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Gallese V, Ardizzi M, Ferroni F. Schizophrenia and the bodily self. Schizophr Res 2024; 269:152-162. [PMID: 38815468 DOI: 10.1016/j.schres.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
Despite the historically consolidated psychopathological perspective, on the one hand, contemporary organicistic psychiatry often highlights abnormalities in neurotransmitter systems like dysregulation of dopamine transmission, neural circuitry, and genetic factors as key contributors to schizophrenia. Neuroscience, on the other, has so far almost entirely neglected the first-person experiential dimension of this syndrome, mainly focusing on high-order cognitive functions, such as executive function, working memory, theory of mind, and the like. An alternative view posits that schizophrenia is a self-disorder characterized by anomalous self-experience and awareness. This view may not only shed new light on the psychopathological features of psychosis but also inspire empirical research targeting the bodily and neurobiological changes underpinning this disorder. Cognitive neuroscience can today address classic topics of phenomenological psychopathology by adding a new level of description, finally enabling the correlation between the first-person experiential aspects of psychiatric diseases and their neurobiological roots. Recent empirical evidence on the neurobiological basis of a minimal notion of the self, the bodily self, is presented. The relationship between the body, its motor potentialities and the notion of minimal self is illustrated. Evidence on the neural mechanisms underpinning the bodily self, its plasticity, and the blurring of self-other distinction in schizophrenic patients is introduced and discussed. It is concluded that brain-body function anomalies of multisensory integration, differential processing of self- and other-related bodily information mediating self-experience, might be at the basis of the disruption of the self disorders characterizing schizophrenia.
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Affiliation(s)
- Vittorio Gallese
- Dept. of Medicine and Surgery, Unit of Neuroscience, University of Parma, Italy; Italian Academy for Advanced Studies in America, Columbia University, New York, USA.
| | - Martina Ardizzi
- Dept. of Medicine and Surgery, Unit of Neuroscience, University of Parma, Italy
| | - Francesca Ferroni
- Dept. of Medicine and Surgery, Unit of Neuroscience, University of Parma, Italy
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2
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Ballerini M, Magnani F, Amorosi S, Dell'Anna C, Borrelli DF, Marchesi C, Lucarini V, Castellini G, Tonna M. Anomalous Self-Experiences are predictive of social dysfunction in people with schizophrenia. Schizophr Res 2024; 266:116-117. [PMID: 38401409 DOI: 10.1016/j.schres.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/21/2023] [Accepted: 02/17/2024] [Indexed: 02/26/2024]
Affiliation(s)
| | - Francesca Magnani
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | - Stefano Amorosi
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | - Caterina Dell'Anna
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | | | - Carlo Marchesi
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy
| | - Valeria Lucarini
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, Paris, France
| | | | - Matteo Tonna
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy.
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3
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Nonweiler J, Torrecilla P, Kwapil TR, Ballespí S, Barrantes-Vidal N. I don't understand how I feel: mediating role of impaired self-mentalizing in the relationship between childhood adversity and psychosis spectrum experiences. Front Psychiatry 2023; 14:1268247. [PMID: 38098634 PMCID: PMC10719857 DOI: 10.3389/fpsyt.2023.1268247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Childhood adversity is associated with the severity of multiple dimensions of psychosis, but the mechanisms underpinning the close link between the two constructs is unclear. Mentalization may underlie this relationship, as impaired mentalizing is found in various stages of the psychosis continuum. Nonetheless, the differential roles of self- and other-mentalizing in psychosis are not well understood. Methods Parallel multiple mediation was conducted for the relationship between a diverse range of childhood adversity types, including intentional and nonintentional harm, and schizotypy (positive, negative, disorganized), psychotic-like experiences (PLE) and paranoia via self-mentalizing (attention to emotions and emotional clarity) and other-mentalizing in n = 1,156 nonclinically ascertained young adults. Results Significant parallel multiple mediation models were found for all psychotic outcomes except negative schizotypy. The associations between intentionally harmful childhood adversity and psychotic outcomes were significantly mediated by increased attention to emotions for most models and decreased emotional clarity for some models. No significant mediation was found for parental loss. Paternal abuse was only mediated by attention to emotions whereas the effects of maternal abuse were mediated by attention to emotions and emotional clarity. Other-mentalizing only showed mediating effects on one of thirty models tested. Conclusion Results highlight the mediating role of impaired self-mentalizing in the association between childhood adversity and psychosis. This is consistent with disturbances of self-concept and self-boundary characterizing, in particular, the positive dimension of psychosis. Maternal versus paternal figures may contribute differentially to the development of mentalizing. These results could inform future preventative interventions, focusing on the development and maintenance of self-mentalizing.
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Affiliation(s)
- Jacqueline Nonweiler
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Torrecilla
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas R. Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Sergi Ballespí
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
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4
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de With J, de Haan L, Schirmbeck F. Attachment Style and Self-Experience: The Association Between Attachment Style and Self-Reported Altered Self-Experience in Patients With Psychotic Disorders, Unaffected Siblings, and Healthy Controls. J Nerv Ment Dis 2023; 211:440-447. [PMID: 36971431 DOI: 10.1097/nmd.0000000000001634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT The present study aimed to examine the cross-sectional association between attachment style and self-reported disturbed self-awareness (disturbed sense of mineness of experiences) and depersonalization (disturbed sense of first-person perspective) in patients with psychotic disorders, unaffected siblings, and healthy controls. Data pertain to a subsample of the GROUP (Genetic Risk and Outcome of Psychosis) study. We found positive associations between anxious attachment and disturbed self-awareness and depersonalization across participants with different psychosis vulnerability. We also found a positive association between avoidant attachment and depersonalization, although on a trend level. Findings indicate that attachment style is associated with self-reported disturbed self-awareness and depersonalization over and above the influence of psychotic or depressive experiences in people across the vulnerability spectrum of psychosis. This supports the importance of attachment style, self-awareness, and depersonalization as potential targets in prevention and treatment interventions in patients with psychotic disorders or those with increased vulnerability.
