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Poletti M, Raballo A. Ontogenesis of self-disorders in the schizophrenia spectrum: A phenomenological neuro-developmental model. Schizophr Res 2024; 272:26-35. [PMID: 39181008 DOI: 10.1016/j.schres.2024.08.007] [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: 03/28/2024] [Revised: 06/28/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
The concept of basic Self-disorders (SD) captures the experiential aspects associated with vulnerability to schizophrenia spectrum disorders (SSD). SD emerge prior to, and constitute the underlying structure for, the emergence of major diagnostic symptoms, including positive psychotic ones. SD are also detectable in populations with familial risk for SSD. This paper proposes a two-stage phenomenological-developmental model, exploring the early deficit in multisensory integration and their impact on the ontogeny of the Minimal Self in the first years of life. It also examines subsequent emergence of schizotaxic vulnerability, which later manifests as typical anomalies of subjectivity, such as basic symptoms and self-disorders.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Chair of Psychiatry, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Cantonal Sociopsychiatric Organisation, Public Health Division, Department of Health and Social Care, Repubblica e Cantone Ticino, Mendrisio, Switzerland.
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Burgin S, Reniers R, Humpston C. Prevalence and assessment of self-disorders in the schizophrenia spectrum: a systematic review and meta-analysis. Sci Rep 2022; 12:1165. [PMID: 35064201 PMCID: PMC8782935 DOI: 10.1038/s41598-022-05232-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Self-disorders have been proposed as the "clinical core" of the schizophrenia spectrum. This has been explored in recent studies using self-disorder assessment tools. However, there are few systematic discussions of their quality and utility. Therefore, a literature search was performed on Medline, Embase, PsychINFO, PubMed and the Web of Science. Studies using these assessment tools to explore self-disorders within schizophrenia spectrum disorders (SSDs) were included. A meta-analysis was performed on the outcomes of total self-disorder score and odds ratios of self-disorders, using Comprehensive Meta-Analysis software. Weighted pooled effect sizes in Hedge's g were calculated using a random-effects model. 15 studies were included, giving a sample of 810 participants on the schizophrenia spectrum. Self-disorders showed a greater aggregation within schizophrenia spectrum groups compared to non-schizophrenia spectrum groups, as measured with the Bonn Scale for the Assessment of Basic Symptoms (Hedge's g = 0.774, p < 0.01) and Examination of Anomalous Self-Experiences (Hedge's g = 1.604, p < 0.01). Also, self-disorders had a greater likelihood of occurring within SSDs (odds ratio = 5.435, p < 0.01). These findings help to validate self-disorders as a core clinical feature of the broad schizophrenia spectrum.
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Affiliation(s)
- Sam Burgin
- University of Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK
| | - Renate Reniers
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK
| | - Clara Humpston
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.
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Sengutta M, Karow A, Gawęda Ł. Anomalous self-experiences (ASE) in relation to clinical high risk for psychosis (CHRP), childhood trauma and general psychopathology among adolescent and young adult help seekers. Schizophr Res 2021; 237:182-189. [PMID: 34536752 DOI: 10.1016/j.schres.2021.09.009] [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: 03/22/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anomalous self-experiences (ASE) are suggested as a phenotypic core feature of schizophrenia spectrum disorders and present in at risk samples as well. In our study, we investigated the relation between ASE and clinical high risk state for psychosis (CHRP) against the background of further influencing factors like childhood trauma and general psychopathology. METHODS 126 help-seeking adolescents were included. CHR-P patients were identified using the Structured Interview for Psychosis-Risk Syndromes (SIPS). ASE were assessed with the Inventory of Psychotic-like Anomalous Self-Experiences (IPASE). Childhood trauma, depression and anxiety were assessed with well-established questionnaires (CTQ; PHQ-9; GAD-7). RESULTS CHR-P subgroup (n = 50, 39.7%) show significantly higher scores in IPASE total (t (81.07) = -5.150, p = .000) and CTQ total (t (85.95) = -2.75, p = .007) in comparison with the non CHR-P subgroup. Logistic regression analysis confirmed that IPASE total could predict CHR-P status (OR 1.03, 95% CI 1.01-1.04, p = .000). Furthermore, CTQ total and IPASE total show moderate to strong positive correlation (r = 0.44, p < .001) as well as CTQ total with both IPASE subdomains Cognition (r = 0.404, p < .001) and Self- Awareness (r = 0.443, p < .001). CONCLUSION The CHR-P subgroup shows significantly more ASE than the non CHR-P subgroup. Further, ASE predicted CHR-P status. Our results indicated that ASE could play a considerable role in the identification of high risk for developing schizophrenia spectrum disorder and could complement CHR-P testing. Importantly, it seems that ASE may be related to exposure to childhood trauma.
