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Mancini M, Esposito CM, Estradé A, Rosfort R, Fusar-Poli P, Stanghellini G. Major Depression as a Disorder of the Narrative Self: A Qualitative Study. Psychopathology 2024:1-11. [PMID: 38776880 DOI: 10.1159/000538942] [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: 02/13/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Abnormal self-experiences are a common feature of major depression despite their absence from current diagnostic manuals. Current diagnostic criteria leave us with an impoverished conception of depressive disorders, and they fail to exploit the diverse experiential alterations that might be useful for understanding and diagnosing patients, and last but not least for explaining the aetiology of these disorders. Although some phenomenological descriptions of abnormal self-experiences in major depression are available, further research is needed to validate these through detailed clinical interviews. METHODS To characterize these phenomena in more detail and to verify and consolidate previous accounts, we conducted a qualitative study using the Consensual Qualitative Research method. RESULTS Our findings identified three categories of abnormal self-experiences: (1) impossibility to project oneself forward, (2) not recognizing one's self, and (3) losing control on one's self. CONCLUSION Before delving into these results, we briefly described how the self is conceptualized in phenomenological psychopathology and explored in the literature on the self-experience in major depression. After discussing our results in the light of recent and contemporary phenomenological literature, we suggest that the inability to recognize otherness as part of oneself - which is the core of depressive experiences - ends in specific symptoms of depersonalization that differ from schizophrenic ones. We conclude that the self-experience, and in particular narrative identity, is central to the development and maintenance of depression.
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Affiliation(s)
- Milena Mancini
- Department of Psychological, Health, and Territorial Sciences "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - René Rosfort
- Søren Kierkegaard Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
- Kings College Hospital in London and the Institute of Psychiatry, London, UK
| | - Giovanni Stanghellini
- Kings College Hospital in London and the Institute of Psychiatry, London, UK
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
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2
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Wolff A, Northoff G. Temporal imprecision of phase coherence in schizophrenia and psychosis-dynamic mechanisms and diagnostic marker. Mol Psychiatry 2024; 29:425-438. [PMID: 38228893 DOI: 10.1038/s41380-023-02337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 01/18/2024]
Abstract
Schizophrenia (SCZ) is a complex disorder in which various pathophysiological models have been postulated. Brain imaging studies using EEG/MEG and fMRI show altered amplitude and, more recently, decrease in phase coherence in response to external stimuli. What are the dynamic mechanisms of such phase incoherence, and can it serve as a differential-diagnostic marker? Addressing this gap in our knowledge, we uniquely combine a review of previous findings, novel empirical data, and computational-dynamic simulation. The main findings are: (i) the review shows decreased phase coherence in SCZ across a variety of different tasks and frequencies, e.g., task- and frequency-unspecific, which is further supported by our own novel data; (ii) our own data demonstrate diagnostic specificity of decreased phase coherence for SCZ as distinguished from major depressive disorder; (iii) simulation data exhibit increased phase offset in SCZ leading to a precision index, in the millisecond range, of the phase coherence relative to the timing of the external stimulus. Together, we demonstrate the key role of temporal imprecision in phase coherence of SCZ, including its mechanisms (phase offsets, precision index) on the basis of which we propose a phase-based temporal imprecision model of psychosis (PTP). The PTP targets a deeper dynamic layer of a basic disturbance. This converges well with other models of psychosis like the basic self-disturbance and time-space experience changes, as discussed in phenomenological and spatiotemporal psychopathology, as well as with the models of aberrant predictive coding and disconnection as in computational psychiatry. Finally, our results show that temporal imprecision as manifest in decreased phase coherence is a promising candidate biomarker for clinical differential diagnosis of SCZ, and more broadly, psychosis.
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Affiliation(s)
- Annemarie Wolff
- University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada.
| | - Georg Northoff
- University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada.
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3
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Pentury MH, Herwawan JH, Tasijawa FA. Religious Practices and Spiritual Well-Being of Schizophrenia: Muslim Perspective [Letter]. Psychol Res Behav Manag 2023; 16:5183-5184. [PMID: 38148775 PMCID: PMC10750476 DOI: 10.2147/prbm.s454424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023] Open
Affiliation(s)
| | - Joan Herly Herwawan
- Faculty of Health, Universitas Kristen Indonesia Maluku, Maluku Province, Indonesia
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4
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Northoff G, Daub J, Hirjak D. Overcoming the translational crisis of contemporary psychiatry - converging phenomenological and spatiotemporal psychopathology. Mol Psychiatry 2023; 28:4492-4499. [PMID: 37704861 PMCID: PMC10914603 DOI: 10.1038/s41380-023-02245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
Despite all neurobiological/neurocomputational progress in psychiatric research, recent authors speak about a 'crisis of contemporary psychiatry'. Some argue that we do not yet know the computational mechanisms underlying the psychopathological symptoms ('crisis of mechanism') while others diagnose a neglect of subjectivity, namely first-person experience ('crisis of subjectivity'). In this perspective, we propose that Phenomenological Psychopathology, due to its focus on first-person experience of space and time, is in an ideal position to address the crisis of subjectivity and, if extended to the brain's spatiotemporal topographic-dynamic structure as key focus of Spatiotemporal Psychopathology, the crisis of mechanism. We demonstrate how the first-person experiences of space and time differ between schizophrenia, mood disorders and anxiety disorders allowing for their differential-diagnosis - this addresses the crisis of subjectivity. Presupposing space and time as shared features of brain, experience, and symptoms as their "common currency", the structure of abnormal space and time experience may also serve as template for the structure of the brain's spatiotemporal neuro-computational mechanisms - this may address the crisis of mechanism. Preliminary scientific evidence in our examples of schizophrenia, bipolar disorder, anxiety disorder, and depression support such clinically relevant spatiotemporal determination of both first-person experience (crisis of subjectivity) and the brain's neuro-computational structure (crisis of mechanism). In conclusion, converging Phenomenological Psychopathology with Spatiotemporal Psychopathology might help to overcome the translational crisis in psychiatry by delineating more fine-grained neuro computational and -phenomenal mechanisms; this offers novel candidate biomarkers for diagnosis and therapy including both pharmacological and non-pharmacological treatment.
