation with TMS and/or tDCS.

What Can Different Motor Circuits Tell Us About Psychosis? An RDoC Perspective

Signs of motor dysfunction are evidenced across a range of psychiatric disorders including schizophrenia. Historically, these features have been neglected but emerging theoretical and methodological advancements have shed new light on the utility of considering movement abnormalities. Indeed, the National Institute of Mental Health Research Domain Criteria initiative has recently met to develop a Motor Systems Domain. This reflects a growing appreciation for the enhanced reliability and validity that can come along with evaluating disturbances relevant to psychiatric illnesses from multiple levels of analysis, and conceptualizing these domains with respect to the complexity of their role in a broader integrated system (ie, weighing contributions and interactions between the cognitive, affective, and motor domains). This article discusses motor behaviors and seeks to explain how research into basal ganglia, cerebellar, and cortico-motor circuit function/dysfunction, grounded in brain circuit-motor behavior relationships, can elucidate our understanding of pathophysiology, provide vital links to other key systems of interest, significantly improve identification and classification, and drive development of targeted individualized treatments.

Embodiment and Schizophrenia: A Review of Implications and Applications

In recent decades, embodiment has become an influential concept in psychology and cognitive neuroscience. Embodiment denotes the study of the reciprocal (causal) relationships between mind and body, with the mind not only affecting the body but also vice versa. Embodied cognition comes to the fore in sensorimotor coupling, predictive coding, and nonverbal behavior. Additionally, the embodiment of the mind constitutes the basis of social interaction and communication, as evident in research on nonverbal synchrony and mimicry. These theoretical and empirical developments portend a range of implications for schizophrenia research and treatment. Sensorimotor dysfunctions are closely associated with affective and psychotic psychopathology, leading to altered timing in the processing of stimuli and to disordered appraisals of the environment. Problems of social cognition may be newly viewed as disordered embodied communication. The embodiment perspective suggests novel treatment strategies through psychotherapy and body-oriented interventions, and may ultimately provide biomarkers for diagnosis.

Clinical and biochemical study of d-serine metabolism among schizophrenia patients

BACKGROUND

Schizophrenia is a typical N-methyl-d-aspartate receptor (NMDA-R) hypofunction disorder. Decreased d-serine (d-Ser) levels in the periphery occur in schizophrenia and may reflect decreased availability of d-Ser to activate NMDA-R in the brain.

OBJECTIVE

The objective of this study was to investigate the role of d-Ser metabolism in the pathogenesis of schizophrenia via biochemical assays and correlates, the serum level of d-Ser, d-serine racemase (SR) (responsible for its formation from l-serine [l-Ser]) and d-amino acid oxidase (DAAO) (responsible for its catabolism), among different clinical types of schizophrenia patients.

PATIENTS AND METHODS

This cross-sectional case-control study was carried out on 100 patients and 50 controls. They were recruited from the outpatients' psychiatric unit of the Neuropsychiatric Department of Assiut University Hospital, Upper Egypt. The type of schizophrenia was determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), while the severity of schizophrenia was determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Serum d-Ser levels were estimated using high-performance liquid chromatography (HPLC), while serum SR and DAAO were measured using commercially available enzyme-linked immunosorbent assay kits.

RESULTS

There were significantly lower mean serum levels of d-Ser and SR and significantly higher mean serum levels of DAAO (P-value <0.01 for each) among schizophrenia patients when compared with the control group. Paranoid schizophrenia had the highest frequency, with a significantly lower serum levels of d-Ser and SR in the residual type and significantly higher serum levels of DAAO in undifferentiated and catatonic types. Combined receiver-operating characteristic curve for serum d-Ser, SR and DAAO indicated that the best serum level cutoff points at which schizophrenia manifestations started to appear were ≤ 61.4 mg/L for d-Ser, ≤ 15.5 pg/mL for SR and >35.6 pg/mL for DAAO.

CONCLUSION

The present study confirms that disturbed d-Ser metabolism could be implicated in the pathogenesis of schizophrenia.

Implicit Timing as the Missing Link between Neurobiological and Self Disorders in Schizophrenia?

