84 results on '"First rank symptom"'
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2. Shall we really say goodbye to first rank symptoms?
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Anissa Abi-Dargham, Undine E. Lang, Martin Voss, J.H. Krystal, Michael Bauer, Aaron L. Mishara, Juergen Gallinat, Stephen M. Lawrie, Silvana Galderisi, Georg Juckel, Peter Falkai, Andreas Heinz, Werner Strik, Michael A. Rapp, Heinz, A., Voss, M, Lawrie, S. M., Mishara, A., Bauer, M., Gallinat, J., Juckel, G., Lang, U., Rapp, M., Falkai, P., Strik, W., Krystal, J., Abi Dargham, A., and Galderisi, Silvana
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Psychosis ,medicine.medical_specialty ,animal structures ,Schizophrenia (object-oriented programming) ,Schizoaffective disorder ,Context (language use) ,Self-disorder ,Delusions ,First rank symptom ,DSM ,03 medical and health sciences ,0302 clinical medicine ,Delusion ,International Classification of Diseases ,medicine ,Humans ,Psychiatry ,Psychiatric Status Rating Scales ,Psychopathology ,Mental Disorders ,ICD ,medicine.disease ,030227 psychiatry ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,Psychotic Disorders ,Schizophrenia ,Schizophrenic Psychology ,medicine.symptom ,Psychology ,030217 neurology & neurosurgery ,Clinical psychology ,Diagnosis of schizophrenia - Abstract
BackgroundFirst rank symptoms (FRS) of schizophrenia have been used for decades for diagnostic purposes. In the new version of the DSM-5, the American Psychiatric Association (APA) has abolished any further reference to FRS of schizophrenia and treats them like any other “criterion A” symptom (e.g. any kind of hallucination or delusion) with regard to their diagnostic implication. The ICD-10 is currently under revision and may follow suit. In this review, we discuss central points of criticism that are directed against the continuous use of first rank symptoms (FRS) to diagnose schizophrenia.MethodsWe describe the specific circumstances in which Schneider articulated his approach to schizophrenia diagnosis and discuss the relevance of his approach today. Further, we discuss anthropological and phenomenological aspects of FRS and highlight the importance of self-disorder (as part of FRS) for the diagnosis of schizophrenia. Finally, we will conclude by suggesting that the theory and rationale behind the definition of FRS is still important for psychopathological as well as neurobiological approaches today.ResultsResults of a pivotal meta-analysis and other studies show relatively poor sensitivity, yet relatively high specificity for FRS as diagnostic marker for schizophrenia. Several methodological issues impede a systematic assessment of the usefulness of FRS in the diagnosis of schizophrenia. However, there is good evidence that FRS may still be useful to differentiate schizophrenia from somatic causes of psychotic states. This may be particularly important in countries or situations with little access to other diagnostic tests. FRS may thus still represent a useful aid for clinicians in the diagnostic process.ConclusionIn conclusion, we suggest to continue a tradition of careful clinical observation and fine-grained psychopathological assessment, including a focus on symptoms regarding self-disorders, which reflects a key aspect of psychosis. We suggest that the importance of FRS may indeed be scaled down to a degree that the occurrence of a single FRS alone should not suffice to diagnose schizophrenia, but, on the other hand, absence of FRS should be regarded as a warning sign that the diagnosis of schizophrenia or schizoaffective disorder is not warranted and requires specific care to rule out other causes, particularly neurological and other somatic disorders. With respect to the current stage of the development of ICD-11, we appreciate the fact that self-disorders are explicitly mentioned (and distinguished from delusions) in the list of mandatory symptoms but still feel that delusional perceptions and complex hallucinations as defined by Schneider should be distinguished from delusions or hallucinations of “any kind”. Finally, we encourage future research to explore the psychopathological context and the neurobiological correlates of self-disorders as a potential phenotypic trait marker of schizophrenia.
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- 2016
3. Phenomenological study of thinking and perceptual disorders in schizophrenia.
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Baruah, Aparajeeta and Chaudhury, Pranit Kumar
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SCHIZOPHRENIA , *COGNITION disorders , *PERCEPTUAL disorders , *DELUSIONS , *HALLUCINATIONS - Abstract
Background: The diagnosis of schizophrenia is entirely dependent upon its symptom cluster or phenomenology and there lies the importance of studying the disease from this angle. Materials and methods: Seventy patients with schizophrenia fulfilling the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III R) criteria were the subjects of this study. The principal objective was to study thought and perceptual disorders in schizophrenia. Besides the sociodemographic data, a selected questionnaire (Assamese version) was prepared from the Present State Examination schedule (ninth edition) for investigating the patients. Results: The phenomenology was studied under three headings: First rank symptoms, types of delusions and hallucinations. Twenty six patients had first rank symptoms. Auditory hallucinations in the form of voices arguing and voices commenting topped the list followed by somatic passivity and volitional acts. Audible thoughts were the most infrequent ones. Delusions of reference scored highest. Delusions of persecution and misinterpretation were next followed by religious and grandiose delusions. Delusions of pregnancy, sexual and fantastic delusions scored the minimum. In morbid jealousy or delusion of infidelity, females outnumbered males. Auditory hallucinations were highest among the hallucinations followed by visual, tactile, olfactory and gustatory hallucinations. In tactile hallucinations, the percentage frequency was quite high in females. Conclusion: In the phenomena of delusions and hallucinations, sociocultural factors played the primary role. This study is a proof to the .universality. theory of schizophrenia in relation to its phenomenology. [ABSTRACT FROM AUTHOR]
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- 2012
4. White matter abnormalities and neurocognitive deficits associated with the passivity phenomenon in schizophrenia: a diffusion tensor imaging study.
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Sim K, Yang GL, Loh D, Poon LY, Sitoh YY, Verma S, Keefe R, Collinson S, Chong SA, Heckers S, Nowinski W, and Pantelis C
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- Adult, Anisotropy, Attention physiology, Brain physiopathology, Brain Mapping, Cerebral Cortex pathology, Cerebral Cortex physiopathology, Cognition Disorders pathology, Cognition Disorders physiopathology, Female, Functional Laterality, Humans, Male, Neural Pathways physiopathology, Neuropsychological Tests, Schizophrenia physiopathology, Brain pathology, Cognition Disorders diagnosis, Diffusion Magnetic Resonance Imaging, Schizophrenia diagnosis, Schizophrenia pathology, Schizophrenic Psychology
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The passivity phenomenon is a distressing Schneiderian first rank symptom in patients with schizophrenia. Based on extant data of functional and structural cerebral changes underlying passivity, we sought to examine cerebral white matter integrity in our subjects. We hypothesised that the passivity phenomenon would be associated with white matter changes in specific cortical (frontal, parietal cortices, and cingulate gyrus) and subcortical regions (thalamus and basal ganglia) and correlated with relevant neurocognitive deficits, compared with characteristics in those without the passivity phenomenon. Thirty-six subjects (11 with passivity and 25 without passivity) with schizophrenia were compared with 32 age-, gender- and handedness-matched healthy controls using diffusion tensor imaging. Neuropsychological testing was administered. Patients with passivity were associated with increased fractional anisotropy within the frontal cortex, cingulate gyrus, and basal ganglia and decreased fractional anisotropy within the thalamus when compared with patients without passivity. Within patients with passivity, fractional anisotropy in the frontal cortex correlated with the age of onset of illness and neurocognitive deficits related to attention and executive functioning. The findings suggest distributed involvement of cortical and subcortical regions underlying passivity and support the notion of neural network models underlying specific psychiatric symptoms such as passivity.
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- 2009
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5. A comparison of symptoms and family history in schizophrenia with and without prior cannabis use: implications for the concept of cannabis psychosis.
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Boydell J, Dean K, Dutta R, Giouroukou E, Fearon P, and Murray R
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- Adult, Comorbidity, Cross-Sectional Studies, Female, Hallucinations chemically induced, Hallucinations epidemiology, Hallucinations genetics, Humans, London, Male, Middle Aged, Psychiatric Status Rating Scales, Psychoses, Substance-Induced diagnosis, Psychoses, Substance-Induced psychology, Registries, Risk Factors, Schizophrenia chemically induced, Schizophrenia genetics, Statistics as Topic, Cannabinoids toxicity, Marijuana Abuse epidemiology, Psychoses, Substance-Induced epidemiology, Schizophrenia epidemiology, Schizophrenic Psychology
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Background: There is considerable interest in cannabis use in psychosis. It has been suggested that the chronic psychosis associated with cannabis use, is symptomatically distinct from idiopathic schizophrenia. Several studies have reported differences in psychopathology and family history in people with schizophrenia according to whether or not they were cannabis users. We set out to test the hypotheses arising from these studies that cannabis use is associated with more bizarre behaviour, more thought disorder, fewer negative symptoms including blunted affect, more delusions of reference, more paranoid delusions and a stronger family history of schizophrenia., Method: We used a case register that contained 757 cases of first onset schizophrenia, 182 (24%) of whom had used cannabis in the year prior to first presentation, 552 (73%) had not and 3% had missing data. We completed the OPCRIT checklist on all patients and investigated differences in the proportion of people with distractibility, bizarre behaviour, positive formal thought disorder, delusions of reference, well organised delusions, any first rank symptom, persecutory delusions, abusive/accusatory hallucinations, blunted affect, negative thought disorder, any negative symptoms (catatonia, blunted affect, negative thought disorder, or deterioration), lack of insight, suicidal ideation and a positive family history of schizophrenia, using chi square tests. Logistic regression modelling was then used to determine whether prior cannabis use affected the presence of the characteristics after controlling for age, sex and ethnicity., Results: There was no statistically significant effect of cannabis use on the presence of any of the above. There remained however a non-significant trend towards more insight (OR 0.65 p=0.055 for "loss of insight") and a finding of fewer abusive or accusatory hallucinations (OR 0.65 p=0.049) of borderline significance amongst the cannabis users. These were in the hypothesised direction. There was no evidence of fewer negative symptoms or greater family history amongst cannabis users., Conclusion: We found few appreciable differences in symptomatology between schizophrenic patients who were or were not cannabis users. There were no differences in the proportion of people with a positive family history of schizophrenia between cannabis users and non-users. This argues against a distinct schizophrenia-like psychosis caused by cannabis.
