Schizophrenia and the bodily self

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.

Schizophrenia, the very idea: On self-disorder, hyperreflexivity, and the diagnostic concept

The purpose of the present article is to consider schizophrenia-the very idea-from the perspective of phenomenological psychopathology, with special attention to the problematic nature of the diagnostic concept as well as to the prospect and challenges inherent in focusing on subjective experience. First, we address historical and philosophical topics relevant to the legitimacy of diagnostic categorization-in general and regarding "schizophrenia" in particular. William James's pragmatist approach to categorization is discussed. Then we offer a version of the well-known basic-self or ipseity-disturbance model (IDM) of schizophrenia, but in a significantly revised form (IDMrevised). The revised model better acknowledges the diverse and even seemingly contradictory nature of schizophrenic symptoms while, at the same time, interpreting these in a more unitary fashion via the key concept of hyperreflexivity-a form of exaggerated self-awareness that tends to undermine normal world-directedness and the stability of self-experience. Particular attention is paid to forms of exaggerated "self-presence" that are sometimes neglected yet imbue classically schizophrenic experiences involving subjectivism or quasi-solipsism and/or all-inclusive or ontological forms of paranoia. We focus on the distinctively paradoxical nature of schizophrenic symptomatology. In concluding we consider precursors in the work of Klaus Conrad, Kimura Bin and Henri Grivois. Finally we defend the concept of schizophrenia by considering its distinctive way of altering certain core aspects of the human condition itself.

The self, neuroscience and psychosis study: Testing a neurophenomenological model of the onset of psychosis

AIM

Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self-disturbance model of psychosis by examining the relationship between specific clinical, neurocognitive, and neurophysiological variables in UHR patients, and (2) develop a prediction model using these neurophenomenological disturbances for persistence or deterioration of UHR symptoms at 12-month follow-up.

METHODS

SNAP is a longitudinal observational study. Participants include 400 UHR individuals, 100 clinical controls with no attenuated psychotic symptoms, and 50 healthy controls. All participants complete baseline clinical and neurocognitive assessments and electroencephalography. The UHR sample are followed up for a total of 24 months, with clinical assessment completed every 6 months.

RESULTS

This paper presents the protocol of the SNAP study, including background rationale, aims and hypotheses, design, and assessment procedures.

CONCLUSIONS

The SNAP study will test whether neurophenomenological disturbances associated with basic self-disturbance predict persistence or intensification of UHR symptomatology over a 2-year follow up period, and how specific these disturbances are to a clinical population with attenuated psychotic symptoms. This may ultimately inform clinical care and pathoaetiological models of psychosis.

Mental Gravity: Depression as Spacetime Curvature of the Self, Mind, and Brain

The principle of mental gravity contends that the mind uses physical gravity as a mental model or simulacrum to express the relation between the inner self and the outer world in terms of "UP"-ness and "DOWN"-ness. The simulation of increased gravity characterises a continuum of mental gravity which states includes depression as the paradigmatic example of being down, low, heavy, and slow. The physics of gravity can also be used to model spacetime curvature in depression, particularly gravitational time dilation as a property of MG analogous to subjective time dilation (i.e., the slowing of temporal flow in conscious experience). The principle has profound implications for the Temporo-spatial Theory of Consciousness (TTC) with regard to temporo-spatial alignment that establishes a "world-brain relation" that is centred on embodiment and the socialisation of conscious states. The principle of mental gravity provides the TTC with a way to incorporate the structure of the world into the structure of the brain, conscious experience, and thought. In concert with other theories of cognitive and neurobiological spacetime, the TTC can also work towards the "common currency" approach that also potentially connects the TTC to predictive processing frameworks such as free energy, neuronal gauge theories, and active inference accounts of depression. It gives the up/down dimension of space, as defined by the gravitational field, a unique status that is connected to both our embodied interaction with the physical world, and also the inverse, reflective, emotional but still embodied experience of ourselves.

