Arthur Schopenhauer: An underappreciated philosopher in psychiatry and his applied epistemology of body and self- experience

BACKGROUND

Arthur Schopenhauer (1788-1860) was one of the most important thinkers of the 19th century. Although his writings have exerted great influence in many different disciplines, his epistemological concepts and analysis of the body and self-experience were rarely considered in the context of psychiatric research of schizophrenia spectrum disorders (SSD) and depression (MDD).

METHODS

The method applied for the study of anomalous self and body-experience first consists in the close reading and analysis of Schopenhauer's most influential writings, namely his opus magnus "The World as Will and Representation" and his dissertation "On the Fourfold Root of the Principle of Sufficient Reason". Second, psychopathological and phenomenological aspects of the anomalous body and self, as well as altered space and time experience, are discussed by means of Schopenhauer's philosophy and four patient cases.

RESULTS

Schopenhauer's insights contribute to contemporary psychiatry by (1) unifying materialistic (neurobiological) and idealistic (subjective) conceptions of psychiatric disorders and improving the awareness of methods in psychiatric research; (2) emphasizing the integral significance of the body as a gateway to the surrounding world and basal self-experience; (3) delineating subjective space and time-experience as crucial dimensions of the conditio humana in SSD and MDD; and (4) demonstrating the feasibility of transferring his theories directly to clinical case vignettes stemming from the daily clinical routine.

CONCLUSION

Close reading of Schopenhauer's texts might help bridge the gap between different scientific methods in psychiatry and overcome the translational crisis of contemporary psychiatry by unifying neurobiological and subjective approaches to SSD and MDD.

Deciphering the interplay between psychopathological symptoms, sensorimotor, cognitive and global functioning: a transdiagnostic network analysis

BACKGROUND

Understanding the relationship between psychopathology and major domains of human neurobehavioral functioning may identify new transdiagnostic treatment targets. However, studies examining the interrelationship between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample are lacking. We hypothesized a close relationship between sensorimotor and cognitive functioning in a transdiagnostic patient sample.

METHODS

We applied network analysis and community detection methods to examine the interplay and centrality [expected influence (EI) and strength] between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample consisting of 174 schizophrenia spectrum (SSD) and 38 mood disorder (MOD) patients. All patients (n = 212) were examined with the Positive and Negative Syndrome Scale (PANSS), the Heidelberg Neurological Soft Signs Scale (NSS), the Global Assessment of Functioning (GAF), and the Brief Cognitive Assessment Tool for Schizophrenia consisted of trail making test B (TMT-B), category fluency (CF) and digit symbol substitution test (DSST).

RESULTS

NSS showed closer connections with TMT-B, CF, and DSST than with GAF and PANSS. DSST, PANSS general, and NSS motor coordination scores showed the highest EI. Sensory integration, DSST, and CF showed the highest strength.

CONCLUSIONS

The close connection between sensorimotor and cognitive impairment as well as the high centrality of sensorimotor symptoms suggests that both domains share aspects of SSD and MOD pathophysiology. But, because the majority of the study population was diagnosed with SSD, the question as to whether sensorimotor symptoms are really a transdiagnostic therapeutic target needs to be examined in future studies including more balanced diagnostic groups.

[German version of the Northoff scale for subjective experience in catatonia (NSSC-dv) : A validated instrument for examination of the subjective experience in catatonia]

Patients with catatonia often show serious motor, affective and behavioral symptoms, behind which the subjective experience often remains hidden. Therefore, this study disseminates our own systematic empirical investigation of the subjective experience of catatonia patients to a German-speaking audience of clinicians and researchers. Based on current evidence and the clinical experience of the authors, the self-report questionnaire Northoff Scale for Subjective Experience in Catatonia (NSSC) was modified, extended and validated and now consists of 26 items capturing the subjective experience of catatonia in its clinical diversity. A total of 46 patients with catatonia according to the International Classification of Diseases (11th revision, ICD-11) were asked about their subjective experience during the acute phase of the disease using the NSSC. The NSSC showed high internal consistency (Cronbach's alpha = 0.91). The NSSC total score was significantly associated with the Northoff Catatonia Rating Scale (NCRS; r = 0.46; p < 0.05), the total score of the Positive and Negative Syndrome Scale (PANSS; r = 0.30; p < 0.05), the Brief Psychiatric Rating Scale (BPRS; r = 0.33; p < 0.05), and Trait Anxiety (STAI; r = 0.64; p < 0.01), supporting its validity. Preliminary validation of the NSSC revealed good psychometric properties. The NSSC is a useful instrument for routine clinical use to assess the subjective experience of patients with catatonia in order to provide tailored psychotherapeutic interventions.