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- 2007
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6. Schneider's first rank symptoms and continuous performance disturbance as indices of dysconnectivity of left- and right-hemispheric components of language in schizophrenia.
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Ceccherini-Nelli A, Turpin-Crowther K, and Crow TJ
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- Adult, Cerebral Cortex physiopathology, Cross-Sectional Studies, Diagnosis, Differential, Diagnostic and Statistical Manual of Mental Disorders, Female, Functional Laterality physiology, Humans, Inhibition, Psychological, International Classification of Diseases, Language Disorders physiopathology, Language Disorders psychology, Male, Middle Aged, Schizophrenia physiopathology, Attention physiology, Dominance, Cerebral physiology, Language Disorders diagnosis, Neuropsychological Tests, Psychomotor Performance physiology, Schizophrenia diagnosis, Schizophrenic Language, Schizophrenic Psychology
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Background: Here we investigate pathophysiological dimensions (language disturbance, negative symptoms, lateralisation and the continuous performance test) in relation to ICD-10 and DSM-IV concepts of diagnosis., Methods: A total of 32 consecutive psychotic patients with at least one Schneider's first rank symptom (SFRS), 15 depressed patients without SFRS and 17 normal volunteers were assessed with the Clinical Language Disorder Rating Scale (CLANG), SFRS, "pure defect" Huber's basic symptoms (HBS), handedness (Annett's pegboard task), and the A-X Continuous Performance Test (AX-CPT)., Results: CLANG total score (an index of severity of language disorder) was correlated with the severity of SFRS, a higher leftward shift of handedness, and poorer performance on AX-CPT. Receiver operating characteristic (ROC) analysis showed that only CLANG and AX-CPT variables had adequate predictive validity in separating cases of ICD-10 schizophrenia from other diagnoses. The logistic regression model predicting the presence of ICD-10 schizophrenia was statistically significant using CLANG and AX-CPT variables, but not SFRS or other variables. HBS did not correlate with other variables and did not predict ICD-10 diagnosis., Conclusions: A cross-sectional diagnosis based on language disturbance and CPT performance yields a diagnostic construct largely overlapping with the ICD-10 definition of schizophrenia. We suggest that Schneider's first rank symptoms (that play a large role in the DSM-IV concept) can be considered an index of left hemisphere dysconnectivity for language whereas CPT dysfunction reflects dysconnectivity of the right hemisphere for those remoter ("spatial") associations that are closer to Bleuler's core defect and to the chronicity implicit in the ICD definition. Thus the dimensions of language disturbance in psychosis can be traced to specific cortico-cortical dysconnectivities.
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- 2007
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7. Does consciousness entail subjectivity? The puzzle of thought insertion.
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Billon, Alexandre
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CONSCIOUSNESS ,SUBJECTIVITY ,THOUGHT insertion ,SCHIZOPHRENIA ,CARTESIANISM (Philosophy) - Abstract
“There is a thought in me which is not mine.” This is, roughly, the complaint of patients suffering from thought insertion. This first-rank symptom of schizophrenia is particularly puzzling for it seems to challenge a very well entrenched principle to the effect that our conscious thoughts are necessarily subjective, that we necessarily have a sense of ownership for them (Cartesian principle). Despite their wide disagreement, classical accounts of the symptom save the Cartesian principle by interpreting thought insertion as a problem of the sense of agency for thought rather than as a problem of subjectivity. I argue that those accounts fail and that thought insertion really is a problem of subjectivity. We can nevertheless save the Cartesian principle if we realize that the presupposition, shared by classical accounts, to the effect that inserted thoughts are unequivocally conscious, is ill-grounded. Distinguishing between reflexive awareness and phenomenal consciousness, and relying on a careful comparison between thought insertion and other pathologies of agency, I propose a novel account of the symptom which is compatible with the Cartesian principle and which allows to take the patient's reports seriously. This account, I conclude, opens up novel perspectives on the comprehension of schizophrenia, and reveals a common confusion between two different dimensions of the mind. [ABSTRACT FROM AUTHOR]
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- 2013
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8. Disintegration of the components of language as the path to a revision of Bleuler's and Schneider's concepts of schizophrenia. Linguistic disturbances compared with first-rank symptoms in acute psychosis.
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Ceccherini-Nelli A and Crow TJ
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- Adolescent, Adult, Aged, Case-Control Studies, Confidence Intervals, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Odds Ratio, Psychiatric Status Rating Scales statistics & numerical data, ROC Curve, Statistics, Nonparametric, Language, Schizophrenia diagnosis, Schizophrenic Psychology
- Abstract
Background: The 20th century ended without a resolution of the debate about the supremacy of Schneider's psychopathological conceptualisation of schizophrenia (the first-rank symptoms) over Bleuler's 'four As' (disorders of association and affect, ambivalence and autism)., Aims: To examine the relationships between linguistic deviations and symptoms in patients with acute psychosis., Method: We assessed language disturbances and first-rank symptoms with the Clinical Language Disorder Rating Scale (CLANG) in 30 consecutive patients with acute psychosis, selected for the presence of at least one active first-rank symptom, and 15 control participants with depression but no psychotic symptoms., Results: Strong positive correlations were found between the CLANG factor 'poverty' and first-rank delusions of control and between semantic/phonemic paraphasias and verbal auditory hallucinations [corrected]. Language disturbances were superior to nuclear symptoms in discriminating ICD-10 schizophrenia from other psychoses., Conclusions: Evaluating the features of psychosis as deviations in the cerebral organisation of language paves the way to a concept of psychosis that supersedes these traditional but competing categorical concepts.
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- 2003
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9. Catatonia-like behavior and immune activation: a crosstalk between psychopathology and pathology in schizophrenia.
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Messina, Antonino, Caraci, Filippo, Aguglia, Eugenio, and Signorelli, Maria Salvina
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BIOMARKERS ,RESEARCH ,AFFECT (Psychology) ,SCHIZOPHRENIA ,COGNITIVE processing speed ,CATATONIA ,NEUTROPHIL lymphocyte ratio ,PATHOLOGICAL psychology ,DISEASE duration ,EMOTIONS ,STATISTICAL correlation ,MONOCYTE lymphocyte ratio ,SYMPTOMS - Abstract
Background: In Kalhbaum's first characterization of catatonia, the emotional symptoms, such as decreased or restricted expression of feelings and emotions, which is described as blunted affect, are related to the motor symptoms. In later years, the affective domain was excluded from the concept of catatonia and was not included among the diagnostic criteria in the various Diagnostic Statistical Manual (DSM) versions. In recent times, some authors have proposed the proposition of reevaluating the notion of catatonia through the reintroduction of the affective domain. The objective of this study was to examine the correlation between catatonic-like behavior (CLB), such as emotional withdrawal, blunted affect, and psychomotor slowing, and inflammatory markers, namely the neutrophil/lymphocytes ratio (NLR) and lymphocytes/monocytes ratio (LMR), in individuals diagnosed with schizophrenia. Method: A sample of 25 patients with schizophrenia (10 females, 15 males) was recruited, and the Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of emotional withdrawal, blunted affect, and psychomotor slowing. Findings: The correlation analysis (Spearman ρ) revealed a robust direct association between blunted affect and psychomotor slowing (ρ = 0.79, P = 0.001), and a significant direct correlation between CLB (emotional withdrawal, ρ = 0.51, P = 0.05; blunted affect ρ = 0.58, P = 0.05; motor retardation, ρ = 0.56, P = 0.05) and LMR (ρ = 0.53, P = 0.05). In addition, patients with a duration of illness (DOI) older than five years had a higher presence of CLB and a higher LMR than patients with a more recent diagnosis of the disease. Likely, patients with positive symptoms and in the prodromal and active stages of the disease have a different immune profile than patients in the residual stage and with a predominance of negative symptoms. Conclusions: Psychomotor slowing and blunted affect are two significantly related features, representing the two-faced Janus of immobility. Furthermore, aggregating them in CLB is more predominant the longer the duration of schizophrenia and is associated with different a specific pattern of immune activation. [ABSTRACT FROM AUTHOR]
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- 2023
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10. The prevalence and diagnostic significance of Schneiderian first-rank symptoms in a random sample of acute psychiatric in-patients.
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O'Grady JC
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- Acute Disease, Adolescent, Adult, Aged, Female, Hallucinations, Hospitalization, Humans, Male, Middle Aged, Prevalence, Psychological Tests, Random Allocation, Schizophrenic Psychology, Time Factors, Schizophrenia diagnosis
- Abstract
Ninety-nine acute in-patients were interviewed within four days of admission to hospital. The interview included items concerning all 11 first-rank symptoms. Two definitions (wide and narrow) of each first-rank symptom were employed. Three definitions of schizophrenia and a research diagnosis of major affective disorder were used to determine their relationship with first-rank symptoms. Of subjects with schizophrenia, 73% had first-rank symptoms, as had five (14%) of 34 subjects with affective disorder. The results do not support the hypothesis that first-rank symptoms are specific to schizophrenia, although the specificity of first-rank symptoms for schizophrenia increased if a narrow rather than a wide definition of symptoms was employed.
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- 1990
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11. Personal narratives and the pursuit of purpose and possibility in psychosis: directions for developing recovery-oriented treatments.
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Wiesepape, Courtney N, Lysaker, John T, Queller, Sarah E, and Lysaker, Paul H
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The experience of psychosis involves changes in an individual's sense of self and their understanding of others and the world around them. Studying life narratives and narrative identity offers one way to better understand these changes. Narratives of persons with psychosis display alterations in their themes, structures, and processes. These narratives often portray the person as possessing relatively little sense of agency, without meaningful connections to others, and often describe events in a negative emotional tone. The structure of these narratives often lacks temporal cohesion, unfolding in a disjointed manner. The overall structure and content of narratives further appear to struggle to respond to experience, suggesting that individuals with psychosis may have difficulty incorporating new information into their narrative, leading to a lack of narrative evolution. This body of research illustrates how psychosis reflects the interruption of an unfolding life in which sense of self is compromised and cannot be understood as a collection of symptoms and skill deficits. There is a need for treatment to address disruptions in personal narratives among persons with psychosis to promote a sense of purpose, possibility and meaning. As our understanding of psychosis continues to evolve and we emphasize first-person life stories, the authors believe that stigma in providers will decrease and the importance of subjective recovery will be further revealed. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Schneider's first-rank symptoms have neither diagnostic value for schizophrenia nor higher clinical validity than other delusions and hallucinations in psychotic disorders.