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Affiliation(s)
- Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.
| | - Jonas Daub
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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5
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Northoff G, Hirjak D. Integrating subjective and objective-spatiotemporal approach to psychiatric disorders. Mol Psychiatry 2023; 28:4022-4024. [PMID: 37198263 DOI: 10.1038/s41380-023-02100-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Hirjak D, Daub J, Brandt GA, Krayem M, Kubera KM, Northoff G. [Spatiotemporal psychopathology-German version of the Scale for Space and Time Experience in Psychosis (STEP) : A validated measurement instrument for the assessment of spatial and temporal experience in psychotic disorders]. DER NERVENARZT 2023; 94:835-841. [PMID: 37428239 PMCID: PMC10499921 DOI: 10.1007/s00115-023-01519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/11/2023]
Abstract
Historical authors (e.g., Ludwig Binswanger and Eugène Minkowski) postulated that the experience of patients with schizophrenia is characterized by time fragmentation. From a clinical perspective, patients with schizophrenia also suffer from difficulties in spatial perception (e.g., abnormalities in the experience of interpersonal distance and spatial orientation). Although these changes can lead to a serious detachment from reality, to considerable suffering of the affected persons and to difficulties in the therapeutic process, the abnormal experience of space and time in psychotic disorders has not yet been sufficiently investigated. One possible reason is the lack of appropriate and standardized instruments that quantify the experience of space and time in patients with psychotic disorders. Based on an innovative concept, the so-called spatiotemporal psychopathology (STPP), a clinical rating scale for the systematic-quantitative assessment of spatial and temporal experience in patients with psychotic disorders was developed. This article presents the German version of the Scale for Space and Time Experience in Psychosis (STEP). The original English version of the STEP measures different spatial (14 phenomena) and temporal (11 phenomena) phenomena in 25 items. The STEP shows both a high internal consistency (Cronbach's alpha = 0.94) and a significant correlation with the Positive and Negative Syndrome Scale (PANSS; p < 0.001). In summary, the German version of the STEP scale presented here represents an important instrument in the German-speaking countries for the assessment of spatial and temporal experience in patients with psychotic disorders.
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Affiliation(s)
- Dusan Hirjak
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
| | - Jonas Daub
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Geva A Brandt
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Maria Krayem
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Katharina M Kubera
- Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universität Heidelberg, Heidelberg, Deutschland
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Kanada
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Ren H, Zhang Q, Ren Y, Zhou Q, Fang Y, Huang L, Li X. Characteristics of psychological time in patients with depression and potential intervention strategies. Front Psychiatry 2023; 14:1173535. [PMID: 37304430 PMCID: PMC10248015 DOI: 10.3389/fpsyt.2023.1173535] [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: 02/24/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Psychological time reveals information about an individual's psychological state and psychopathological traits and, thus, has become a new perspective through which the occurrence and development of depression can be examined. Psychological time includes time perception, time perspective, circadian rhythms, and passage of time. Patients with depression are characterized by inaccurate time interval estimation, habitual negative thoughts about the past and future, evening-type circadian rhythms, and slow passage of time. Habitual negative thoughts about the past and future and evening-type circadian rhythms influence the formation of depression, and poor time interval estimation and slow passage of time may result from depression. Further study is needed accurately exploring psychological time and influencing factors in patients with depression, and prospective cohort studies could further clarify this complex relationship. In addition, the study of psychological time has important implications for developing effective interventions to reduce depression.
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Affiliation(s)
- Hanlin Ren
- The Third People's Hospital of Zhongshan, Zhongshan, China
- Fujian Key Laboratory of Applied Cognition and Personality, Minnan Normal University, Zhangzhou, China
| | - Qing Zhang
- School of Foreign Studies, Zhongshan Institute, University of Electronic Science and Technology of China, Zhongshan, China
| | - Yanzhen Ren
- The Third People's Hospital of Zhongshan, Zhongshan, China
| | - Qiang Zhou
- The Third People's Hospital of Zhongshan, Zhongshan, China
| | - Yuan Fang
- The Third People's Hospital of Zhongshan, Zhongshan, China
| | - Liang Huang
- Fujian Key Laboratory of Applied Cognition and Personality, Minnan Normal University, Zhangzhou, China
| | - Xiaobao Li
- Faculty of Education, Henan University, Kaifeng, China
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8
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Kent L, Nelson B, Northoff G. Can disorders of subjective time inform the differential diagnosis of psychiatric disorders? A transdiagnostic taxonomy of time. Early Interv Psychiatry 2023; 17:231-243. [PMID: 36935204 DOI: 10.1111/eip.13333] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/09/2022] [Accepted: 05/29/2022] [Indexed: 12/01/2022]
Abstract
AIM Time is a core aspect of psychopathology with potential for clinical use and early intervention. Temporal experience, perception, judgement and processing are distorted in various psychiatric disorders such as mood (depression and mania), anxiety, autistic, impulse-control, dissociative and attention-deficit/hyperactivity disorders. Can these disorders of time be used as early diagnostic or predictive markers? To answer this question, we develop a Transdiagnostic Taxonomy of (disordered) Time (TTT) that maps on to the symptomatological, phenomenal, perceptual and functional descriptions of each underlying disorder in a 2 × 2 × 2 state space. Temporal distortions may precede functional decline, and so assist efforts at early detection and intervention in at-risk groups. METHOD Firstly, this article integrates a psychological model of how time is processed with a subjective or phenomenological model of how time is experienced or perceived. Secondly, the integrated combined model of time is then used to heuristically map major psychiatric disorders on to the basic elements of temporal flow and integration. RESULTS The TTT systematically describes the basic temporal nature of eight diagnostic categories of psychiatric illness. It differentiates between diagnoses primarily associated with distorted "macro-level" phenomenal temporal experiences (i.e. anxiety, dissociation/PTSD, depression, and mania) from those primarily related to distorted 'micro-level' temporal processing (i.e. psychotic, impulse-control, autistic and attention-deficit/hyperactivity disorders). CONCLUSIONS The TTT allows differential diagnostic classification of various psychiatric disorders in terms of a possible underlying time disorder, making it useful for future diagnostic and predictive purposes using novel techniques of temporal processing, time perception, passage of time, and time perspective.
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Affiliation(s)
- Lachlan Kent
- Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Georg Northoff
- Mental Health Center, Zhejiang University School of Medicine, Zhejiang, Hangzhou, People's Republic of China
- Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, People's Republic of China
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9
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Giersch A, Laprévote V. Perceptual Functioning. Curr Top Behav Neurosci 2023; 63:79-113. [PMID: 36306053 DOI: 10.1007/7854_2022_393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Perceptual disorders are not part of the diagnosis criteria for schizophrenia. Yet, a considerable amount of work has been conducted, especially on visual perception abnormalities, and there is little doubt that visual perception is altered in patients. There are several reasons why such perturbations are of interest in this pathology. They are observed during the prodromal phase of psychosis, they are related to the pathophysiology (clinical disorganization, disorders of the sense of self), and they are associated with neuronal connectivity disorders. Perturbations occur at different levels of processing and likely affect how patients interact and adapt to their surroundings. The literature has become very large, and here we try to summarize different models that have guided the exploration of perception in patients. We also illustrate several lines of research by showing how perception has been investigated and by discussing the interpretation of the results. In addition to discussing domains such as contrast sensitivity, masking, and visual grouping, we develop more recent fields like processing at the level of the retina, and the timing of perception.