Extension, translation and preliminary validation of the Northoff Scale for Subjective Experience in Catatonia (NSSC)

BACKGROUND

In the last two decades, much neuroscientific research has been done on the pathomechanisms of catatonia. However, catatonic symptoms have mainly been assessed with clinical rating scales based on observer ratings. Although catatonia is often associated with strong affective reactions, the subjective domain of catatonia has simply been neglected in scientific research.

METHODS

The main objective of this study was to modify, extend and translate the original German version of the Northoff Scale for Subjective Experience in Catatonia (NSSC) and to examine its preliminary validity and reliability. Data were collected from 28 patients diagnosed with catatonia associated with another mental disorder (6A40) according to ICD-11. Descriptive statistics, correlation coefficients, internal consistency and principal component analysis were employed to address preliminary validity and reliability of the NSSC.

RESULTS

NSSC showed high internal consistency (Cronbach's alpha = 0.92). NSSC total scores were significantly associated with Northoff Catatonia Rating Scale (r = 0.50, p < .01) and Bush Francis Catatonia Rating Scale (r = 0.41, p < .05) thus supporting its concurrent validity. There was no significant association between NSSC total score and Positive and Negative Symptoms Scale total (r = 0.26, p = .09), Brief Psychiatric Rating Scale (r = 0.29, p = .07) and GAF (r = 0.03, p = .43) scores.

CONCLUSION

The extended version of the NSSC consists of 26 items and was developed to assess the subjective experience of catatonia patients. Preliminary validation of the NSSC revealed good psychometric properties. NSSC is a useful tool for everyday clinical work to assess the subjective experience of catatonia patients.

Overcoming the translational crisis of contemporary psychiatry - converging phenomenological and spatiotemporal psychopathology

Despite all neurobiological/neurocomputational progress in psychiatric research, recent authors speak about a 'crisis of contemporary psychiatry'. Some argue that we do not yet know the computational mechanisms underlying the psychopathological symptoms ('crisis of mechanism') while others diagnose a neglect of subjectivity, namely first-person experience ('crisis of subjectivity'). In this perspective, we propose that Phenomenological Psychopathology, due to its focus on first-person experience of space and time, is in an ideal position to address the crisis of subjectivity and, if extended to the brain's spatiotemporal topographic-dynamic structure as key focus of Spatiotemporal Psychopathology, the crisis of mechanism. We demonstrate how the first-person experiences of space and time differ between schizophrenia, mood disorders and anxiety disorders allowing for their differential-diagnosis - this addresses the crisis of subjectivity. Presupposing space and time as shared features of brain, experience, and symptoms as their "common currency", the structure of abnormal space and time experience may also serve as template for the structure of the brain's spatiotemporal neuro-computational mechanisms - this may address the crisis of mechanism. Preliminary scientific evidence in our examples of schizophrenia, bipolar disorder, anxiety disorder, and depression support such clinically relevant spatiotemporal determination of both first-person experience (crisis of subjectivity) and the brain's neuro-computational structure (crisis of mechanism). In conclusion, converging Phenomenological Psychopathology with Spatiotemporal Psychopathology might help to overcome the translational crisis in psychiatry by delineating more fine-grained neuro computational and -phenomenal mechanisms; this offers novel candidate biomarkers for diagnosis and therapy including both pharmacological and non-pharmacological treatment.