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Peralta, Victor and Cuesta, Manuel J
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DIAGNOSIS of schizophrenia ,HALLUCINATIONS ,DELUSIONS ,CONFIDENCE intervals ,PSYCHOSES ,SCHIZOPHRENIA ,SOCIAL adjustment ,PHENOMENOLOGY ,FUNCTIONAL assessment ,DESCRIPTIVE statistics ,HOSPITAL care ,SENSITIVITY & specificity (Statistics) - Abstract
The validity of studies on the diagnostic significance of first-rank symptoms (FRS) for schizophrenia has been put in doubt because of a poor compliance with Schneider's criterion for their definition and the lack of use of the phenomenological method for their assessment. In this study, using a rigorously phenomenological approach to elicit FRS, we examined (a) the degree to which unequivocally present FRS differentiated schizophrenia (n=513) from other psychotic disorders (n=633), and (b) the comparative validity between FRS and other reality-distortion symptoms against 16 external validators in the whole sample of psychotic disorders (n=1146). Diagnostic performance indices (with 95% CIs) of FRS for diagnosing schizophrenia were as follows: sensitivity=0.58 (0.54−0.61), specificity=0.65 (0.62−0.67), positive predictive value=0.57 (0.54−0.60) and negative predictive value=0.65 (0.63−0.68). While the overall association pattern of FRS and non-FRS scores with the validators was rather similar, three validators (premorbid social adjustment, number of hospitalizations and global assessment of functioning) were significantly related to non-FRS scores (p < 0.006) but not to FRS scores (p > 0.05). Furthermore, no validator was significantly related to FRS scores and unrelated to non-FRS scores, all of which indicates an overall better predictive validity for non-FRS delusions and hallucinations. These findings suggest that FRS do not have diagnostic value for diagnosing schizophrenia and that they do not meaningfully add to the external validity showed by other delusions and hallucinations. We believe that much of the misunderstanding about the diagnostic and clinical validity of FRS for schizophrenia is rooted in Schneider's confusing concept of the disorder. [ABSTRACT FROM AUTHOR]
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- 2023
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13. Delusional Perception Revisited.
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Nielsen, Kasper Møller, Nordgaard, Julie, and Henriksen, Mads Gram
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SYMPTOMS ,INTERNATIONAL Statistical Classification of Diseases & Related Health Problems ,DELUSIONS ,SCHIZOPHRENIA - Abstract
Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology, delusional perception was considered almost pathognomonic for schizophrenia. Since delusional perception has been erased from ICD-11 and always been absent in DSM, it risks slipping out of clinical awareness. In this article, we explore the clinical roots of delusional perception, elucidate the psychopathological phenomenon, and discuss its two predominant conceptualizations, i.e., Schneider's well-known two-link model and Matussek's lesser known one-link model. The two-link model posits that delusional perception amounts to an abnormal interpretation of an intact perception, whereas the one-link model posits that the delusional meaning is contained within a changed perception. Despite their differences, both models stress that delusional perception is a primary delusion that takes place within an altered experiential framework that is characteristic of the psychopathological Gestalt of schizophrenia. We discuss the role of delusional perception in future psychopathological and diagnostic assessment and argue that such assessments must be conducted in comprehensive manner, eliciting the psychopathological context within which symptoms and signs are embedded. Finally, we discuss the compatibility of the two models of delusional perception with contemporary cognitive models on delusion and cognitive psychotherapeutic approaches. [ABSTRACT FROM AUTHOR]
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- 2022
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14. FIRST RANK SYMPTOMS IN THE DIAGNOSIS OF SCHIZOPHRENIA.
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Idrees, Mohammad, Khan, Imran, Irfan, Muhammad, and Sarwar, Robina
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DIAGNOSIS of schizophrenia , *SYMPTOMS , *SCHIZOPHRENIA treatment , *INTERVIEWING in psychiatry , *STATISTICAL sampling - Abstract
Objectives: To determine the usefulness of Schneider's first rank symptoms of schizophrenia. Methodology: Patients suffering from schizophrenia, admitted to the Psychiatry Ward Khyber Teaching Hospital, Peshawar during the year 2009 were selected by non probability purposive sampling. It was a descriptive study and the diagnosis was made according to DSM-IV criteria. Patients were interviewed by using a semi structured questionnaire based on Present State Examination and first rank symptoms were assessed. Results: Out of 100 patients suffering from schizophrenia, there were 58 males and 42 females. Thirty four (34%) (22 male & 12 females) reported having one or more first rank symptoms while Sixty six (66%) patients although diagnosed with schizophrenia on DSM IV criteria did not show first rank symptoms. The most often found individual first rank symptoms in these 34 patients were voices commenting (n=14, %), made impulses (n=12, %), and voices arguing (n=12, %). None reported delusional perception. Conclusions: The reliability of the presence of first rank symptoms in Schizophrenia should be taken cautiously as only one third of the patients diagnosed with schizophrenia as per the DSM IV criteria showed any first rank symptom. [ABSTRACT FROM AUTHOR]
- Published
- 2010
15. Ethnicity and first-rank symptoms in patients with psychosis
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Arnold, Lesley M., Keck Jr., Paul E., Collins, Jacqueline, Wilson, Rodgers, Fleck, David E., Corey, Kimberly B., Amicone, Jennifer, Adebimpe, Victor R., Strakowski, Stephen M., and Keck, Paul E Jr
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ETHNICITY , *PSYCHOSES , *SYMPTOMS , *DIAGNOSIS of schizophrenia , *COMPARATIVE studies , *DIFFERENTIAL diagnosis , *ETHNIC groups , *RESEARCH methodology , *MEDICAL cooperation , *CLASSIFICATION of mental disorders , *MENTAL status examination , *PSYCHOLOGICAL tests , *PSYCHOLOGY , *RESEARCH , *STATISTICAL sampling , *SCHIZOPHRENIA , *SEX distribution , *ETHNOLOGY research , *PSYCHOLOGY of Black people , *SOCIOECONOMIC factors , *EVALUATION research , *DIAGNOSIS - Abstract
Previous studies suggested that African-American patients with psychotic disorders present more commonly with first-rank symptoms. However, it was unclear whether these results reflected true differences among African- and Euro-Americans in symptom presentation or instead resulted from raters being more likely to assign first-rank symptoms to African-American patients. In this study, a total of 195 African- and Euro-American patients presenting for hospitalization with psychosis were evaluated using structured diagnostic and symptom rating instruments; this evaluation was audiotaped. The tapes were transcribed and all cues indicating the patient''s ethnicity were edited from the transcript and from medical records. Two board-certified psychiatrists then evaluated the transcripts and medical records in order to make consensus expert diagnosis and rate first-rank symptoms. Ratings of first-rank symptoms in African- and Euro-American patients were compared between ethnicity-blinded expert consensus assessments and the unblinded structured interview. African-American men received higher first-rank symptom ratings than the remaining patient groups by both ethnicity-blinded expert consensus and unblinded structured interview. African-American men also had significantly more total psychotic symptoms than Euro-American men. However, the ethnically blinded expert consensus did not find an increased rate of schizophrenia in the African-American men. These findings indicate that psychotic symptom presentation should be evaluated in the context of other symptoms (e.g., affective symptoms) in diagnostic assessments in order to prevent misdiagnoses of schizophrenia. [Copyright &y& Elsevier]
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- 2004
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16. A Phenomenological Exploration of the Voices Reported by Borderline Personality and Schizophrenia Patients.
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Barrera, Alvaro, Bajorek, Tomasz, Dekker, Romanie, Hothi, Gurjiven, Lewis, Alexandra, and Pearce, Steve
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SCHIZOTYPAL personality disorder ,AUDITORY hallucinations ,PEOPLE with schizophrenia ,BORDERLINE personality disorder ,MULTIDIMENSIONAL scaling ,GENDER - Abstract
Introduction: Over time, there have been different views regarding the verbal auditory hallucinations (VAHs) reported by borderline personality disorder (BPD) and schizophrenia patients. More recently, their similarity has been emphasized, a view that undoubtedly has significant implications in terms of differential diagnosis and management. To explore this important issue, we undertook a detailed phenomenological assessment of persistent VAH reported by BPD and schizophrenia DSM-IV participants. Methods: The Psychotic Symptoms Rating Scale (PSYRATS), the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Multidimensional Scale for Hallucinations (MSH), and a detailed clinical interview were administered to 11 BPD and 10 schizophrenia DSM-IV participants. Results: The VAHs of both groups were similar regarding intensity, reported as located inside or outside the head, and frequency in which they were described as a third-person phenomenon. However, the patients' stance towards their VAH was clearly different. Whilst BPD patients identified them in a clear way in terms of gender and age and disliked them, schizophrenia patients identified them more vaguely, reported them both as more disruptive but at the same time engaged with them more positively; schizophrenia patients also integrated their VAH more into delusions. Discussion: Whilst reporting similar intensity of their VAH, the 2 groups' stance towards them were strikingly different in that BPD participants regarded them as identifiable and unequivocally unpleasant whilst schizophrenia participants regarded them in a rather vague and ambiguous manner. Methodologically, this preliminary study suggests that in-depth phenomenological assessment can help to elucidate the differential diagnosis of VAH in these, possibly other, clinical groups. Further research is warranted to establish whether these preliminary findings are replicated on a bigger clinical sample. [ABSTRACT FROM AUTHOR]
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- 2021
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17. A major flaw in the diagnosis of schizophrenia: what happened to the Schneider's first rank symptoms.