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Affiliation(s)
- Anne Giersch
- University of Strasbourg, INSERM U1114, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.
| | - Vincent Laprévote
- University of Strasbourg, INSERM U1114, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
- CLIP Centre de Liaison et d'Intervention Précoce, Centre Psychothérapique de Nancy, Laxou, France
- Faculté de Médecine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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10
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Bogotá JD, Djebbara Z. Time-consciousness in computational phenomenology: a temporal analysis of active inference. Neurosci Conscious 2023; 2023:niad004. [PMID: 36937108 PMCID: PMC10022603 DOI: 10.1093/nc/niad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/13/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023] Open
Abstract
Time plays a significant role in science and everyday life. Despite being experienced as a continuous flow, computational models of consciousness are typically restricted to a sequential temporal structure. This difference poses a serious challenge for computational phenomenology-a novel field combining phenomenology and computational modelling. By analysing the temporal structure of the active inference framework, we show that an integrated continuity of time can be achieved by merging Husserlian temporality with a sequential order of time. We also show that a Markov blanket of the present moment integrates past and future moments of both subjective temporality and objective time in an asynchronous manner. By applying the integrated continuity, it is clear that active inference makes use of both subjective temporality and objective time in an integrated fashion. We conclude that active inference, on a temporal note, qualifies as a computational model for phenomenological investigations.
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Affiliation(s)
- Juan Diego Bogotá
- *Corresponding authors.Department of Social and Political Sciences, Philosophy, and Anthropology University of Exeter Byrne House, St German’s Road, Exeter Devon EX4 4PJ UK: E-mail: and Department of Architecture, Design, Media and Technology Aalborg University Rendsburggade 14, Aalborg Nordjylland 9000 Denmark. E-mail:
| | - Zakaria Djebbara
- *Corresponding authors.Department of Social and Political Sciences, Philosophy, and Anthropology University of Exeter Byrne House, St German’s Road, Exeter Devon EX4 4PJ UK: E-mail: and Department of Architecture, Design, Media and Technology Aalborg University Rendsburggade 14, Aalborg Nordjylland 9000 Denmark. E-mail:
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Amadeo MB, Esposito D, Escelsior A, Campus C, Inuggi A, Pereira Da Silva B, Serafini G, Amore M, Gori M. Time in schizophrenia: a link between psychopathology, psychophysics and technology. Transl Psychiatry 2022; 12:331. [PMID: 35961974 PMCID: PMC9374791 DOI: 10.1038/s41398-022-02101-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
It has been widely demonstrated that time processing is altered in patients with schizophrenia. This perspective review delves into such temporal deficit and highlights its link to low-level sensory alterations, which are often overlooked in rehabilitation protocols for psychosis. However, if temporal impairment at the sensory level is inherent to the disease, new interventions should focus on this dimension. Beyond more traditional types of intervention, here we review the most recent digital technologies for rehabilitation and the most promising ones for sensory training. The overall aim is to synthesise existing literature on time in schizophrenia linking psychopathology, psychophysics, and technology to help future developments.
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Affiliation(s)
- Maria Bianca Amadeo
- U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy. .,Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa - Clinica Psichiatrica ed SPDC-Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE), Italy.
| | - Davide Esposito
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.5606.50000 0001 2151 3065Department of Informatics, Bioengineering, Robotics and Systems Engineering, Università degli Studi di Genova, Genoa, Italy
| | - Andrea Escelsior
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Campus
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Alberto Inuggi
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Beatriz Pereira Da Silva
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Gianluca Serafini
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Gori
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
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12
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Frankle L. Entropy, Amnesia, and Abnormal Déjà Experiences. Front Psychol 2022; 13:794683. [PMID: 35967717 PMCID: PMC9364811 DOI: 10.3389/fpsyg.2022.794683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Previous research has contrasted fleeting erroneous experiences of familiarity with equally convincing, and often more stubborn erroneous experiences of remembering. While a subset of the former category may present as nonpathological “déjà vu,” the latter, termed “déjà vécu” can categorize a delusion-like confabulatory phenomenon first described in elderly dementia patients. Leading explanations for this experience include the dual process view, in which erroneous familiarity and erroneous recollection are elicited by inappropriate activation of the parahippocampal cortex and the hippocampus, respectively, and the more popular encoding-as-retrieval explanation in which normal memory encoding processes are falsely flagged and interpreted as memory retrieval. This paper presents a novel understanding of this recollective confabulation that builds on the encoding-as-retrieval hypothesis but more adequately accounts for the co-occurrence of persistent déjà vécu with both perceptual novelty and memory impairment, the latter of which occurs not only in progressive dementia but also in transient epileptic amnesia (TEA) and psychosis. It makes use of the growing interdisciplinary understanding of the fluidity of time and posits that the functioning of memory and the perception of novelty, long known to influence the subjective experience of time, may have a more fundamental effect on the flow of time.
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13
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Vogel DHV. The Temporality of Aberrant Salience and Schizophrenia. Front Integr Neurosci 2022; 16:925716. [PMID: 35898443 PMCID: PMC9309519 DOI: 10.3389/fnint.2022.925716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
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14
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Coelho S, Bonatti SM, Doering E, Paskaleva-Yankova A, Stephan A. Moral Agency, Rules, and Temporality in People Who Are Diagnosed With Mild Forms of Autism: In Defense of a Sentimentalist View. Front Psychol 2022; 13:875680. [PMID: 35837636 PMCID: PMC9275809 DOI: 10.3389/fpsyg.2022.875680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
The origin of moral agency is a much-debated issue. While rationalists or Kantians have argued that moral agency is rooted in reason, sentimentalists or Humeans have ascribed its origin to empathic feelings. This debate between rationalists and sentimentalists still stands with respect to persons with mental disorders, such as individuals diagnosed with mild forms of Autism Spectrum Disorder (ASD), without intellectual impairment. Individuals with ASD are typically regarded as moral agents, however their ability for empathy remains debated. The goal of this paper is to investigate the mechanisms of moral actions in people with ASD, by finding arguments for the origin of their moral actions, supporting either the sentimentalist or the rationalist view of the dispute. We propose to revisit the debate using Interpretative Phenomenological Analysis to study the autobiographies of individuals with High-Functioning Autism (HFA) and Asperger Syndrome (AS). While conducting the systematic analysis of 10 autobiographies, we re-examined both the rationalist and the sentimentalist positions, considering the links between empathic feelings and moral agency. The investigation of the temporal dimensions of emotional experiences, an aspect overlooked by previous research, indicated that individuals with ASD empathize with others, but in different ways as compared to neurotypicals. A relationship between emotional experience and the type of moral agency exhibited by individuals with forms of ASD was established. As a consequence, our analyses support the sentimentalist stance on moral action.
