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Lo Buglio G, Boldrini T, Polari A, Fiorentino F, Nelson B, Solmi M, Lingiardi V, Tanzilli A. Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder. Front Psychol 2024; 15:1381864. [PMID: 38966724 PMCID: PMC11223645 DOI: 10.3389/fpsyg.2024.1381864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/29/2024] [Indexed: 07/06/2024] Open
Abstract
Aims To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations. Methods We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023. Results 33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting "clinical high at risk mental state" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders. Conclusion The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries. Systematic Review Registration https://osf.io/8mz7a.
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Affiliation(s)
- Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Psychology and Educational Science, Pegaso Telematic University, Naples, Italy
| | - Andrea Polari
- Orygen Specialist Programs, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Flavia Fiorentino
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Gruber M, Alexopoulos J, Doering S, Feichtinger K, Friedrich F, Klauser M, Hinterbuchinger B, Litvan Z, Mossaheb N, Parth K, Wininger A, Blüml V. Personality functioning and self-disorders in individuals at ultra-high risk for psychosis, with first-episode psychosis and with borderline personality disorder. BJPsych Open 2023; 9:e150. [PMID: 37563768 PMCID: PMC10594090 DOI: 10.1192/bjo.2023.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 04/21/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Assessment of personality functioning in different stages of psychotic disorders could provide valuable information on psychopathology, course of illness and treatment planning, but empirical data are sparse. AIMS To investigate personality functioning and sense of self in individuals at ultra-high risk (UHR) for psychosis and with first-episode psychosis (FEP) in comparison with a clinical control group of individuals with borderline personality disorder (BPD) and healthy controls. METHOD In a cross-sectional design, we investigated personality functioning (Structured Interview of Personality Organization, STIPO; Level of Personality Functioning Scale, LPFS) and disturbances of the basic self (Examination of Anomalous Self-Experience, EASE) in 107 participants, comprising 24 individuals at UHR, 29 individuals with FEP, 27 individuals with BPD and 27 healthy controls. RESULTS The UHR, FEP and BPD groups had moderate to severe deficits in personality organisation (STIPO) compared with the healthy control group. Self-functioning with its subdomain (facet) 'self-direction' (LPFS) was significantly worse in participants with manifest psychosis (FEP) compared with those at-risk for psychosis (UHR). The FEP group showed significantly worse overall personality functioning than the UHR group and significantly higher levels of self-disturbance (EASE) than the BPD group, with the UHR group lying between these diagnostic groups. Hierarchical cluster analysis based on the seven STIPO domains yielded three clusters differing in level of personality functioning and self-disturbances. CONCLUSIONS Our data demonstrate that psychotic disorders are associated with impaired personality functioning and self-disturbances. Assessment of personality functioning can inform treatment planning for patients at different stages of psychotic disorder.
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Affiliation(s)
- Maria Gruber
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria; and Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Johanna Alexopoulos
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Feichtinger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Fabian Friedrich
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Miriam Klauser
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Barbara Hinterbuchinger
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Zsuzsa Litvan
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Karoline Parth
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Antonia Wininger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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3
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Gupta T, Antezana L, Porter C, Mayanil T, Bylsma LM, Maslar M, Horton LE. Skills program for awareness, connectedness, and empowerment: A conceptual framework of a skills group for individuals with a psychosis-risk syndrome. Front Psychiatry 2023; 14:1083368. [PMID: 37025348 PMCID: PMC10072161 DOI: 10.3389/fpsyt.2023.1083368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Intervention strategies for those diagnosed with psychotic disorders such as schizophrenia can be effective in reducing symptoms and improving quality of life. While strides have been made in developing prevention and intervention strategies earlier on in the disease progression, among those at clinical high-risk (CHR) for psychosis, challenges with heterogeneity can limit symptom and diagnosis specific treatment. Here, we discuss a newly developed therapy skills group called the Skills Program for Awareness, Connectedness, and Empowerment (SPACE) that integrates different types of behavioral skills - standard and radically open dialectical behavioral therapy as well as cognitive behavioral therapy - for CHR youth between the ages of 13-18 years. With the diathesis-stress framework serving as a foundation, the intervention is divided into three stages. These stages target specific signs and symptoms contributing to the progression of CHR symptoms. Stage 1 targets stress (with the goal of developing awareness and reducing distress), stage 2 targets self-disturbances (with a goal of increasing self-connectedness), and stage 3 targets social connectedness (with a goal of improving social domains of functioning). The focus of this article is to introduce the theoretical framework underlying the pilot skills group and discuss ongoing progress. Clinical Trial Registration NCT05398120; https://clinicaltrials.gov/ct2/show/NCT05398120.
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Affiliation(s)
- Tina Gupta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ligia Antezana
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Christian Porter
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tushita Mayanil
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Lauren M. Bylsma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Michael Maslar
- The Family Institute at Northwestern University, Evanston, IL, United States
| | - Leslie E. Horton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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4
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Burgin S, Reniers R, Humpston C. Prevalence and assessment of self-disorders in the schizophrenia spectrum: a systematic review and meta-analysis. Sci Rep 2022; 12:1165. [PMID: 35064201 PMCID: PMC8782935 DOI: 10.1038/s41598-022-05232-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Self-disorders have been proposed as the "clinical core" of the schizophrenia spectrum. This has been explored in recent studies using self-disorder assessment tools. However, there are few systematic discussions of their quality and utility. Therefore, a literature search was performed on Medline, Embase, PsychINFO, PubMed and the Web of Science. Studies using these assessment tools to explore self-disorders within schizophrenia spectrum disorders (SSDs) were included. A meta-analysis was performed on the outcomes of total self-disorder score and odds ratios of self-disorders, using Comprehensive Meta-Analysis software. Weighted pooled effect sizes in Hedge's g were calculated using a random-effects model. 15 studies were included, giving a sample of 810 participants on the schizophrenia spectrum. Self-disorders showed a greater aggregation within schizophrenia spectrum groups compared to non-schizophrenia spectrum groups, as measured with the Bonn Scale for the Assessment of Basic Symptoms (Hedge's g = 0.774, p < 0.01) and Examination of Anomalous Self-Experiences (Hedge's g = 1.604, p < 0.01). Also, self-disorders had a greater likelihood of occurring within SSDs (odds ratio = 5.435, p < 0.01). These findings help to validate self-disorders as a core clinical feature of the broad schizophrenia spectrum.