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Moscarelli, Massimo
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DIAGNOSIS of schizophrenia ,DELUSIONS ,PHENOMENOLOGY ,CLASSIFICATION of mental disorders ,PATIENT compliance ,PATHOLOGICAL psychology ,SCHIZOPHRENIA - Abstract
Kurt Schneider introduced in the definition of the first-rank symptoms (FRS) the criterion that, where unequivocally present, the FRS are always psychological primaries and irreducible. This criterion, grounded on 'phenomenology' (description of subjective experiences), cannot be applied, according to Schneider, to delusions, either two-stage FRS delusional perception, or second-rank delusional notions. The Schneider's key criterion was neglected since the initial adoption of the 'Schneider's FRS' in the subsequent international literature (e.g. PSE, RDC, DSM, and ICD). The 'Schneider's FRS' (e.g. thought insertion, thought withdrawal, passivity, and influence) were persistently equivocated as 'delusions', in spite of the Schneider's FRS exclusion criterion. The internationally equivocated 'Schneider's FRS' (only homonymous of the original 'Schneider's FRS'), were eliminated in the DSM-5 and de-emphasized in ICD-11. However, the diagnostic value of the original 'Schneider's FRS', assessed on the basis of the strict compliance with the Schneider's criterion for their definition, was never determined. The 'damnatio memoriae' of the original Schneider's FRS may be premature. The definition and assessment of the 'experienced' symptoms of schizophrenia, only directly observed and reported by the patients, represent a specific, crucial, irreplaceable domain of psychopathology, to be carefully distinguished from the domain of the 'behavioral' symptoms observed by the clinician. Contemporary psychopathology research is aware of the absolute need for psychiatry to enhance precision and exactness in the definition of the experienced symptoms of schizophrenia, through the formulation of unequivocal inclusion and exclusion criteria (descriptive micro-psychopathology), in order to determine their value in research and care. [ABSTRACT FROM AUTHOR]
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- 2020
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18. Toward a Phenomenological Psychotherapy for Schizophrenia.
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Škodlar, Borut and Henriksen, Mads Gram
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PSYCHOTHERAPY ,SCHIZOPHRENIA ,PSYCHIATRIC hospitals ,CARDIAC patients ,UNIVERSITY hospitals - Abstract
During the last decades, research in phenomenological psychopathology has provided a vast array of insights that are invaluable for understanding the experiential worlds of patients with schizophrenia. Precisely, knowledge of patients' experiences is a necessary basis for a sound and thoughtful psychotherapy. This is especially important in psychotherapy for schizophrenia, where patients' experiences may not always be easily accessible or understandable. In the available literature, we found only scattered suggestions for a translation of insights from phenomenological psychopathology into psychotherapeutic practice. The aim of this article is to offer a preliminary translation. First, we outline characteristics of the experiential worlds in schizophrenia, highlighting what we call "core experiences" and "experience-near concepts." Then we explore the psychotherapeutic methods and strategies that can be developed and elaborated on the basis of the accumulated research in phenomenological psychopathology, drawing also on experiences from a phenomenologically informed psychotherapy unit at the University Psychiatric Hospital of Ljubljana. Here, we propose principles of a phenomenological psychotherapy for schizophrenia, dividing them into the following subgroups: (1) overall goals, (2) general attitudes, (3) main domains, and (4) therapeutic strategies. The unique value of phenomenological psychotherapy seems to lie in its ability to capture the heart of the patients' experiences and their inherent vulnerabilities and then use these insights to inform psychotherapeutic interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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19. Self-disorders in schizophrenia-spectrum disorders: a 5-year follow-up study.
- Author
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Nordgaard, Julie, Nilsson, Lars Siersbæk, Sæbye, Ditte, and Parnas, Josef
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SCHIZOPHRENIA ,PATHOLOGICAL psychology ,MENTAL illness ,PSYCHOSES ,SYMPTOMS - Abstract
Self-disorders have been hypothesized to be an underlying and trait-like core feature of schizophrenia-spectrum disorders and a certain degree of temporal stability of self-disorders would therefore be expected. The aim of the study was to examine the persistence of self-disorders measured by the Examination of Anomalous Self Experiences over a time span of 5 years. 48 patients with schizophrenia-spectrum disorders were thoroughly assessed for psychopathology at baseline and 5 years later. Self-disorders were assessed by the Examination of Anomalous Self Experiences. The level of self-disorders was same at the two occasions for the full Examination of Anomalous Self Disorders and for four out of the five domains. For one domain, the level of self-disorders increased slightly from baseline to follow-up. The correlations between baseline and follow-up were moderate. 9 out of the 13 most-frequently rated items at baseline showed equal frequencies at follow-up. The baseline level of self-disorders predicted global symptomatic, but not functional outcome. Self-disorders measured by the Examination of Anomalous Self Experiences show a high level of temporal persistence over 5 years and predict symptomatic outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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20. CHARACTERISTICS OF HALLUCINATIONS ARISING FROM SCHIZOPHRENIA AND OTHER PSYCHIATRIC DISORDERS DURING CHILDHOOD AND ADOLESCENCE.
- Author
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Tatsuhiko YAGIHASHI, Takashi NAGASAWA, Mari KASAHARA, and Nana HOSOGANE
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SCHIZOPHRENIA ,HALLUCINATIONS ,PATHOLOGICAL psychology ,CHILD psychiatry ,ADOLESCENT psychiatry - Abstract
Background: The occurrence of hallucinations can suggest the presence of various psychiatric disorders. Objective: The aim of this study was to identify differences between hallucinations in children and adolescents with and without schizophrenia. Methods: Among 356 patients under 20 years of age, patients with hallucinations were enrolled through retrospective review of their medical records. Results: Thirty-one patients (8.7%) had experienced some form of hallucination. Fourteen of the 31 patients were classified into a schizophrenia group, seven in a stress-related disorder group, nine into a developmental disorder group, and one into an other disorders group. Sixteen patients (51.6%) had experienced some type of traumatic event. Five patients with schizophrenia had at least one of Schneider’s first-rank symptoms. Some hallucinations in patients without schizophrenia included command or criticisms, but none experienced voices commenting on the individual’s actions. Conclusion: Detailed descriptions regarding psychiatric symptoms might aid in rendering differential diagnoses in clinical settings of child psychiatry. [ABSTRACT FROM AUTHOR]
- Published
- 2018
21. Neurological Soft Signs in Schizophrenia: An Update on the State- versus Trait-Perspective.
- Author
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Bachmann, Silke and Schröder, Johannes
- Subjects
SCHIZOPHRENIA ,MENTAL illness ,MENTAL health - Abstract
Background: Neurological soft signs (NSS) represent minor neurological signs, which indicate non-specific cerebral dysfunction. In schizophrenia, their presence has been documented extensively across all stages of the disease. Until recently, NSS were considered an endophenotype or a trait phenomenon. During the past years, however, researchers report fluctuations of the NSS scores. Aims: To further clarify the question whether NSS exhibit state or trait components or both, studies that have investigated NSS longitudinally were reviewed. Method: Studies which have assessed NSS longitudinally in adults suffering from schizophrenia, were searched for. The time frame was January 1966 to June 2017. Studies on teenagers were excluded because of interferences between brain maturation and pathology. Results: Twenty-nine follow-up studies were identified. They included patients during different stages of their illness and mainly used established instruments for NSS assessment. Patients with a first episode or a remitting course predominantly show a decrease of NSS over time, whereas a worsening of NSS can be found in the chronically ill. It was shown that change of NSS total scores over time is predominantly caused by motor system subscales and to a lesser extent by sensory integration scales. With respect to medication, the majority of studies agree on a relationship between medication response and improvement of NSS while the type of antipsychotic does not seem to play a major role. Moreover, where information on side-effects is given, it does not favor a strong relationship with NSS. However, NSS seem to correlate with negative and cognitive symptoms. Conclusion: Studies manifest a conformity regarding the presence of NSS in schizophrenia patients on the one hand. On the other hand, fluctuations of NSS scores have been widely described in subgroups. Taken together results strongly support a state-trait dichotomy of NSS. Thus, the usage of NSS as an endophenotype has to be called into question. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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22. Listening to the Voices People Hear: Auditory Hallucinations Beyond a Diagnostic Framework.
- Author
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Longden, Eleanor
- Subjects
AUDITORY hallucinations ,EMOTIONAL trauma ,MENTAL illness ,PSYCHIATRIC treatment ,PSYCHOSES ,SCHIZOPHRENIA - Abstract
While voice hearing (auditory verbal hallucinations) is closely allied with psychosis/schizophrenia, it is well-established that the experience is reported by individuals with nonpsychotic diagnoses, as well as those with no history of psychiatric contact. The phenomenological similarities in voice hearing within these different populations, as well as increased recognition of associations between adversity exposure and voice presence/content, have helped strengthened the contention that voice hearing may be more reliably associated with psychosocial variables per se rather than specific clinical diagnoses. Evidence is examined for understanding voice hearing as a psychological response to environmental stressors, and the implications of this for clinical practice. Consideration is also given to the impact of the International Hearing Voices Movement, an influential survivor-led initiative that promotes person-centered, nondiagnostic approaches to the voice-hearing experience. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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23. Exploring social cognition in schizophrenia.
- Author
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Revsbech, R., Mortensen, E., Nordgaard, J., Jansson, L., Saebye, D., Flensborg-Madsen, T., Cutting, J., and Parnas, J.
- Subjects
SOCIAL perception ,PEOPLE with schizophrenia ,SCHIZOPHRENIA ,NEUROPSYCHOLOGICAL tests ,INTELLECT - Abstract
The aim of the study was to compare social cognition between groups of patients diagnosed with schizophrenia and healthy controls and to replicate two previous studies using tests of social cognition that may be particularly sensitive to social cognitive deficits in schizophrenia. Thirty-eight first-admitted patients with schizophrenia and 38 healthy controls solved 11 'imaginary conversation (i.e., theory of mind)' items, 10 'psychological understanding' items, and 10 'practical understanding' items. Statistical tests were made of unadjusted and adjusted group differences in models adjusting for intelligence and neuropsychological test performance. Healthy controls performed better than patients on all types of social cognitive tests, particularly on 'psychological understanding.' However, after adjusting for intelligence and neuropsychological test performance, all group differences became nonsignificant. When intelligence and global cognitive functioning is taken into account, schizophrenia patients and healthy controls perform similarly on social cognitive tests. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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24. Basic Self-Disturbances beyond Schizophrenia: Discrepancies and Affinities in Panic Disorder - An Empirical Clinical Study.