Disorders of consciousness and the self are at the forefront of schizophrenia symptomatology. Patients are impaired in feeling themselves as the authors of their thoughts and actions. In addition, their flow of consciousness is disrupted, and thought fragmentation has been suggested to be involved in the patients' difficulties in feeling as being one unique, unchanging self across time. Both impairments are related to self disorders, and both have been investigated at the experimental level. Here we review evidence that both mechanisms of motor control and the temporal structure of signal processing are impaired in schizophrenia patients. Based on this review, we propose that the sequencing of action and perception plays a key role in the patients' impairments. Furthermore, the millisecond time scale of the disorders, as well as the impaired sequencing, highlights the cooperation between brain networks including the cerebellum, as proposed by Andreasen (1999). We examine this possibility in the light of recent knowledge on the anatomical and physiological properties of the cerebellum, its role in timing, and its involvement in known physiological impairments in patients with schizophrenia, e.g., resting states and brain dynamics. A disruption in communication between networks involving the cerebellum, related to known impairments in dopamine, glutamate and GABA transmission, may help to better explain why patients experience reduced attunement with the external world and possibly with themselves.

Is Anorexia Nervosa a Disorder of the Self? A Psychological Approach

The debate concerning the pathogenesis and the maintaining factors of eating disorders, anorexia nervosa in particular, is ongoing especially since therapeutic interventions do not result in satisfactory and enduring rates of remission. This paper presents a model for the pathogenesis of eating disorders, based on the hypothesis of a deficiency in the development of the self. We present the theory in light of new evidence concerning the role of attachment insecurity in the development and maintenance of eating disorders. In particular, we define the self in eating disorders in a comprehensive way by taking into account recent evidence from experimental psychology and neurobiology. The paper considers the development of the self in terms of its synchronic (i.e., experienced in the moment) and diachronic (i.e., experienced as continuous over time) aspects. Both synchronic and diachronic aspects of the self are relevant to the expression of eating disorder symptoms. Further, the maturation of the self is interwoven with the development of attachment functioning from infancy to adolescence. This interplay between these developmental processes of the self and of attachment could be crucial in understanding the pathogenesis of eating disorders. The final part of the paper suggests a neurobiological link between the theory of the self in the eating disorders and the spatiotemporal functioning of the brain. Disturbances in spatiotemporal functioning may represent the neurobiological pathway by which deficiencies in the self is related to attachment functions in individuals with eating disorders.

How to Link Brain and Experience? Spatiotemporal Psychopathology of the Lived Body

The focus of the present article is on sketching a psychopathology of the body in schizophrenia and linking it to brain activity. This is done providing converging data from psychopathological evidence (phenomenal), phenomenological contructs (trans-phenomenal) and neuroscientific measures (pre-phenomenal). The phenomenal level is the detailed documentation of the patients' subjective anomalous experiences. These phenomena are explicit contents in the patients' field of consciousness. The trans-phenomenal level targets the implicit yet operative matrix that underlies these anomalous subjective experiences. Abnormal phenomena are viewed as expressions of a modification of trans-phenomenal matrix, that is, in terms of an abnormal synthesis or integration through time of intero-, proprio- and extero-ceptive stimuli. Finally, we link the abnormalities of the trans-phenomenal matrix to pre-phenomenal alterations of the brain resting state and of its spatio-temporal organization, as documented by neurobiological methods providing spatial and temporal resolution of intrinsic brain activity (with many features of the resting state remaining yet unclear though). Based on phenomenological research, the body in schizophrenia is typically experienced in an itemized way as an object external to one's self and unrelated to events in the external world. Based on neurobiological data, we tentatively hypothesize that such anomalies of the lived body are related to decreased integration between intero-, extero- and proprioceptive experiences by the brain's spontaneous activity and its temporal structure. Taken all together, this suggests that we view abnormalities of bodily experience in terms of their underlying abnormal spatiotemporal features which, as we suppose, can be traced back to the spatiotemporal features of the brain's spontaneous activity.

Is the Sense of Agency in Schizophrenia Influenced by Resting-State Variation in Self-Referential Regions of the Brain?