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Affiliation(s)
- Sam Burgin
- University of Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK
| | - Renate Reniers
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK
| | - Clara Humpston
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.
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5
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Pionke-Ubych R, Frydecka D, Cechnicki A, Krężołek M, Nelson B, Gawęda Ł. Integrating trauma, self-disturbances, cognitive biases, and personality into a model for the risk of psychosis: a longitudinal study in a non-clinical sample. Eur Arch Psychiatry Clin Neurosci 2022; 272:1073-1085. [PMID: 34859297 PMCID: PMC9388435 DOI: 10.1007/s00406-021-01355-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
The hypothesis of the psychosis continuum enables to study the mechanisms of psychosis risk not only in clinical samples but in non-clinical as well. The aim of this longitudinal study was to investigate self-disturbances (SD), a risk factor that has attracted substantial interest over the last two decades, in combination with trauma, cognitive biases and personality, and to test whether SD are associated with subclinical positive symptoms (PS) over a 12-month follow-up period. Our study was conducted in a non-clinical sample of 139 Polish young adults (81 females, age M = 25.32, SD = 4.51) who were selected for frequent experience of subclinical PS. Participants completed self-report questionnaires for the evaluation of SD (IPASE), trauma (CECA.Q), cognitive biases (DACOBS) and personality (TCI), and were interviewed for subclinical PS (CAARMS). SD and subclinical PS were re-assessed 12 months after baseline measurement. The hypothesized model for psychosis risk was tested using path analysis. The change in SD and subclinical PS over the 12-month period was investigated with non-parametric equivalent of dependent sample t-tests. The models with self-transcendence (ST) and harm avoidance (HA) as personality variables were found to be well-fitted and explained 34% of the variance in subclinical PS at follow-up. Moreover, we found a significant reduction of SD and subclinical PS after 12 months. Our study suggests that combining trauma, cognitive biases, SD and personality traits such as ST and HA into one model can enhance our understanding of appearance as well as maintenance of subclinical PS.
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Affiliation(s)
- Renata Pionke-Ubych
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza 1, 00-378 Warsaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College Jagiellonian University, Krakow, Poland
| | - Martyna Krężołek
- II Department of Psychiatry, The Medical University of Warsaw, Warszaw, Poland
| | - Barnaby Nelson
- Orygen, Parkville, VIC Australia ,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC Australia
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza 1, 00-378, Warsaw, Poland.
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6
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West ML, Guest RM, Carmel A. Comorbid early psychosis and borderline personality disorder: Conceptualizing clinical overlap, etiology, and treatment. Personal Ment Health 2021; 15:208-222. [PMID: 33955194 DOI: 10.1002/pmh.1509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
Despite substantial efforts aimed at the detection and intervention for early symptoms of mental illness, there is relatively limited research on the clinical overlap between borderline personality disorder (BPD) and early psychosis, for example, clinical high risk (CHR) for psychosis, in young people. We present a narrative review of the clinical overlap between BPD and psychosis spectrum symptoms. Both conditions have unstable temporal course, and both are marked by functional impairment, increased suicide risk, and higher rates of psychiatric inpatient services. We then review evidence-based treatments for psychosis and BPD, emphasizing treatments for early presentations of these symptoms and initial research considering treatments for the overlap. Psychotherapies with the strongest empirical support include cognitive behavioral models, with BPD showing limited response to adjunctive pharmacotherapy. We end by discussing specific recommendations for future research, including longitudinal studies to determine the predictors of the course of illness and the development of treatments to target comorbid BPD and CHR symptoms.
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Affiliation(s)
- Michelle L West
- CEDAR Clinic and Research Program, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, University of Colorado School of Medicine (CUSOM), Aurora, Colorado, USA
| | - Ryan M Guest
- Department of Psychology, Emory University, Atlanta, Georgia, USA
| | - Adam Carmel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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7
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Integrating clinical staging and phenomenological psychopathology to add depth, nuance, and utility to clinical phenotyping: a heuristic challenge. Lancet Psychiatry 2021; 8:162-168. [PMID: 33220779 DOI: 10.1016/s2215-0366(20)30316-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022]
Abstract
Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the US National Institute of Mental Health's Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, the general psychopathology factor, and a revival of interest in phenomenological psychopathology. The question naturally emerges about what the relationship between these new approaches is. Are they mutually exclusive and competing approaches, or can they be integrated in some way and be used to enrich each other? In this Personal View, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology (eg, selfhood, embodiment, and affectivity) can be overlaid on clinical stages to enrich and deepen the phenotypes captured in clinical staging (creating high-resolution clinical phenotypes). This approach might be useful both ideographically and nomothetically, to complement diagnosis, enrich clinical formulation, inform treatment of individual patients, and help to guide aetiology research, prediction of clinical trajectory and treatment. Overlaying phenomenological domains on clinical stages might require reformulating these domains in dimensional rather than categorial terms. This integrative project requires assessment tools (some of which are already available) that are sufficiently sensitive and thorough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging might be enriched by introducing greater depth to phenotypes; phenomenological psychopathology might be enriched by introducing stages of severity and disorder progression to phenomenological analysis.