- Author
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Madeira, Luís, Carmenates, Sergio, Costa, Cristina, Linhares, Ludgero, Stanghellini, Giovanni, Figueira, Maria Luísa, and Sass, Louis
- Subjects
PHENOMENOLOGY ,SCHIZOPHRENIA ,AFFECTIVE disorders ,PERSONALITY disorders ,ANXIETY disorders ,PANIC disorders - Abstract
Background: Anomalous self-experiences (ASEs), presumably involving alterations in "core" or "minimal self," have been studied as manifest in schizophrenia and its spectrum, in contrast with mood disorder and personality disorder samples. This is the first study to examine ASEs in panic disorder (PD), beginning the exploration of these disturbances of subjectivity in anxiety disorders. We aimed to clarify what might, or might not, be specific to the schizophrenia spectrum domain - which, in turn, could be useful for developing pathogenetic models for various disorders. Sampling and Methods: 47 hospital outpatients with PD and no other medical and psychiatric comorbidity and 47 healthy control (HC) subjects were assessed with the Examination of Anomalous Self Experiences (EASE) and Cambridge Depersonalization Scale (CDS). Results: All our PD patients had overall ASE and EASE scores significantly higher than our HCs (mean ± SD 17.94 ± 11.88 vs. HC 1.00 ± 1.81), approaching levels found in previous schizophrenia spectrum samples. The distribution of particular EASE items and subitems in the PD sample was heterogeneous, varying from rare (<10%) or absent (termed "discrepancies" with schizophrenia spectrum: 29 items) to being present in >50% of subjects ("affinities" with schizophrenia spectrum: 7 items). EASE and CDS scores were highly correlated ( r = 0.756, 95% CI 0.665-0.840). Conclusions : PD patients scored higher on items suggesting common forms of derealization and depersonalization, perhaps suggesting "secondary" and defensive psychological processes, while lacking indicators of more profound ipseity disturbance. Our study supports the basic-self-disturbance model of schizophrenia, while suggesting the possibility of transnosological "schizophrenia-like phenomena," which might require careful phenomenological exploration to be distinguished from those of true psychotic or schizophrenic conditions. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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25. The impact of HLA-G 3′ UTR variants and sHLA-G on risk and clinical correlates of schizophrenia.
- Author
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Rajasekaran, Ashwini, Shivakumar, Venkataram, Kalmady, Sunil V., Narayanaswamy, Janardhanan C., Subbana, Manjula, Venugopal, Deepthi, Amaresha, Anekal C., Venkatasubramanian, Ganesan, Berk, Michael, and Debnath, Monojit
- Subjects
- *
HLA histocompatibility antigens , *AUTOIMMUNITY , *MAJOR histocompatibility complex , *SCHIZOPHRENIA risk factors , *GENOTYPE-environment interaction , *PREGNANCY complications - Abstract
The Major Histocompatibility Complex (MHC)/Human Leukocyte Antigen (HLA) is known to influence the pathogenesis of several complex human diseases resulting from gene-environmental interactions. Recently, it has emerged as one of the risk determinants of schizophrenia. The HLA-G protein (a non-classical MHC class I molecule), encoded by the HLA-G gene, is shown to play important role in embryonic development. Importantly, its genetic variations and aberrant expression have been implicated in pregnancy complications like preeclampsia, inflammation, and autoimmunity. Converging evidence implicates these phenomena as risk mechanisms of schizophrenia. However, the functional implications of HLA-G in schizophrenia are yet to be empirically examined. The impact of two functional polymorphisms [14 bp Insertion/Deletion (INDEL) and +3187 A > G] and soluble HLA-G (sHLA-G) levels on schizophrenia risk was evaluated. In this exploratory study, the Ins/Ins genotype of 14 bp INDEL was found to confer a strong risk for schizophrenia. Further, low levels of sHLA-G were shown to have a significant impact on Clinical Global Impression (CGI) severity in people with schizophrenia. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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26. Understanding causes of and developing effective interventions for schizophrenia and other psychoses
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Jesus Perez, Debra A Russo, Jan Stochl, Gillian F Shelley, Carolyn M Crane, Michelle Painter, James B Kirkbride, Tim J Croudace, and Peter B Jones
- Subjects
early intervention ,epidemiology ,psychosis ,primary care ,risk ,schizophrenia ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Early-intervention services (EISs) offer prompt and effective care to individuals with first-episode psychosis (FEP) and detect people at high risk (HR) of developing it. Aims: We aimed to educate general practitioners about psychosis and guide their referrals to specialist care; investigate determinants of the transition of HR to FEP; and predict numbers of new cases to guide policy and service planning. Incidence of psychosis in socially and ethnically diverse settings: We studied the incidence of new referrals for psychosis in a well-established EIS called CAMEO [see www.cameo.nhs.uk (accessed 18 January 2016)] and built on other epidemiological studies. The overall incidence of FEP was 45.1 per 100,000 person-years [95% confidence interval (CI) 40.8 to 49.9 per 100,000 person-years]. This was two to three times higher than the incidence predicated by the UK Department of Health. We found considerable psychosis morbidity in diverse, rural communities. Development of a population-level prediction tool for the incidence of FEP: We developed and validated a population-level prediction tool, PsyMaptic, capable of accurately estimating the expected incidence of psychosis [see www.psymaptic.org/ (accessed 18 January 2016)]. The Liaison with Education and General practiceS (LEGS) trial to detect HR: We tested a theory-based intervention to improve detection and referral of HR individuals in a cluster randomised controlled trial involving primary care practices in Cambridgeshire and Peterborough. Consenting practices were randomly allocated to (1) low-intensity liaison with secondary care, a postal campaign to help with the identification and referral of individuals with early signs of psychosis, or (2) the high-intensity theory-based intervention, which, in addition to the postal campaign, included a specialist mental health professional to liaise with each practice. Practices that did not consent to be randomised included a practice-as-usual (PAU) group. The approaches were implemented over 2 years for each practice between April 2010 and October 2013. New referrals were stratified into those who met criteria for HR/FEP (together: psychosis true positives) and those who did not fulfil such criteria (false positives). The primary outcome was the number of HR referrals per practice. Referrals from PAU practices were also analysed. We quantified the cost-effectiveness of the interventions and PAU using the incremental cost per additional true positive identified. Of 104 eligible practices, 54 consented to be randomised. Twenty-eight practices were randomised to low-intensity liaison and 26 practices were randomised to the high-intensity intervention. Two high-intensity practices withdrew. High-intensity practices referred more HR [incidence rate ratio (IRR) 2.2, 95% CI 0.9 to 5.1; p = 0.08], FEP (IRR 1.9, 95% CI 1.05 to 3.4; p = 0.04) and true-positive (IRR 2.0, 95% CI 1.1 to 3.6; p = 0.02) cases. High-intensity practices also referred more false-positive cases (IRR 2.6, 95% CI 1.3 to 5.0; p = 0.005); most (68%) of these were referred on to appropriate services. The total costs per true-positive referral in high-intensity practices were lower than those in low-intensity or PAU practices. Increasing the resources aimed at managing the primary–secondary care interface provided clinical and economic value. The Prospective Analysis of At-risk mental states and Transitions into psycHosis (PAATH) study: We aimed to identify the proportion of individuals at HR who make the transition into FEP and to elucidate the common characteristics that can help identify them. Sixty help-seeking HR individuals aged 16–35 years were stratified into those who met the criteria for HR/FEP (true positives) according to the Comprehensive Assessment of At-Risk Mental States (CAARMS) and those who did not (false positives). HR participants were followed up over 2 years using a comprehensive interview schedule. A random sample of 60 healthy volunteers (HVs) matched for age (16–35 years), sex and geographical area underwent the same battery of questionnaires. Only 5% of our HR sample transitioned to a structured clinical diagnosis of psychosis over 2 years. HR individuals had a higher prevalence of moderate or severe depression, anxiety and suicidality than HVs. In fact, psychometric analyses in other population samples indicate that psychotic experiences measure the severe end of a common mental distress factor, consistent with these results. HR individuals also experienced significantly more traumatic events than HVs, but equivalent distress. Almost half of HR individuals had at least one Schneiderian first-rank symptom traditionally considered indicative of schizophrenia and 21.6% had more than one. HR individuals had very poor global functioning and low quality of life. Conclusions: This National Institute for Health Research programme developed our understanding of the social epidemiology of psychosis. A new theory-based intervention doubled the identification of HR and FEP in primary care and was cost-effective. The HR mental state has much in common with depression and anxiety; very few people transitioned to full psychosis over 2 years, in line with other recent evidence. This new understanding will help people at HR receive appropriate services focused on their current mental state. Trial registration: The primary LEGS trial is registered as ISRCTN70185866 and UKCRN ID 7036. The PAATH study is registered as UKCRN ID 7798. Funding: The National Institute for Health Research Programme Grants for Applied Research programme.
- Published
- 2016
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27. Implicit Timing as the Missing Link between Neurobiological and Self Disorders in Schizophrenia?