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Affiliation(s)
- Justine de With
- Early Psychosis Department, Amsterdam UMC (location AMC), Department of Psychiatry; and
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5
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Dourron HM, Strauss C, Hendricks PS. Self-Entropic Broadening Theory: Toward a New Understanding of Self and Behavior Change Informed by Psychedelics and Psychosis. Pharmacol Rev 2022; 74:982-1027. [DOI: 10.1124/pharmrev.121.000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/22/2022] Open
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6
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Fusar‐Poli P, Estradé A, Stanghellini G, Venables J, Onwumere J, Messas G, Gilardi L, Nelson B, Patel V, Bonoldi I, Aragona M, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Tamelini MG, Maschião LF, Puchivailo MC, Piedade VL, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Kuipers E, Arango C, Maj M. The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. World Psychiatry 2022; 21:168-188. [PMID: 35524616 PMCID: PMC9077608 DOI: 10.1002/wps.20959] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud-based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self-referentiality and permeated self-world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re-establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,OASIS serviceSouth London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly,National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Giovanni Stanghellini
- Department of Psychological, Territorial and Health Sciences“G. d'Annunzio” UniversityChietiItaly,Center for Studies on Phenomenology and Psychiatry, Medical Faculty“D. Portales” UniversitySantiagoChile
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Juliana Onwumere
- National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK,Department of Psychology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Bethlem Royal HospitalSouth London and Maudsley NHS Foundation TrustBeckenhamUK
| | - Guilherme Messas
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | | | - Barnaby Nelson
- OrygenParkvilleVICAustralia,Centre for Youth Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Ana Cabrera
- Asociación Española de Apoyo en PsicosisMadridSpain
| | - Joseba Rico
- Asociación Española de Apoyo en PsicosisMadridSpain
| | - Arif Hoque
- Young Person's Mental Health Advisory Group (YPMHAG)King's College LondonLondonUK
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group (YPMHAG)King's College LondonLondonUK
| | - Nicholas Hunter
- NHS South London and Maudsley (SLaM) Recovery CollegeLondonUK
| | | | - Luca F. Maschião
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | - Mariana Cardoso Puchivailo
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil,Department of PsychologyFAE University CenterCuritibaBrazil
| | - Valter L. Piedade
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks‐Europe (GAMIAN‐Europe)BrusselsBelgium
| | - Lily Kpodo
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Jianan Bao
- OASIS serviceSouth London and Maudsley NHS Foundation TrustLondonUK,Department of Forensic and Neurodevelopment Sciences, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - David Shiers
- Psychosis Research UnitGreater Manchester Mental Health TrustManchesterUK,Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK,School of MedicineKeele UniversityStaffordshireUK
| | - Elizabeth Kuipers
- National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK,Department of Psychology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Bethlem Royal HospitalSouth London and Maudsley NHS Foundation TrustBeckenhamUK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental HealthHospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of MadridMadridSpain
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
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7
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de Jong S, Hasson-Ohayon I, Lavi-Rotenberg A, Carter SA, Castelein S, Lysaker PH. Longitudinal assessments of therapeutic alliance predict work performance in vocational rehabilitation for persons with schizophrenia. Psychol Psychother 2021; 94:915-928. [PMID: 33904233 DOI: 10.1111/papt.12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To promote functional recovery in persons diagnosed with a psychotic disorder, vocational interventions have emerged over the last few decades which range from sheltered employment to supported employment in the community. DESIGN Using data from a 6-month vocational rehabilitation programme, we examined whether assessments of the therapeutic alliance were related to the quality of work performed in this work placement. Our first hypothesis was that stronger alliances would be related to better work performance. Second, we expected that client assessments of the TA would better predict outcomes than therapist assessments. Third, we expected that the discrepancy between assessment scores from the client and therapist (client rating minus therapist rating) would be a better predictor for outcome than individual assessments by the therapists or clients. RESULTS Clients systematically rated the alliance higher than therapists. Modelling the data longitudinally, we found both therapist and client ratings predictive of outcome, though client assessments over time were inversely related to work performance. CONCLUSIONS Discrepancy in scores was also shown to be predictive of work performance during the program. Clinicians are advised to routinely assess the therapeutic alliance from both client and therapist perspectives and calculate the discrepancy between them as they may indicate ruptures are occurring and thus hamper the intervention. PRACTITIONER POINTS Clinicians are advised to regularly assess the therapeutic alliance from both their own and the client's perspective. Growing discrepancy in scores may impede intervention effectiveness. Therapeutic alliance may help buffer against work stresses experienced by participants in a vocational programme. Be aware that therapists tend to rate the alliance lower than their clients.
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Affiliation(s)
- Steven de Jong
- Lentis Research, Lentis Psychiatric Institute, Groningen, the Netherlands
| | | | | | - Sarah A Carter
- University College Roosevelt, Utrecht University, Middelburg, The Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, the Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral Sciences, University of Groningen, Groningen, the Netherlands
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center and the Indiana University School of Medicine, Indiana, USA
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8
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Anomalous self-experiences are related to general cognition deficits in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:707-712. [PMID: 33221938 DOI: 10.1007/s00406-020-01213-z] [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: 05/02/2020] [Accepted: 11/07/2020] [Indexed: 12/29/2022]
Abstract
Anomalous self-experiences (ASEs) are prevalent in schizophrenia, but its underpinnings are not completely understood. Given the likely complex substrate of the experience of the self, neurocognitive functions requiring coordinate cerebral activity may relate to ASEs. Moreover, cognitive deficits functioning may be involved in the link between self-experience disturbances and some aspects of social dysfunction in schizophrenia. We have assessed ASEs in 41 schizophrenia patients (11 first episodes) using the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE), and the general cognition using the Brief Assessment of Cognition in Schizophrenia (BACS). Besides, social cognition was assessed using two complementary tools Meyer, Salovey and Caruso Emotional Intelligence Test (MSCEIT) and GEOPTE (Grupo Español para la Optimización del Tratamiento de la Esquizofrenia). The results revealed that Self-awareness/presence and Somatization IPASE scores were inversely explained by motor speed in the BACS; Consciousness IPASE scores were inversely explained by problem solving performance in the BACS. These data reveal a significant relationship between certain domains of general cognition and anomalous self-experiences, that may be useful in further investigation on the substrates of ASEs.
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Hinterbuchinger B, Mossaheb N. Psychotic-Like Experiences: A Challenge in Definition and Assessment. Front Psychiatry 2021; 12:582392. [PMID: 33854445 PMCID: PMC8039445 DOI: 10.3389/fpsyt.2021.582392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022] Open
Abstract
Assuming a continuum between psychotic experiences and psychotic symptoms aligned between healthy individuals and patients with non-psychotic and psychotic disorders, recent research has focused on subclinical psychotic experiences. The wide variety of definitions, assessment tools, and concepts of psychotic-like experiences (PLEs) might contribute to the mixed findings concerning prevalence and persistence rates and clinical impact. In this narrative review, we address the panoply of terminology, definitions, and assessment tools of PLEs and associated concerns with this multitude. Moreover, the ambiguous results of previous studies regarding the clinical relevance of PLEs are described. In conclusion, we address clinical implications and highly suggest conceptual clarity and consensus concerning the terminology and definition of PLEs. The development of an agreed upon use of a "gold standard" assessment tool seems essential for more comparable findings in future research.
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Affiliation(s)
- Barbara Hinterbuchinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nilufar Mossaheb
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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10
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Lee HS, Griffith T, Park S. Bodily Self-Disturbances in Schizophrenia: A Comparative Study of South Korea and the USA. Psychopathology 2021; 54:262-274. [PMID: 34380136 DOI: 10.1159/000517933] [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: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bodily self-disturbances are highly salient to the phenomenology of schizophrenia (SZ) but difficult to quantify owing to the subjective nature of these experiences that challenge verbal descriptions. The Benson et al. [PsyCh J. 2019 Mar;8(1):110-21] Body Disturbances Inventory (B-BODI) provides visual aids to help participants access the frequency, distressfulness, and vividness of subjective self-experiences with good reliability and validity in North American samples. However, the concept of the self and, accordingly, the conceptualization of self-disorders are influenced by culture. Therefore, we examined self-disturbances in individuals with SZ and control (CO) participants in 2 distinct cultures. METHODS B-BODI was administered to South Korean and North American participants, with and without SZ. Severity of symptoms in diagnosed individuals with SZ and schizotypy in CO was assessed. We also assessed perceived social isolation and mood in all participants. RESULTS Endorsement and frequency of bodily self-disturbances in SZ were similar in both cultures. In contrast, there were significant cultural differences in the degree of distress and vividness of self-disturbances. Bodily self-disturbances were experienced as more vivid and distressing to Americans than Koreans, regardless of diagnosis. For both cultures, B-BODI scores were associated with positive, but not negative, symptoms in SZ. For CO, elevated schizotypy was associated with B-BODI scores. Mood and loneliness were not associated with B-BODI scores. CONCLUSION SZ reported overall increased levels of bodily self-disturbances compared with CO, regardless of culture. However, there were cultural differences in one's emotional reaction to these experiences. Americans were more distressed by self-disturbances and experienced them more vividly than Koreans. These findings suggest that Americans may be less accepting of anomalous bodily self-experiences relative to Koreans. Last, B-BODI appears to be a useful tool for future cross-cultural studies of SZ phenomenology.