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8
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Rasmussen AR, Reich D, Lavoie S, Li E, Hartmann JA, McHugh M, Whitford TJ, Nelson B. The relation of basic self-disturbance to self-harm, eating disorder symptomatology and other clinical features: Exploration in an early psychosis sample. Early Interv Psychiatry 2020; 14:275-282. [PMID: 31264785 DOI: 10.1111/eip.12850] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/30/2019] [Accepted: 06/09/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS The notion of basic self-disturbance has been proposed as a core feature of schizophrenia-spectrum disorders and as an indicator of future transition to psychosis in high-risk populations. However, the relation of this notion to many clinical characteristics has not been explored. The aim of this study was: (a) to investigate the distribution of self-disturbance and other symptoms dimensions in ultra-high risk (UHR), first-episode psychosis (FEP) and healthy control groups; and (b) to explore the association of self-disturbance with a history of self-harm, suicidal attempt, eating disorder symptomatology, school bullying victimization and sexual or physical abuse. METHODS Patients with UHR status (n = 38) or FEP (n = 26) and healthy controls (n = 33) were assessed with the Examination of Anomalous Self-Experience (EASE) and the Comprehensive Assessment of at Risk Mental States (CAARMS). The clinical-historical variables were assessed through medical records. RESULTS The FEP group scored significantly higher on the EASE than the UHR group, which scored significantly higher than the healthy control group, which had a very low score. Multivariate logistic regression analyses revealed that higher EASE score was significantly associated with a history of self-harm, disordered eating and bullying victimization (but not with suicide attempts or sexual/physical abuse) after controlling for positive, negative and depressive symptoms. CONCLUSION These novel findings suggest that self-disturbance may be related to a history of school bullying victimization, self-harm and eating disorder symptomatology in patients with or at-risk of psychosis. If further confirmed, these findings are potentially relevant to clinical risk assessment and therapy.
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Affiliation(s)
- Andreas R Rasmussen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Mental Health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Reich
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Emily Li
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Meredith McHugh
- Health Care for the Homeless, Baltimore, Maryland.,Youth Empowered Society, Baltimore, Maryland
| | - Thomas J Whitford
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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9
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Cavelti M, Thompson K, Hulbert C, Betts J, Jackson H, Francey S, McCutcheon L, Chanen AM. Testing the Interpersonal-Cognitive Model of Auditory Verbal Hallucinations in Youths with Either Early-Stage Borderline Personality Disorder or First-Episode Schizophrenia Spectrum Disorder. Psychopathology 2020; 53:23-35. [PMID: 32289803 DOI: 10.1159/000505194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
This is the first study to explore interpersonal schemata in outpatient youths (age 15-25 years) with early-stage borderline personality disorder (BPD) and auditory verbal hallucinations (AVH). It also aimed to replicate, in a transdiagnostic youth sample, the finding from studies of adults with AVH that negative beliefs about the self and others lead to negative appraisals of voices, which in turn elicits depression. The following 3 groups were compared: youth with BPD+AVH (n = 23), youth with schizophrenia spectrum disorder (SZ) with AVH (SZ+AVH, n = 20), and youths with BPD who did not experience AVH (BPD no AVH, n = 23). The BPD+AVH group reported more negative and fewer positive self schemata than the SZ+AVH group. They also saw themselves as being more socially inferior to others than did the SZ+AVH group, but they did not differ in appraisals of self or others, compared with the BPD no AVH group. In youths with AVH (BPD+AVH, SZ+AVH combined), the indirect effect of beliefs about self or others, via negative appraisals of voices on depression, was not significant. Instead, a significant indirect effect of negative appraisals of voices on depression, via negative beliefs about self, was found. The experience of AVH during adolescence and young adulthood, when the identity is still being formed, might have a more profound effect on the developing self than during later adulthood, when the self is more stable and resilient. Negative self-appraisals might constitute a treatment target for early intervention for youths with distressing voices, including those with BPD.
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Affiliation(s)
- Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katherine Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Louise McCutcheon
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia, .,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia, .,Orygen Youth Health, Melbourne, Victoria, Australia,
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10
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Valle R, Perales A. Self-disorders in Early Stages of the Schizophrenia Spectrum. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2019; 48:244-251. [PMID: 31779875 DOI: 10.1016/j.rcp.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/04/2018] [Accepted: 02/08/2018] [Indexed: 06/10/2023]
Abstract
The pathogenic nucleus of schizophrenia has varied according to the different eras and influences of distinguished clinical researchers. Self-disorders have also been recognised to be at the heart of this disorder, although they have seldom been studied due to their subjective nature. Recently, due to the growing interest in the study of the early stages of schizophrenia, the study of self-disorders has been resumed. The self-disorders in schizophrenia model, developed by Sass and Parnas, proposes that in this disorder the person suffers loss of the first-person perspective and experiences hyperreflexibility, diminished self-affection and disturbance of the field of awareness. Therefore, the person experiences feelings of strangeness about him/herself, difficulty in understanding the common sense of things and difficulty interacting with his/her environment. Based on this model, self-disorder evaluation instruments have been developed and empirical studies have been conducted to evaluate people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in prepsychotic stages and that their manifestation may predict the transition to schizophrenia spectrum disorders. These results have important clinical implications as they enable people in the early stages of the disorder to be identified and create the opportunity to apply early therapeutic interventions.