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Affiliation(s)
- Sara Coelho
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- *Correspondence: Sara Coelho,
| | | | - Elena Doering
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | | | - Achim Stephan
- Institute of Cognitive Science, Osnabrück University, Osnabrück, Germany
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15
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Arantes-Gonçalves F, Wolman A, Bastos-Leite AJ, Northoff G. Scale for Space and Time Experience in Psychosis: Converging Phenomenological and Psychopathological Perspectives. Psychopathology 2022; 55:132-142. [PMID: 34872083 DOI: 10.1159/000519500] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Abnormalities in the experience of space and time are fundamental to understanding schizophrenia spectrum disorders, but the precise relation between such abnormalities and psychopathological symptoms is still unclear. Therefore, the aim of our study was to introduce a novel scale for space and time experience in psychosis (STEP), specifically devised to assess schizophrenia spectrum disorders. METHODS The STEP scale is a semiquantitative instrument developed on the basis of several items from previous scales and phenomenological reports addressing the experience of space and time. We applied the STEP scale to three groups of subjects (patients with schizophrenia spectrum disorders, patients with predominant affective symptoms, and healthy control subjects), to whom we also applied other more general psychopathological scales, such as the Positive and Negative Syndrome Scale and the Ego-Psychopathology Inventory. RESULTS Patients with schizophrenia spectrum disorders scored significantly higher on general psychopatho<X00_Del_TrennDivis>--</X00_Del_TrennDivis>logical scales relative to subjects belonging to the other groups. The STEP scale provided good psychometric properties regarding reliability. We also tested convergent and divergent validity of the STEP scale and found that space and time subscale scores of STEP significantly correlated with each other, as well as with the remaining general psychopathological scores. DISCUSSION/CONCLUSION We introduced the STEP scale as a novel instrument for the assessment of experience of space and time. Its psychometric properties showed high validity and reliability to identify psychopathological symptoms and enabled to differentiate patients with predominantly psychotic symptoms from those with predominantly affective symptoms. The STEP scale provides a standardized measure for assessing disturbances in the experience of space and time. Furthermore, it probably represents a leap forward toward the establishment of an additional dimension of symptoms proposed as "spatiotemporal psychopathology."
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Affiliation(s)
| | - Angelika Wolman
- Mind, Brain Imaging and Neuroethics Research Unit, Royal Ottawa Healthcare Group, University of Ottawa, Ottawa, Ontario, Canada
| | - António J Bastos-Leite
- Department of Medical Imaging, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, Royal Ottawa Healthcare Group, University of Ottawa, Ottawa, Ontario, Canada
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16
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Stanghellini G, Ballerini M, Fernandez AV, Cutting J, Mancini M. Abnormal Body Phenomena in Persons with Major Depressive Disorder. Psychopathology 2021; 54:203-213. [PMID: 34062548 DOI: 10.1159/000514642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depressive disorders, despite being classified as mood or affective disorders, are known to include disturbances in the experience of body, space, time, and intersubjectivity. However, current diagnostic manuals largely ignore these aspects of depressive experience. In this article, we use phenomenological accounts of embodiment as a theoretical foundation for a qualitative study of abnormal body phenomena (ABP) in depressive disorders. METHODS 550 patients affected by schizophrenic and affective disorders were interviewed in a clinical setting. Interviews sought to uncover the qualitative features of experiences through self-descriptions. Clinical files were subsequently digitized and re-examined using consensual qualitative research. RESULTS Ninety-nine out of 100 patients with MDD reported at least one ABP. From cross-analysis of the MDD sample, we obtained 4 general categories of ABP, 3 of which had additional subcategories. The 4 categories include slowed embodied temporality (N = 90), anomalous vital rhythms (N = 82), worries about one's body (N = 22), and body deformation (N = 47). CONCLUSIONS The results provide empirical evidence in support of theoretical discussions of embodiment in MDD found in the work of classical and contemporary phenomenologists. The findings also provide nuanced insight into the experience of persons living with MDD. Some categories of ABP, like slowed embodied temporality, can help to finely characterize psychomotor retardation or the so-called "medically unexplained symptoms" (MUS). This fine-tuned characterization can help to connect MUS to neuropsychological and neurobiological (e.g., alterations of interoceptive processes linked to anomalies of the brain resting-state hypothesis) and inflammatory (e.g., studies linking environmental stressors, inflammation mediators, and neurovegetative and affective symptoms) models of MDD. Our results can also support a pathogenic model of MDD, which posits, on the phenomenal level, ABP as the point of departure for the development of secondary symptoms including cognitive elaborations of these, namely, delusions about the body. Moreover, some of the categories, when contrasted with phenomenological qualitative studies of other disorders, provide conceptual resources of differential diagnosis and of identifying a "depressive core syndrome." For example, findings within category 4, deformation of the body, provide resources for using ABP to distinguish between MDD and schizophrenia.
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Affiliation(s)
- Giovanni Stanghellini
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University, Chieti, Italy.,D. Portales' University, Santiago, Chile
| | | | - Anthony Vincent Fernandez
- Department of Philosophy, Kent State University, Kent, Ohio, USA.,Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - John Cutting
- Kings College Hospital in London and the Institute of Psychiatry, London, United Kingdom
| | - Milena Mancini
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University, Chieti, Italy
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17
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Mancini M, Mignogna S, Stanghellini G. Dear Body… An Explorative Study on Anomalous Bodily Experiences in Persons with Feeding and Eating Disorders. Psychopathology 2021; 54:242-252. [PMID: 34350886 DOI: 10.1159/000517505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to provide a qualitative analysis of anomalous bodily experiences (ABEs) of persons affected by feeding and eating disorders (FEDs). In particular, this study aimed to refine the description of bodily experiences in persons with FEDs so as to improve their treatment. SAMPLING AND METHODS This is a naturalistic explorative study on a group of 29 patients affected by FED in psychotherapeutic treatment and 12 healthy controls. We asked the participants to write a letter on the way they experience their body. Later, we analysed their letters by means of consensual qualitative research. RESULTS All patients (29) reported at least 1 ABE. The main categories identified are (1) body-obstacle (the body interposes between the person and the world); (2) body-tyrant (the body imposes itself on the will of the person); (3) body-hyper-visible (the body is experienced as an exposed object); (4) body-geometric (the body is experienced or associated with a geometric form); and (5) body-numerical (the body is defined by numbers). All these categories are present in the clinical group, and they are absent in the control group. CONCLUSION To grasp the experiential nuances of ABEs is relevant to understand the disorder of embodied self-hood and personal identity in these patients and thus to refine clinical treatment.
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Affiliation(s)
- Milena Mancini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Silvio Mignogna
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Giovanni Stanghellini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy.,Centro de Estudios de Fenomenología y Psiquiatría, Diego Portales' University, Santiago, Chile
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18
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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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19
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Blom JD, Nanuashvili N, Waters F. Time Distortions: A Systematic Review of Cases Characteristic of Alice in Wonderland Syndrome. Front Psychiatry 2021; 12:668633. [PMID: 34025485 PMCID: PMC8138562 DOI: 10.3389/fpsyt.2021.668633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Of the perceptual distortions characteristic of Alice in Wonderland syndrome, substantial alterations in the immediate experience of time are probably the least known and the most fascinating. We reviewed original case reports to examine the phenomenology and associated pathology of these time distortions in this syndrome. A systematic search in PubMed, Ovid Medline, and the historical literature yielded 59 publications that described 168 people experiencing time distortions, including 84 detailed individual case reports. We distinguished five different types of time distortion. The most common category comprises slow-motion and quick-motion phenomena. In 39% of all cases, time distortions were unimodal in nature, while in 61% there was additional involvement of the visual (49%), kinaesthetic (18%), and auditory modalities (14%). In all, 40% of all time distortions described were bimodal in nature and 19% trimodal, with 1% involving four modalities. Underlying neurological mechanisms are varied and may be triggered by intoxications, infectious diseases, metabolic disorders, CNS lesions, paroxysmal neurological disorders, and psychiatric disorders. Bizarre sensations of time alteration-such as time going backwards or moving in circles-were mostly associated with psychosis. Pathophysiologically, mainly occipital areas appear to be involved, although the temporal network is widely disseminated, with separate component timing mechanisms not always functioning synchronously, thus occasionally creating temporal mismatches within and across sensory modalities (desynchronization). Based on our findings, we propose a classification of time distortions and formulate implications for research and clinical practice.