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Affiliation(s)
- Hyeon-Seung Lee
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Taylor Griffith
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
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11
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Nelson B, Torregrossa L, Thompson A, Sass L, Park S, Hartmann J, McGorry P, Alvarez-Jimenez M. Improving treatments for psychotic disorders: beyond cognitive behaviour therapy for psychosis. PSYCHOSIS 2020; 13:78-84. [PMID: 33889197 PMCID: PMC8057716 DOI: 10.1080/17522439.2020.1742200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
More effective treatments for people with psychotic disorders are urgently required. Here, we make three suggestions for progress: 1. Targeting the disorders' core phenomenological features ('phenomenological phenotype'), 2. Addressing social disconnection, isolation and loneliness, and 3. Leveraging 'hot' cognitions and using symptom capture approaches that combine psychotherapy with advances in technology and neuroscience.
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Affiliation(s)
- B. Nelson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - L. Torregrossa
- Department of Psychology, Vanderbilt University, Nashville, USA
| | - A. Thompson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - L.A. Sass
- Rutgers, the State University of New Jersey, New Jersey, USA
| | - S. Park
- Department of Psychology, Vanderbilt University, Nashville, USA
| | - J.A. Hartmann
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - P.D. McGorry
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - M. Alvarez-Jimenez
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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12
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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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13
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The neurophenomenology of early psychosis: An integrative empirical study. Conscious Cogn 2020; 77:102845. [DOI: 10.1016/j.concog.2019.102845] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/23/2022]
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Svendsen IH, Øie MG, Møller P, Nelson B, Haug E, Melle I. Basic self-disturbances independently predict recovery in psychotic disorders: A seven year follow-up study. Schizophr Res 2019; 212:72-78. [PMID: 31420200 DOI: 10.1016/j.schres.2019.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recovery is the ultimate goal of psychosis treatment. Basic self-disturbances (BSDs) are non-psychotic phenomena associated with clinical outcome, present in prodromal, psychotic and residual phases of psychotic disorders. AIM To investigate the relationship between BSDs and recovery seven years after first treatment in patients with psychotic disorders. METHOD Prospective longitudinal study of 56 patients recruited during first adequate treatment for schizophrenia (n = 35) and other psychotic disorders (n = 21) (psychotic bipolar disorder, delusional disorder, psychotic disorder NOS). At baseline and follow-up BSDs were assessed using the Examination of Anomalous Self-Experience (EASE) manual, while standard clinical instruments were used to ascertained diagnosis, clinical symptom severity, and functioning. Recovery was defined as absence of psychotic symptoms and regaining of functioning that persisted the last two years before follow-up. RESULTS At follow up, 34% achieved recovery (5 (14%) with schizophrenia and 14 (67%) with other psychoses at baseline). Recovery was predicted by an absence of a schizophrenia diagnosis, low baseline level of BSDs and further reductions in BSDs from baseline to follow-up. Change in BSDs was the strongest predictor, also after adjusting for premorbid adjustment and duration of untreated psychosis, and was not confounded by diagnosis. CONCLUSION Low baseline levels of basic self-disturbances and further reductions over time independently predict recovery seven years later in first treated psychosis patients.
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Affiliation(s)
- Ingrid Hartveit Svendsen
- Innlandet Hospital Trust, Department of Acute Psychiatry and Psychosis Treatment, Presteseter 1, 2840 Reinsvoll, Norway; University of Oslo, Faculty of Medicine, P. B. 1018 Blindern, 0315 Oslo, Norway.
| | - Merete G Øie
- Department of Psychology, University of Oslo, Pb 1094 Blindern, Norway; Division of Research, Innlandet Hospital Trust, Norway.
| | - Paul Møller
- Vestre Viken Hospital Trust, Division of Mental Health and Addiction, Department of Mental Health Research and Development, Norway.
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd (Locked Bag 10), Parkville, Victoria 3052, Australia.
| | - Elisabeth Haug
- Innlandet Hospital Trust, Department of Acute Psychiatry and Psychosis Treatment, Presteseter 1, 2840 Reinsvoll, Norway.
| | - Ingrid Melle
- NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, P.O. Box 1039 Blindern, 0315 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 1039 Blindern, 0315 Oslo, Norway.
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15
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Nelson B, Li E, Cicero DC, Gawęda Ł, Hartmann JA, Koren D, Polari A, Whitford TJ, Lavoie S. The construct validity of the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE) as a measure of minimal self-disturbance: Preliminary data. Early Interv Psychiatry 2019; 13:686-691. [PMID: 29968972 DOI: 10.1111/eip.12711] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/10/2018] [Indexed: 01/17/2023]
Abstract
AIM The Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE) is a self-report measure of minimal self-disturbance. The aim of the current report was to assess the construct validity of the scale by examining its convergent validity with the gold-standard measure of minimal self-disturbance, the Examination of Anomalous Self-Experience (EASE), and its discriminant validity. METHOD The sample consisted of 46 participants (21 ultra-high risk for psychosis patients, 14 first episode psychosis patients, 11 healthy controls). Correlations between the clinical instruments were examined. RESULTS The IPASE correlated strongly with general psychopathology and positive psychotic symptoms, moderately with negative symptoms, and weakly with manic symptoms. The strongest correlation (r = 0.92) was apparent between IPASE and EASE total scores. CONCLUSION These preliminary data indicate construct validity of the IPASE, demonstrating both convergent and discriminant validity. The IPASE may be suitable as a screener measure for minimal self-disturbance, but should not be used as a replacement to measure the construct of minimal self-disturbance, which requires considerable psychopathological sophistication.
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Affiliation(s)
- Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Parkville
| | - Emily Li
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Parkville
| | - David C Cicero
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Łukasz Gawęda
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry, The Medical University of Warsaw, Warsaw, Poland
| | - Jessica A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Parkville
| | - Danny Koren
- Psychology Department, University of Haifa, Haifa, Israel
| | - Andrea Polari
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Parkville.,Orygen Youth Health Clinical Program, Melbourne, Victoria, Australia
| | - Thomas J Whitford
- Department of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Parkville
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16
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Gawęda Ł, Pionke R, Arciszewska A, Prochwicz K, Frydecka D, Misiak B, Cechnicki A, Cicero DC, Nelson B. A combination of self-disturbances and psychotic-like experiences. A cluster analysis study on a non-clinical sample in Poland. Psychiatry Res 2019; 273:394-401. [PMID: 30684785 DOI: 10.1016/j.psychres.2019.01.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
We aimed to perform a cluster analysis to investigate the group structure of a combination of psychotic-like experiences (PLEs) and self-disturbances in a non-clinical sample. Non-clinical adults (n = 677) were assessed with the Community Assessment of Psychic Experiences (CAPE), the Davos Assessment of Cognitive Biases Scale (DACOBS) and the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE). Cluster analysis was conducted based on the positive and negative dimension of CAPE and a total score of IPASE. Four distinct groups were revealed by the cluster analysis. The High Profile group had the highest means, and the Low Profile had the lowest scores of positive and negative subscales of the CAPE and IPASE. The Positive Profile group had a significantly higher level of self-disturbances (in 'Cognition', 'Consciousnesses and 'Somatization' dimensions) from participants with the 'Negative Profile'. The High Profile group had more cognitive biases (i.e., inadequate cognitive inference about internal and external events) related to psychosis as assessed with DACOBS, had the highest means on each IPASE subscale and had a higher level of emotional distress. A combination of high level of PLEs and self-disturbances may capture the highest risk of psychosis in the general population associated with cognitive biases characteristic for psychosis.