- Author
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Giersch, Anne, Lalanne, Laurence, and Isope, Philippe
- Subjects
SCHIZOPHRENIA ,NEURAL transmission ,MILD cognitive impairment ,NEUROBIOLOGY ,DOPAMINE ,GLUTAMIC acid ,PATIENTS ,THERAPEUTICS - Abstract
Disorders of consciousness and the self are at the forefront of schizophrenia symptomatology. Patients are impaired in feeling themselves as the authors of their thoughts and actions. In addition, their flow of consciousness is disrupted, and thought fragmentation has been suggested to be involved in the patients' difficulties in feeling as being one unique, unchanging self across time. Both impairments are related to self disorders, and both have been investigated at the experimental level. Here we review evidence that both mechanisms of motor control and the temporal structure of signal processing are impaired in schizophrenia patients. Based on this review, we propose that the sequencing of action and perception plays a key role in the patients' impairments. Furthermore, the millisecond time scale of the disorders, as well as the impaired sequencing, highlights the cooperation between brain networks including the cerebellum, as proposed by Andreasen (1999). We examine this possibility in the light of recent knowledge on the anatomical and physiological properties of the cerebellum, its role in timing, and its involvement in known physiological impairments in patients with schizophrenia, e.g., resting states and brain dynamics. A disruption in communication between networks involving the cerebellum, related to known impairments in dopamine, glutamate and GABA transmission, may help to better explain why patients experience reduced attunement with the external world and possibly with themselves. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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28. Misattributing the Source of Self-Generated Representations Related to Dissociative and Psychotic Symptoms.
- Author
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Chui-De Chiu, Mei-Chih Meg Tseng, Yi-Ling Chien, Shih-Cheng Liao, Chih-Min Liu, Yei-Yu Yeh, Hai-Gwo Hwu, Barrantes-Vidal, Neus, Brown, Richard James, and Doron, Guy
- Subjects
DISSOCIATIVE disorders ,PSYCHOSES ,SCHIZOPHRENIA ,PATHOLOGICAL psychology ,COGNITIVE ability - Abstract
Objective: An intertwined relationship has been found between dissociative and psychotic symptoms, as the two symptom clusters frequently co-occur, suggesting some shared risk factors. Using a source monitoring paradigm, previous studies have shown that patients with schizophrenia made more errors in source monitoring, suggesting that a weakened sense of individuality may be associated with psychotic symptoms. However, no studies have verified a relationship between sense of individuality and dissociation, and it is unclear whether an altered sense of individuality is a shared sociocognitive deficit underlying both dissociation and psychosis. Method: Data from 80 acute psychiatric patients with unspecified mental disorders were analyzed to test the hypothesis that an altered sense of individuality underlies dissociation and psychosis. Behavioral tasks, including tests of intelligence and source monitoring, as well as interview schedules and self-report measures of dissociative and psychotic symptoms, general psychopathology, and trauma history, were administered. Results: Significant correlations of medium effect sizes indicated an association between errors attributing the source of self-generated items and positive psychotic symptoms and the absorption and amnesia measures of dissociation. The associations with dissociative measures remained significant after the effects of intelligence, general psychopathology, and trauma history were excluded. Moreover, the relationships between source misattribution and dissociative measures remained marginally significant and significant after controlling for positive and negative psychotic symptoms, respectively. Limitations: Self-reported measures were collected from a small sample, and most of the participants were receiving medications when tested, which may have influenced their cognitive performance. Conclusions: A tendency to misidentify the source of self-generated items characterized both dissociation and psychosis. An altered sense of individuality embedded in self-referential representations appears to be a common sociocognitive deficit of dissociation and psychosis. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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29. Privileged Access and the Agent in the Thought-Insertion.
- Author
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Humpston, Clara S.
- Subjects
THOUGHT insertion ,SCHIZOPHRENIA ,DELUSIONS ,PSYCHOLOGY ,SUBJECTIVITY - Published
- 2018
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30. Authorship of thoughts in thought insertion: What is it for a thought to be one's own?
- Author
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Seeger, Max
- Subjects
PHILOSOPHY of authorship ,COGNITIVE science ,SCHIZOPHRENIA ,SELF-consciousness (Awareness) ,THOUGHT insertion - Abstract
In thought insertion, subjects experience thoughts which they claim not to be their own. What they claim, it is typically said, is that the thought is not theirs in the sense that they are not the agent or author of the thought. But what does it mean to be the agent or author of a thought? The most intuitive idea is that for a thought to be one's own means for the thought to causally originate within the subject. I defend this analysis against rivaling accounts and discuss several challenges that have not been recognized so far. [ABSTRACT FROM PUBLISHER]
- Published
- 2015
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31. Structural MRI differences between patients with and without first rank symptoms: a delusion?
- Author
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Heering, Henriette D., Koenders, Laura, Machielsen, Marise W. J., Meijer, Carin J., de Haan, Lieuwe, Koevoets, Godefridus J. C., Kubota, Manabu, de Nijs, Jessica, Cahn, Wiepke, Pol, Hilleke E. Hulshoff, Kahn, Rene S., van Haren, Neeltje E. M., Wi Hoon Jung, and Kambeitz, Joseph
- Subjects
DIAGNOSIS of schizophrenia ,DIAGNOSTIC imaging ,BRAIN imaging - Abstract
Objective: It has been suggested that specific psychotic symptom clusters may be explained by patterns of biological abnormalities. The presence of first rank symptoms (FRS) has been associated with cognitive abnormalities, e.g., deficits in self-monitoring or in the experience of agency, suggesting that a specific network of neural abnormalities might underlie FRS. Here, we investigate differences in cortical and subcortical brain volume between patients with and without FRS. Methods: Three independent patient samples (referred to as A, B, and C) with different mean ages and in different illness stages were included, leading to a total of 348 patients within the schizophrenia-spectrum. All underwent magnetic resonance imaging of the brain. In addition, the presence of FRS was established using a diagnostic interview. Patients with (FRS+, A: n=63, B: n=129, and C: n=96) and without FRS (FRS, A: n=35, B: n=17, and C: n=8) were compared on global and local cortical volumes as well as subcortical volumes, using a whole brain (cerebrum) approach. Results: Nucleus accumbens volume was significantly smaller in FRS+ as compared with FRS in sample A (p<0.005). Furthermore, FRS+ showed a smaller volume of the pars-opercularis relative to FRS in sample B (p<0.001). No further significant differences were found in cortical and subcortical volumes between FRS+ and FRS in either one of the three samples after correction for multiple comparison. Conclusion: Brain volume differences between patients with and without FRS are, when present, subtle, and not consistent between three independent samples. Brain abnormalities related to FRS may be too subtle to become visible through structural brain imaging. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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32. Influence of observing another person’s action on self-generated performance in schizophrenia.
- Author
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Nakagawa, Yoshiro and Hoshiyama, Minoru
- Subjects
SCHIZOPHRENIA ,NEURONS ,MENTAL illness ,NERVOUS system ,SELF - Abstract
Introduction.Observing another person’s action influences the execution of one’s own action via the mirror neuron system. However, the ability to control the effect of such action observation on one’s voluntary action has not been investigated. The aim of this study was to elucidate the influence of observing another’s action on own voluntary movement in patients with schizophrenia. Methods.Fifteen patients with schizophrenia and 15 healthy age-matched controls participated in this study. Subjects were asked to perform a gripping task at 50% of their maximal voluntary force (MVF), whereas simultaneously watching others performed the same task with a different grip force (0%, 50% and 100% MVF). Results.The healthy controls applied a constant grip force under each condition. In patients with schizophrenia, the grip force was significantly reduced during viewing the gripping of others at 50% MVF compared to during viewing other’s gripping at 0% and 100% MVF. The score of the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Positive Symptoms were correlated with the fluctuation in grip force among the action observation conditions. Conclusion.Patients with schizophrenia might have difficulty controlling the influence of action observation on self-generated performance. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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33. First rank symptoms of schizophrenia: their nature and origin.
- Author
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Cutting, J
- Subjects
SCHIZOPHRENIA ,SYMPTOMS ,DELUSIONS ,HALLUCINATIONS ,PATHOLOGICAL psychology - Abstract
Kurt Schneider’s insight nearly 80 years ago that schizophrenia could be demarcated from other psychoses by a small set of particular delusions and hallucinations powerfully influenced diagnostic practice. The theoretical status of such ‘first rank symptoms’ as a whole, however, has rarely been addressed. But if they are sensitive and specific to the condition, it is about time that their essential nature and potential origin be considered. This is the purpose of the present paper. I argue that these psychopathological phenomena are indeed relatively sensitive and specific to the condition, that their nature can be formulated within a Schelerian model of what constitutes a human being, and that their origin fits anthropological and neuropsychological notions of the make-up of contemporary human beings. [ABSTRACT FROM PUBLISHER]
- Published
- 2015
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34. Thought insertion: Abnormal sense of thought agency or thought endorsement?
- Author
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Sousa, Paulo and Swiney, Lauren
- Abstract
The standard approach to the core phenomenology of thought insertion characterizes it in terms of a normal sense of thought ownership coupled with an abnormal sense of thought agency. Recently, Fernández ( 2010 ) has argued that there are crucial problems with this approach and has proposed instead that what goes wrong fundamentally in such a phenomenology is a sense of thought commitment, characterized in terms of thought endorsement. In this paper, we argue that even though Fernández raises new issues that enrich the topic, his proposal cannot rival the version of the standard approach we shall defend. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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35. The voice-hearer.
- Author
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Woods, Angela
- Subjects
STORYTELLING ,AUDITORY hallucinations ,SCHIZOPHRENIA - Abstract
For 25 years, the international Hearing Voices Movement and the UK Hearing Voices Network have campaigned to improve the lives of people who hear voices. In doing so, they have introduced a new term into the mental health lexicon: "the voice-hearer." This article offers a "thick description" of the figure of "the voice-hearer." A selection of prominent texts (life narratives, research papers, videos and blogs), the majority produced by people active in the Hearing Voices or consumer/survivor/ex-patient movements, were analysed from an interdisciplinary medical humanities perspective. "The voice-hearer" (i) asserts voice-hearing as a meaningful experience, (ii) challenges psychiatric authority and (iii) builds identity through sharing life narrative. While technically accurate, the definition of "the voice-hearer" as simply "a person who has experienced voice-hearing or auditory verbal hallucinations" fails to acknowledge that this is a complex, politically resonant and value-laden identity. The figure of "the voice-hearer" comes into being through a specific set of narrative practices as an "expert by experience" who challenges the authority and diagnostic categories of mainstream psychiatry, especially the category of "schizophrenia." [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
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36. Are Lay People Good at Recognising the Symptoms of Schizophrenia?
- Author
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Erritty, Philip and Wydell, Taeko N.