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Affiliation(s)
- Jan Dirk Blom
- Outpatient Clinic for Uncommon Psychiatric Syndromes, Parnassia Psychiatric Institute, The Hague, Netherlands.,Faculty of Social Sciences, Leiden University, Leiden, Netherlands.,Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Nutsa Nanuashvili
- Amsterdam Brain and Cognition Center, University of Amsterdam, Amsterdam, Netherlands
| | - Flavie Waters
- Clinical Research Centre, Graylands Hospital, North Metro Health Service Mental Health, Perth, WA, Australia.,School of Psychological Sciences, University of Western Australia, Perth, WA, Australia
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20
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Meadows R, Hine C, Suddaby E. Conversational agents and the making of mental health recovery. Digit Health 2020; 6:2055207620966170. [PMID: 33282335 PMCID: PMC7683843 DOI: 10.1177/2055207620966170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background Artificial intelligence (AI) is said to be “transforming mental health”. AI-based technologies and technique are now considered to have uses in almost every domain of mental health care: including decision-making, assessment and healthcare management. What remains underexplored is whether/how mental health recovery is situated within these discussions and practices. Method Taking conversational agents as our point of departure, we explore the ways official online materials explain and make sense of chatbots, their imagined functionality and value for (potential) users. We focus on three chatbots for mental health: Woebot, Wysa and Tess. Findings “Recovery” is largely missing as an overt focus across materials. However, analysis does reveal themes that speak to the struggles over practice, expertise and evidence that the concept of recovery articulates. We discuss these under the headings “troubled clinical responsibility”, “extended virtue of (technological) self-care” and “altered ontologies and psychopathologies of time”. Conclusions Ultimately, we argue that alongside more traditional forms of recovery, chatbots may be shaped by, and shaping, an increasingly individualised form of a “personal recovery imperative”.
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Affiliation(s)
- Robert Meadows
- Department of Sociology, University of Surrey, Guildford, Surrey, UK
| | - Christine Hine
- Department of Sociology, University of Surrey, Guildford, Surrey, UK
| | - Eleanor Suddaby
- Department of Sociology, University of Surrey, Guildford, Surrey, UK
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21
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Vogel DHV, Jording M, Kupke C, Vogeley K. The Temporality of Situated Cognition. Front Psychol 2020; 11:546212. [PMID: 33132954 PMCID: PMC7550648 DOI: 10.3389/fpsyg.2020.546212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/27/2020] [Indexed: 12/02/2022] Open
Abstract
Situated cognition embeds perceptions, thoughts, and behavior within the contextual framework of so-called “4E cognition” understanding cognition to be embodied, enactive, extended, and embedded. Whereas this definition is primarily based on the spatial properties of a situation, it neglects a fundamental constituent: the cognitive situation as enduring. On a subpersonal level, situated cognition requires the integration of information processing within a minimal temporal extension generating the basic building blocks of perception and action (“microlayer” of time). On a personal level, lived situations and experienced narratives leading to our biography can be defined by their broader temporal horizons (“macrolayer” of time). The macrolayer of time is based on and emerges from information processing on the microlayer of time. Whereas the constraints on the microlayer are primarily defined by the integrity of neurobiological processes within an individual cognitive system, the temporal horizons and subsequently the situational context on the macrolayer are defined by the complex affordances of a situation on a personal or interpersonal level. On both time layers, cognition can be defined as a continuous dynamic process, reflecting the transition from one situated state to another. Taken together, the events forming the delimiting horizons of these situations correspond to the temporal structure of the cognitive process along which it continuously proceeds. The dynamic driving and enabling this transition from state to state is synonymous with the inherent flow of time. Just as the layers of time, flow and structure, are inseparably connected. The integration of temporal flow and temporal structure into the continuous dynamic process constitutes the enduring situatedness of cognition. By providing everyday examples and examples from psychopathology, we highlight the benefits of understanding cognitive processes as part of enduring situations.
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Affiliation(s)
- David H V Vogel
- Research Center Jülich, Institute of Neuroscience and Medicine (INM3), Jülich, Germany.,Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mathis Jording
- Research Center Jülich, Institute of Neuroscience and Medicine (INM3), Jülich, Germany.,Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Kupke
- Department of Psychiatry, Society for Philosophy and Sciences of the Psyche, Charité, Humboldt-University Berlin, Berlin, Germany
| | - Kai Vogeley
- Research Center Jülich, Institute of Neuroscience and Medicine (INM3), Jülich, Germany.,Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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22
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Northoff G, Sandsten KE, Nordgaard J, Kjaer TW, Parnas J. The Self and Its Prolonged Intrinsic Neural Timescale in Schizophrenia. Schizophr Bull 2020; 47:170-179. [PMID: 32614395 PMCID: PMC7825007 DOI: 10.1093/schbul/sbaa083] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Schizophrenia (SCZ) can be characterized as a basic self-disorder that is featured by abnormal temporal integration on phenomenological (experience) and psychological (information processing) levels. Temporal integration on the neuronal level can be measured by the brain's intrinsic neural timescale using the autocorrelation window (ACW) and power-law exponent (PLE). Our goal was to relate intrinsic neural timescales (ACW, PLE), as a proxy of temporal integration on the neuronal level, to temporal integration related to self-disorder on psychological (Enfacement illusion task in electroencephalography) and phenomenological (Examination of Anomalous Self-Experience [EASE]) levels. SCZ participants exhibited prolonged ACW and higher PLE during the self-referential task (Enfacement illusion), but not during the non-self-referential task (auditory oddball). The degree of ACW/PLE change during task relative to rest was significantly reduced in self-referential task in SCZ. A moderation model showed that low and high ACW/PLE exerted differential impact on the relationship of self-disorder (EASE) and negative symptoms (PANSS). In sum, we demonstrate abnormal prolongation in intrinsic neural timescale during self-reference in SCZ including its relation to basic self-disorder and negative symptoms. Our results point to abnormal relation of self and temporal integration at the core of SCZ constituting a "common currency" of neuronal, psychological, and phenomenological levels.