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Affiliation(s)
- Łukasz Gawęda
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Poland, Rychlińskiego 1, 05-901 Ząbki, Poland.
| | - Renata Pionke
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Poland, Rychlińskiego 1, 05-901 Ząbki, Poland
| | - Aleksandra Arciszewska
- SWPS University of Social Sciences and Humanities, Sopot, Poland; Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | | | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | - David C Cicero
- Department of Psychology, University of Hawai'i at Manoa, Honolulu, United States
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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17
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Extrinsic and default mode networks in psychiatric conditions: Relationship to excitatory-inhibitory transmitter balance and early trauma. Neurosci Biobehav Rev 2019; 99:90-100. [PMID: 30769024 DOI: 10.1016/j.neubiorev.2019.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 02/08/2023]
Abstract
Over the last three decades there has been an accumulation of Magnetic Resonance Imaging (MRI) studies reporting that aberrant functional networks may underlie cognitive deficits and other symptoms across a range of psychiatric diagnoses. The use of pharmacological MRI and 1H-Magnetic Resonance Spectroscopy (1H-MRS) has allowed researchers to investigate how changes in network dynamics are related to perturbed excitatory and inhibitory neurotransmission in individuals with psychiatric conditions. More recently, changes in functional network dynamics and excitatory/inhibitory (E/I) neurotransmission have been linked to early childhood trauma, a major antecedents for psychiatric illness in adulthood. Here we review studies investigating whether perturbed network dynamics seen across psychiatric conditions are related to changes in E/I neurotransmission, and whether such changes could be linked to childhood trauma. Whilst there is currently a paucity of studies relating early traumatic experiences to altered E/I balance and network function, the research discussed here lead towards a plausible mechanistic hypothesis, linking early traumatic experiences to cognitive dysfunction and symptoms mediated by E/I neurotransmitter imbalances.
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18
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Klaunig MJ, Trask CL, Neis AM, Cohn JR, Chen X, Berglund AM, Cicero DC. Associations among domains of self-disturbance in schizophrenia. Psychiatry Res 2018; 267:187-194. [PMID: 29913377 DOI: 10.1016/j.psychres.2018.05.082] [Citation(s) in RCA: 7] [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: 09/12/2017] [Revised: 05/09/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
Abstract
Self-disturbances are increasingly recognized as important, possibly even central, features of schizophrenia. However, little is known about the associations among different manifestations of self-disturbances. The aims of the current study were threefold. We aimed to (1) replicate previous findings of increased self-disturbances in schizophrenia, (2) correlate manifestations of self-disturbances in schizophrenia across three domains, and (3) correlate self-disturbances with five symptoms domains of schizophrenia, including positive, negative, disorganized symptoms, excitement, and emotional distress. We examined three domains of self-experience, including somatosensation, anomalous self-experiences, and self-concept clarity. Participants included 48 individuals with schizophrenia and 36 non-psychiatric controls. The results of this study replicate previous findings of significantly higher levels of self-disturbances in people with schizophrenia. The results also indicate positive correlations between the domains of anomalous self-experiences and self-concept clarity, but not somatosensation, in individuals with schizophrenia. As well, anomalous self-experiences were positively correlated with positive symptoms, disorganized symptoms, and emotional distress and self-concept clarity was negatively correlated with disorganized symptoms and emotional distress.
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Affiliation(s)
- Mallory J Klaunig
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Christi L Trask
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Aaron M Neis
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Jonathan R Cohn
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Xuefang Chen
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Alysia M Berglund
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - David C Cicero
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA.
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19
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Ebisch SJH, Gallese V, Salone A, Martinotti G, di Iorio G, Mantini D, Perrucci MG, Romani GL, Di Giannantonio M, Northoff G. Disrupted relationship between "resting state" connectivity and task-evoked activity during social perception in schizophrenia. Schizophr Res 2018; 193:370-376. [PMID: 28735643 DOI: 10.1016/j.schres.2017.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 01/23/2023]
Abstract
Schizophrenia has been described as a self-disorder, whereas social deficits are key features of the illness. Changes in "resting state" activity of brain networks involved in self-related processing have been consistently reported in schizophrenia, but their meaning for social perception deficits remains poorly understood. Here, we applied a novel approach investigating the relationship between task-evoked neural activity during social perception and functional organization of self-related brain networks during a "resting state". "Resting state" functional MRI was combined with task-related functional MRI using a social perception experiment. Twenty-one healthy control participants (HC) and 21 out-patients with a diagnosis of schizophrenia (SCH) were included. There were no significant differences concerning age, IQ, education and gender between the groups. Results showed reduced "resting state" functional connectivity between ventromedial prefrontal cortex and dorsal posterior cingulate cortex in SCH, compared to HC. During social perception, neural activity in dorsal posterior cingulate cortex and behavioral data indicated impaired congruence coding of social stimuli in SCH. Task-evoked activity during social perception in dorsal posterior cingulate cortex co-varied with dorsal posterior cingulate cortex-ventromedial prefrontal cortex functional connectivity during a "resting state" in HC, but not in SCH. Task-evoked activity also correlated with negative symptoms in SCH. These preliminary findings, showing disrupted prediction of social perception measures by "resting state" functioning of self-related brain networks in schizophrenia, provide important insight in the hypothesized link between self and social deficits. They also shed light on the meaning of "resting state" changes for tasks such as social perception.
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Affiliation(s)
- Sjoerd J H Ebisch
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy; Institute of Advanced Biomedical Technologies (ITAB), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy.
| | - Vittorio Gallese
- Department of Medicine and Surgery, Section of Neuroscience, University of Parma, Via Volturno 39E, 43125 Parma, Italy; Institute of Philosophy, School of Advanced Study, University of London, London, UK
| | - Anatolia Salone
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy; University of Hertfordshire, Department of Pharmacy, Pharmacology, Clinical Sciences, Herts, UK
| | - Giuseppe di Iorio
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy
| | - Dante Mantini
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Department of Experimental Psychology, University of Oxford, Oxford, UK; Research Center for Motor Control and Neuroplasticity, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Mauro Gianni Perrucci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy; Institute of Advanced Biomedical Technologies (ITAB), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy
| | - Gian Luca Romani
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy; Institute of Advanced Biomedical Technologies (ITAB), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy
| | - Georg Northoff
- The Royal's Institute of Mental Health Research & University of Ottawa Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, ON K1Z 7K4, Canada; Mental Health Centre, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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20
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Wennogle LP, Hoxie H, Peng Y, Hendrick JP. Phosphodiesterase 1: A Unique Drug Target for Degenerative Diseases and Cognitive Dysfunction. ADVANCES IN NEUROBIOLOGY 2018; 17:349-384. [PMID: 28956339 DOI: 10.1007/978-3-319-58811-7_13] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The focus of this chapter is on the cyclic nucleotide phosphodiesterase 1 (PDE1) family. PDE1 is one member of the 11 PDE families (PDE 1-11). It is the only phosphodiesterase family that is calcium/calmodulin activated. As a result, whereas other families of PDEs 2-11 play a dominant role controlling basal levels of cyclic nucleotides, PDE1 is involved when intra-cellular calcium levels are elevated and, thus, has an "on demand" or activity-dependent involvement in the control of cyclic nucleotides in excitatory cells including neurons, cardiomyocytes and smooth muscle. As a Class 1 phosphodiesterase, PDE1 hydrolyzes the 3' bond of 3'-5'-cyclic nucleotides, cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Here, we review evidence for this family of enzymes as drug targets for development of therapies aimed to address disorders of the central nervous system (CNS) and of degenerative diseases. The chapter includes sections on the potential for cognitive enhancement in mental disorders, as well as a review of PDE1 enzyme structure, enzymology, tissue distribution, genomics, inhibitors, pharmacology, clinical trials, and therapeutic indications. Information is taken from public databases. A number of excellent reviews of the phosphodiesterase family have been written as well as reviews of the PDE1 family. References cited here are not comprehensive, rather pointing to major reviews and key publications.