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Affiliation(s)
- Mary Sengutta
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
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Well-Being and Self-Disorders in Schizotypal Disorder and Asperger Syndrome/Autism Spectrum Disorder. J Nerv Ment Dis 2020; 208:418-423. [PMID: 31977719 DOI: 10.1097/nmd.0000000000001145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We explored subjective well-being in two groups of young adult participants diagnosed with either schizotypal disorder (Sd) (n = 29) or Asperger syndrome/autism spectrum disorder (As/ASD) (n = 22). Well-being was impaired in both groups and was lower in the Sd group than in the As/ASD group. Furthermore, there was a negative correlation between well-being and the presence of self-disorders. The negative effect of self-disorders on well-being was still significant when adjusted for diagnosis, age and gender, and level of function. The present findings point toward clinically important disorder-specific differences in the nature of impaired well-being between the Sd group and the As/ASD group, as there seems to be a self-disorder-driven additional contribution to impaired subjective well-being within the schizophrenia spectrum. These findings further nuance the understanding of fundamental and clinically important qualitative differences between the schizophrenia spectrum and the autism spectrum.
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Cicero DC, Gawęda Ł, Nelson B. The placement of anomalous self-experiences within schizotypal personality in a nonclinical sample. Schizophr Res 2020; 218:219-225. [PMID: 31973995 DOI: 10.1016/j.schres.2019.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Anomalous self-experiences are disturbances in the subjective experience of the self and have been shown to be related to the premorbid, prodromal, acute, and chronic phases of schizophrenia-spectrum disorders. Despite having a long history in psychopathology research, anomalous self-experiences are not explicitly represented in any major nosology of mental disorders. Previous research suggests that anomalous self-experiences are correlated, but distinct from other aspects of schizotypal personality, but this has not been examined with confirmatory factor analysis. The current research aimed to examine where anomalous self-experiences fit within the structure of schizotypal personality including cognitive-perceptual, interpersonal, disorganized, and paranoid factors. It also examined the measurement invariance of the factor structure across ethnicity and between sexes. Seven hundred forty-four participants completed multiple measures of anomalous self-experiences and schizotypal personality. The best fitting model was a five-factor model with anomalous self-experiences, cognitive-perceptual, interpersonal, disorganized, and paranoid factors. This model fit better than models with anomalous self-experiences loading on any of the four schizotypal personality factors. The structure had configural, metric, and scalar invariance across race/ethnicities, but lacked scalar invariance between sexes. Anomalous self-experience scores did not differ among race/ethnicity or between sexes. These results suggest that anomalous self-experiences are highly correlated with but distinct from other facets of schizotypal personality. Future research may examine whether anomalous self-experiences should be added to nosologies of psychotic-spectrum disorders.
