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Jimenez AM, Green MF. Disturbance at the self-other boundary in schizophrenia: Linking phenomenology to clinical neuroscience. Schizophr Res 2024; 272:51-60. [PMID: 39190982 DOI: 10.1016/j.schres.2024.07.048] [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: 03/22/2024] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024]
Abstract
In this selective review, we describe the current neuroscientific literature on disturbances of the self-other boundary in schizophrenia as they relate to structural and experiential aspects of the self. Within these two broad categories, the structural self includes body ownership and agency, and the experiential self includes self-reflection, source monitoring, and self-referential and autobiographical memory. Further, we consider how disturbances in these domains link to the phenomenology of schizophrenia. We identify faulty internal predictive coding as a potential mechanism of disturbance in body ownership and agency, which results in susceptibility to bias (over- or under-attributing outcomes to one's own actions or intentions). This is reflected in reduced activity in the temporoparietal junction (TPJ), a heteromodal association area implicated in several aspects of self-other processing, as well as reduced fronto-parietal functional connectivity. Deficits of the experiential self in schizophrenia may stem from a lack of salience of self-related information, whereby the mental representation of self is not as rich as in healthy controls and therefore does not result in the same level of privileged processing. As a result, memory for self-referential material and autobiographical memory processes is impaired, which hinders creation of a cohesive life narrative. Impairments of the experiential self implicate abnormal activation patterns along the cortical midline, including medial prefrontal cortex and posterior cingulate/precuneus, as well as TPJ. In fact, TPJ appears to be involved in all the reviewed aspects of the self-other disturbance. We conclude with suggestions for future work, including implications for interventions with critical timing considerations.
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Affiliation(s)
- Amy M Jimenez
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, USA; VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, UCLA, USA.
| | - Michael F Green
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, USA; VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, UCLA, USA
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2
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Sabbah SG, Northoff G. Global neural self-disturbance in schizophrenia: A systematic fMRI review. Schizophr Res 2024; 269:163-173. [PMID: 38820980 DOI: 10.1016/j.schres.2024.05.015] [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: 11/29/2023] [Revised: 04/04/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
There is a general consensus that schizophrenia (SZ) is characterized by major changes in the sense of self. Phenomenological studies suggest that these changes in the sense of self stem from a basic disturbance, hence the term 'basic self-disturbance'. While imaging studies demonstrate changes in various regions during self-focused tasks, the exact neural correlates of such basic self-disturbances remain unclear. If the self-disturbance is indeed basic and thereby underlies all other symptoms, one would expect it to be related to more global rather than local changes in the brain. Testing this hypothesis, we conducted a systematic review of fMRI studies on self in SZ. Our main findings are 1. Abnormal activity related to the self can be observed in a variety of different regions ranging from higher-order transmodal to lower-order unimodal regions, 2. These findings hold true across different tasks including self-reflection, self-referentiality, and self-agency, and 3. The global neural abnormalities related to the self in SZ correspond to all layers of the self, predominantly the mental and exteroceptive self. Such global neural disturbance of self converges well with the basic self-disturbance as described in phenomenology.
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Affiliation(s)
- Sami George Sabbah
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada; 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
| | - 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
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Salgado-Pineda P, Fuentes-Claramonte P, Spanlang B, Pomes A, Landin-Romero R, Portillo F, Bosque C, Franquelo JC, Teixido C, Sarró S, Salvador R, Pomarol-Clotet E. Neural correlates of disturbance in the sense of agency in schizophrenia: An fMRI study using the 'enfacement' paradigm. Schizophr Res 2022; 243:395-401. [PMID: 34218983 DOI: 10.1016/j.schres.2021.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/26/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
An altered sense of self-awareness and agency has been proposed to underlie symptoms of schizophrenia. In this study, we used the enfacement illusion paradigm - in which perception of another person's face leads to changes in perception of one's own peri-personal space - to examine the brain correlates of the sense of agency and its potential disruption in schizophrenia. Thirty-three schizophrenic patients and 27 healthy controls underwent fMRI scanning during performance of a task designed to elicit the enfacement illusion. Activations were examined using whole-brain analysis and also in an a priori identified region of interest (ROI) in the temporoparietal junction (TPJ), a region that has been described as involved in self/other differentiation and sense of agency. Both groups showed a pattern of cortical activation involving the pre and postcentral cortex, Rolandic operculum, insula, parietal, temporal and occipital cortex bilaterally as well as TPJ (but only right-side in patients). Examination of the TPJ ROI revealed significantly reduced activation on the left in the patients that was associated with poorer insight. The findings suggest brain functional abnormality in schizophrenia related to the formation or maintenance of processes related to self and/or agency. Decreased function in the TPJ may have a role in the impaired insight seen in patients with the disorder.