[Spatiotemporal psychopathology-German version of the Scale for Space and Time Experience in Psychosis (STEP) : A validated measurement instrument for the assessment of spatial and temporal experience in psychotic disorders]

Historical authors (e.g., Ludwig Binswanger and Eugène Minkowski) postulated that the experience of patients with schizophrenia is characterized by time fragmentation. From a clinical perspective, patients with schizophrenia also suffer from difficulties in spatial perception (e.g., abnormalities in the experience of interpersonal distance and spatial orientation). Although these changes can lead to a serious detachment from reality, to considerable suffering of the affected persons and to difficulties in the therapeutic process, the abnormal experience of space and time in psychotic disorders has not yet been sufficiently investigated. One possible reason is the lack of appropriate and standardized instruments that quantify the experience of space and time in patients with psychotic disorders. Based on an innovative concept, the so-called spatiotemporal psychopathology (STPP), a clinical rating scale for the systematic-quantitative assessment of spatial and temporal experience in patients with psychotic disorders was developed. This article presents the German version of the Scale for Space and Time Experience in Psychosis (STEP). The original English version of the STEP measures different spatial (14 phenomena) and temporal (11 phenomena) phenomena in 25 items. The STEP shows both a high internal consistency (Cronbach's alpha = 0.94) and a significant correlation with the Positive and Negative Syndrome Scale (PANSS; p < 0.001). In summary, the German version of the STEP scale presented here represents an important instrument in the German-speaking countries for the assessment of spatial and temporal experience in patients with psychotic disorders.

[Debriefing in pediatric emergency care]

Kommunikationsfehler und systembedingte Probleme wirken sich negativ auf Teamarbeit und gemeinsame Entscheidungsfindung aus und können den Patienten Schaden zufügen. Regelmäßige Nachbesprechungen nach kritischen Ereignissen wiederum wirken sich positiv auf die Teamzusammenarbeit und das Patientenoutcome in der Kindernotfallversorgung aus. Das gemeinsame Reflektieren fördert das Lernen, hilft den Teams, sich zu verbessern, und verhindert, dass sich Fehler in Zukunft wiederholen. Dennoch werden Debriefings im präklinischen und klinischen Alltag noch immer qualitativ unzureichend durchgeführt. Gründe dafür sind mangelnde Zeit, Fehlen von erfahrenen Debriefern und fehlende Unterstützung durch Verantwortungsträger. Debriefings können je nach Bedarf zu verschiedenen Zeitpunkten mit unterschiedlicher Dauer stattfinden. Nachbesprechungen können auch rein virtuell oder als sogenannte Hybridveranstaltung durchgeführt werden. Nachbesprechungen sollten sich auf gemeinsames Lernen und das Erarbeiten zukunftsorientierter Verbesserungen konzentrieren. Nicht nur lebensbedrohliche Ereignisse können Nachbesprechungen auslösen, sondern auch potenziell kritische Situationen, wie routinemäßige Intubationen. Debriefing-Skripte fördern eine Strukturierung und ermöglichen selbst unerfahrenen Moderatoren, alle Aspekte zu bearbeiten. Neben der Diskussion schwieriger Abläufe sollten unbedingt positive Leistungen besprochen werden, um diese zu verstärken und das Lernen am Erfolg zu ermöglichen. Dabei sollten die Beweggründe eines Verhaltens erfragt und nicht nur die nach außen sichtbaren Leistungen bewertet werden. Diese Strategie fördert bedarfsgerechtes Lernen und konzentriert sich auf Lösungen. Hilfreich sind dabei spezielle Fragetechniken, echtes Interesse und eine positive Sicherheitskultur.