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Affiliation(s)
- Georg Northoff
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada,To whom correspondence should be addressed; Mental Health Centre/7th Hospital, Zhejiang University School of Medicine, Hangzhou, Tianmu Road 305, Hangzhou, Zhejiang Province, 310013, China; Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, Royal Ottawa Healthcare Group and University of Ottawa, 1145 Carling Avenue, Room 6467, Ottawa, ON K1Z 7K4, Canada; tel: 613-722-6521 ex. 6959, fax: 613-798-2982, e-mail:
| | - Karl Erik Sandsten
- Early Psychosis Intervention Center, Region Zealand Psychiatry, Roskilde, Denmark
| | | | | | - Josef Parnas
- Center for Subjectivity Research, Copenhagen University, Copenhagen, Denmark,Mental Health Center Glostrup, Denmark
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23
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Stanghellini G, Fernandez AV, Ballerini M, Blasi S, Belfiore E, Cutting J, Mancini M. Abnormal Space Experiences in Persons With Schizophrenia: An Empirical Qualitative Study. Schizophr Bull 2020; 46:530-539. [PMID: 31784743 PMCID: PMC7147594 DOI: 10.1093/schbul/sbz107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abnormal space experience (ASE) is a common feature of schizophrenia, despite its absence from current diagnostic manuals. Phenomenological psychopathologists have investigated this experiential disturbance, but these studies were typically based on anecdotal evidence from limited clinical interactions. To better understand the nature of ASE in schizophrenia and attempt to validate previous phenomenological accounts, we conducted a qualitative study of 301 people with schizophrenia. Clinical files were analyzed by means of Consensual Qualitative Research, an inductive method for analyzing descriptions of lived experience. Our main findings can be summed up as follows: (1) ASEs are a relevant feature in schizophrenia (70.1% of patients reported at least 1 ASE). (2) ASE in schizophrenia are characterized by 5 main categories of phenomena (listed from more represented to less represented): (a) experiences of strangeness and unfamiliarity (eg "Everything appeared weird. Face distorted, world looks terrible, nasty"); (b) experiences of centrality/invasion of peripersonal space (eg "Handkerchief on scaffolding: message telling him something"); (c) alteration of the quality of things (eg "Buildings leaning down"); (d) alteration of the quality of the environment (eg "Person sitting six feet away seemed to be at an infinite distance"); and (e) itemization and perceptive salience (eg "All patients [in ward] have bright eyes"). (3) ASEs are much more frequent in acute (91.9%) than in chronic (28.15%) schizophrenia patients. Moreover, our findings further empirical support for phenomenological accounts of schizophrenia, including those developed by Jaspers, Binswanger, Minkowski, and Conrad, among others and provide the background for translational research.
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Affiliation(s)
- Giovanni Stanghellini
- Department of Psychological, Health and Territorial Sciences, “G. d’Annunzio” University, Via Dei Vestini 31, IT 66013, Chieti, Italy,Centro de Estudios de Fenomenología y Psiquiatría - Faciltad de Medicina, “D. Portales” University, Santiago, Chile,To whom correspondence should be addressed; tel: +39/3473790707, e-mail:
| | - Anthony Vincent Fernandez
- Department of Philosophy, Kent State University, Ohio,Faculty of Philosophy, University of Oxford, Oxford
| | | | - Stefano Blasi
- Department of Human Science, University of Urbino, Urbino, Italy
| | - Erika Belfiore
- Department of Human Science, University of Urbino, Urbino, Italy
| | - John Cutting
- Kings College Hospital in London and the Institute of Psychiatry, London, United Kingdom
| | - Milena Mancini
- Department of Psychological, Health and Territorial Sciences, “G. d’Annunzio” University, Via Dei Vestini 31, IT 66013, Chieti, Italy
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24
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Vogel D, Beeker T, Haidl T, Kupke C, Heinze M, Vogeley K. Disturbed time experience during and after psychosis. Schizophr Res Cogn 2019; 17:100136. [PMID: 31193856 PMCID: PMC6543123 DOI: 10.1016/j.scog.2019.100136] [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: 01/04/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 02/04/2023]
Abstract
Disturbances in time experience have been argued to play a significant, if not causative role in the clinical presentation of schizophrenia. Phenomenological considerations suggest a fragmented or dis-articulated time experience causing both primary symptoms such as hallucinations, delusions, and self-disorders, as well as an intersubjective desynchronization. We employed content analysis on material collected from patients diagnosed with schizophrenia using the Time Questionnaire to generate hypotheses on possible disturbances of time experience in schizophrenia. As a key result we find evidence for the distinction between acute psychotic and post-psychotic syndromes. Acute psychosis is predominantly a disturbance of the passage of time, whereas the remission from psychosis is primarily defined by changes in the experience of the explicit structure of time integrating past, present, and future. We discuss our findings with regards to previous insights and observations on time experience and time perception. We suggest our findings hold significance for the diagnostic and therapeutic understanding of schizophrenia as well as for future integrative research on time experience in general.
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Affiliation(s)
- D.H.V. Vogel
- Research Center Jülich, Institute of Neuroscience and Medicine (INM3)
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry
| | - T. Beeker
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - T. Haidl
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry
| | - C. Kupke
- Department of Psychiatry, Society for Philosophy and Sciences of the Psyche, Charité, Humboldt-University Berlin, Germany
| | - M. Heinze
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - K. Vogeley
- Research Center Jülich, Institute of Neuroscience and Medicine (INM3)
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry
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25
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Daly A, Gallagher S. Towards a Phenomenology of Self-Patterns in Psychopathological Diagnosis and Therapy. Psychopathology 2019; 52:33-49. [PMID: 31018215 PMCID: PMC6878753 DOI: 10.1159/000499315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/19/2022]
Abstract
Categorization-based diagnosis, which endeavors to be consistent with the third-person, objective measures of science, is not always adequate with respect to problems concerning diagnostic accuracy, demarcation problems when there are comorbidities, well-documented problems of symptom amplification, and complications of stigmatization and looping effects. While psychiatric categories have proved useful and convenient for clinicians in identifying a recognizable constellation of symptoms typical for a particular disorder for the purposes of communication and eligibility for treatment regimes, the reification of these categories has without doubt had negative consequences for the patient and also for the general understanding of psychiatric disorders. We argue that a complementary, integrated framework that focuses on descriptive symptom-based classifications (drawing on phenomenological interview methods and narrative) combined with a more comprehensive conception of the human subject (found in the pattern theory of self), can not only offer a solution to some of the vexed issues of psychiatric diagnosis but also support more efficacious therapeutic interventions.