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Affiliation(s)
- Lawrence P Wennogle
- Alexandria Center for Life Science, Intra-Cellular Therapies, Inc., New York, 10016, NY, USA.
| | - Helen Hoxie
- Alexandria Center for Life Science, Intra-Cellular Therapies, Inc., New York, 10016, NY, USA
| | - Youyi Peng
- Rutgers University, 7 College Ave, New Brunswick, NJ, 08901, USA
| | - Joseph P Hendrick
- Alexandria Center for Life Science, Intra-Cellular Therapies, Inc., New York, 10016, NY, USA
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21
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Gawęda Ł, Pionke R, Krężołek M, Prochwicz K, Kłosowska J, Frydecka D, Misiak B, Kotowicz K, Samochowiec A, Mak M, Błądziński P, Cechnicki A, Nelson B. Self-disturbances, cognitive biases and insecure attachment as mechanisms of the relationship between traumatic life events and psychotic-like experiences in non-clinical adults - A path analysis. Psychiatry Res 2018; 259:571-578. [PMID: 29195191 DOI: 10.1016/j.psychres.2017.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/28/2017] [Accepted: 11/03/2017] [Indexed: 01/04/2023]
Abstract
Although traumatic life events have been linked to psychotic-like experiences, the mechanisms of the relationship remain unclear. We investigated whether insecure (anxious and avoidant) attachment styles, cognitive biases and self-disturbances serve as significant mediators in the relationship between traumatic life events and psychotic-like experiences in non-clinical sample. Six-hundred and ninety healthy participants (522 females) who have not ever been diagnosed with psychiatric disorders took part in the study. Participants completed self-report scales that measure traumatic life events, psychotic-like experiences, cognitive biases, attachment styles and self-disturbances. Our model was tested with path analysis. Our integrated model fit to the data with excellent goodness-of-fit indices. The direct effect was significantly reduced after the mediators were included. Significant pathways from traumatic life events to psychotic-like experiences were found through self-disturbances and cognitive biases. Traumatic life events were associated with anxious attachment through cognitive biases. Self-disturbances, cognitive biases and anxious attachment had a direct effect on psychotic-like experiences. The results of our study tentatively suggest that traumatic life events are related with psychotic-like experiences through cognitive biases and self-disturbances. Further studies in clinical samples are required to verify our model.
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Affiliation(s)
- Łukasz Gawęda
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany; II Department of Psychiatry, Medical University of Warsaw, Poland.
| | - Renata Pionke
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Martyna Krężołek
- II Department of Psychiatry, Medical University of Warsaw, Poland
| | | | - Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Poland
| | - Błażej Misiak
- Department of Geneticts, Wroclaw Medical University, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Poland
| | - Agnieszka Samochowiec
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, Poland
| | - Monika Mak
- Department of Psychiatry, Pomeranian Medical University, Poland
| | - Piotr Błądziński
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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22
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Impaired self-agency inferences in schizophrenia: The role of cognitive capacity and causal reasoning style. Eur Psychiatry 2017; 47:27-34. [PMID: 29096130 DOI: 10.1016/j.eurpsy.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The sense of self-agency, i.e., experiencing oneself as the cause of one's own actions, is impaired in patients with schizophrenia. Normally, inferences of self-agency are enhanced when actual outcomes match with pre-activated outcome information, where this pre-activation can result from explicitly set goals (i.e., goal-based route) or implicitly primed outcome information (i.e., prime-based route). Previous research suggests that patients show specific impairments in the prime-based route, implicating that they do not rely on matches between implicitly available outcome information and actual action-outcomes when inferring self-agency. The question remains: Why? Here, we examine whether neurocognitive functioning and self-serving bias (SSB) may explain abnormalities in patients' agency inferences. METHODS Thirty-six patients and 36 healthy controls performed a commonly used agency inference task to measure goal- and prime-based self-agency inferences. Neurocognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS) and the SSB was assessed with the Internal Personal and Situational Attributions Questionnaire. RESULTS Results showed a substantial smaller effect of primed outcome information on agency experiences in patients compared with healthy controls. Whereas patients and controls differed on BACS and marginally on SSB scores, these differences were not related to patients' impairments in prime-based agency inferences. CONCLUSIONS Patients showed impairments in prime-based agency inferences, thereby replicating previous studies. This finding could not be explained by cognitive dysfunction or SSB. Results are discussed in the context of the recent surge to understand and examine deficits in agency experiences in schizophrenia.
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23
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Tsirigotis K. Indirect self-destructiveness in individuals with schizophrenia. REVISTA BRASILEIRA DE PSIQUIATRIA 2017; 40:41-47. [PMID: 28658441 PMCID: PMC6899412 DOI: 10.1590/1516-4446-2016-2012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 02/27/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the indirect self-destructiveness syndrome in patients with schizophrenia. METHODS Two hundred individuals with paranoid schizophrenia (117 men and 83 women, mean age 37.15 years), all in remission, were examined using the Polish version of the Chronic Self-Destructiveness Scale. Two hundred well-matched healthy individuals served as a control group. RESULTS The intensity of indirect self-destructiveness was greater in the schizophrenia group than in controls. The intensity of each manifestation was as follows (in decreasing order): helplessness and passiveness in the face of difficulties (A5), personal and social neglects (A3), lack of planfulness (A4), poor health maintenance (A2), transgression and risk (A1). CONCLUSION Patients with schizophrenia displayed more behaviors that were indirectly self-destructive than healthy controls; they scored better than healthy controls only on caring for their own health. The patients showed the lowest intensity of behaviors connected with the active form of indirect self-destructiveness, and the highest intensity of behaviors connected with the passive form. These findings may enable delivery of more effective forms of pharmacological and psychosocial help to patients with schizophrenia.
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Affiliation(s)
- Konstantinos Tsirigotis
- Department of Psychology, The Jan Kochanowski University in Kielce, Piotrków Trybunalski Branch, Poland
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24
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Noel JP, Cascio CJ, Wallace MT, Park S. The spatial self in schizophrenia and autism spectrum disorder. Schizophr Res 2017; 179:8-12. [PMID: 27650196 PMCID: PMC5219859 DOI: 10.1016/j.schres.2016.09.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/07/2016] [Accepted: 09/14/2016] [Indexed: 11/25/2022]
Abstract
Schizophrenia (SZ) and autism spectrum disorder (ASD) have been both described as disorders of the self. However, the manner in which the sense of self is impacted in these disorders is strikingly different. In the current review, we propose that SZ and ASD lay at opposite extremes of a particular component of the representation of self; namely, self-location and the construct of peripersonal space. We evaluate emerging literature suggesting that while SZ individuals possess an extremely weak or variable bodily boundary between self and other, ASD patients possess a sharper self-other boundary. Furthermore, based on recent behavioral and neural network modeling findings, we propose that multisensory training focused on either sharpening (for SZ) or making shallower (for ASD) the self-other boundary may hold promise as an interventional tool in the treatment of these disorders.
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Affiliation(s)
- Jean-Paul Noel
- Neuroscience Graduate Program, Vanderbilt Brain Institute, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA.
| | - Carissa J Cascio
- Department of Psychiatry, Vanderbilt School of Medicine, Vanderbilt University, Nashville, TN, USA; Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA
| | - Mark T Wallace
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA; Department of Hearing and Speech, Vanderbilt School of Medicine, Vanderbilt University, Nashville, TN, USA; Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Sohee Park
- Department of Psychiatry, Vanderbilt School of Medicine, Vanderbilt University, Nashville, TN, USA; Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Pérez-Álvarez M, García-Montes JM, Vallina-Fernández O, Perona-Garcelán S. Rethinking Schizophrenia in the Context of the Person and Their Circumstances: Seven Reasons. Front Psychol 2016; 7:1650. [PMID: 27857696 PMCID: PMC5093139 DOI: 10.3389/fpsyg.2016.01650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/07/2016] [Indexed: 12/26/2022] Open
Abstract
We know a great deal about schizophrenia, but the current state of the art is one of uncertainty. Researchers are confused, and patients feel misunderstood. This situation has been identified as due largely to the fact that the dominant neurobiological perspective leaves out the person. The aim of the present article is to review and integrate a series of clinical, phenomenological, historical, cultural, epidemiological, developmental, epigenetic, and therapeutic phenomena in support of a suggestion that schizophrenia is above all a disorder of the person rather than of the brain. Specifically, we review seven phenomena, beginning with the conception of schizophrenia as a particular disorder of the self. We continue by looking at its recent origin, as a modern phenomenon, its juvenile onset, related to the formation of the self, the better prognosis in developing countries compared to developed countries, and the high incidence of the disorder among migrants. In the context of these phenomena of a marked socio-cultural nature, we consider the so-called "genetic myth," according to which schizophrenia would have a genetic origin. On reviewing the current genetic emphasis in the light of epigenetics, it emerges that the environment and behavior recover their prominent role in the vicissitudes of development. The seventh reason, which closes the circle of the argument, concerns the role of interpersonal "chemistry" in recovery of the sense of self.