Electron transfer through bridging molecular structures

Pairs of reducible pentakis(thiophenyl)benzene subunits are linked by different molecular structures as model compounds for reducible molecular-wire-type synthons showing varying electron-transfer ability as a function of the bridging structures, consisting of either para-divinylbenzene, bis-hydrazone, or diacetylene. Their electron-transfer ability from one reducible subunit to the other was investigated by electrochemical and spectroelectrochemical methods. In the case of the bis-hydrazone bridge and the diacetylene bridge, the solid-state structures support the experimental findings. While the para-divinylbenzene bridge completely isolates the reducible subunits (class I system) the diacetylene bridge electronically connects the two reducible structures (class III system), demonstrating its potential application as a "molecular wire." The bis-hydrazone linked dimer displays electronic communication only to a small extend, which was only observed in the spectroelectrochemical investigation. The diacetylene connection as active electron-transfer linker together with poly(thiophenyl)benzene as reducible subunits was used to design more complex molecular architectures. Linear rodlike structures did allow adjustment of the length of these type of molecular wires and investigation of the extent of electron mobility. Cyclic structures addressed the possibility of moving electrons on a bent molecular wire.

Chemistry of porphyrin-appended cellulose strands with a helical structure: spectroscopy, electrochemistry, and in situ circular dichroism spectroelectrochemistry

Around 100 porphyrin units have been selectively linked at C(6)-O to a cellulose (Avicel). The properties of the metal-free and zincated porphyrin-celluloses 2 and Zn-2 have been determined by optical and electrochemical methods. Circular dichroism indicates a helical arrangement of the porphyrin units and reveals intra-chain coupling reminiscent, in the broadest sense, of strands of nucleic acids. Cyclic voltammetry and spectroelectrochemistry have been used to characterize the radical ions and dianions. The electrochromism of the oxidation of cellulose 2 to porphyrin radical cations of 2 has been employed for both molecular switching and the transduction of an electrochemical input into chiroptical signal expression.

Electron transfer through molecular bridges between reducible pentakis(thiophenyl)benzene subunits

"Dimers" 3, 4 and 7, which consist of two reducible pentakis(thiophenyl)benzene subunits linked by different molecular structures, have been synthesised as model compounds for reducible molecular-wire-type synthons to represent differences in the electron-transfer ability as a function of the bridging structure. The bridging units consist of para-divinylbenzene in 3, bis-hydrazone in 4 and diacetylene in 7. Their ability to transfer electrons from one reducible subunit to the other was investigated by electrochemical and spectroelectrochemical methods and, in the case of 4 and 7, the solid-state structures support the experimental findings. The para-divinylbenzene bridge in 3 was found to completely isolate the reducible structures (Class I system). In contrast, the diacetylene bridge in 7 electronically connects the two reducible structures (Class III system) and, thus, demonstrates its potential application as a "molecular wire". The bis-hydrazone-linked compound 4 displayed only a low level of electronic connection between the subunits and was only observed in the spectroelectrochemical investigation.

Multimode-photochromism based on strongly coupled dihydroazulene and diarylethene

Synthesis and photophysical/photochemical investigations of 1,8a-dihydro-2,3-bis(2,5-dimethy-3-thienyl)-azulene-1,1-dicarbonitrile (1A) and 1,8a-dihydro-2,3-diphenylazulene-1,1-dicarbonitrile (2A) are reported. The photoprocesses and thermal reactions of systems 1 and 2 were studied by time-resolved and steady-state techniques under various conditions. The dihydroazulene (DHA)-dithienylethene (DTE) conjugate 1A is photochemically converted into the dihydrothienobenzothiophene (DHB) isomer 1C and the vinylheptafulvene (VHF) isomer 1B. System 2 exhibits exclusively DHA/VHF photochromism. For both systems the VHF form thermally reverts back into the DHA form. Their rate constant (kB-->A) increases with the solvent polarity and the relaxation kinetics proceed by means of an activation barrier of 65-80 kJ mol(-1); kB-->A and the activation parameters of the isomerisation reactions are rather similar. The photostationary state of the 1A-->1B and 1A-->1C photoisomerisation is sensitive to the irradiation wavelength. The concept of cycloswitching is discussed.

Analysis of genes expressed at the infective larval stage validates utility of Litomosoides sigmodontis as a murine model for filarial vaccine development

We used an expressed sequence tag approach to analyze genes expressed by the infective larvae of the rodent filarial parasite Litomosoides sigmodontis. One hundred fifty two new genes were identified, including several proposed as vaccine candidates in studies with human filarial parasites. Our findings have important implications for the use of L. sigmodontis as a model for filarial infection.