- Subjects
SCHIZOPHRENIA ,AWARENESS ,PSYCHOSES ,VIGNETTES ,MENTAL illness ,SYMPTOMS - Abstract
Aim: The aim of this study was to explore the general public's perception of schizophrenia symptoms and the need to seek- help for symptoms. The recognition (or 'labelling') of schizophrenia symptoms, help-seeking behaviours and public awareness of schizophrenia have been suggested as potentially important factors relating to untreated psychosis. Method: Participants were asked to rate to what extent they believe vignettes describing classic symptoms (positive and negative) of schizophrenia indicate mental illness. They were also asked if the individuals depicted in the vignettes required help or treatment and asked to suggest what kind of help or treatment. Results: Only three positive symptoms (i.e., Hallucinatory behaviour, Unusual thought content and Suspiciousness) of schizophrenia were reasonably well perceived (above 70%) as indicating mental illness more than the other positive or negative symptoms. Even when the participants recognised that the symptoms indicated mental illness, not everyone recommended professional help. Conclusion: There may be a need to improve public awareness of schizophrenia and psychosis symptoms, particularly regarding an awareness of the importance of early intervention for psychosis. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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37. Neuroimaging studies in schizophrenia: An overview of research from Asia.
- Author
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Narayanaswamy, Janardhanan C., Venkatasubramanian, Ganesan, and Gangadhar, Bangalore N.
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SCHIZOPHRENIA ,NEUROBEHAVIORAL disorders ,BRAIN imaging ,MAGNETIC resonance imaging - Abstract
Neuroimaging studies in schizophrenia help clarify the neural substrates underlying the pathogenesis of this neuropsychiatric disorder. Contemporary brain imaging in schizophrenia is predominated by magnetic resonance imaging (MRI)-based research approaches. This review focuses on the various imaging studies from India and their relevance to the understanding of brain abnormalities in schizophrenia. The existing studies are predominantly comprised of structural MRI reports involving region-of-interest and voxel-based morphometry approaches, magnetic resonance spectroscopy and single-photon emission computed tomography/positron emission tomography (SPECT/PET) studies. Most of these studies are significant in that they have evaluated antipsychotic-naïve schizophrenia patients - a relatively difficult population to obtain in contemporary research. Findings of these studies offer robust support to the existence of significant brain abnormalities at very early stages of the disorder. In addition, theoretically relevant relationships between these brain abnormalities and developmental aberrations suggest possible neurodevelopmental basis for these brain deficits. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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38. The failure of the schizophrenia concept and the argument for its replacement by hebephrenia: applying the medical model for disease recognition.
- Author
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Taylor, Michael Alan, Shorter, Edward, Vaidya, Nutan Atre, and Fink, Max
- Subjects
SCHIZOPHRENIA ,NEUROBEHAVIORAL disorders ,PSYCHOSES ,DEMENTIA - Abstract
The article reflects on the failure of the schizophrenia concept and the argument for its replacement by hebephrenia. It is said that the historical record and empirical data for schizophrenia find that hebephrenia is a more homogeneous construct with distinctive and reliably identified clinical features. It is said that patients with hebephrenia amounted to thirteen percent of the cases of dementia praecox.
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- 2010
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39. Misattributions of agency in schizophrenia are based on imprecise predictions about the sensory consequences of one's actions.
- Author
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Synofzik, Matthis, Thier, Peter, Leube, Dirk T., Schlotterbeck, Peter, and Lindner, Axel
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SCHIZOPHRENIA ,PEOPLE with schizophrenia ,DELUSIONS ,PEOPLE with mental illness ,SENSORIMOTOR integration - Abstract
The experience of being the initiator of one's own actions seems to be infallible at first glance. Misattributions of agency of one's actions in certain neurological or psychiatric patients reveal, however, that the central mechanisms underlying this experience can go astray. In particular, delusions of influence in schizophrenia might result from deficits in an inferential mechanism that allows distinguishing whether or not a sensory event has been self-produced. This distinction is made by comparing the actual sensory information with the consequences of one's action as predicted on the basis of internal action-related signals such as efference copies. If this internal prediction matches the actual sensory event, an action is registered as self-caused; in case of a mismatch, the difference is interpreted as externally produced. We tested the hypothesis that delusions of influence are based on deficits in this comparator mechanism. In particular, we tested whether patients’ impairments in action attribution tasks are caused by imprecise predictions about the sensory consequences of self-action. Schizophrenia patients and matched controls performed pointing movements in a virtual-reality setup in which the visual consequences of movements could be rotated with respect to the actual movement. Experiment 1 revealed higher thresholds for detecting experimental feedback rotations in the patient group. The size of these thresholds correlated positively with patients’ delusions of influence. Experiment 2 required subjects to estimate their direction of pointing visually in the presence of constantly rotated visual feedback. When compared to controls, patients’ estimates were significantly better adapted to the feedback rotation and exhibited an increased variability. In interleaved trials without visual feedback, i.e. when pointing estimates relied solely on internal action-related signals, this variability was likewise increased and correlated with both delusions of influence and the size of patients’ detection thresholds as assessed in the first experiment. These findings support the notion that delusions of influence are based on imprecise internal predictions about the sensory consequences of one's actions. Moreover, we suggest that such imprecise predictions prompt patients to rely more strongly on (and thus adapt to) external agency cues, in this case vision. Such context-dependent weighted integration of imprecise internal predictions and alternative agency cues might thus reflect the common basis for the various misattributions of agency in schizophrenia patients. [ABSTRACT FROM PUBLISHER]
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- 2010
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40. Broadcasting and schizophrenia.
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Peters, John Durham
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BROADCAST advertising ,SCHIZOPHRENIA ,MASS media ,TELEPATHY ,COMMUNICATIVE disorders ,MASS media audiences - Abstract
This article explores the peculiar ways that the practitioners and audiences of broadcasting had to learn to think about impersonal and interpersonal address, pushing media history into the rich and under-explored field of psychiatry. Each media format or technology implies its own communicative disorders. During the broadcast era, it became normal for media personalities to simulate interactive talk, but pathological for a member of the audience to hear their words as a personal response. Broadcast talk encoded an implicit line between madness and rationality. By exploring a number of notions from media theory, media history, and 20th-century psychiatry such as para-social interaction, for-anyone-as-someone structures, thought broadcasting, delusions of reference, and telepathy, this article explores the assumptions about the public and the private that once informed broadcasting but now may be fading in a digital era. [ABSTRACT FROM AUTHOR]
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- 2010
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41. PSYCHOPATHOLOGY OF SCHIZOPHRENIA IN LJUBLJANA (SLOVENIA) FROM 1881 TO 2000: CHANGES IN THE CONTENT OF DELUSIONS IN SCHIZOPHRENIA PATIENTS RELATED TO VARIOUS SOCIOPOLITICAL, TECHNICAL AND SCIENTIFIC CHANGES.
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Škodlar, B., Dernovšek, M. Z., and Kocmur, M.
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SCHIZOPHRENIA ,PATHOLOGICAL psychology ,PSYCHOSES ,PEOPLE with schizophrenia - Abstract
Background: Clinical observations and research have found the content of delusions in schizophrenia to be sensitive to sociopolitical and cultural factors. Aims: The aim of this retrospective case-note study was to determine changes in the frequencies of various contents of delusions in schizophrenia patients over time. Methods: A total of 120 records of first-time admission schizophrenia patients at Ljubljana's psychiatric hospital in the period from 1881 to 2000 were randomly selected. Information was taken from each record to fill out a form specially created for this study. The frequencies of delusions with regard to their content in various time spans were compared. Results: A marked increase in two delusional themes -- persecution and self -reference -- was found after the change of political regime (1941-2000) in Slovenia. After the spread of radio in the 1920s and television in the 1950s in Slovenia, there was an obvious increase in delusions of outside influence and control as well as delusions with technical themes. A striking increase in the percentage of Schneiderian first-rank symptoms was found after the spread of Schneider's ideas in the 1950s. Conclusions: Sociopolitical changes and scientific and technical developments have a marked influence on the delusional content in schizophrenia. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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42. Perceptual Anomalies in Schizophrenia: Integrating Phenomenology and Cognitive Neuroscience.
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Uhlhaas, Peter J. and Mishara, Aaron L.
- Abstract
From phenomenological and experimental perspectives, research in schizophrenia has emphasized deficits in “higher” cognitive functions, including attention, executive function, as well as memory. In contrast, general consensus has viewed dysfunctions in basic perceptual processes to be relatively unimportant in the explanation of more complex aspects of the disorder, including changes in self-experience and the development of symptoms such as delusions. We present evidence from phenomenology and cognitive neuroscience that changes in the perceptual field in schizophrenia may represent a core impairment. After introducing the phenomenological approach to perception (Husserl, the Gestalt School), we discuss the views of Paul Matussek, Klaus Conrad, Ludwig Binswanger, and Wolfgang Blankenburg on perception in schizophrenia. These 4 psychiatrists describe changes in perception and automatic processes that are related to the altered experience of self. The altered self-experience, in turn, may be responsible for the emergence of delusions. The phenomenological data are compatible with current research that conceptualizes dysfunctions in perceptual processing as a deficit in the ability to combine stimulus elements into coherent object representations. Relationships of deficits in perceptual organization to cognitive and social dysfunction as well as the possible neurobiological mechanisms are discussed. [ABSTRACT FROM PUBLISHER]
- Published
- 2007
43. The Cardiff Anomalous Perceptions Scale (CAPS): A New Validated Measure of Anomalous Perceptual Experience.
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Bell, Vaughan, Halligan, Peter W, and Ellis, Hadyn D
- Abstract
The study describes the Cardiff Anomalous Perceptions Scale (CAPS), a new validated measure of perceptual anomalies. The 32-item CAPS measure is a reliable, self-report scale, which uses neutral language, demonstrates high content validity, and includes subscales that measure distress, intrusiveness, and frequency of anomalous experience. The CAPS was completed by a general population sample of 336 participants and 20 psychotic inpatients. Approximately 11% of the general population sample scored above the mean of the psychotic patient sample, although, as a group, psychotic inpatients scored significantly more than the general population on all CAPS subscales. A principal components analysis of the general population data revealed 3 components: “clinical psychosis” (largely Schneiderian first-rank symptoms), “temporal lobe disturbance” (largely related to temporal lobe epilepsy and related seizure-like disturbances) and “chemosensation” (largely olfactory and gustatory experiences), suggesting that there are multiple contributory factors underlying anomalous perceptual experience and the “psychosis continuum.” [ABSTRACT FROM PUBLISHER]
- Published
- 2006
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44. The Neural Basis of Relational Memory Deficits in Schizophrenia.