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Cicero DC, Klaunig MJ, Trask CL, Neis AM. Anomalous Self-Experiences and positive symptoms are independently associated with emotion processing deficits in schizophrenia. Schizophr Res 2016; 176:456-461. [PMID: 27562615 DOI: 10.1016/j.schres.2016.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 11/16/2022]
Abstract
Social-cognitive models posit a role of Anomalous Self-Experiences (ASEs), disturbances in the subjective experience of the self, in the development and maintenance of psychosis. Theorists have suggested that ASEs may underlie the social-cognitive deficits that are common in people with schizophrenia. Positive symptoms, negative symptoms, and ASEs may interfere with the ability to perceive, use, understand, and manage emotions. In the current study, 45 people with schizophrenia and 28 healthy controls completed the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE), the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), and were rated on the Positive and Negative Syndrome Scale (PANSS). Participants with schizophrenia had higher IPASE scores and lower MSCEIT scores than the comparison group. In a series of simultaneous regressions, ASEs, but not positive or negative symptoms, were associated with Total MSCEIT scores and the Using Emotions branch score. In contrast, positive symptoms, but not ASEs or negative symptoms were associated with Perceiving and Managing Emotions branches. Both ASEs and positive symptoms independently contributed to Emotional Experiencing scores. The severity of negative symptoms was not associated with deficits in any MSCEIT scores. These results suggest unique roles for ASEs and positive symptoms in emotion processing deficits in people with schizophrenia.
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Nour MM, Evans L, Nutt D, Carhart-Harris RL. Ego-Dissolution and Psychedelics: Validation of the Ego-Dissolution Inventory (EDI). Front Hum Neurosci 2016; 10:269. [PMID: 27378878 PMCID: PMC4906025 DOI: 10.3389/fnhum.2016.00269] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/20/2016] [Indexed: 02/05/2023] Open
Abstract
AIMS The experience of a compromised sense of "self", termed ego-dissolution, is a key feature of the psychedelic experience. This study aimed to validate the Ego-Dissolution Inventory (EDI), a new 8-item self-report scale designed to measure ego-dissolution. Additionally, we aimed to investigate the specificity of the relationship between psychedelics and ego-dissolution. METHOD Sixteen items relating to altered ego-consciousness were included in an internet questionnaire; eight relating to the experience of ego-dissolution (comprising the EDI), and eight relating to the antithetical experience of increased self-assuredness, termed ego-inflation. Items were rated using a visual analog scale. Participants answered the questionnaire for experiences with classical psychedelic drugs, cocaine and/or alcohol. They also answered the seven questions from the Mystical Experiences Questionnaire (MEQ) relating to the experience of unity with one's surroundings. RESULTS Six hundred and ninety-one participants completed the questionnaire, providing data for 1828 drug experiences (1043 psychedelics, 377 cocaine, 408 alcohol). Exploratory factor analysis demonstrated that the eight EDI items loaded exclusively onto a single common factor, which was orthogonal to a second factor comprised of the items relating to ego-inflation (rho = -0.110), demonstrating discriminant validity. The EDI correlated strongly with the MEQ-derived measure of unitive experience (rho = 0.735), demonstrating convergent validity. EDI internal consistency was excellent (Cronbach's alpha 0.93). Three analyses confirmed the specificity of ego-dissolution for experiences occasioned by psychedelic drugs. Firstly, EDI score correlated with drug-dose for psychedelic drugs (rho = 0.371), but not for cocaine (rho = 0.115) or alcohol (rho = -0.055). Secondly, the linear regression line relating the subjective intensity of the experience to ego-dissolution was significantly steeper for psychedelics (unstandardized regression coefficient = 0.701) compared with cocaine (0.135) or alcohol (0.144). Ego-inflation, by contrast, was specifically associated with cocaine experiences. Finally, a binary Support Vector Machine classifier identified experiences occasioned by psychedelic drugs vs. cocaine or alcohol with over 85% accuracy using ratings of ego-dissolution and ego-inflation alone. CONCLUSION Our results demonstrate the psychometric structure, internal consistency and construct validity of the EDI. Moreover, we demonstrate the close relationship between ego-dissolution and the psychedelic experience. The EDI will facilitate the study of the neuronal correlates of ego-dissolution, which is relevant for psychedelic-assisted psychotherapy and our understanding of psychosis.
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Affiliation(s)
- Matthew M Nour
- Psychiatric Imaging Group, MRC Clinical Sciences Centre, Imperial College LondonLondon, UK; Institute of Psychiatry Psychology and Neuroscience, King's College LondonLondon, UK
| | - Lisa Evans
- Faculty of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London London, UK
| | - David Nutt
- Faculty of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London London, UK
| | - Robin L Carhart-Harris
- Faculty of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London London, UK
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Abstract
A number of recent articles, many appearing in Schizophrenia Bulletin, signal a renewed interest in phenomenological approaches to our understanding of schizophrenia. These approaches conceptualize schizophrenia as a disorder of altered self-awareness and decreased prereflective social attunement, which may manifest as an impaired understanding of self, others, and the physical world. Phenomenological approaches to psychopathology are sometimes construed as being incompatible with the reductionistic methodology of contemporary neuroscience. In this article, we re-examine findings from the phenomenological investigation of schizophrenia in light of an influential neurocomputational account of mindreading, which postulates that understanding of others is subserved by coherent internal self-models. We argue that the phenomenological approach to schizophrenia is not incompatible with a neurocomputational account of mindreading, and that the 2 approaches should instead be viewed as existing in a relationship of mutual constraint and enlightenment. Our hypothesis, while speculative, is an attempt to marry the phenomenological and neuronal realities of schizophrenia. Furthermore, it has implications for psychotherapeutic interventions and future research.