Schizophrenia is a disturbance of the self, of which the attribution of agency is a major component. In this article, we review current theories of the Sense of Agency, their relevance to schizophrenia, and propose a novel framework for future research. We explore some of the models of agency, in which both bottom-up and top-down processes are implicated in the genesis of agency. We further this line of inquiry by suggesting that ongoing neurological activity (the brain's resting state) in self-referential regions of the brain can provide a deeper level of influence beyond what the current models capture. Based on neuroimaging studies, we suggest that aberrant activity in regions such as the default mode network of individuals with schizophrenia can lead to a misattribution of internally/externally generated stimuli. This can result in symptoms such as thought insertion and delusions of control. Consequently, neuroimaging can contribute to a more comprehensive conceptualization and measurement of agency and potential treatment implications.

Focus on psychosis

The concept of psychosis has been shaped by traditions in the concepts of mental disorders during the last 170 years. The term "psychosis" still lacks a unified definition, but denotes a clinical construct composed of several symptoms. Delusions, hallucinations, and thought disorders are the core clinical features. The search for a common denominator of psychotic symptoms points toward combinations of neuropsychological mechanisms resulting in reality distortion. To advance the elucidation of the causes and the pathophysiology of the symptoms of psychosis, a deconstruction of the term into its component symptoms is therefore warranted. Current research is dealing with the delineation from "normality", the genetic underpinnings, and the causes and pathophysiology of the symptoms of psychosis.

Spatiotemporal psychopathology I: No rest for the brain's resting state activity in depression? Spatiotemporal psychopathology of depressive symptoms

Despite intense neurobiological investigation in psychiatric disorders like major depressive disorder (MDD), the basic disturbance that underlies the psychopathological symptoms of MDD remains, nevertheless, unclear. Neuroimaging has focused mainly on the brain's extrinsic activity, specifically task-evoked or stimulus-induced activity, as related to the various sensorimotor, affective, cognitive, and social functions. Recently, the focus has shifted to the brain's intrinsic activity, otherwise known as its resting state activity. While various abnormalities have been observed during this activity, their meaning and significance for depression, along with its various psychopathological symptoms, are yet to be defined. Based on findings in healthy brain resting state activity and its particular spatial and temporal structure - defined in a functional and physiological sense rather than anatomical and structural - I claim that the various depressive symptoms are spatiotemporal disturbances of the resting state activity and its spatiotemporal structure. This is supported by recent findings that link ruminations and increased self-focus in depression to abnormal spatial organization of resting state activity. Analogously, affective and cognitive symptoms like anhedonia, suicidal ideation, and thought disorder can be traced to an increased focus on the past, increased past-focus as basic temporal disturbance o the resting state. Based on these findings, I conclude that the various depressive symptoms must be conceived as spatiotemporal disturbances of the brain's resting state's activity and its spatiotemporal structure. Importantly, this entails a new form of psychopathology, "Spatiotemporal Psychopathology" that directly links the brain and psyche, therefore having major diagnostic and therapeutic implications for clinical practice.

Spatiotemporal Psychopathology II: How does a psychopathology of the brain's resting state look like? Spatiotemporal approach and the history of psychopathology

Psychopathology as the investigation and classification of experience, behavior and symptoms in psychiatric patients is an old discipline that ranges back to the end of the 19th century. Since then different approaches to psychopathology have been suggested. Recent investigations showing abnormalities in the brain on different levels raise the question how the gap between brain and psyche, between neural abnormalities and alteration in experience and behavior can be bridged. Historical approaches like descriptive (Jaspers) and structural (Minkoswki) psychopathology as well as the more current phenomenological psychopathology (Paarnas, Fuchs, Sass, Stanghellini) remain on the side of the psyche giving detailed description of the phenomenal level of experience while leaving open the link to the brain. In contrast, the recently introduced Research Domain Classification (RDoC) aims at explicitly linking brain and psyche by starting from so-called 'neuro-behavioral constructs'. How does Spatiotemporal Psychopathology, as demonstrated in the first paper on depression, stand in relation to these approaches? In a nutshell, Spatiotemporal Psychopathology aims to bridge the gap between brain and psyche. Specifically, as demonstrated in depression in the first paper, the focus is on the spatiotemporal features of the brain's intrinsic activity and how they are transformed into corresponding spatiotemporal features in experience on the phenomenal level and behavioral changes, which can well account for the symptoms in these patients. This second paper focuses on some of the theoretical background assumptions in Spatiotemporal Psychopathology by directly comparing it to descriptive, structural, and phenomenological psychopathology as well as to RDoC.