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Öngür, Dost, Cullen, Thomas J., Wolf, Daniel H., Rohan, Michael, Barreira, Paul, Zalesak, Martin, and Heckers, Stephan
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SCHIZOPHRENIA ,MEMORY ,MAGNETIC resonance imaging ,COGNITION ,HIPPOCAMPUS (Brain) - Abstract
The article discusses the neural correlates of relational memory in schizophrenia using functional magnetic resonance imaging. Schizophrenia affects cognition and causes impairment of the memory. But, memory deficits related to schizophrenia is minimal and is limited to the episodic and relational forms of memory. A study revealed that schizophrenia is represented by a specific deficit of relational memory due to the impaired function of the parietal cortex and hippocampus.
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- 2006
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45. Early adolescent cannabis exposure and positive and negative dimensions of psychosis.
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Stefanis, N. C., Delespaul, P., Henquet, C., Bakoula, C., Stefanis, C. N., and Van Os, J.
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CANNABIS (Genus) ,SMOKABLE plants ,PSYCHOSES ,PATHOLOGICAL psychology ,TEENAGERS ,BIPOLAR disorder - Abstract
To investigate the effect of exposure to cannabis early in adolescence on subclinical positive and negative symptoms of psychosis.Cross-sectional survey in the context of an ongoing cohort study.Government-supported general population cohort study.A total of 3500 representative 19-year olds in Greece.Subjects filled in the 40-item Community Assessment of Psychic Experiences, measuring subclinical positive (paranoia, hallucinations, grandiosity, first-rank symptoms) and negative psychosis dimensions and depression. Drug use was also reported on.Use of cannabis was associated positively with both positive and negative dimensions of psychosis, independent of each other, and of depression. An association between cannabis and depression disappeared after adjustment for the negative psychosis dimensions. First use of cannabis below age 16 years was associated with a much stronger effect than first use after age 15 years, independent of life-time frequency of use. The association between cannabis and psychosis was not influenced by the distress associated with the experiences, indicating that self-medication may be an unlikely explanation for the entire association between cannabis and psychosis.These results add credence to the hypothesis that cannabis contributes to the population level of expression of psychosis. In particular, exposure early in adolescence may increase the risk for the subclinical positive and negative dimensions of psychosis, but not for depression. [ABSTRACT FROM AUTHOR]
- Published
- 2004
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46. Psychosis in Elderly Patients: Classification and Pharmacotherapy.
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Mintzer, Jacobo and Targum, Steven D.
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PSYCHOSES ,OLDER people ,ALZHEIMER'S disease ,PARKINSON'S disease ,SCHIZOPHRENIA - Abstract
Psychosis in elderly patients is a growing clinical concern because psychotic symptoms most frequently occur as noncognitive manifestations of Alzheimer's disease, as side effects of drug therapy for Parkinson's disease, or as the primary abnormalities in schizophrenia, and the clinical characteristics of psychosis are distinct for each. In planning antipsychotic pharmacotherapy for elderly patients, age-related pharmacokinetic changes, polypharmacy for comorbid diseases, and concerns about the underlying conditions responsible for the psychotic symptoms must be considered. Traditional antipsychotic agents bind to dopamine receptors and effectively relieve positive schizophrenic symptoms but frequently cause tardive dyskinesia and other extrapyramidal symptoms, a problem for elderly patients, particularly for those with Parkinson's disease. Atypical antipsychotics bind to dopamine and serotonin receptors, relieving both positive and negative symptoms, and are less likely to cause extrapyramidal symptoms. The authors review common diagnostics associated with psychosis in the elderly and clinical guidelines to selecting antipsychotic pharmacotherapy. [ABSTRACT FROM AUTHOR]
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- 2003
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47. SULLIVAN'S APPROACH TO INNER PSYCHOTIC EXPERIENCES: A CASE ILLUSTRATION.
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Kam-shing Yip
- Subjects
SCHIZOPHRENIA ,PSYCHOSES ,PSYCHOANALYSIS ,OBJECT relations ,PSYCHIATRIC social work ,DELUSIONS ,SELF-perception - Abstract
Harry Stack Sullivan's concept of interpersonal psychiatry has been recognized as a landmark in the American psychoanalytic movement, in particular his influence on the development of object-relations theory. He is an influential figure in interpreting the inner experiences of persons with schizophrenia. Psychotic experiences represent a failure of one's self-system and the dissociation dynamism. Delusions and hallucinations are experiences in lost control of self-awareness. The person regresses to dreams or experiences from infancy and childhood in facing spontaneous conflicts and anxiety in interpersonal transaction. As a result, the tripartite self-system is fractured. In this paper, the writer applies Sullivan's concept in interpreting the inner psychotic experiences of a client with schizophrenia. Its implication for clinical social work practice is also discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2002
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48. A Case of 'Pfropfschizophrenia': Kraepelin's Bridge Between Neurodegenerative and Neurodevelopmental Conceptions of Schizophrenia.
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Mack, Avram H., Feldman, James J., and Tsuang, Ming T.
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SCHIZOPHRENIA ,INTELLECTUAL disabilities - Abstract
Assesses the neurodegenerative and neurodevelopmental conceptions of schizophrenia. Types of dementia praecox; Association between schizophrenia and mental retardation (MR); Psychopathologies of patients with MR.
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- 2002
- Full Text
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49. Cannabis-induced psychosis: a cross-sectional comparison with acute schizophrenia.
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Núñez, L. A. and Gurpegui, M.
- Subjects
PSYCHOSES ,CANNABIS (Genus) - Abstract
Objective: The existence of cannabis-induced psychosis (CP) remains controversial, partly because of methodological problems. We hypothesize that acute schizophrenia (AS) and CP can have distinct demographic, premorbid and clinical features. Method: We compared 26 patients with CP to 35 with AS, after their cannabis-consumption status was confirmed by repeated urine screens. Patients with CP were assessed after at least 1 week but not more than 1 month of abstinence. Symptoms were evaluated with the Present State Examination (PSE). Results: In group CP, male gender, expansive mood and ideation, derealization/depersonalization, visual hallucinations, and disturbances of sensorium were more frequent than in group AS. Premorbid schizoid personality traits were more frequently associated to AS and antisocial personality traits to CP. Conclusion: The continuous heavy use of cannabis can induce a psychotic disorder distinct from AS. These two clinical entities share some features but they differ in others. [ABSTRACT FROM AUTHOR]
- Published
- 2002
- Full Text
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50. 12.4 THE BODILY SELF IN PSYCHOSIS: SENSORIMOTOR INDUCTION OF AUDITORY MISATTRIBUTION IN PSYCHOSIS IS LINKED TO NEURAL DISCONNECTIVITY
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Pierre Progin, Fosco Bersconi, Silvia Marchesotti, Olaf Blanke, Patric Hagmann, Andrea Serino, Roy Salomon, Philippe Conus, Kim Q. Do, Giulio Rognini, and Alessandra Griffa
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Psychosis ,Sense of agency ,Resting state fMRI ,Cognition ,medicine.disease ,Insular cortex ,Plenary/Symposia ,Psychiatry and Mental health ,Schizophrenia ,medicine ,Misattribution of memory ,Psychology ,Neuroscience ,Neurocognitive - Abstract
Background Psychosis is often depicted as a disruption of the self-model. Patients suffering from psychosis report many symptoms relating to deficiencies in the minimal self, including loss of the sense of control over their actions (Sense of Agency) as well as numerous disturbances of body representation (e.g. Body Ownership). Positive symptoms of psychosis such as passivity symptoms and auditory hallucinations (termed first-rank symptoms) are characterized by a diminished demarcation of self-other boundaries, causing misattribution of self-generated actions to external sources. It has been suggested that this deficiency in self-monitoring in schizophrenia is due to abnormal sensorimotor prediction mechanisms, causing a loss of agency for actions and thoughts. While the neurobiological underpinnings of schizophrenia are yet unclear, many studies have reported aberrant neural connectivity in schizophrenia patients which may impact sensorimotor prediction and integration. Methods Recently, we have shown that introducing sensorimotor conflict (SMC) can induce psychosis like symptoms in healthy patients. Employing a master-slave robotic system we induced a conflict by introducing a delay between the participants’ movements and the haptic feedback. The SMC caused a feeling of a Presence (FoP) which is a first rank symptom of psychosis. The FoP is also found in neurological patients with lesions in cortical regions of the temporoparietal cortex, insular cortex and fronto-parietal cortex related to abnormal bodily self-representation. Here, we tested if SMC may cause misattribution of auditory stimuli and if this is related to neural connectivity. We tested first episode psychosis patients (N=31) with and without first rank symptoms (related to the sense of control over actions and thoughts) as well as healthy participants (N=20) on an auditory attribution task while inducing conflict with the master-slave robot. Results We found that when a SMC was introduced patients with first rank symptoms showed a decrease in their ability to judge if the auditory stimuli were in their own voice or the voice of another person. Resting state functional connectivity analysis indicated that the first rank patients had reduced connectivity in the network related to the SMC, but not in other control regions. Furthermore, the reduced functional connectivity correlated with the rates of auditory misattribution. Conclusions Our results show that induction of SMC can cause auditory misattributions, and that this is related to reduced cortical communication in regions related to sensorimotor body representation. These findings connect two influential theories of psychosis linking cognitive theories of sensorimotor prediction error in schizophrenia with systems level theories of neural disconnectivity. Understanding these neurocognitive mechanisms underlying the disruption of the self-model in psychosis may allow novel approaches in early diagnosis and treatment of these conditions.
- Published
- 2019
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