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Affiliation(s)
- Rubén Valle
- Centro de Investigación en Epidemiología Clínica y Medicina Basada en Evidencias, Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Perú; Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; DEIDAE de Adultos y Adultos Mayores, Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Perú.
| | - Alberto Perales
- Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; Instituto de Ética en Salud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
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11
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Madeira L, Pienkos E, Filipe T, Melo M, Queiroz G, Eira J, Costa C, Figueira ML, Sass L. Self and world experience in non-affective first episode of psychosis. Schizophr Res 2019; 211:69-78. [PMID: 31307860 DOI: 10.1016/j.schres.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/19/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
A disturbance of "minimal self," - of the immediate sense of mine-ness inherent in experience-is hypothesized to be the core disturbance in schizophrenia. Research with the Examination of Anomalous Self Experience (EASE) has demonstrated the selective aggregation of anomalous self-experiences in the schizophrenia spectrum. Conceptual research suggests that anomalous world experiences, including changes in the experience of space, time, and other persons, occur alongside anomalous self-experiences and are an important aspect of subjectivity in schizophrenia. The Examination of Anomalous World Experience (EAWE) is a recently published interview format designed to explore changes in world experience in schizophrenia. In the current study, 24 hospital outpatients with non-affective first-episode psychosis and 24 healthy-control participants were assessed with the EAWE and the EASE. First episode psychosis patients had total EAWE and EASE scores that were both, on average, significantly higher than the healthy-control group. EAWE and EASE scores were highly correlated, even after removing overlapping items. The distribution of EAWE items and subtypes in the first-episode psychosis sample was heterogeneous. We conclude that anomalous world experiences represent a relevant aspect of first-episode psychosis, and that they may be related to the self-disturbances thought to underlie schizophrenia spectrum disorders.
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Affiliation(s)
- Luis Madeira
- Centro Hospitalar Universitário de Lisboa Norte, Psychiatry Department, Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | | | - Teresa Filipe
- Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - Mariana Melo
- Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | | | - João Eira
- Universidade do Porto, Porto, Portugal
| | - Cristina Costa
- Centro Hospitalar Universitário de Lisboa Norte, Psychiatry Department, Lisbon, Portugal
| | | | - Louis Sass
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
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12
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Bonoldi I, Allen P, Madeira L, Tognin S, Bossong MG, Azis M, Samson C, Quinn B, Calem M, Valmaggia L, Modinos G, Stone J, Perez J, Howes O, Politi P, Kempton MJ, Fusar-Poli P, McGuire P. Basic Self-Disturbances Related to Reduced Anterior Cingulate Volume in Subjects at Ultra-High Risk for Psychosis. Front Psychiatry 2019; 10:254. [PMID: 31133887 PMCID: PMC6526781 DOI: 10.3389/fpsyt.2019.00254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/03/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Alterations of the "pre-reflective" sense of first-person perspective (e.g., of the "basic self") are characteristic features of schizophrenic spectrum disorders and are significantly present in the prodromal phase of psychosis and in subjects at ultra-high risk for psychosis (UHR). Studies in healthy controls suggest that neurobiological substrate of the basic self involves cortical midline structures, such as the anterior and posterior cingulate cortices. Neuroimaging studies have identified neuroanatomical cortical midline structure abnormalities in schizophrenic spectrum disorders. Objectives: i) To compare basic self-disturbances levels in UHR subjects and controls and ii) to assess the relationship between basic self-disturbances and alterations in cortical midline structures volume in UHR subjects. Methods: Thirty-one UHR subjects (27 antipsychotic-naïve) and 16 healthy controls were assessed using the 57-item semistructured Examination of Anomalous Self-Experiences (EASE) interview. All subjects were scanned using magnetic resonance imaging (MRI) at 3 T, and gray matter volume was measured in a priori defined regions of interest (ROIs) in the cortical midline structures. Results: EASE scores were much higher in UHR subjects than controls (p < 0.001). The UHR group had smaller anterior cingulate volume than controls (p = 0.037). There were no structural brain imaging alterations between UHR individuals with or without self-disturbances. Within the UHR sample, the subgroup with higher EASE scores had smaller anterior cingulate volumes than UHR subjects with lower EASE scores and controls (p = 0.018). In the total sample, anterior cingulate volume was inversely correlated with the EASE score (R = 0.52, p < 0.016). Conclusions: Basic self-disturbances in UHR subjects appear to be related to reductions in anterior cingulate volume.
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Affiliation(s)
- Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychology, University of Roehampton, London, United Kingdom.,Department of Psychiatry, Icahn Medical School, Mt Sinai Hospital, New York, NY, United States
| | - Luis Madeira
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
| | - Matthijs G Bossong
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mathilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,The West London Early Intervention service, Imperial College London, London, United Kingdom
| | - Carly Samson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
| | - Beverly Quinn
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Maria Calem
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gemma Modinos
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - James Stone
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,The West London Early Intervention service, Imperial College London, London, United Kingdom
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,MRC Clinical Sciences Centre (CSC), London, United Kingdom.,Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Paolo Fusar-Poli
- OASIS service, SLaM NHS Foundation Trust, London, United Kingdom.,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, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
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13
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Boldrini T, Tanzilli A, Pontillo M, Chirumbolo A, Vicari S, Lingiardi V. Comorbid Personality Disorders in Individuals With an At-Risk Mental State for Psychosis: A Meta-Analytic Review. Front Psychiatry 2019; 10:429. [PMID: 31333509 PMCID: PMC6625011 DOI: 10.3389/fpsyt.2019.00429] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/31/2019] [Indexed: 12/19/2022] Open
Abstract
Increasing evidence shows that personality pathology is common among patients at clinical high risk (CHR) for psychosis. Despite the important impact that this comorbidity might have on presenting high-risk psychopathology, psychological functioning, and transition to full psychotic disorders, the relationship between personality syndromes and CHR state has received relatively little empirical attention. The present meta-analytic review aimed at 1) estimating the prevalence rates of personality disorders (PDs) in CHR individuals and 2) examining the potential role of PDs in predicting transition from CHR state to a full-blown psychotic disorder. The systematic search of the empirical literature identified 17 relevant studies, including a total of 1,868 CHR individuals. Three distinct meta-analyses were performed to provide prevalence estimates of PDs in the CHR population. The first and more comprehensive meta-analysis focused on any comorbid PD (at least one diagnosis), the second one focused on schizotypal personality disorder (SPD), and the last one focused on borderline personality disorder (BPD). Moreover, a narrative review was presented to define the predictive role of personality disorders in promoting more severe outcomes in CHR patients. The findings showed that the prevalence rate of personality disorders in CHR patients was 39.4% (95% CI [26.5%-52.3%]). More specifically, 13.4% (95% CI [8.2%-18.5%]) and 11.9% (95% CI [0.73%-16.6%]) of this clinical population presented with SPD and BPD, respectively. Finally, the studies examining the effects of baseline personality diagnoses on conversion to psychotic disorders showed contradictory and insufficient results concerning the potential significant impact of SPD. Conversely, no effect of BPD was found. This meta-analytic review indicated that the CHR population includes a large subgroup with serious personality pathology, that may present with attenuated psychotic symptoms conjointly with distinct and very heterogeneous personality features. These findings support the need for improved understanding of both core psychological characteristics of CHR patients and differentiating aspects of personality that could have relevant clinical implications in promoting individualized preventive interventions and enhancing treatment effectiveness.
