Understanding / Psychosis

“Understanding” in Jaspers’ sense is the essential concept for defining psychosis, although its relationship is paradoxical, that is, psychosis is defined by un-understandability or inability to understand. Un-understandability means the inability of empathizing with the patient’s mind and implies the existence of a pathological process in the patient’s brain. The pivotal concept which makes psychotic patients be judged as irresponsible in forensic cases is disturbed self-understanding or un-understandability of their own intentions. It is suggested that self-disorder representing psychosis might be based on disturbed self-understanding.

Abnormal ERPs and Brain Dynamics Mediate Basic Self Disturbance in Schizophrenia: A Review of EEG and MEG Studies

Background: Interest in disordered sense of self in schizophrenia has recently re-emerged in the literature. It has been proposed that there is a basic self disturbance, underlying the diagnostic symptoms of schizophrenia, in which the person's sense of being a bounded individual continuous through time loses stability. This disturbance has been documented phenomenologically and at the level of cognitive tasks. However, the neural correlates of basic self disorder in schizophrenia are poorly understood.Methods: A search of PubMed was used to identify studies on self and schizophrenia that reported EEG or MEG data.Results: Thirty-three studies were identified, 32 using EEG and one using MEG. Their operationalizations of the self were divided into six paradigms: self-monitoring for errors, proprioception, self-other integration, self-referential processing, aberrant salience, and source monitoring. Participants with schizophrenia were less accurate on self-referential processing tasks and had slower response times across most studies. Event-related potential amplitudes differed across many early and late components, with reduced N100 suppression in source monitoring paradigms being the most replicated finding. Several studies found differences in one or more frequency band, but no coherent overall finding emerged in this area. Various other measures of brain dynamics also showed differences in single studies. Only some of the study designs were adequate to establish a causal relationship between the self and EEG or MEG measures.Conclusion: The broad range of changes suggests a global self disturbance at the neuronal level, possibly carried over from the resting state. Further studies that successfully isolate self-related effects are warranted to better understand the temporal-dynamic and spatial-topographic basis of self disorder and its relationship to basic self disturbance on the phenomenological level.

Formal Thought Disorder and Self-Disorder: An Empirical Study

Background: Formal thought disorder was constitutively linked to the original concept of schizophrenia and has since been one of central features supporting its diagnosis. Bleuler considered formal thought disorder as a fundamental symptom of schizophrenia among other fundamental symptoms, including ego disorders. The contemporary concept of self-disorder represents a more developed, nuanced, and systematic approach to disturbances of self-experience than the Bleulerian concept of ego disorders. As fundamental symptoms, on Bleuler's account, are persistently present in every case, an association between these symptoms could be expected. The purpose of this study was to examine the association between self-disorder and formal thought disorder.Methods: A sample of 94 diagnostically heterogeneous patients was examined for formal thought disorder using clinical rating and a proverb test. The proverb test was analyzed for two different aspects of formal thought disorder: literal responses and bizarre responses. The sample was comprehensively assessed for psychopathology, including self-disorder as measured with the Examination of Anomalous Self-Experience scale.Results: The patients, who provided bizarre responses, had a higher level of self-disorder, more negative symptoms, lower level of social functioning, and lower level of intelligence. Bizarre answers aggregated in patients diagnosed within the schizophrenia spectrum compared with patients outside the schizophrenia spectrum. We found moderate correlations between the two measures of formal thought disorder (clinically rated and bizarre responses) and self-disorder (0.454 [p < 0.01] and 0.328 [p < 0.01]). Literal responses did not differ between diagnostic groups and also did not correlate with bizarre responses. Specificity of bizarre responses for a diagnosis within schizophrenia spectrum was 86.89%, whereas sensitivity was 40.85%.Conclusion: The close relation between formal thought disorder and self-disorder further adds to the notion of self-disorder as a unifying psychopathological core beneath the apparently heterogeneous symptoms of schizophrenia.

The Self and Its Prolonged Intrinsic Neural Timescale in Schizophrenia

Schizophrenia (SCZ) can be characterized as a basic self-disorder that is featured by abnormal temporal integration on phenomenological (experience) and psychological (information processing) levels. Temporal integration on the neuronal level can be measured by the brain’s intrinsic neural timescale using the autocorrelation window (ACW) and power-law exponent (PLE). Our goal was to relate intrinsic neural timescales (ACW, PLE), as a proxy of temporal integration on the neuronal level, to temporal integration related to self-disorder on psychological (Enfacement illusion task in electroencephalography) and phenomenological (Examination of Anomalous Self-Experience [EASE]) levels. SCZ participants exhibited prolonged ACW and higher PLE during the self-referential task (Enfacement illusion), but not during the non-self-referential task (auditory oddball). The degree of ACW/PLE change during task relative to rest was significantly reduced in self-referential task in SCZ. A moderation model showed that low and high ACW/PLE exerted differential impact on the relationship of self-disorder (EASE) and negative symptoms (PANSS). In sum, we demonstrate abnormal prolongation in intrinsic neural timescale during self-reference in SCZ including its relation to basic self-disorder and negative symptoms. Our results point to abnormal relation of self and temporal integration at the core of SCZ constituting a “common currency” of neuronal, psychological, and phenomenological levels.

The McGurk effect in self-recognition of people with schizophrenia

The McGurk effect is a robust illusion phenomenon in the perception of speech; however, there is little research on its demonstration in nonverbal domains. Thus, we tested for the McGurk effect in the context of self-recognition. We presented a group of people with schizophrenia and a control group of people without mental illnesses, with 2 videos accompanied by a soundtrack featuring different identity information. The first video had a matched face and voice; the other featured conflicting face–voice information. The participants judged if the voice in the video was their own or someone else's. The results show there was a robust McGurk effect in self-recognition, which was stronger among participants with schizophrenia because of the influence of self-disorder. Further, people with schizophrenia were less accurate in voice self-recognition when there was conflicting face–voice identity information. Thus, presenting audiovisual-consistent information is conducive to information processing for people with schizophrenia.