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Affiliation(s)
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Nilsson M, Arnfred S, Carlsson J, Nylander L, Pedersen L, Mortensen EL, Handest P. Self-Disorders in Asperger Syndrome Compared to Schizotypal Disorder: A Clinical Study. Schizophr Bull 2020; 46:121-129. [PMID: 31050761 PMCID: PMC6942161 DOI: 10.1093/schbul/sbz036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are historical and theoretical indications of a difference in subjective experience between autism spectrum disorder (ASD) and the schizophrenia spectrum. However, this difference has not been empirically explored. Therefore, to explore potential differences in subjective experience between the 2 spectra, we examined the presence/absence of self-disorders in Asperger syndrome/autism spectrum disorder (As/ASD) compared to schizotypal disorder (Sd). Self-disorders represent changes in basic self-awareness which have been found to accumulate within the schizophrenia spectrum. METHODS All participants were recruited from clinical units and interviewed with a focus on the exploration of presence/absence of self-disorders, with the Examination of Anomalous Self-Experience (EASE) scale, and a general assessment of present psychopathology, with Schedules for Clinical Assessment in Neuropsychiatry (SCAN). RESULTS A total of 51 participants (As/ASD, n = 22; Sd, n = 29) were included in the statistical analyses. When controlling for age, gender, years of education, mental problems before the age of 16, and special needs school attendance, there was a clear difference in presence/absence of self-disorders between the 2 groups, with significantly higher levels in the Sd group. Further, there was an overlap in SCAN-rated symptoms between the 2 groups. CONCLUSION Our results indicate a significant difference between As/ASD and Sd at the level of the basic self, which, in turn, indicates that an exploration of anomalous self-experience is a valuable supplement in the clinical differentiation between As/ASD and Sd.
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Affiliation(s)
- Maria Nilsson
- Mental Health Centre Ballerup, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sidse Arnfred
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services - Region Zealand, Slagelse, Denmark
| | - Jessica Carlsson
- Mental Health Centre Ballerup, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lena Nylander
- Department of Clinical Sciences/Psychiatry, Lund University, Lund, Sweden
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | | | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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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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Hamm JA, Leonhardt BL, Ridenour J, Lysaker JT, Lysaker PH. Phenomenological and recovery models of the subjective experience of psychosis: discrepancies and implications for treatment. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2018. [DOI: 10.1080/17522439.2018.1522540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jay A. Hamm
- Midtown Community Mental Health, Eskenazi Health, Indianapolis IN, USA
- College of Pharmacy, Purdue University, Indianapolis IN, USA
| | - Bethany L. Leonhardt
- Midtown Community Mental Health, Eskenazi Health, Indianapolis IN, USA
- School of Medicine, Indiana University, Indianapolis IN, USA
| | | | | | - Paul H. Lysaker
- School of Medicine, Indiana University, Indianapolis IN, USA
- Roudebush VA Medical Center, Indianapolis IN, USA
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Nelson B, Sass LA. Towards integrating phenomenology and neurocognition: Possible neurocognitive correlates of basic self-disturbance in schizophrenia. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to disruption of the sense of ownership of experience and agency of action and is associated with a variety of anomalous subjective experiences. Little is known about the neurocognitive correlates of basic self-disturbance. In this paper, we review recent phenomenological and neurocognitive research and point to a convergence of these approaches around the concept of self-disturbance. Specifically, we propose that subjective anomalies associated with basic self-disturbance may be associated with: 1. source monitoring deficits, which may contribute particularly to disturbances of “ownership” and “mineness” (the phenomenological notion of presence) and 2. aberrant salience, and associated disturbances of memory, prediction, and attention processes, which may contribute to hyper-reflexivity, disturbed “grip” or “hold” on the perceptual and conceptual field, and disturbances of intuitive social understanding (“common sense”). These two streams of research are reviewed in turn before considering ways forward in integrative models, particularly regarding the role of early neurodevelopmental disturbances, primary versus secondary disturbances, and the state versus trait nature of such pathology. Empirical studies are required in a variety of populations in order to test the proposed associations between phenomenological and neurocognitive aspects of self-disturbance in schizophrenia. An integration of findings across the phenomenological and neurocognitive domains would represent a significant advance in the understanding of schizophrenia and possibly enhance early identification and intervention strategies.
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Affiliation(s)
- Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health , Melbourne , Australia
- Centre for Youth Mental Health , University of Melbourne , Melbourne , Australia
| | - Louis A. Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology , Rutgers University , Piscataway , New Jersey, United States of America
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