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Affiliation(s)
- Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
| | - P Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Bernhard Spanlang
- Event Lab, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Institute of Neuroscience of the University of Barcelona, Barcelona, Spain; Virtual Bodyworks S.L., Barcelona, Spain
| | - Ausias Pomes
- Event Lab, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain; Accenture, Barcelona, Spain
| | - Ramón Landin-Romero
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; The University of Sydney, Brain & Mind Centre, Sydney, NSW, Australia; Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney,NSW, Australia
| | | | - Clara Bosque
- Benito Menni Complex Assistencial en Salut Mental, Barcelona, Spain
| | | | - Cristina Teixido
- Hospital Mare de Dèu de la Mercé, Unitat Polivalent Barcelona Nord, Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
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4
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van Gool KCA, Collin G, Bauer CCC, Molokotos E, Mesholam-Gately RI, Thermenos HW, Seidman LJ, Gabrieli JDE, Whitfield-Gabrieli S, Keshavan MS. Altered working memory-related brain activity in children at familial high risk for psychosis: A preliminary study. Schizophr Res 2022; 240:186-192. [PMID: 35032903 DOI: 10.1016/j.schres.2021.12.030] [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: 05/06/2021] [Revised: 10/03/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Schizophrenia spectrum disorders are heritable illnesses that usually manifest in early adulthood but are increasingly viewed as neurodevelopmental disorders. Functional magnetic resonance imaging (fMRI) studies show altered brain activity during performance of working memory (WM) tasks in both individuals with schizophrenia and their first-degree relatives as compared to healthy controls (HC). This study examined whether similar changes are already present in pre-adolescent children at familial high-risk (FHR) for psychosis. METHODS 37 children (17 FHR, 20 HC) between 7 and 12 years old participated in this study. WM performance was assessed using the Wechsler Intelligence Scale for Children-IV (WISC-IV). To assess brain activation during WM performance, participants completed a visual block-designed n-back task with 2 conditions (2-back and 0-back) during scanning. fMRI data was preprocessed and analyzed using FSL Feat. RESULTS Compared to HC, FHR children showed significantly lower WISC-IV WM scores. In addition, FHR children exhibited hypoactivation in the 2-back (versus 0-back) condition in a cluster encompassing bilateral precuneus and cuneus and right posterior cingulate cortex. There were no significant group-differences in n-back task performance and brain activation. The precuneus cluster was not correlated with n-back performance or WISC WM scores. CONCLUSIONS The current results provide preliminary evidence of impaired WM function and altered brain activity during WM performance in children with a familial predisposition for psychosis. Longitudinal studies are needed to determine whether these findings are related to abnormal brain development and predictive of cognitive deficits and psychosis later in life.