The filarial genome project: analysis of the nuclear, mitochondrial and endosymbiont genomes of Brugia malayi

The Filarial Genome Project (FGP) was initiated in 1994 under the auspices of the World Health Organisation. Brugia malayi was chosen as the model organism due to the availability of all life cycle stages for the construction of cDNA libraries. To date, over 20000 cDNA clones have been partially sequenced and submitted to the EST database (dbEST). These ESTs define approximately 7000 new Brugia genes. Analysis of the EST dataset provides useful information on the expression pattern of the most abundantly expressed Brugia genes. Some highly expressed genes have been identified that are expressed in all stages of the parasite's life cycle, while other highly expressed genes appear to be stage-specific. To elucidate the structure of the Brugia genome and to provide a basis for comparison to the Caenorhabditis elegans genome, the FGP is also constructing a physical map of the Brugia chromosomes and is sequencing genomic BAC clones. In addition to the nuclear genome, B. malayi possesses two other genomes: the mitochondrial genome and the genome of a bacterial endosymbiont. Eighty percent of the mitochondrial genome of B. malayi has been sequenced and is being compared to mitochondrial sequences of other nematodes. The bacterial endosymbiont genome found in B. malayi is closely related to the Wolbachia group of rickettsia-like bacteria that infects many insect species. A set of overlapping BAC clones is being assembled to cover the entire bacterial genome. Currently, half of the bacterial genome has been assembled into four contigs. A consortium has been established to sequence the entire genome of the Brugia endosymbiont. The sequence and mapping data provided by the FGP is being utilised by the nematode research community to develop a better understanding of the biology of filarial parasites and to identify new vaccine candidates and drug targets to aid the elimination of human filariasis.

A survey of genes expressed in adults of the human hookworm, Necator americanus

Hookworms are gut-dwelling, blood-feeding nematodes that infect hundreds of millions of people, particularly in the tropics. As part of a program aiming to define novel drug targets and vaccine candidates for human parasitic nematodes, genes expressed in adults of the human hookworm Necator americanus were surveyed by the expressed sequence tag approach. In total 161 new hookworm genes were identified. For the majority of these, a function could be assigned by homology. The dataset includes proteases, protease inhibitors, a lipid binding protein, C-type lectins, an anti-bacterial factor, globins and other genes of interest from a drug or vaccine development viewpoint. Three different classes of small, secreted proteins were identified that may be involved in the host-parasite interaction, including potential potassium channel blocking peptides. One third of the genes were novel. These included highly expressed, secreted (glyco)proteins which may be part of the excretory-secretory products of these important pathogens. Of particular interest are a family of 9 genes with similarity to the immunomodulatory protein, neutrophil inhibitory factor, that may play a role in establishing an immunocompromised niche for this successful parasite.

Parasitic helminth genomics. Filarial Genome Project

The initiation of genome projects on helminths of medical importance promises to yield new drug targets and vaccine candidates in unprecedented numbers. In order to exploit this emerging data it is essential that the user community is aware of the scope and quality of data available, and that the genome projects provide analyses of the raw data to highlight potential genes of interest. Core bioinformatics support for the parasite genome projects has promoted these approaches. In the Brugia genome project, a combination of expressed sequence tag sequencing from multiple cDNA libraries representing the complete filarial nematode lifecycle, and comparative analysis of the sequence dataset, particularly using the complete genome sequence of the model nematode C. elegans, has proved very effective in gene discovery.