How do resting state changes in depression translate into psychopathological symptoms? From 'Spatiotemporal correspondence' to 'Spatiotemporal Psychopathology'

PURPOSE OF REVIEW

To review the recent findings in resting-state activity in major depressive disorder (MDD) and link them to psychopathological symptoms.

RECENT FINDINGS

MDD shows changes in resting state functional connectivity (rsFC) mainly within the default-mode network with a focus on especially the perigenual anterior cingulate cortex. rsFC in perigenual anterior cingulate cortex is abnormally high in MDD and decreased in the lateral prefrontal cortex with the central executive network (CEN). rsFC in other networks like the salience network, including the insula, amygdala, and supragenual anterior cingulate cortex and the sensorimotor network is also affected in MDD.

SUMMARY

Resting-state activity in MDD shows abnormal topographical and spatiotemporal pattern. The spatiotemporal alterations in resting state may translate into corresponding spatiotemporal changes underlying the sensorimotor, affective, and cognitive functions, and thus, the various symptoms. Such spatiotemporal correspondence between resting state changes and psychopathological symptoms may make necessary the development of what I describe as 'Spatiotemporal Psychopathology'.

Phenomenology and neurobiology of self disorder in schizophrenia: Secondary factors

Schizophrenia is a diverse and varying syndrome that defies most attempts at classification and pathogenetic explanation. This is the second of two articles offering a comprehensive model meant to integrate an understanding of schizophrenia-related forms of subjectivity, especially anomalous core-self experience (disturbed ipseity), with neurocognitive and neurodevelopmental findings. Previously we discussed the primary or foundational role of disturbed intermodal perceptional integration ("perceptual dys-integration"). Here we discuss phenomenological alterations that can be considered secondary in a pathogenetic sense--whether as consequential products downstream from a more originary disruption, or as defensive reactions involving quasi-intentional or even volitional compensations to the more primary disruptions. These include secondary forms of: 1, hyperreflexivity, 2, diminished self-presence (self-affection), and 3. disturbed "rip" or "hold" on the cognitive/perceptual field of awareness. We consider complementary relations between these secondary abnormal experiences while also considering their temporal relationships and pathogenetic intertwining with the more primary phenomenological alterations discussed previously, all in relation to the neurodevelopmental model. The secondary phenomena can be understood as highly variable factors involving overall orientations or attitudes toward experience; they have some affinities with experiences of meditation, introspectionism, and depersonalization defense. Also, they seem likely to become more pronounced during adolescence as a result of new cognitive capacities related to development of the prefrontal lobes, especially attention allocation, executive functions, abstraction, and meta-awareness. Heterogeneity in these secondary alterations might help explain much of the clinical diversity in schizophrenia, both between patients and within individual patients over time--without however losing sight of key underlying commonalities.

Disruption of information processing in schizophrenia: The time perspective

We review studies suggesting time disorders on both automatic and subjective levels in patients with schizophrenia. Patients have difficulty explicitly discriminating between simultaneous and asynchronous events, and ordering events in time. We discuss the relationship between these difficulties and impairments on a more elementary level. We showed that for undetectable stimulus onset asynchronies below 20 ms, neither patients nor controls merge events in time, as previously believed. On the contrary, subjects implicitly distinguish between events even when evaluating them to be simultaneous. Furthermore, controls privilege the last stimulus, whereas patients seem to stay stuck on the first stimulus when asynchronies are sub-threshold. Combining previous results shows this to be true for patients even for asynchronies as short as 8 ms. Moreover, this peculiarity predicts difficulties with detecting asynchronies longer than 50 ms, suggesting an impact on the conscious ability to time events. Difficulties on the subjective level are also correlated with clinical disorganization. The results are interpreted within the framework of predictive coding which can account for an implicit ability to update events. These results complement a range of other results, by suggesting a difficulty with binding information in time as well as space, and by showing that information processing lacks continuity and stability in patients. The time perspective may help bridge the gap between cognitive impairments and clinical symptoms, by showing how the innermost structure of thought and experience is disrupted.