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Affiliation(s)
- Kevin C A van Gool
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands.
| | - Guusje Collin
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands; Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Clemens C C Bauer
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Psychology, Northeastern University, Boston, MA, USA
| | - Elena Molokotos
- Department of Psychology, Suffolk University, Boston, MA, USA
| | | | - Heidi W Thermenos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John D E Gabrieli
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Psychology, Northeastern University, Boston, MA, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Mental Health, Massachusetts Mental Health Center, Boston, MA, USA
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5
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Collin G, Bauer CCC, Anteraper SA, Gabrieli JDE, Molokotos E, Mesholam-Gately R, Thermenos HW, Seidman LJ, Keshavan MS, Shenton ME, Whitfield-Gabrieli S. Hyperactivation of Posterior Default Mode Network During Self-Referential Processing in Children at Familial High-Risk for Psychosis. Front Psychiatry 2021; 12:613142. [PMID: 33633608 PMCID: PMC7900488 DOI: 10.3389/fpsyt.2021.613142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022] Open
Abstract
Patients with schizophrenia spectrum disorders show disturbances in self-referential processing and associated neural circuits including the default mode network (DMN). These disturbances may precede the onset of psychosis and may underlie early social and emotional problems. In this study, we examined self-referential processing in a group of children (7-12 years) at familial high risk (FHR) for psychosis (N = 17), compared to an age and sex-matched group of healthy control (HC) children (N = 20). The participants were presented with a list of adjectives and asked to indicate whether or not the adjectives described them (self-reference condition) and whether the adjectives described a good or bad trait (semantic condition). Three participants were excluded due to chance-level performance on the semantic task, leaving N = 15 FHR and N = 19 HC for final analysis. Functional MRI (fMRI) was used to measure brain activation during self-referential vs. semantic processing. Internalizing and externalizing problems were assessed with the Child Behavior Checklist (CBCL). Evaluating main effects of task (self > semantic) showed activation of medial prefrontal cortex in HC and precuneus/posterior cingulate cortex (PCC) in FHR. Group-comparison yielded significant results for the FHR > HC contrast, showing two clusters of hyperactivation in precuneus/ PCC (p = 0.004) and anterior cerebellum / temporo-occipital cortex (p = 0.009). Greater precuneus/PCC activation was found to correlate with greater CBCL internalizing (r = 0.60, p = 0.032) and total (r = 0.69, p = 0.009) problems. In all, this study shows hyperactivity of posterior DMN during self-referential processing in pre-adolescent FHR children. This finding posits DMN-related disturbances in self-processing as a developmental brain abnormality associated with familial risk factors that predates not just psychosis, but also the prodromal stage. Moreover, our results suggest that early disturbances in self-referential processing may be related to internalizing problems in at-risk children.
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Affiliation(s)
- Guusje Collin
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, Netherlands
| | - Clemens C C Bauer
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
| | - Sheeba Arnold Anteraper
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
| | - John D E Gabrieli
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Elena Molokotos
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Raquelle Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Heidi W Thermenos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
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6
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Ebisch SJH. The Self and Its Nature: A Psychopathological Perspective on the Risk-Reducing Effects of Environmental Green Space for Psychosis. Front Psychol 2020; 11:531840. [PMID: 33262717 PMCID: PMC7686509 DOI: 10.3389/fpsyg.2020.531840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
Epidemiological studies have shown that environmental green space contributes to the reduction of psychosis incidence in the population. Clarifying the psychological and neuro-functional mechanisms underlying the risk-decreasing effects of green surroundings could help optimize preventive environmental interventions. This perspective article specifically aims to open a new window on the link between environmental green space and psychosis by considering its core psychopathological features. Psychotic disorders, such as schizophrenia, are essentially characterized by self-disturbances. The psychological structure of the self has been described as a multidimensional phenomenon that emerges from the reciprocal interaction with the environment through intrinsic and extrinsic self-processes. The intrinsic self refers to the experience of mental activity and environmental information as inherently related to one’s own person, which involves self-referential processing, self-reflection, memory, interoception, and emotional evaluation. The extrinsic self refers to sensorimotor interactions with the environment and the sense of agency, that is, the experience of being the source of one’s own actions and the multisensory consequences thereof. In psychosis, anomalous self-processing has been related to a functional fragmentation of intrinsic and extrinsic self-processes and related brain networks. Moreover, evidence from cognitive neuroscience suggests that green space could have beneficial effects on self-related processing. Based on the literature, it could be hypothesized that self-processing is involved in mediating the beneficial effects of green space for psychosis. Considering the multidimensionality of the self, it is proposed that urban green space design aimed at improving mental health ideally impacts the complexity of self-facets and thus restores the individual’s self.