Chemiluminescent detection of sequential DNA hybridizations to high-density, filter-arrayed cDNA libraries: a subtraction method for novel gene discovery

A chemiluminescent approach for sequential DNA hybridizations to high-density filter arrays of cDNAs, using a biotin-based random priming method followed by a streptavidin/alkaline phosphatase/CDP-Star detection protocol, is presented. The method has been applied to the Brugia malayi genome project, wherein cDNA libraries, cosmid and bacterial artificial chromosome (BAC) libraries have been gridded at high density onto nylon filters for subsequent analysis by hybridization. Individual probes and pools of rRNA probes, ribosomal protein probes and expressed sequence tag probes show correct specificity and high signal-to-noise ratios even after ten rounds of hybridization, detection, stripping of the probes from the membranes and rehybridization with additional probe sets. This approach provides a subtraction method that leads to a reduction in redundant DNA sequencing, thus increasing the rate of novel gene discovery. The method is also applicable for detecting target sequences, which are present in one or only a few copies per cell; it has proven useful for physical mapping of BAC and cosmid high-density filter arrays, wherein multiple probes have been hybridized at one time (multiplexed) and subsequently "deplexed" into individual components for specific probe localizations.

Laboratory diagnosis and molecular epidemiology of an outbreak of hepatitis C virus infection among recipients of human intravenous immunoglobulin in Spain

BACKGROUND

Passive transfer of antibody to hepatitis C virus (HCV) has been thought to occur after infusion of human intravenous immunoglobulin (IVIG), as anti-HCV and/or HCV RNA was commonly found in that product. Recently, however, HCV RNA was detected in the serum of recipients of IVIG. Establishment of a causal relationship between IVIG therapy and HCV infection in recipients was attempted.

STUDY DESIGN AND METHODS

Anti-HCV and HCV RNA sequences were investigated in serum samples from 39 persons who received a human IVIG product in seven different hospitals in Spain. HCV RNA was also investigated in two batches of the IVIG shared by some recipients. All the viral RNA detected were characterized with a line probe assay, restriction fragment length polymorphism analysis of the 5'-noncoding and core regions, and sequencing of the nonstructural 5 region.

RESULTS

On the basis of both clinical and laboratory data, a relationship could be established between the IVIG therapy and the acquisition of the HCV infection by the recipients. Several HCV strains were detected among the recipients, with most of the recipients coming from the same hospital presenting with closely related strains. Moreover, an HCV strain almost identical to the main strain detected among the recipients was found in one batch of the IVIG that probably was shared by most of them. Follow-up studies and evaluation of low-avidity anti-HCV IgG suggested that both acute primary infections and reinfections were produced. In one case, direct evidence of reinfection by a different HCV strain was obtained.

CONCLUSION

The results did not exclude the possibility that a second HCV strain associated with a further, unidentified batch of the IVIG could have contributed to this outbreak.

Outbreak of acute hepatitis C following the use of anti-hepatitis C virus--screened intravenous immunoglobulin therapy

BACKGROUND & AIMS

Hepatitis C virus (HCV) infection has been associated with intravenous (IV) immunoglobulin (Ig), and plasma donations used to prepare IV Ig are now screened to prevent transmission. Thirty-six patients from the United Kingdom received infusions from a batch of anti-HCV antibody-screened intravenous Ig (Gammagard; Baxter Healthcare Ltd., Thetford, Norfolk, England) that was associated with reports of acute hepatitis C outbreak in Europe. The aim of this study was to document the epidemiology of this outbreak.

METHODS

Forty-six patients from the United Kingdom treated with Gammagard (34 exposed and 12 unexposed to the batch) returned epidemiological questionnaires.

RESULTS

Eighty-two percent of the exposed patients (28 of 34) became positive for HCV RNA. Eighteen percent of the patients (6 of 34) who had infusions with this batch tested negative for HCV RNA, but 2 of the patients had abnormal liver function and subsequently seroconverted to anti-HCV antibody positive. Twenty-seven percent of the patients (9 of 34) developed jaundice, and 79% (27 of 34) had abnormal liver transferase levels. Virus isolates (n=21), including an isolate from the implicated batch, were genotype 1a and virtually identical by sequence analysis of the NS5 region, consistent with transmission from a single source.

CONCLUSIONS

Hepatitis C infection can be transmitted by anti-HCV-screened IV Ig. Careful documentation of IV Ig batch numbers and regular biochemical monitoring is recommended for all IV Ig recipients.