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Affiliation(s)
| | - Alvaro Barrera
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK
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Fonseca-Pedrero E, Badoud D, Antico L, Caputo GB, Eliez S, Schwartz S, Debbané M. Strange-face-in-the-mirror illusion and schizotypy during adolescence. Schizophr Bull 2015; 41 Suppl 2:S475-82. [PMID: 25810060 PMCID: PMC4373638 DOI: 10.1093/schbul/sbu196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients with schizophrenia can sometimes report strange face illusions when staring at themselves in the mirror; such experiences have been conceptualized as anomalous self-experiences that can be experienced with a varying degree of depersonalization. During adolescence, anomalous self-experiences can also be indicative of increased risk to develop schizophrenia-spectrum disorders. To date however, the Mirror-Gazing test (MGT), an experimentally validated experiment to evaluate the propensity of strange face illusions in nonclinical and clinical adults, has yet to be investigated in an adolescent sample. The first goal of the present study was to examine experimentally induced self-face illusions in a nonclinical sample of adolescents, using the MGT. The second goal was to investigate whether dimensions of adolescent trait schizotypy were differentially related to phenomena arising during the MGT. One hundred and ten community adolescents (59 male) aged from 12 to 19 years (mean age = 16.31, SD age = 1.77) completed the MGT and Schizotypal Personality Questionnaire. The results yielded 4 types of strange face illusions; 2 types of illusions (slight change of light/color [20%] and own face deformation [45.5%]) lacked depersonalization-like phenomena (no identity change), while 2 other types (vision of other identity [27.3%], and vision of non-human identity [7.3%]) contained clear depersonalization-like phenomena. Furthermore, the disorganization dimension of schizotypy associated negatively with time of first illusion (first press), and positively with frequency of illusions during the MGT. Statistically significant differences on positive and disorganized schizotypy were found when comparing groups on the basis of degree of depersonalization-like phenomena (from slight color changes to non-human visions). Similarly to experimentally induced self-face illusions in patients with schizophrenia, such illusions in a group of nonclinical adolescents present significant associations to schizotypy dimensions.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain; Prevention Program for Psychosis (P3), Cantabria, Spain;
| | - Deborah Badoud
- Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland;,Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Lia Antico
- Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | | | - Stephan Eliez
- Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland;,Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Sophie Schwartz
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Martin Debbané
- Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland;,Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland;,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Haug E, Øie M, Andreassen OA, Bratlien U, Raballo A, Nelson B, Møller P, Melle I. Anomalous self-experiences contribute independently to social dysfunction in the early phases of schizophrenia and psychotic bipolar disorder. Compr Psychiatry 2014; 55:475-82. [PMID: 24378241 DOI: 10.1016/j.comppsych.2013.11.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 11/12/2013] [Accepted: 11/14/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Psychotic disorders are associated with significant social dysfunction. Anomalous self-experiences (ASE) present in psychotic disorders could contribute to social dysfunction. AIM To investigate if ASE contribute to social dysfunction in the early phases of psychotic disorders after controlling for factors related to social functioning including diagnoses. METHODS ASE were assessed by means of the EASE (Examination of Anomalous Self-Experience) in 76 patients referred to their first adequate treatment for schizophrenia or psychotic bipolar disorder. Diagnoses, symptom severity, and functioning were assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Premorbid Adjustment Scale, Global Assessment of Functioning--Split Version, and Social Functioning Scale. Neurocognitive assessments included measures of psychomotor speed, working memory, executive and memory functions. Duration of untreated psychosis was also assessed. RESULTS High levels of ASE were significantly associated with poorer social functioning in the early phases of schizophrenia and psychotic bipolar disorder also after correcting for diagnosis. CONCLUSION This study demonstrates the significance of ASE for social dysfunction in patients with psychotic disorders, and contributes to the understanding of the complexity of illness-related factors that affect social functioning.
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Affiliation(s)
- Elisabeth Haug
- Innlandet Hospital Trust, Division of Mental Health, Norway.
| | - Merete Øie
- Innlandet Hospital Trust, Division of Mental Health, Norway; Department of Psychology, University of Oslo, Norway
| | - Ole A Andreassen
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Norway
| | - Unni Bratlien
- Innlandet Hospital Trust, Division of Mental Health, Norway
| | - Andrea Raballo
- Department of Mental Health and Pathological Addiction, AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Barnaby Nelson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne
| | - Paul Møller
- Department of Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Norway
| | - Ingrid Melle
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Norway
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Abstract
Sense of self (SOS)--understood as the foundation upon which individuals experience their daily lives--has been increasingly investigated in schizophrenia. A disrupted SOS is thought to represent a platform for the experience of psychiatric symptoms, social cognitive deficits, and other abnormalities of consciousness. Few studies, however, have investigated the specificity of disrupted SOS to schizophrenia. The primary objective of the present study was to test the hypothesis that SOS is deficient in schizophrenia patients compared to both nonpsychiatric controls and patients with psychotic bipolar disorder. Using select scales from the Assessment of Self Descriptions, the present study assessed SOS from spontaneous narratives provided by schizophrenia patients (N = 50), bipolar patients with psychotic features (N = 17), and nonpsychiatric controls (N = 24). Our findings indicate that facets of SOS-in particular, certain aspects of agency and relatedness to others-are deficient in schizophrenia compared to nonpsychiatric controls and bipolar patients with psychotic features, even when overall level of functioning and psychiatric symptoms are accounted for. Implications of these results are discussed.
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Affiliation(s)
- Aubrey M. Moe
- *To whom correspondence should be addressed; Department of Psychology, Kent State University, Kent, OH 44240, US; tel: (330)-672-7671, fax: (330)-672-3786, e-mail:
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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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Nelson B, Thompson A, Chanen AM, Amminger GP, Yung AR. Is basic self-disturbance in ultra-high risk for psychosis ('prodromal') patients associated with borderline personality pathology? Early Interv Psychiatry 2013; 7:306-10. [PMID: 23347769 DOI: 10.1111/eip.12011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/01/2012] [Indexed: 12/24/2022]
Abstract
AIM Research in the phenomenological tradition suggests that the schizophrenia spectrum is characterized by disturbance of the 'basic' self, whereas borderline personality disorder involves disturbance of the 'narrative' self. The current study investigated this proposal in an ultra-high risk for psychosis sample. METHODS The sample consisted of 42 ultra-high-risk participants with a mean age of 19.22 years. Basic self-disturbance was measured using the Examination of Anomalous Self-Experience. Borderline personality pathology was measured using the borderline personality disorder items from the structured clinical interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis II Personality Questionnaire. RESULTS No correlation was found between the measures of basic self-disturbance and borderline personality pathology. CONCLUSIONS The finding is consistent with the proposal that different (although not mutually exclusive) types of self-disturbance characterize the schizophrenia spectrum and borderline personality disorder. Further research should further examine the question of basic self-disturbance in patients with established borderline personality disorder.
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Affiliation(s)
- Barnaby Nelson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
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Kidd SA. From social experience to illness experience: reviewing the psychological mechanisms linking psychosis with social context. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:52-8. [PMID: 23327757 DOI: 10.1177/070674371305800110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review was undertaken to describe the psychological processes that are associated with the social experiences and behaviours of people with psychosis. A systematic search was conducted using MEDLINE and PsycINFO search engines. In each of the major topic domains, the search was comprised of review articles published from 2004 to present, and individual article searches for papers published from 2010 to present. The key psychological mechanisms in this context are social cognition, self-concept, emotion, and communication. While diverse in content, there were several cross-cutting themes in these literatures. These include evidence of the presence of social processing difficulties in high-risk and psychosis populations that have both state and trait characteristics, are related to, but not fully accounted for by, neurocognition and symptomatology, and have significant implications for social functioning. There are numerous established and promising treatments linked to our understanding of social cognition. Limitations cutting across these literatures include a substantial reliance on cross-sectional studies that use control groups comprised of people who have not experienced significant psychological or social adversity. There is also limited inquiry into how psychological mechanisms may differ owing to sex, ethnicity, and race. Despite these issues, this line of inquiry is very promising as part of the larger movement toward an integrative model of psychosis that is able to account for the complex interactions of social, biological, and psychological risks.
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Affiliation(s)
- Sean A Kidd
- Independent Clinician Scientist and Head, Psychology Service, Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario.