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Affiliation(s)
- Sjoerd J H Ebisch
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies (ITAB), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
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Duran KA, O'Halloran H, Soder H, Yasin S, Kramer R, Rosen S, Brenya J, Chavarria K, Savitska L, Keenan JP. The medial prefrontal cortex: a potential link between self-deception and affect. Int J Neurosci 2020; 131:701-707. [PMID: 32253949 DOI: 10.1080/00207454.2020.1753729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Medial Prefrontal Cortex (MPFC) is crucial for normal social functioning in humans. Because of its involvement in social monitoring, self-awareness, and self-enhancement, the MPFC may be critical to buffering negative affect and establishing a positive self-esteem. For example, we have previously found that disruption of the MPFC leads to more honest responses, which implies that the MPFC may be critically involved in self-deception. We therefore hypothesized that disrupting the MPFC would lead to a decrease in affect. Employing a virtual lesion TMS (Transcranial Magnetic Stimulation) technique, we disrupted the MPFC while participants rated their mood based on two anchor affect terms. During TMS, the participants rated their current emotional mental state. Compared to sham TMS, it was found that mood was reduced immediately following single-pulse MPFC stimulation. The results supported the hypothesis the MPFC mood reduction occurs when the MPFC is disrupted. Because this study replicated the conditions employed in previous self-deception studies, we suggest that the results may indicate that lack of self-enhancement may lead to a decrease in mood. Further studies should examine this possibility.
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Affiliation(s)
- Kelly A Duran
- School of Public Policy and Administration, University of Delaware, Newark, New Jersey, USA
| | - Hannah O'Halloran
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Heather Soder
- McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Saeed Yasin
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, New Jersey, USA
| | - Rachel Kramer
- Department of Psychology, University of North Dakota, Grand Forks, North Dakota, USA
| | - Sydney Rosen
- McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Janet Brenya
- McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Katherine Chavarria
- McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Liliia Savitska
- McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Julian Paul Keenan
- McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
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8
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Fuentes-Claramonte P, Martin-Subero M, Salgado-Pineda P, Santo-Angles A, Argila-Plaza I, Salavert J, Arévalo A, Bosque C, Sarri C, Guerrero-Pedraza A, Capdevila A, Sarró S, McKenna PJ, Pomarol-Clotet E, Salvador R. Brain imaging correlates of self- and other-reflection in schizophrenia. NEUROIMAGE-CLINICAL 2019; 25:102134. [PMID: 31877452 PMCID: PMC6931228 DOI: 10.1016/j.nicl.2019.102134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/29/2019] [Accepted: 12/13/2019] [Indexed: 01/06/2023]
Abstract
Self- and other-reflection in schizophrenia were studied with fMRI. Patients failed to activate the right temporo-parietal junction in other-reflection. They also hyperactivated lateral prefrontal cortex for self and other-reflection. These findings might be linked to altered self/other processing in schizophrenia.
Background An alteration in self/other differentiation has been proposed as a basis for several symptoms in schizophrenia, including delusions of reference and social functioning deficits. Dysfunction of the right temporo-parietal junction (TPJ), a region linked with social cognition, has been proposed as the basis of this alteration. However, imaging studies of self- and other-processing in schizophrenia have shown, so far, inconsistent results. Methods Patients with schizophrenia and healthy controls underwent fMRI scanning while performing a task with three conditions: self-reflection, other-reflection and semantic processing. Results Both groups activated similar brain regions for self- and other-reflection compared to semantic processing, including the medial prefrontal cortex, the precuneus and the TPJ. Compared to healthy subjects, patients hyperactivated the left lateral frontal cortex during self- and other-reflection. In other-reflection, compared to self-reflection, patients failed to increase right TPJ activity. Conclusions Altered activity in the right TPJ supports a disturbance in self/other differentiation in schizophrenia, which could be linked with psychotic symptoms and affect social functioning in patients. Hyperactivity of the lateral frontal cortex for self- and other-reflection suggests the presence of greater cognitive demand to perform the task in the patient group.