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Affiliation(s)
- Tommaso Boldrini
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Antonio Chirumbolo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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14
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Abstract
The interaction of personality pathology and schizophrenia has conceptually been a topic of considerable interest in psychiatry. Recent advances in taxonomy and assessment of relevance to the clinician and researcher is presented. Cluster A and avoidant personality disorders are regarded as risk factors or antecedents for the development of schizophrenia. Some features of borderline personality disorder may resemble schizophrenia. With both a hierarchical structure and symptom-focused classification systems, personality pathology and personality disorder comorbidities can be overlooked. They can remain untreated because they are seen as part of the psychotic syndrome or superseded. A case formulation of a patient with schizophrenia is likely enriched by considering both these facets and may highlight comorbid personality disorder that warrants independent treatment.
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Affiliation(s)
- Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,To whom correspondence should be addressed; Psychiatric Research Unit, Region Zealand, Faelledvej 6, DK-4200 Slagelse, Denmark; tel: +45-20108293, e-mail:
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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15
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Martin B, Franck N, Cermolacce M, Coull JT, Giersch A. Minimal Self and Timing Disorders in Schizophrenia: A Case Report. Front Hum Neurosci 2018; 12:132. [PMID: 29686612 PMCID: PMC5900747 DOI: 10.3389/fnhum.2018.00132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
For years, phenomenological psychiatry has proposed that distortions of the temporal structure of consciousness contribute to the abnormal experiences described before schizophrenia emerges, and may relate to basic disturbances in consciousness of the self. However, considering that temporality refers mainly to an implicit aspect of our relationship with the world, disturbances in the temporal structure of consciousness remain difficult to access. Nonetheless, previous studies have shown a correlation between self disorders and the automatic ability to expect an event in time, suggesting timing is a key issue for the psychopathology of schizophrenia. Timing disorders may represent a target for cognitive remediation, but this requires that disorders can be demonstrated at an individual level. Since cognitive impairments in patients with schizophrenia are discrete, and there is no standardized timing exploration, we focused on timing impairments suggested to be related to self disorders. We present the case report of AF, a 22 year old man suffering from schizophrenia, with no antipsychotic intake. Although AF shows few positive and negative symptoms and has a normal neurocognitive assessment, he shows a high level of disturbance of Minimal Self Disorders (SDs) (assessed with the EASE scale). Moreover, AF has a rare ability to describe his self and time difficulties. An objective assessment of timing ability (variable foreperiod task) confirmed that AF had temporal impairments similar to those previously described in patients, i.e., a preserved ability to distinguish time intervals, but a difficulty to benefit from the passage of time to expect a visual stimulus. He presents additional difficulties in benefitting from temporal cues and adapting to changes in time delays. The impairments were ample enough to yield significant effects with analyses at the individual level. Although causal relationships between subjective and objective impairments cannot be established, the results show that exploring timing deficits at the individual level is possible in patients with schizophrenia. Besides, the results are consistent with hypotheses relating minimal self disorders (SDs) to timing difficulties. They suggest that both subjective and objective timing investigations should be developed further so that their use at an individual level can be generalized in clinical practice.
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Affiliation(s)
- Brice Martin
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Référent Lyonnais en Réhabilitation et en Remédiation Cognitive Hôpital du Vinatier, Centre National de la Recherche Scientifique UMR 5229, Lyon, France
| | - Nicolas Franck
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Référent Lyonnais en Réhabilitation et en Remédiation Cognitive Hôpital du Vinatier, Centre National de la Recherche Scientifique UMR 5229, Lyon, France
| | - Michel Cermolacce
- Service Universitaire de Psychiatrie, Hôpital Ste Marguerite, Marseille, France
| | - Jennifer T Coull
- Laboratoire des Neurosciences Cognitives (UMR 7291), Aix-Marseille Université & Centre National de la Recherche Scientifique, Marseille, France
| | - Anne Giersch
- Institut National de la Santé et de la Recherche Médicale U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire of Strasbourg, Université de Strasbourg, Paris, France
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16
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Nelson B, Sass LA. Towards integrating phenomenology and neurocognition: Possible neurocognitive correlates of basic self-disturbance in schizophrenia. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to disruption of the sense of ownership of experience and agency of action and is associated with a variety of anomalous subjective experiences. Little is known about the neurocognitive correlates of basic self-disturbance. In this paper, we review recent phenomenological and neurocognitive research and point to a convergence of these approaches around the concept of self-disturbance. Specifically, we propose that subjective anomalies associated with basic self-disturbance may be associated with: 1. source monitoring deficits, which may contribute particularly to disturbances of “ownership” and “mineness” (the phenomenological notion of presence) and 2. aberrant salience, and associated disturbances of memory, prediction, and attention processes, which may contribute to hyper-reflexivity, disturbed “grip” or “hold” on the perceptual and conceptual field, and disturbances of intuitive social understanding (“common sense”). These two streams of research are reviewed in turn before considering ways forward in integrative models, particularly regarding the role of early neurodevelopmental disturbances, primary versus secondary disturbances, and the state versus trait nature of such pathology. Empirical studies are required in a variety of populations in order to test the proposed associations between phenomenological and neurocognitive aspects of self-disturbance in schizophrenia. An integration of findings across the phenomenological and neurocognitive domains would represent a significant advance in the understanding of schizophrenia and possibly enhance early identification and intervention strategies.