‘The schizophrenic basic mood (self-disorder)’, by Hans W Gruhle (1929)

During the first half of the twentieth century, German psychiatry came to consider ‘ Ich-Störungen’, best translated as self-disorders, to be important features of schizophrenia. The present text is a translation of a chapter by the German psychiatrist Hans Gruhle, which is extraordinarily clear and emblematic for this research line. Published in 1929, it was part of a book co-written with Josef Berze, The Psychology of Schizophrenia (concerning its subjectivity). Gruhle claims that the essential core of schizophrenia is of an affective nature, a ‘mood’ manifesting itself as self-disorder, an unstable, incomplete pre-reflective self-awareness. His impact on contemporary psychiatry was probably limited due to his confrontational style, but this text has great significance for the modern revival of phenomenological research in schizophrenia.

S191. A SCOPING REVIEW AND PHENOMENOLOGICAL EVALUATION OF METACOGNITIVE TRAINING FOR SCHIZOPHRENIA

Background The self-disorder (SD) approach to schizophrenia posits that although schizophrenia involves a core disruption, this alteration nonetheless leaves room for variable experiential pathways toward delusion formation, which are held to account for variation in thematic content. This view of delusions, then, complicates the picture provided by the theory and research that supports MCT, raising the question of how these separate bodies of empirical evidence might be weighed against each other and reconciled. A major point of difference between these two perspectives is on the issue of “normalizing”. Given that the self-disorder approach posits anomalous alterations in self and world experience, the way the patient with schizophrenic delusions is taken as believing is radically different than the individual whose experience cannot be characterized by such anomalous experience. Thus, although the biases posited by MCT may indeed reflect some general and common errors of cognition and reasoning, there is reason to be cautious about interpreting the observation of such biases in the context of schizophrenia as implying that they play the same role as in the development of erroneous beliefs in non-schizophrenic populations. Moreover, while it is of course possible that a specific metacognitive skill taught during a MCT module may nonetheless prove useful for managing delusional ideation, the variable experiential pathways from which different types of delusions emerge may render a given type of delusion as more or less amenable to treatment by means of a specific MCT module and its corresponding metacognitive skill. However, unless MCT studies have thus far considered the relative impact of individual modules on specific types of delusions, the question of which metacognitive skills can be shown as effective for a specific type of delusion remains unknown. Methods A scoping review was conducted in order to discern if published MCT studies have examined the impact of individual MCT modules on types of delusions as they occur in the context of schizophrenia spectrum disorders. Results It was found that 2% of the 38 MCT studies reviewed provided explicit information about the types of delusions treated, with 5% of such studies reporting on module-specific effects, one study of which specified effects on paranoid delusions. Discussion This scoping review is novel in its demonstration that, overall, published MCT studies have not taken into consideration the heterogeneity of delusions, nor have they extensively evaluated whether or not there are differential, module specific, outcomes for different types of delusions. From a phenomenological perspective, this risks ignoring how differences in the thematic content of delusions emerge from differing experiential precursors. How each cognitive and affective mechanism targeted by MCT modules may differently contribute to the maintenance or treatment of different types of delusions will be critically evaluated in consideration of the phenomenology of delusions, and suggestions for further research and practice, which aim toward the goal of individualized medicine, will also be considered.

Delusion and Hallucination in Schizophrenia: A Phenomenological Perspective

The present paper reflects on hallucination and delusion in schizophrenia from a phenomenological perspective. The paper’s aim is to understand the relationship between these two symptoms within the theoretical paradigm of schizophrenia as a self-disorder. The paper draws on fundamental insights from contemporary phenomenological research by Louis A. Sass, Josef Parnas and Thomas Fuchs. The argument begins with current definitions of hallucination and schizophrenia in the DSM-5. I will critically illuminate these definitions by key thinkers of phenomenological psychopathology (or close to it), such as Karl Jaspers, Eugène Minkowski, Henri Ey and Merleau-Ponty. The paper’s main challenge is to understand hallucination and delusion beyond their respective alignment with perception (as though hallucination would simply be a perception without an object to perceptive) or false belief (as if delusion would simply be an absurd conviction).

Reconfiguration of Dynamic Functional Connectivity in Sensory and Perceptual System in Schizophrenia

Schizophrenia is thought as a self-disorder with dysfunctional brain connectivity. This self-disorder is often attributed to high-order cognitive impairment. Yet due to the frequent report of sensorial and perceptual deficits, it has been hypothesized that self-disorder in schizophrenia is dysfunctional communication between sensory and cognitive processes. To further verify this assumption, the present study comprehensively examined dynamic reconfigurations of resting-state functional connectivity (rsFC) in schizophrenia at voxel level, region level, and network levels (102 patients vs. 124 controls). We found patients who show consistently increased rsFC variability in sensory and perceptual system, including visual network, sensorimotor network, attention network, and thalamus at all the three levels. However, decreased variability in high-order networks, such as default mode network and frontal–parietal network were only consistently observed at region and network levels. Taken together, these findings highlighted the rudimentary role of elevated instability of information communication in sensory and perceptual system and attenuated whole-brain integration of high-order network in schizophrenia, which provided novel neural evidence to support the hypothesis of disrupted perceptual and cognitive function in schizophrenia. The foci of effects also highlighted that targeting perceptual deficits can be regarded as the key to enhance our understanding of pathophysiology in schizophrenia and promote new treatment intervention.