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Affiliation(s)
- Paola Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Marta Martin-Subero
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Aniol Santo-Angles
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Isabel Argila-Plaza
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain
| | - Josep Salavert
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Psychiatry Department, Hospital Sant Rafael, Barcelona, Spain
| | - Antoni Arévalo
- Psychiatry Department, Hospital Sagrat Cor Martorell Barcelona, Spain
| | - Clara Bosque
- Benito Menni Centre Assistencial en Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
| | - Carmen Sarri
- Benito Menni Centre Assistencial en Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Antoni Capdevila
- Radiology Unit, Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain; CIBER-BBN (Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina), Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain.
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Carrer Dr. Antoni Pujadas, 38, 08830 Sant Boi de Llobregat, Barcelona Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain
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9
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Furuichi A, Kawasaki Y, Takahashi T, Nakamura K, Tanino R, Noguchi K, Kurachi M, Suzuki M. Altered neural basis of self-reflective processing in schizophrenia: An fMRI study. Asian J Psychiatr 2019; 45:53-60. [PMID: 31505454 DOI: 10.1016/j.ajp.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Impaired self-awareness has often been described in schizophrenia. Recent neuroimaging studies examining the self-reflection processes in schizophrenia have produced inconsistent results. METHOD We examined the self-reflective neural network using self- and other-evaluation tasks in schizophrenia. Fifteen schizophrenia patients and fifteen age- and sex-matched healthy subjects underwent functional magnetic resonance imaging. Subjects were required to decide whether the sentence described their own personal trait (self-evaluation) and that of their close friends (other-evaluation). RESULTS Unlike normal control subjects, the schizophrenia patients did not have greater activation of the left posterior cingulate gyrus and hippocampus during self-evaluation than during other-evaluation. On the other hand, the schizophrenia patients had higher activation of the right superior frontal and right supramarginal gyri during self-evaluation than control subjects. Only the patient group exhibited hyperactivation in the left hippocampus and right external capsule associated with the other-evaluation task. CONCLUSIONS These findings provide evidence for an altered neural basis of self-reflective processing, which may underlie the self-awareness deficits in schizophrenia.
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Affiliation(s)
- Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
| | - Yasuhiro Kawasaki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Department of Neuropsychiatry, Kanazawa Medical University, Uchinada, Japan
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kazue Nakamura
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Hoshiicho Mental Clinic, Toyama, Japan
| | - Ryoichiro Tanino
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Tanino Gozan Hospital, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Masayoshi Kurachi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan; Arisawabashi Hospital, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
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Potvin S, Gamache L, Lungu O. A Functional Neuroimaging Meta-Analysis of Self-Related Processing in Schizophrenia. Front Neurol 2019; 10:990. [PMID: 31572296 PMCID: PMC6749044 DOI: 10.3389/fneur.2019.00990] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/30/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Schizophrenia is characterized by self-disturbances, including impaired self-evaluation abilities and source monitoring. The cortical midline structures (e.g., medial prefrontal cortex, anterior and posterior cingulate cortex, and precuneus) and the temporoparietal junction are known to play a key role in self-related processing. In theory, self-disturbances in schizophrenia may arise from impaired activity in these regions. We performed a functional neuroimaging meta-analysis to verify this hypothesis. Methods: A literature search was performed with PubMed and Google Scholar to identify functional neuroimaging studies examining the neural correlates of self-processing in schizophrenia, using self-other or source monitoring paradigms. Fourteen studies were retrieved, involving 245 patients and 201 controls. Using peak coordinates to recreate an effect-size map of contrast results, a standard random-effects variance weighted meta-analysis for each voxel was performed with the Seed-based d Mapping software. Results: During self-processing, decreased activations were observed in schizophrenia patients relative to controls in the bilateral thalamus and the left dorsal anterior cingulate cortex (dACC) and dorso-medial prefrontal cortex. Importantly, results were homogeneous across studies, and no publication bias was observed. Sensitivity analyses revealed that results were replicable in 93-100% of studies. Conclusion: The current results partially support the hypothesized impaired activity of cortical midline brain regions in schizophrenia during self-processing. Decreased activations were observed in the dACC and dorsomedial prefrontal cortex, which are involved in cognitive control and/or salience attribution, as well as decision-making, respectively. These alterations may compromise patients' ability to direct their attention toward themselves and/or others and to make the decision whether a certain trait applies to one's self or to someone else. In addition, decreased activations were observed in the thalamus, which is not a core region of the default-mode network, and is involved in information integration. These thalamic alterations may compromise self-coherence in schizophrenia.