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Affiliation(s)
- Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health , Melbourne , Australia
- Centre for Youth Mental Health , University of Melbourne , Melbourne , Australia
| | - Louis A. Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology , Rutgers University , Piscataway , New Jersey, United States of America
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17
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Ryan J, Graham A, Nelson B, Yung A. Borderline personality pathology in young people at ultra high risk of developing a psychotic disorder. Early Interv Psychiatry 2017; 11:208-214. [PMID: 25808212 DOI: 10.1111/eip.12236] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/16/2015] [Indexed: 11/30/2022]
Abstract
AIM The association between borderline personality disorder and the ultra high risk (UHR) for psychosis state is unclear. The following study aimed to investigate the type of attenuated psychotic symptoms and prevalence of borderline personality pathology in a sample of UHR young people. Additionally, the study aimed to explore whether borderline personality pathology influenced the transition rate to psychosis. METHODS Medical records from Orygen Youth Health between 2007 and 2009 were examined. There were 180 patients who met UHR criteria and were included for analysis. Most patients were females (62.8%) and age ranged from 15 to 24 years. RESULTS A quarter (25.2%) of UHR patients endorsed items consistent with borderline personality pathology. UHR patients with borderline personality pathology experienced a range of attenuated psychotic symptoms and could not be statistically differentiated from UHR patients with less significant or without borderline personality pathology. Borderline personality pathology did not increase or decrease the risk of developing a psychotic disorder. The absence of depression was the only predictor of psychosis. CONCLUSIONS Many UHR patients present with concurrent borderline personality features. The psychotic experiences reported by UHR patients with borderline personality features were not limited to paranoid ideation, supporting the idea that borderline personality disorder may include a wider range of psychotic symptoms than previously thought. It is further possible that the psychotic symptoms experienced in this group could also be indicative of an emerging psychotic disorder.
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Affiliation(s)
- Jaymee Ryan
- College of Arts, Victoria University, Melbourne, Victoria, Australia
| | - Anne Graham
- College of Arts, Victoria University, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Yung
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, UK
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18
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Madeira L, Bonoldi I, Rocchetti M, Samson C, Azis M, Queen B, Bossong M, Perez J, Stone J, Allen P, Howes OD, McGuire P, Raballo A, Fusar-Poli P, Ballerini M, Stanghellini G. An initial investigation of abnormal bodily phenomena in subjects at ultra high risk for psychosis: Their prevalence and clinical implications. Compr Psychiatry 2016; 66:39-45. [PMID: 26995234 DOI: 10.1016/j.comppsych.2015.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Contemporary phenomenological research has considered abnormal bodily phenomena (ABP) to be a phenotypic trait of subjects with schizophrenia in their first psychotic episode. Yet the prevalence of ABP and their clinical significance in subjects at Ultra High Risk (UHR) of psychosis remain unidentified. This study is an exploratory investigation of ABP in UHR subjects and matched healthy controls (HCs) examining their relation to clinical features and basic self-disturbances. METHODS A sample of 26 UHR and 14 HC subjects from three prodromal and early intervention clinics in South London, West London and Cambridge was assessed with the Abnormal Bodily Phenomena questionnaire (ABPq), Comprehensive Assessment of At-Risk Mental States (CAARMS), the Positive and Negative Syndrome Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS) and the Examination of Anomalous Self Experiences (EASE) checklist. RESULTS In our sample ABP occurred in 73.1% of UHR subjects and prominent ABP (proABP) were referred in 53.8% of them. No HC subject reported ABP. The UHR group with proABP had lower CAARMS total score (t=-9.265, p=0.006). There were no differences in PANSS total score (t=-1.235, p=0.277), SOFAS score (H(2) 22.27, p=0.666) and EASE total scores (z=8.565, adjusted p=0.185) in the UHR subjects with prominent ABP versus those that did not. DISCUSSION This initial investigation suggests that ABP could be a prevalent phenotypic feature of UHR subjects.
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Affiliation(s)
- Luis Madeira
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" prodromal clinic, SLaM NHS Foundation Trust, London, UK; Hospital Santa Maria, Psychiatry Department, Lisbon, Portugal.