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Affiliation(s)
- Anya Daly
- School of Philosophical and Historical Studies, The University of Melbourne, Melbourne, Victoria, Australia,
| | - Shaun Gallagher
- Lillian and Morrie Moss Chair of Excellence in Philosophy, Department of Philosophy, University of Memphis, Memphis, Tennessee, USA
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26
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Interrupted Time Experience in Autism Spectrum Disorder: Empirical Evidence from Content Analysis. J Autism Dev Disord 2019; 49:22-33. [PMID: 30284137 DOI: 10.1007/s10803-018-3771-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although the experience of time is of central relevance for psychopathology, qualitative approaches to study the inner experience of time have been largely neglected in autism research. We present results from qualitative data acquired from 26 adults with high functioning autism spectrum disorder (ASD). Employing inductive content analysis we identified a distinct pattern of interrupted time experience in ASD. Individuals with ASD seemed to implement structured and routine behavior by future planning to guarantee that the present passed uninterrupted. We reason that the success of corresponding compensatory mechanisms determines the development of distress and noticeable symptoms. Considering recent theories on Bayesian perceptual inference we relate the syndrome of interrupted time experience to the putative neuronal mechanisms underlying time experience.
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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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Humpston CS, Adams RA, Benrimoh D, Broome MR, Corlett PR, Gerrans P, Horga G, Parr T, Pienkos E, Powers AR, Raballo A, Rosen C, Linden DEJ. From Computation to the First-Person: Auditory-Verbal Hallucinations and Delusions of Thought Interference in Schizophrenia-Spectrum Psychoses. Schizophr Bull 2019; 45:S56-S66. [PMID: 30715542 PMCID: PMC6357975 DOI: 10.1093/schbul/sby073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Schizophrenia-spectrum psychoses are highly complex and heterogeneous disorders that necessitate multiple lines of scientific inquiry and levels of explanation. In recent years, both computational and phenomenological approaches to the understanding of mental illness have received much interest, and significant progress has been made in both fields. However, there has been relatively little progress bridging investigations in these seemingly disparate fields. In this conceptual review and collaborative project from the 4th Meeting of the International Consortium on Hallucination Research, we aim to facilitate the beginning of such dialogue between fields and put forward the argument that computational psychiatry and phenomenology can in fact inform each other, rather than being viewed as isolated or even incompatible approaches. We begin with an overview of phenomenological observations on the interrelationships between auditory-verbal hallucinations (AVH) and delusional thoughts in general, before moving on to review several theoretical frameworks and empirical findings in the computational modeling of AVH. We then relate the computational models to the phenomenological accounts, with a special focus on AVH and delusions that involve the senses of agency and ownership of thought (delusions of thought interference). Finally, we offer some tentative directions for future research, emphasizing the importance of a mutual understanding between separate lines of inquiry.
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Affiliation(s)
- Clara S Humpston
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom,School of Psychology, Cardiff University, Cardiff, United Kingdom,To whom correspondence should be addressed;Department of Psychological Medicine (PO72), Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, LondonSE5 8AF, United Kingdom; tel: +44 (0) 20 7848 0088, fax: +44 (0) 20 7848 0298, e-mail:
| | - Rick A Adams
- Division of Psychiatry, University College London, London, United Kingdom
| | - David Benrimoh
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom,Department of Psychiatry,Medical Sciences Division, University of Oxford, Oxford, United Kingdom,Faculty of Philosophy, Humanities Division, University of Oxford, Oxford, United Kingdom
| | | | - Philip Gerrans
- Department of Philosophy, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Thomas Parr
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom
| | - Elizabeth Pienkos
- Graduate Institute of ProfessionalPsychology, University of Hartford, West Hartford, CT
| | | | - Andrea Raballo
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway,Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - David E J Linden
- School of Psychology, Cardiff University, Cardiff, United Kingdom,Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Schmidt P. The Relevance of Explanatory First-Person Approaches (EFPA) for Understanding Psychopathological Phenomena. The Role of Phenomenology. Front Psychol 2018; 9:694. [PMID: 29973890 PMCID: PMC6019490 DOI: 10.3389/fpsyg.2018.00694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/20/2018] [Indexed: 11/21/2022] Open
Abstract
The main aim of this paper is to demonstrate the contributions of phenomenology-inspired approaches to the explanation of psychopathological phenomena. First, I introduce the notion of Explanatory First-Person Approaches (EFPA) which share the assumption that the explanation of consciousness and conscious phenomena necessitates, at least partially, phenomenal facts functioning as explanans. Phenomenal facts refer to facts about structures and processes of consciousness. To differentiate phenomenology from other EFPA and to extract its distinctive feature, I compare phenomenology to the method falling under the category of EFPA it overlaps with the most: new introspective methods as recently described. I then present genetic phenomenology as the distinctive feature of phenomenology and show how particularly genetic phenomenology complements biological explanations of psychopathological phenomena in the context of psychiatric disorders such as schizophrenia. Moreover, I present Cognitive Theory (CT) as the most acknowledged EFPA in the broader scientific community, demonstrate CT's limitations in explaining conscious phenomena in the context of psychological disturbances such as depression, and show how genetic phenomenology can also significantly complement the cognitive approach. An example in the context of burnout-depression will be given. The overall argument for the significance of phenomenology is as follows: Genetic phenomenology renders phenomenology a distinctive kind of EFPA; genetic phenomenology can complement one of the most dominant non-EFPA accounts in the science of psychiatric disorders: biological reductionism; and genetic phenomenology can complement the most dominant existing EFPA in the science of psychological disturbances: Cognitive Theory.
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Affiliation(s)
- Philipp Schmidt
- Department of Philosophy, University of Vienna, Vienna, Austria
- Phenomenological Psychopathology and Psychiatry, University Clinic Heidelberg, Heidelberg, Germany
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30
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Sass L, Borda JP, Madeira L, Pienkos E, Nelson B. Varieties of Self Disorder: A Bio-Pheno-Social Model of Schizophrenia. Schizophr Bull 2018; 44. [PMID: 29529266 PMCID: PMC6007751 DOI: 10.1093/schbul/sby001] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Louis Sass
- Department of Clinical Psychology, GSAPP-Rutgers University, Piscataway, NJ,To whom correspondence should be addressed; tel: 917-513-9798, fax: 732-445-4888, e-mail:
| | - Juan P Borda
- Faculty of Medicine, Corporación Universitaria Empresarial Alexander von Humboldt, Armenia, Colombia
| | - Luis Madeira
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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31
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Vogel DHV, Krämer K, Schoofs T, Kupke C, Vogeley K. Disturbed Experience of Time in Depression-Evidence from Content Analysis. Front Hum Neurosci 2018. [PMID: 29515385 PMCID: PMC5826190 DOI: 10.3389/fnhum.2018.00066] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Disturbances in the experience of time have been a commonly reported feature of depressive disorders since the beginning of modern psychiatry and psychological research. However, qualitative research approaches to investigate the phenomenon are rarely used. We employed content analysis to investigate disturbances of time experience in Major Depressive Disorder. Our analysis from 25 participants showed that individuals with Major Depressive Disorder subjectively seem to have lost the ability to influence or change the present, resulting in an impersonal and blocked future. The present is rendered meaningless, the past unchangeably negative, and the passage of time turned into a dragging, inexorable, and viscous continuance. The overall,—possibly intersubjective—concept of time experience, remains largely intact, causing or adding to depressive mood and suffering. We elaborate on how these findings reflect previous theories on the experience of time in depression. This study might encourage future inquiries into both the phenomenal and neuroscientific foundation of time experience under psychopathological conditions.