Influence of E/I balance and pruning in peri-personal space differences in schizophrenia: A computational approach

The encoding of the space close to the body, named peri-personal space (PPS), is thought to play a crucial role in the unusual experiences of the self observed in schizophrenia (SCZ). However, it is unclear why SCZ patients and high schizotypal (H-SPQ) individuals present a narrower PPS and why the boundaries of the PPS are more sharply defined in patients. We hypothesise that the unusual PPS representation observed in SCZ is caused by an imbalance of excitation and inhibition (E/I) in recurrent synapses of unisensory neurons or an impairment of bottom-up and top-down connectivity between unisensory and multisensory neurons. These hypotheses were tested computationally by manipulating the effects of E/I imbalance, feedback weights and synaptic density in the network. Using simulations we explored the effects of such impairments in the PPS representation generated by the network and fitted the model to behavioural data. We found that increased excitation of sensory neurons could account for the smaller PPS observed in SCZ and H-SPQ, whereas a decrease of synaptic density caused the sharp definition of the PPS observed in SCZ. We propose a novel conceptual model of PPS representation in the SCZ spectrum that can account for alterations in self-world demarcation, failures in tactile discrimination and symptoms observed in patients.

More phenomenology in psychiatry? Applied ontology as a method towards integration

There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causation, diagnostics, and treatment of mental health conditions. A phenomenological approach aims to elucidate the subjective experiences of mental health, which its advocates claim have been largely neglected by current diagnostic frameworks in psychiatry (eg, DSM-5). The consequence of neglecting rich phenomenological information is a comparatively more constrained approach to theory development, empirical research, and care programmes. Although calls for more phenomenology in psychiatry have been met with enthusiasm, there is still relatively little information on how to practically facilitate this integration. In this Personal View, we argue that phenomenological approaches need a shared semantic framework to drive their innovative potential, thus enabling consistent data capture, exchange, and interoperability with current mental health data and informatics approaches (eg, the Research Domain Criteria project). We show how an applied ontology of phenomenological psychopathology offers a suitable method to address these challenges.

Disturbance of Ecological Self and Impairment of Affordance Perception

Affordance, a radical concept James Gibson introduced in the 1970s, remains controversial today. Defined as environmental properties taken with reference to an animal's anatomy and action capabilities, affordances are opportunities for action the environment offers. By perceiving affordances, organisms hold meaningful relationships with their surroundings. Affordance is not just a theoretical concept but, as the embodiment of meanings and values, has serious psychological implications. We contend that the lack of these meanings and values underlies the irrational behavior seen in patients with self disorders such as schizophrenia. We reason that it is by perceiving affordances that individuals keep in touch with their surroundings and stay mentally healthy. Using contrapositive reasoning, the reverse could also be true. That is, when individuals experience difficulty maintaining meaningful relations with their surroundings and suffer from mental health problems, we might anticipate that their affordance detection systems are impaired. In two studies conducted in our laboratory, patients with schizophrenia and Alzheimer's disease were shown to have impaired capacity to perceive affordances, a result qualifying as contra-positive evidence corroborating the affordance concept. In addition, our results provide support for accepting contra-positive evidence as a complementary tool to positive evidence for empirically validating concepts such as affordance and meaning.

Neural Correlates of Aberrant Salience and Source Monitoring in Schizophrenia and At-Risk Mental States-A Systematic Review of fMRI Studies

Cognitive biases are an important factor contributing to the development and symptom severity of psychosis. Despite the fact that various cognitive biases are contributing to psychosis, they are rarely investigated together. In the current systematic review, we aimed at investigating specific and shared functional neural correlates of two important cognitive biases: aberrant salience and source monitoring. We conducted a systematic search of fMRI studies of said cognitive biases. Eight studies on aberrant salience and eleven studies on source monitoring were included in the review. We critically discussed behavioural and neuroimaging findings concerning cognitive biases. Various brain regions are associated with aberrant salience and source monitoring in individuals with schizophrenia and the risk of psychosis. The ventral striatum and insula contribute to aberrant salience. The medial prefrontal cortex, superior and middle temporal gyrus contribute to source monitoring. The anterior cingulate cortex and hippocampus contribute to both cognitive biases, constituting a neural overlap. Our review indicates that aberrant salience and source monitoring may share neural mechanisms, suggesting their joint role in producing disrupted external attributions of perceptual and cognitive experiences, thus elucidating their role in positive symptoms of psychosis. Account bridging mechanisms of these two biases is discussed. Further studies are warranted.