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" prodromal clinic, SLaM NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matteo Rocchetti
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Carly Samson
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Matilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Beverly Queen
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Matthijs Bossong
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, UK; Department of Psychiatry, University of Cambridge, UK
| | - James Stone
- The West London Early Intervention Service, Imperial College, London, UK
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" prodromal clinic, SLaM NHS Foundation Trust, London, UK
| | - Andrea Raballo
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT and K.G. Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" prodromal clinic, SLaM NHS Foundation Trust, London, UK
| | | | - Giovanni Stanghellini
- 'G. D'Annunzio' University, Chieti, Italy; 'D. Portales' University, Santiago, Chile
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19
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Lauveng A, Tveiten S, Ekeland TJ, Torleif R. Treating symptoms or assisting human development: Can different environmental conditions affect personal development for patients with severe mental illness? A qualitative study. Int J Ment Health Syst 2016; 10:8. [PMID: 26893610 PMCID: PMC4758150 DOI: 10.1186/s13033-016-0041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/05/2016] [Indexed: 12/05/2022] Open
Abstract
Background Recent research suggests that a basic anomaly in self-experience may be a core factor in patients with severe mental illnesses. Given the importance of sense of self, the traditional treatment of symptoms might not be the most effective for these groups of patients. This qualitative study examines how differences in social environmental conditions, organized as education or treatment, might affect personal development in patients with severe mental illness. Methods A qualitative hermeneutical design was used. Data were collected through qualitative interviews. Informants included 14 patients in psychiatric treatment and 15 students at schools for adults with mental illness. Most informants were interviewed on two occasions, 6–8 months apart, totaling 47 interviews. All participants had been diagnosed with severe mental illness with pronounced impact on daily functioning (most often psychoses or personality disorders) for a minimum of 2 years. Results Findings and interpretations showed that the students experienced a supportive environment focused mostly on education. They described personal and enduring development in areas such as capacity for relationships, regulation of symptoms, subjective well-being, and integration in society. The patients experienced an environment focused more on treatment of their illness and less on personal development and interests. They described little development, much loneliness, a poor quality of life, an objectifying attitude of themselves and others, and hopelessness. Conclusions Even if more research is needed, findings indicate that for this group of patients, problems may be closely related to identity development. Therefore, instead of solemnly focusing on specific symptoms, it might be more effective to support patients’ personal and social development by offering intensive and lasting social environmental conditions. This includes stable and mutual relationships, intrinsically motivated activities, and an environment that supports personal choices, acceptance, and development.
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Affiliation(s)
- Arnhild Lauveng
- Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway ; Institute for Clinical Medicine Oslo, University of Oslo, Oslo, Norway
| | - Sidsel Tveiten
- Department of Health, Faculty of Health Sciences, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | | | - Ruud Torleif
- Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway ; Institute for Clinical Medicine Oslo, University of Oslo, Oslo, Norway
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20
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Pallagrosi M, Fonzi L, Picardi A, Biondi M. Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis. Psychopathology 2016; 49:83-94. [PMID: 27073874 DOI: 10.1159/000444506] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Classical psychopathology greatly valued the interaction between clinician and patient, and assigned to the clinician's subjective experience a significant role in the diagnostic process. Psychoanalysis, too, ascribed a privileged position to the clinician's feelings and empathic participation in the assessment and deep understanding of the patient. This study aimed at testing the traditional, though still relatively unexplored empirically, tenet that particular diagnostic groups elicit distinct and diagnostically useful reactions from clinicians. SAMPLING AND METHODS The study was performed in several psychiatric inpatient and outpatient units in Rome, Italy. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire and other standardized assessment instruments when they evaluated a previously unknown patient. All adult patients diagnosed with schizophrenia (n = 119), cluster B personality disorder (n = 114), manic or mixed bipolar I episode (n = 59), and unipolar depression or anxiety disorder (n = 130) were included in the study, for a total of 422 patients evaluated by 35 clinicians. RESULTS We found a significant and theoretically consistent relationship between the clinicians' pattern of subjective experience during the first visit and patients' clinical diagnoses. Patients with unipolar depression/anxiety showed significantly lower scores than the other groups on all ACSE scales except engagement; patients with schizophrenia displayed significantly higher scores than the other groups on difficulty in attunement, and significantly higher scores than patients with cluster B personality disorder on impotence. Compared with the other groups, the patients with cluster B personality disorder displayed significantly lower scores on engagement, and significantly higher scores on disconfirmation. In multivariate models controlling for patient's age and education, symptom severity, clinician's sex, duration of visit and setting, diagnosis remained a significant predictor of scores on all ACSE scales except for impotence. CONCLUSIONS The main limitations of the study are its reliance on clinical diagnoses and the non-independence of assessments. Further studies based on diagnoses made by a third observer through standardized instruments are needed to provide a most stringent test of the hypothesis that different diagnoses are associated with distinct profiles of clinicians' subjective experience. This study provided intriguing, though preliminary, evidence that the clinician's subjective experience may play a useful role in the diagnostic process. Time may have come to reintroduce the concept of intersubjectivity at the core of the diagnostic process.
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Affiliation(s)
- Mauro Pallagrosi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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Abstract
This article explores the phenomenological and empirical rediscovery of anomalous self-experience as a core feature of the schizophrenia spectrum disorders and presents the current status of research in this field. Historically, a disordered self was considered to be a constitutive phenotype of schizophrenia. Although the notion of a disordered self has continued to appear occasionally over the years-mainly in the phenomenologically or psychodynamically oriented literature-this notion was usually considered as a theoretical construct rather than as referring to concretely lived anomalous experiences. Empirical research on the disorders of self-experience in schizophrenia can be traced back to the US-Denmark psychopathological collaboration in the well-known adoption and high-risk studies, which aimed at identifying trait or phenotypic vulnerability features. This research was later followed by clinical work with first-admission schizophrenia patients. We offer clinical descriptions of anomalous self-experience and outline the phenomenological structures of subjectivity that are needed for grasping the nature of these anomalous experiential phenomena. What appears to underlie these experiences is an instability of the first-person perspective that threatens the basic experience of being a self-coinciding, embodied, demarcated, and persisting subject of awareness. We summarize a series of empirical studies targeting self-experience in schizophrenia performed prior to and after the construction of a phenomenologically oriented psychometric instrument for assessing anomalies of self-experience, the Examination of Anomalous Self-Experience (EASE). These empirical studies support the classic clinical intuition that anomalous self-experiences form a central phenotype of schizophrenia. Implications for diagnosis and research are briefly discussed.