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Affiliation(s)
- David H V Vogel
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Katharina Krämer
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Theresa Schoofs
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Christian Kupke
- Department of Psychiatry, Society for Philosophy and Sciences of the Psyche, Charité - Universitätsmedizin Berlin, Humboldt - Universität zu Berlin, Berlin, Germany
| | - Kai Vogeley
- Department of Psychiatry, University of Cologne, Cologne, Germany.,Institute for Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
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32
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Northoff G, Magioncalda P, Martino M, Lee HC, Tseng YC, Lane T. Too Fast or Too Slow? Time and Neuronal Variability in Bipolar Disorder-A Combined Theoretical and Empirical Investigation. Schizophr Bull 2018; 44:54-64. [PMID: 28525601 PMCID: PMC5768053 DOI: 10.1093/schbul/sbx050] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Georg Northoff
- Mental Health Centre, Zhejiang University School of Medicine, Hangzhou, China,University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada,University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Centre for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China,TMU Research Centre for Brain and Consciousness, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan,Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan,To whom correspondence should be addressed; Mental Health Centre/7th Hospital, Zhejiang University School of Medicine, Hangzhou, Tianmu Road 305, Hangzhou, Zhejiang Province, 310013, China; Mind, Brain Imaging and Neuroethics, Canada Research Chair, EJLB-Michael Smith Chair for Neuroscience and Mental Health, Royal Ottawa Healthcare Group, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Room 6467, Ottawa, ON K1Z 7K4, Canada; tel: 613-722-6521 ex. 6959, fax: 613-798-2982, e-mail: , website: http://www.georgnorthoff.com
| | - Paola Magioncalda
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada,University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Matteo Martino
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada,University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Hsin-Chien Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ying-Chi Tseng
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Timothy Lane
- TMU Research Centre for Brain and Consciousness, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan,Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
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Sestito M, Raballo A, Stanghellini G, Gallese V. Editorial: Embodying the Self: Neurophysiological Perspectives on the Psychopathology of Anomalous Bodily Experiences. Front Hum Neurosci 2017; 11:631. [PMID: 29311881 PMCID: PMC5742196 DOI: 10.3389/fnhum.2017.00631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mariateresa Sestito
- Department of Psychology, Wright State University, Dayton, OH, United States
- Unit of Physiology, Department of Neuroscience, University of Parma, Parma, Italy
| | - Andrea Raballo
- Department of Psychology, Psychopathology and Development Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Giovanni Stanghellini
- DiSPUTer, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Cognitive Science and Language, Diego Portales University, Santiago, Chile
| | - Vittorio Gallese
- Unit of Physiology, Department of Neuroscience, University of Parma, Parma, Italy
- Institute of Philosophy, School of Advanced Study, University of London, London, United Kingdom
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34
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Sass L, Pienkos E, Skodlar B, Stanghellini G, Fuchs T, Parnas J, Jones N. EAWE: Examination of Anomalous World Experience. Psychopathology 2017; 50:10-54. [PMID: 28268224 DOI: 10.1159/000454928] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/02/2016] [Indexed: 12/30/2022]
Abstract
The "EAWE: Examination of Anomalous World Experience" is a detailed semi-structured interview format whose aim is to elicit description and discussion of a person's experience of various aspects of their lived world. The instrument is grounded in the tradition of phenomenological psychopathology and aims to explore, in a qualitatively rich manner, six key dimensions of subjectivity - namely, a person's experience of: (1) Space and objects, (2) Time and events, (3) Other persons, (4) Language (whether spoken or written), (5) Atmosphere (overall sense of reality, familiarity, vitality, meaning, or relevance), and (6) Existential orientation (values, attitudes, and worldviews). The EAWE is based on and primarily directed toward experiences thought to be common in, and sometimes distinctive of, schizophrenia spectrum conditions. It can, however, also be used to investigate anomalies of world experience in other populations. After a theoretical and methodological introduction, the EAWE lists 75 specific items, often with subtypes, in its six domains, together with illustrative quotations from patients. The EAWE appears in a special issue of Psychopathology that also contains an orienting preface (where the difficulty as well as necessity of studying subjective life is acknowledged) and a brief reliability report. Also included are six ancillary or background articles, which survey phenomenologically oriented theory, research, and clinical lore relevant to the six experiential domains.
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35
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Iurato G, Khrennikov A, Murtagh F. Formal foundations for the origins of human consciousness. ACTA ACUST UNITED AC 2016. [DOI: 10.1134/s2070046616040014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Northoff G, Stanghellini G. How to Link Brain and Experience? Spatiotemporal Psychopathology of the Lived Body. Front Hum Neurosci 2016; 10:76. [PMID: 27199695 PMCID: PMC4849214 DOI: 10.3389/fnhum.2016.00172] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 04/05/2016] [Indexed: 01/31/2023] Open
Abstract
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.
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Affiliation(s)
- Georg Northoff
- University of Ottawa Institute of Mental Health ResearchOttawa, ON, Canada
- Center for Cognition and Brain Disorders, Hangzhou Normal UniversityHangzhou, China
- Center for Brain and Consciousness and Departments of Radiology and Psychiatry, Sheng Ho Hospital, Taipei Medical University (TMU)Taipei, Taiwan
- College for Humanities and Medicine, Taipei Medical University (TMU)Taipei, Taiwan
- Institute for Advanced Biomedical Technologies (ITAB), “G. d’Annunzio” University of Chieti-PescaraChieti, Italy
| | - Giovanni Stanghellini
- DiSPUTer, “G. d’Annunzio” University of Chieti-PescaraChieti, Italy
- Department of Cognitive Science and Language, Diego Portales UniversitySantiago, Chile
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37
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Northoff G. Spatiotemporal psychopathology I: No rest for the brain's resting state activity in depression? Spatiotemporal psychopathology of depressive symptoms. J Affect Disord 2016; 190:854-866. [PMID: 26048657 DOI: 10.1016/j.jad.2015.05.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Georg Northoff
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China; Center for Brain and Consciousness, Taipeh Medical University (TMU), Taipeh, Taiwan; College for Humanities and Medicine, Taipeh Medical University (TMU), Taipeh, Taiwan; ITAB, University of Chieti, Chieti, Italy.
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Northoff G. Spatiotemporal Psychopathology II: How does a psychopathology of the brain's resting state look like? Spatiotemporal approach and the history of psychopathology. J Affect Disord 2016; 190:867-879. [PMID: 26071797 DOI: 10.1016/j.jad.2015.05.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Georg Northoff
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada; Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China; Center for Brain and Consciousness, Taipeh Medical University (TMU), Taipeh, Taiwan; College for Humanities and Medicine, Taipeh Medical University (TMU), Taipeh, Taiwan; ITAB, University of Chieti, Italy.
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