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35
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Nelson B, Thompson A, Yung AR. Basic self-disturbance predicts psychosis onset in the ultra high risk for psychosis "prodromal" population. Schizophr Bull 2012; 38:1277-87. [PMID: 22349924 PMCID: PMC3494062 DOI: 10.1093/schbul/sbs007] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION 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 a disruption of the sense of ownership of experience and agency of action and is associated with a variety of anomalous subjective experiences. In this study, we investigated the presence of basic self-disturbance in an "ultra high risk" (UHR) for psychosis sample compared with a healthy control sample and whether it predicted transition to psychotic disorder. METHODS Forty-nine UHR patients and 52 matched healthy control participants were recruited to the study. Participants were assessed for basic self-disturbance using the Examination of Anomalous Self-Experience (EASE) instrument. UHR participants were followed for a mean of 569 days. RESULTS Levels of self-disturbance were significantly higher in the UHR sample compared with the healthy control sample (P < .001). Cox regression indicated that total EASE score significantly predicted time to transition (P < .05) when other significant predictors were controlled for. Exploratory analyses indicated that basic self-disturbance scores were higher in schizophrenia spectrum cases, irrespective of transition to psychosis, than nonschizophrenia spectrum cases. DISCUSSION The results indicate that identifying basic self-disturbance in the UHR population may provide a means of further "closing in" on individuals truly at high risk of psychotic disorder, particularly of schizophrenia spectrum disorders. This may be of practical value by reducing inclusion of "false positive" cases in UHR samples and of theoretical value by shedding light on core phenotypic features of schizophrenia spectrum pathology.
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Affiliation(s)
- Barnaby Nelson
- Orygen Youth Health Research Centre, University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 3052, Australia.
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Ferri F, Frassinetti F, Mastrangelo F, Salone A, Ferro FM, Gallese V. Bodily self and schizophrenia: The loss of implicit self-body knowledge. Conscious Cogn 2012; 21:1365-74. [DOI: 10.1016/j.concog.2012.05.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/06/2012] [Accepted: 05/08/2012] [Indexed: 11/29/2022]
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Masillo A, Day F, Laing J, Howes O, Fusar-Poli P, Byrne M, Bhattacharyya S, Fiori Nastro P, Girardi P, McGuire PK, Valmaggia LR. Interpersonal sensitivity in the at-risk mental state for psychosis. Psychol Med 2012; 42:1835-1845. [PMID: 22225783 DOI: 10.1017/s0033291711002996] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Interpersonal sensitivity is a personality trait described as excessive awareness of both the behaviour and feelings of others. Although interpersonal sensitivity has been found to be one of the vulnerability factors to depression, there has been little interest in its relationship with the prodromal phase of psychosis. The aims of this study were to examine the level of interpersonal sensitivity in a sample of individuals with an at-risk mental state (ARMS) for psychosis and its relationship with other psychopathological features. METHOD Sixty-two individuals with an ARMS for psychosis and 39 control participants completed a series of self-report questionnaires, including the Interpersonal Sensitivity Measure (IPSM), the Prodromal Questionnaire (PQ), the Ways of Coping Questionnaire (WCQ) and the Depression and Anxiety Stress Scale (DASS). RESULTS Individuals with an ARMS reported higher interpersonal sensitivity compared to controls. Associations between interpersonal sensitivity, positive psychotic symptoms (i.e. paranoid ideation), avoidant coping and symptoms of depression, anxiety and stress were also found. CONCLUSIONS This study suggests that being 'hypersensitive' to interpersonal interactions is a psychological feature of the putatively prodromal phase of psychosis. The relationship between interpersonal sensitivity, attenuated positive psychotic symptoms, avoidant coping and negative emotional states may contribute to long-term deficits in social functioning. We illustrate the importance, when assessing a young client with a possible ARMS, of examining more subtle and subjective symptoms in addition to attenuated positive symptoms.
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Affiliation(s)
- A Masillo
- Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
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Liemburg EJ, van der Meer L, Swart M, Curcic-Blake B, Bruggeman R, Knegtering H, Aleman A. Reduced connectivity in the self-processing network of schizophrenia patients with poor insight. PLoS One 2012; 7:e42707. [PMID: 22912723 PMCID: PMC3415395 DOI: 10.1371/journal.pone.0042707] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 07/11/2012] [Indexed: 11/18/2022] Open
Abstract
Lack of insight (unawareness of illness) is a common and clinically relevant feature of schizophrenia. Reduced levels of self-referential processing have been proposed as a mechanism underlying poor insight. The default mode network (DMN) has been implicated as a key node in the circuit for self-referential processing. We hypothesized that during resting state the DMN network would show decreased connectivity in schizophrenia patients with poor insight compared to patients with good insight. Patients with schizophrenia were recruited from mental health care centers in the north of the Netherlands and categorized in groups having good insight (n= 25) or poor insight (n = 19). All subjects underwent a resting state fMRI scan. A healthy control group (n = 30) was used as a reference. Functional connectivity of the anterior and posterior part of the DMN, identified using Independent Component Analysis, was compared between groups. Patients with poor insight showed lower connectivity of the ACC within the anterior DMN component and precuneus within the posterior DMN component compared to patients with good insight. Connectivity between the anterior and posterior part of the DMN was lower in patients than controls, and qualitatively different between the good and poor insight patient groups. As predicted, subjects with poor insight in psychosis showed decreased connectivity in DMN regions implicated in self-referential processing, although this concerned only part of the network. This finding is compatible with theories implying a role of reduced self-referential processing as a mechanism contributing to poor insight.
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Affiliation(s)
- Edith J Liemburg
- Department of Neuroscience, University Medical Center Groningen and BCN NeuroImaging Center, University of Groningen, Groningen, The Netherlands.
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Schneider M, Debbané M, Lagioia A, Salomon R, d'Argembeau A, Eliez S. Comparing the neural bases of self-referential processing in typically developing and 22q11.2 adolescents. Dev Cogn Neurosci 2012; 2:277-89. [PMID: 22483077 DOI: 10.1016/j.dcn.2011.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 12/23/2011] [Accepted: 12/24/2011] [Indexed: 02/02/2023] Open
Abstract
The investigation of self-reflective processing during adolescence is relevant, as this period is characterized by deep reorganization of the self-concept. It may be the case that an atypical development of brain regions underlying self-reflective processing increases the risk for psychological disorders and impaired social functioning. In this study, we investigated the neural bases of self- and other-related processing in typically developing adolescents and youths with 22q11.2 deletion syndrome (22q11DS), a rare neurogenetic condition associated with difficulties in social interactions and increased risk for schizophrenia. The fMRI paradigm consisted in judging if a series of adjectives applied to the participant himself/herself (self), to his/her best friend or to a fictional character (Harry Potter). In control adolescents, we observed that self- and other-related processing elicited strong activation in cortical midline structures (CMS) when contrasted with a semantic baseline condition. 22q11DS exhibited hypoactivation in the CMS and the striatum during the processing of self-related information when compared to the control group. Finally, the hypoactivation in the anterior cingulate cortex was associated with the severity of prodromal positive symptoms of schizophrenia. The findings are discussed in a developmental framework and in light of their implication for the development of schizophrenia in this at-risk population.
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Affiliation(s)
- Maude Schneider
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, 1 David Dufour, CP 50, 1211 Geneva 8, Switzerland
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Pérez-Álvarez M, García-Montes JM, Vallina-Fernández O, Perona-Garcelán S, Cuevas-Yust C. New life for schizophrenia psychotherapy in the light of phenomenology. Clin Psychol Psychother 2010; 18:187-201. [PMID: 20677182 DOI: 10.1002/cpp.716] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recent contributions to the theoretical conception and empirical evaluation of schizophrenia in the light of phenomenology are opening the way to new perspectives in psychotherapy. The phenomenological conception understands schizophrenia as a disturbance of the basic sense of selfhood (ipseity) characterized by hyper-reflexivity and diminished sense of self. Evaluation consists of examining the anomalous self-experience in a series of domains, which makes the conception presented operable. On this basis, a phenomenologically informed psychotherapy is introduced. Its characteristics are pointed out and early intervention is reviewed (the last frontier in psychosis) from this perspective. Finally, a series of psychotherapies which, although they do not have a phenomenological origin, may be seen from that perspective, are re-examined. These are the narrative, mindfulness and acceptance and commitment therapies.
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