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Nekovarova T, Fajnerova I, Horacek J, Spaniel F. Bridging disparate symptoms of schizophrenia: a triple network dysfunction theory. Front Behav Neurosci 2014; 8:171. [PMID: 24910597 PMCID: PMC4038855 DOI: 10.3389/fnbeh.2014.00171] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 04/22/2014] [Indexed: 01/24/2023] Open
Abstract
Schizophrenia is a complex neuropsychiatric disorder with variable symptomatology, traditionally divided into positive and negative symptoms, and cognitive deficits. However, the etiology of this disorder has yet to be fully understood. Recent findings suggest that alteration of the basic sense of self-awareness may be an essential distortion of schizophrenia spectrum disorders. In addition, extensive research of social and mentalizing abilities has stressed the role of distortion of social skills in schizophrenia.This article aims to propose and support a concept of a triple brain network model of the dysfunctional switching between default mode and central executive network (CEN) related to the aberrant activity of the salience network. This model could represent a unitary mechanism of a wide array of symptom domains present in schizophrenia including the deficit of self (self-awareness and self-representation) and theory of mind (ToM) dysfunctions along with the traditional positive, negative and cognitive domains. We review previous studies which document the dysfunctions of self and ToM in schizophrenia together with neuroimaging data that support the triple brain network model as a common neuronal substrate of this dysfunction.
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Affiliation(s)
- Tereza Nekovarova
- Department of Neurophysiology of Memory, Institute of Physiology, Academy of Sciences of the Czech Republic Prague, Czech Republic ; Ecology and Ethology Research Group, Department of Zoology, Faculty of Science, Charles University in Prague Prague, Czech Republic
| | - Iveta Fajnerova
- Department of Neurophysiology of Memory, Institute of Physiology, Academy of Sciences of the Czech Republic Prague, Czech Republic ; Prague Psychiatric Center Prague, Czech Republic
| | - Jiri Horacek
- Prague Psychiatric Center Prague, Czech Republic
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Nelson B, Whitford TJ, Lavoie S, Sass LA. What are the neurocognitive correlates of basic self-disturbance in schizophrenia?: Integrating phenomenology and neurocognition. Part 1 (Source monitoring deficits). Schizophr Res 2014; 152:12-9. [PMID: 23810736 DOI: 10.1016/j.schres.2013.06.022] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/27/2013] [Accepted: 06/02/2013] [Indexed: 01/08/2023]
Abstract
Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to disruption of the sense of ownership of experience and agency of action and is associated with a variety of anomalous subjective experiences. Little is known about the neurocognitive underpinnings of basic self-disturbance. In these two theoretical papers (of which this is Part 1), we review some recent phenomenological and neurocognitive research and point to a convergence of these approaches around the concept of self-disturbance. Specifically, we propose that subjective anomalies associated with basic self-disturbance may be associated with: 1. source monitoring deficits, which may contribute particularly to disturbances of "ownership" and "mineness" (the phenomenological notion of presence or self-affection) and 2. aberrant salience, and associated disturbances of memory, prediction and attention processes, which may contribute to hyper-reflexivity, disturbed "grip" or "hold" on the perceptual and conceptual field, and disturbances of intuitive social understanding ("common sense"). In this paper (Part 1) we focus on source monitoring deficits. Part 2 (this issue) addresses aberrant salience. Empirical studies are required in a variety of populations in order to test these proposed associations between phenomenological and neurocognitive aspects of self-disturbance in schizophrenia. An integration of findings across the phenomenological and neurocognitive "levels" would represent a significant advance in the understanding of schizophrenia and possibly enhance early identification and intervention strategies.
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Affiliation(s)
- B Nelson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.
| | - T J Whitford
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - S Lavoie
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - L A Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
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What are the neurocognitive correlates of basic self-disturbance in schizophrenia? Integrating phenomenology and neurocognition: Part 2 (aberrant salience). Schizophr Res 2014; 152:20-7. [PMID: 23863772 DOI: 10.1016/j.schres.2013.06.033] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 11/23/2022]
Abstract
Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to disruption of the sense of ownership of experience and agency of action and is associated with a variety of anomalous subjective experiences. Little is known about the neurocognitive underpinnings of basic self-disturbance. In these two theoretical papers (of which this is Part 2), we review some recent phenomenological and neurocognitive research and point to a convergence of these approaches around the concept of self-disturbance. Specifically, we propose that subjective anomalies associated with basic self-disturbance may be associated with: 1. source monitoring deficits, which may contribute particularly to disturbances of "ownership" and "mineness" (the phenomenological notion of presence or self-affection) and 2. aberrant salience, and associated disturbances of memory, prediction and attention processes, which may contribute to hyper-reflexivity, disturbed "grip" or "hold" on perceptual and conceptual fields, and disturbances of intuitive social understanding ("common sense"). In this paper (Part 2) we focus on aberrant salience. Part 1 (this issue) addressed source monitoring deficits. Empirical studies are required in a variety of populations in order to test these proposed associations between phenomenological and neurocognitive aspects of self-disturbance in schizophrenia. An integration of findings across the phenomenological and neurocognitive "levels" would represent a significant advance in the understanding of schizophrenia and possibly enhance early identification and intervention strategies.
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Nelson B. Varieties of self-disturbance: a prism through which to view mental disorder. Early Interv Psychiatry 2013; 7:231-4. [PMID: 23879831 DOI: 10.1111/eip.12080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Barnaby Nelson
- Orygen Youth Health Research Centre; Centre for Youth Mental Health; The University of Melbourne; Parkville; Victoria; Australia
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