Prevalence, dimensionality and clinical relevance of self-disturbances and psychotic-like experiences in Polish young adults: a latent class analysis approach

OBJECTIVES

We aimed to investigate latent classes of psychotic-like experiences (PLEs) and self-disturbances (SD) and to explore mutual overlapping between derived subgroups. Further, our goal was to investigate class membership relationship with an exposure to childhood trauma and different psychopathological factors such as cognitive biases, depression, insomnia, psychiatric diagnosis and lifetime suicidality.

METHODS

Participants consist of 3167 non-clinical adults. We performed two latent class analyses (LCA), for PLEs and SD separately, to identify subgroups of individuals with different profiles on PLEs and SD. Associations between psychopathological factors and latent class membership were examined using multinomial logistic regression analysis.

RESULTS

LCA produced 5 classes within SD and 3 classes within PLEs. Class of the highest endorsement of SD showed 53% overlap with class of the highest endorsement of PLEs. The highest risk of belonging to High Class for both SD and PLEs was associated in particular with depression, cognitive biases and insomnia. Trauma emerged as a significant predictor only for PLEs classes.

CONCLUSIONS

Our findings confirm that high PLEs and SD co-occur and are concentrated in a relatively small number of individuals, at least in the general population. Their combination may capture the highest risk of psychosis in the general population.

Disturbed time experience during and after psychosis

Disturbances in time experience have been argued to play a significant, if not causative role in the clinical presentation of schizophrenia. Phenomenological considerations suggest a fragmented or dis-articulated time experience causing both primary symptoms such as hallucinations, delusions, and self-disorders, as well as an intersubjective desynchronization. We employed content analysis on material collected from patients diagnosed with schizophrenia using the Time Questionnaire to generate hypotheses on possible disturbances of time experience in schizophrenia. As a key result we find evidence for the distinction between acute psychotic and post-psychotic syndromes. Acute psychosis is predominantly a disturbance of the passage of time, whereas the remission from psychosis is primarily defined by changes in the experience of the explicit structure of time integrating past, present, and future. We discuss our findings with regards to previous insights and observations on time experience and time perception. We suggest our findings hold significance for the diagnostic and therapeutic understanding of schizophrenia as well as for future integrative research on time experience in general.

Movement responses in the Rorschach test. Part 1 Testing healthy and schizophrenic individuals

Introduction: The theoretical basis for the present article is Zygmunt Piotrowski’s concept of prototypal role. This role is understood as a self-concept and as a mechanism guiding and stabilizing relations with the environment. The concept of prototypal role can be regarded as similar to the concept of self.

It is possible to assess the prototypal role by analyzing the movement responses obtained during an examination using the Rorschach test. Empirical data suggest that patients with schizophrenia have an insufficiently developed or peculiarly formed prototypal role and experience certain difficulties in expressing this role.

Material and method: The number of 32 individuals with schizophrenia and 21 healthy individuals were examined using the Rorschach test. Apart from the analysis of movement and posture responses; responses interpreting the shading (chiaroscuro) visible in the inkblots were taken into consideration. Responses of the latter kind are considered to be a measure of anxiety.

Results: There found no differences in the most significant variables, the number of human movement responses was not lower in the group of subjects with schizophrenia, and the number of human movement responses not adequately reflecting the form of the inkblots was not higher in schizophrenic individuals. Some of the movement qualities distinguished by Piotrowski were significantly correlated with anxiety, but these associations were not always consistent with the predictions.

Discussion: Data analysis revealed no specificity in the development of prototypal role in schizophrenic individuals; difficulties in the expression of this role were not frequent and occurred mainly in schizophrenic women as compared to healthy ones. More differences occurred between schizophrenic women and schizophrenic men, what may attest to the influence of gender on the experience of adaptation to disease.

Conclusions: The analysis of movement responses and shading responses provides the basis not so much for differentiating health and disease as for better insight into the very psychological significance of movement and shading responses.