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Affiliation(s)
- Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Lydia Gamache
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Ovidiu Lungu
- Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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11
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Narita N, Kamiya K, Makiyama Y, Iwaki S, Komiyama O, Ishii T, Wake H. Prefrontal modulation during chewing performance in occlusal dysesthesia patients: a functional near-infrared spectroscopy study. Clin Oral Investig 2018; 23:1181-1196. [DOI: 10.1007/s00784-018-2534-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/20/2018] [Indexed: 02/01/2023]
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12
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Jimenez AM, Lee J, Wynn JK, Green MF. The neural correlates of self-referential memory encoding and retrieval in schizophrenia. Neuropsychologia 2017; 109:19-27. [PMID: 29217224 DOI: 10.1016/j.neuropsychologia.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Enhanced memory for self-oriented information is known as the self-referential memory (SRM) effect. fMRI studies of the SRM effect have focused almost exclusively on encoding, revealing selective engagement of the medial prefrontal cortex (mPFC) during "self" relative to other processing conditions. Other critical areas for self-processing include ventrolateral prefrontal cortex (vlPFC), temporo-parietal junction (TPJ) and posterior cingulate/precuneus (PCC/PC). Previous behavioral studies show that individuals with schizophrenia fail to benefit from this memory boost. However, the neural correlates of this deficit, at either encoding or retrieval, are unknown. METHODS Twenty individuals with schizophrenia and 16 healthy controls completed an event-related fMRI SRM paradigm. During encoding, trait adjectives were judged in terms of structural features ("case" condition), social desirability ("other" condition), or as self-referential ("self" condition). Participants then completed an unexpected recognition test (retrieval phase). We examined BOLD activation during both encoding and retrieval within mPFC, vlPFC, TPJ, and PCC/PC regions-of-interest (ROIs). RESULTS During encoding, fMRI data indicated both groups had greater activation during the "self" relative to the "other" condition across ROIs. Controls showed this primarily in mPFC whereas patients showed this in PCC/PC. During retrieval, fMRI data indicated controls showed differentiation across ROIs between "self" and "other" conditions, but patients did not. CONCLUSIONS Results suggest regional differences in the neural processing of self-referential information in individuals with schizophrenia, perhaps because representation of the self is not as well established in patients relative to controls. The current study presents novel findings that add to the literature implicating impaired self-oriented processing in schizophrenia.
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Affiliation(s)
- Amy M Jimenez
- Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, 405 Hilgard Ave., Los Angeles, CA 90095, USA.