Understanding schizophrenia as a disorder of consciousness: biological correlates and translational implications from quantum theory perspectives

From neurophenomenological perspectives, schizophrenia has been conceptualized as "a disorder with heterogeneous manifestations that can be integrally understood to involve fundamental perturbations in consciousness". While these theoretical constructs based on consciousness facilitate understanding the 'gestalt' of schizophrenia, systematic research to unravel translational implications of these models is warranted. To address this, one needs to begin with exploration of plausible biological underpinnings of "perturbed consciousness" in schizophrenia. In this context, an attractive proposition to understand the biology of consciousness is "the orchestrated object reduction (Orch-OR) theory" which invokes quantum processes in the microtubules of neurons. The Orch-OR model is particularly important for understanding schizophrenia especially due to the shared 'scaffold' of microtubules. The initial sections of this review focus on the compelling evidence to support the view that "schizophrenia is a disorder of consciousness" through critical summary of the studies that have demonstrated self-abnormalities, aberrant time perception as well as dysfunctional intentional binding in this disorder. Subsequently, these findings are linked with 'Orch-OR theory' through the research evidence for aberrant neural oscillations as well as microtubule abnormalities observed in schizophrenia. Further sections emphasize the applicability and translational implications of Orch-OR theory in the context of schizophrenia and elucidate the relevance of quantum biology to understand the origins of this puzzling disorder as "fundamental disturbances in consciousness".

Functional connectivity and neuronal variability of resting state activity in bipolar disorder--reduction and decoupling in anterior cortical midline structures

INTRODUCTION

The cortical midline structures seem to be involved in the modulation of different resting state networks, such as the default mode network (DMN) and salience network (SN). Alterations in these systems, in particular in the perigenual anterior cingulate cortex (PACC), seem to play a central role in bipolar disorder (BD). However, the exact role of the PACC, and its functional connections to other midline regions (within and outside DMN) still remains unclear in BD.

METHODS

We investigated functional connectivity (FC), standard deviation (SD, as a measure of neuronal variability) and their correlation in bipolar patients (n = 40) versus healthy controls (n = 40), in the PACC and in its connections in different frequency bands (standard: 0.01-0.10 Hz; Slow-5: 0.01-0.027 Hz; Slow-4: 0.027-0.073 Hz). Finally, we studied the correlations between FC alterations and clinical-neuropsychological parameters and we explored whether subgroups of patients in different phases of the illness present different patterns of FC abnormalities.

RESULTS

We found in BD decreased FC (especially in Slow-5) from the PACC to other regions located predominantly in the posterior DMN (such as the posterior cingulate cortex (PCC) and inferior temporal gyrus) and in the SN (such as the supragenual anterior cingulate cortex and ventrolateral prefrontal cortex). Second, we found in BD a decoupling between PACC-based FC and variability in the various target regions (without alteration in variability itself). Finally, in our subgroups explorative analysis, we found a decrease in FC between the PACC and supragenual ACC (in depressive phase) and between the PACC and PCC (in manic phase).

CONCLUSIONS

These findings suggest that in BD the communication, that is, information transfer, between the different cortical midline regions within the cingulate gyrus does not seem to work properly. This may result in dysbalance between different resting state networks like the DMN and SN. A deficit in the anterior DMN-SN connectivity could lead to an abnormal shifting toward the DMN, while a deficit in the anterior DMN-posterior DMN connectivity could lead to an abnormal shifting toward the SN, resulting in excessive focusing on internal contents and reduced transition from idea to action or in excessive focusing on external contents and increased transition from idea to action, respectively, which could represent central dimensions of depression and mania. If confirmed, they could represent diagnostic markers in BD.