Examination Of Anomalous Self-Experience Research Articles

The association between anomalous self-experience and suicidality in first-episode schizophrenia seems mediated by depression

BackgroundA recent hypothesis is that suicidality in schizophrenia may be linked to the patients' altered basic self-awareness or sense of self, termed self-disorders (SDs). AimThe aim of the study was to investigate whether SDs in first-episode schizophrenia spectrum disorders are related to suicidality and whether this relationship is independent of or mediated by depression or other standard clinical measures. MethodSelf-disorders were assessed in 49 patients with first-episode schizophrenia by means of the Examination of Anomalous Self-Experience (EASE) instrument. Symptoms severity and functioning were assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Global Assessment of Functioning-Split Version. Suicidality was measured by the Calgary Depression Scale for Schizophrenia item 8. ResultsAnalyses detected a significant association between current suicidality, current depression, and SDs as measured by the EASE. The effect of SDs on suicidal ideation appeared to be mediated by depression. ConclusionThe interaction between anomalous self-experiences and depression could be a rational clinical target for the prevention of suicidality in the early phases of schizophrenia and supports the rationale for including assessment of SDs in early intervention efforts.

Examination of Anomalous Self-Experience in First-Episode Psychosis: Interrater Reliability

Background: The growing research focus on early detection of schizophrenia has fostered an increasing interest in the nonpsychotic experiential anomalies that may antedate schizophrenia spectrum disorders and assist early differential diagnosis. The Examination of Anomalous Self-Experience (EASE) is a phenomenologically inspired checklist, specifically designed to support the comprehensive assessment of these characteristic subjective experiences. Aim: To assess the interrater reliability of the EASE. Sampling and Methods: Twenty-five first-episode psychosis (FEP) patients were interviewed with the EASE. Videotaped interviews were blindly reevaluated. Internal consistency, overall interrater correlation and item interrater agreement (Cohen’s kappa) were estimated. Results: The EASE showed good to excellent internal consistency across the two raters (Cronbach’s alpha above 0.87) and an overall inter-rater correlation above 0.80 (Spearman’s rho, p < 0.001). The average kappa of the EASE was 0.65, ranging from 0.51 to 0.73 over the 5 domains; kappa values at an item level were very good in 9 items, good in 20 items, moderate in 11 items and fair in 4 items. Conclusion: The EASE provides a reliable and internally consistent clinical tool for the assessment of subjective experience in FEP patients, suggesting that this instrument could usefully supplement standard clinical assessments during the onset phase of psychosis.

EMERGING EVIDENCE FOR EFFECTIVE APPROACHES TO THE TREATMENT OF PEDIATRIC PATIENTS WITH SCHIZOPHRENIA DISORDERS

The distinction between the schizophrenia spectrum and other types of disorders may be clinically relevant in terms of its predictive validity as suggested by studies showing schizophrenia spectrum patients have more unfavourable outcomes compared to other psychotic disorders. The present study aimed to investigate whether basic self-disturbances and neurocognitive processes that have been linked to psychosis risk have discriminative power for schizophrenia spectrum disorders in patients presenting with first episode psychosis (FEP) and at ultra-high risk for psychosis (UHR).38 FEP patients, 48 UHR patients, and 33 healthy controls were assessed for basic self-disturbances (using the Examination of Anomalous Self-Experience, EASE, interview), source monitoring and aberrant salience (behavioural tasks to measure neurocognitive constructs). Clinical groups were divided into patients with schizophrenia spectrum disorders and those with other non-spectrum disorders and were further compared on measures controlling for symptom severity and age.Basic self-disturbances distinguished schizophrenia spectrum from non-spectrum disorders in the ‘FEP only’ sample, F = 19.76, p < 0.001, η2partial = 0.37, and also in the combined UHR/FEP sample, F = 23.56, p < 0.001, η2partial = 0.22. Additionally, some processes related to source monitoring deficits were elevated in schizophrenia spectrum disorders. In contrast, the two groups (schizophrenia spectrum vs other diagnoses) performed similarly in aberrant salience tasks. Comparable results were obtained for analyses performed with an FEP/UHR combined sample and the ‘FEP only’ sample.Basic self-disturbances at the phenomenological level and source monitoring deficits on the neurocognitive level may be useful in identifying risk of schizophrenia spectrum disorders at the earliest clinical presentation.