| | - Junghee Lee
- Department of Psychiatry and Biobehavioral Sciences, University of California, 405 Hilgard Ave., Los Angeles, CA 90095, USA; Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA
| | - Jonathan K Wynn
- Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, 405 Hilgard Ave., Los Angeles, CA 90095, USA
| | - Michael F Green
- Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, 405 Hilgard Ave., Los Angeles, CA 90095, USA
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13
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Kao YC, Lien YJ, Chang HA, Tzeng NS, Yeh CB, Loh CH. Stigma Resistance in Stable Schizophrenia: The Relative Contributions of Stereotype Endorsement, Self-Reflection, Self-Esteem, and Coping Styles. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:735-744. [PMID: 28884606 PMCID: PMC5638194 DOI: 10.1177/0706743717730827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Stigma resistance (SR) has recently emerged as a prominent aspect of research on recovery from schizophrenia, partly because studies have suggested that the development of stigma-resisting beliefs may help individuals lead a fulfilling life and recover from their mental illness. The present study assessed the relationship between personal SR ability and prediction variables such as self-stigma, self-esteem, self-reflection, coping styles, and psychotic symptomatology. METHOD We performed an exploratory cross-sectional study of 170 community-dwelling patients with schizophrenia. Self-stigma, self-esteem, self-reflection, coping skills, and SR were assessed through self-report. Psychotic symptom severity was rated by the interviewers. Factors showing significant association in univariate analyses were included in a stepwise backward regression model. RESULTS Stepwise regressions revealed that acceptance of stereotypes of mental illness, self-esteem, self-reflection, and only 2 adaptive coping strategies (positive reinterpretation and religious coping) were significant predictors of SR. The prediction model accounted for 27.1% of the variance in the SR subscale score in our sample. CONCLUSIONS Greater reflective capacity, greater self-esteem, greater preferences for positive reinterpretation and religious coping, and fewer endorsements of the stereotypes of mental illness may be key factors that relate to higher levels of SR. These factors are potentially modifiable in tailored interventions, and such modification may produce considerable improvements in the SR of the investigated population. This study has implications for psychosocial rehabilitation and emerging views of recovery from mental illness.
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Affiliation(s)
- Yu-Chen Kao
- 1 Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan.,2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Yin-Ju Lien
- 3 Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsin-An Chang
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Chin-Bin Yeh
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- 5 School of Medicine, National Defense Medical Center, Taipei, Taiwan
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14
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Morosawa S, Iritani S, Fujishiro H, Sekiguchi H, Torii Y, Habuchi C, Kuroda K, Kaibuchi K, Ozaki N. Neuropeptide Y neuronal network dysfunction in the frontal lobe of a genetic mouse model of schizophrenia. Neuropeptides 2017; 62:27-35. [PMID: 28073591 DOI: 10.1016/j.npep.2016.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/18/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022]
Abstract
Neuropeptide Y (NPY) has been found to play a critical role in various mental functions as a neurotransmitter and is involved in the development of schizophrenia, a particularly intractable psychiatric disease whose precise etiology remains unknown. Recent molecular biological investigations have identified several candidate genes which may be associated with this disease, including disrupted-in-schizophrenia 1 (DISC1). The role of DISC1 would involve neurogenesis and neuronal migration. However, the functional consequences of this gene defect have not yet been fully clarified in neuronal systems. In the present study, to clarify the neuropathological changes associated with the function of DISC1, we explored how DISC1 dysfunction can induce abnormalities in the NPY neuronal network in the central nervous system. We performed immunohistochemical analyses (including the observation of the distribution and density) of prefrontal cortex specimens from DISC1-knockout (KO) mice, which are considered to be a novel animal model of schizophrenia. We then evaluated the number and size of NPY-immunoreactive (NPY-IR) neurons and the length of NPY-IR fibers. The number of NPY-IR neurons and the length of the fibers were decreased in the prefrontal cortex of DISC1-KO mice. The decrease was particularly prominent in the superficial regions, and the distribution of NPY-IR neurons differed between wild-type and DISC1-KO mice. However, the size of the neurons in the cortices of the DISC1-KO and wild-type mice did not differ markedly. Our findings suggest that dysfunction of DISC1 may lead to the alteration of NPY neurons and neurotransmission issues in NPY-containing neuron systems, which seem to play important roles in both the mental function and neuronal development. DISC1 dysfunction may be involved in the pathogenesis of schizophrenia through the impairment of the NPY neuronal network.
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Affiliation(s)
- Shunsuke Morosawa
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Shuji Iritani
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Hiroshige Fujishiro
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Hirotaka Sekiguchi
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Youta Torii
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Chikako Habuchi
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Keisuke Kuroda
- Department of Cell Pharmacology, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Kozo Kaibuchi
- Department of Cell Pharmacology, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Norio Ozaki
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
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15
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Umeda K, Iritani S, Fujishiro H, Sekiguchi H, Torii Y, Habuchi C, Kuroda K, Kaibuchi K, Ozaki N. Immunohistochemical evaluation of the GABAergic neuronal system in the prefrontal cortex of a DISC1 knockout mouse model of schizophrenia. Synapse 2016; 70:508-518. [PMID: 27421906 DOI: 10.1002/syn.21924] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/27/2016] [Accepted: 07/11/2016] [Indexed: 01/23/2023]
Abstract
The etiology of schizophrenia remains unknown. However, using molecular biological techniques, some candidate genes have been identified that might be associated with the disease. One of these candidate genes, disrupted-in-schizophrenia 1 (DISC1), was found in a large Scottish family with multiple mental illnesses. The function of DISC1 is considered to be associated with axon elongation and neuron migration in the central nervous system, but the functional consequences of defects in this gene have not been fully clarified in brain neuronal systems. Dysfunction of the gamma-aminobutyric acid (GABA)ergic neuronal system is also considered to contribute to the pathogenesis of schizophrenia. Thus, to clarify the neuropathological changes associated with DISC1 dysfunction, we investigated the number and distribution of GABAergic neurons in the prefrontal cortex of DISC1 knockout mice. We immunohistochemically quantified the laminar density of GABAergic neurons using anti-parvalbumin and anti-calbindin D28k antibodies (markers of GABAergic neuronal subpopulations). We found that the densities of both parvalbumin- and calbindin-immunoreactive neurons in the anterior cingulate, medial prefrontal, and orbitofrontal cortices were markedly lower in DISC1 knockout mice than in wild-type mice. In addition, reductions in cell density were observed in layers II and III and the deep layers of the cortex. This reduction in GABAergic neuronal density was not associated with alterations in neuronal size. These findings suggest that disrupted GABAergic neuronal network formation due to a DISC1 deficit might be involved in the pathophysiology of schizophrenia.
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Affiliation(s)
- Kentaro Umeda
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shuji Iritani
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Hiroshige Fujishiro
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hirotaka Sekiguchi
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Youta Torii
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Chikako Habuchi
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Keisuke Kuroda
- Department of Cell Pharmacology, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kozo Kaibuchi
- Department of Cell Pharmacology, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Norio Ozaki
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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16
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Ebisch SJH, Aleman A. The fragmented self: imbalance between intrinsic and extrinsic self-networks in psychotic disorders. Lancet Psychiatry 2016; 3:784-790. [PMID: 27374147 DOI: 10.1016/s2215-0366(16)00045-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 12/22/2022]
Abstract
Self-disturbances are among the core features of schizophrenia and related psychotic disorders. The basic structure of the self could depend on the balance between intrinsic and extrinsic self-processing. We discuss studies on self-related processing in psychotic disorders that provide converging evidence for disrupted communication between neural networks subserving the so-called intrinsic self and extrinsic self. This disruption might be mainly caused by impaired integrity of key brain hubs. The intrinsic self has been associated with cortical midline structures involved in self-referential processing, autobiographical memory, and emotional evaluation. Additionally, we highlight central aspects of the extrinsic self in its interaction with the environment using sensorimotor networks, including self-experience in sensation and actions. A deficient relationship between these self-aspects because of disrupted between-network interactions offers a framework to explain core clinical features of psychotic disorders. In particular, we show how relative isolation and reduced modularity of networks subserving intrinsic and extrinsic self-processing might trigger the emergence of hallucinations and delusions, and why patients with psychosis typically have difficulties with self-other relationships and do not recognise mental problems.
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Affiliation(s)
- Sjoerd J H Ebisch
- Department of Neuroscience, Imaging & Clinical Sciences, Institute of Advanced Biomedical Technologies (ITAB), G d'Annunzio University, Chieti, Italy.
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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