Phenomenology Of Schizophrenia Research Articles

Understanding, schizophrenia, and the limits of phenomenology

Karl Jaspers’ assertion of the un-understandability of schizophrenic psychosis, which rests on a division between what is psychologically understandable and what must be explained via natural causation, has faced numerous challenges from within phenomenological psychopathology. But despite significant developments in the phenomenology of schizophrenia, I suggest that this dichotomy, between psychological understandability and naturalistic explanation, is still present in some phenomenological research on schizophrenia today, even in work that explicitly critiques the limitations of empathic understanding and the purported incomprehensibility of schizophrenic delusions. Other theories of subjectivity, particularly those in the Lacanian tradition, offer one way to recognize the impossibility of understanding without turning to naturalistic explanation. These theories may encourage us to better integrate other key insights in phenomenology, most clearly articulated in the work of Merleau-Ponty, that look beyond “conscious” awareness—those that allow for a renewed appreciation of the un-understandable in schizophrenia, and indeed in all human experience.

The aberrant salience hypothesis: Unifying the neurobiology and phenomenology of schizophrenia

Introducción: La popularización del reduccionismo neurobiológico en psicopatología conlleva la idea de que la esquizofrenia puede entenderse simplemente como el producto de alteraciones en el funcionamiento cerebral. Por otro lado, y criticando esta tradición, el enfoque fenomenológico propone que la esquizofrenia debería entenderse como un trastorno del yo. Si bien ambas tradiciones son relevantes en la actualidad, creemos que una comprensión completa del fenómeno psicótico envuelve una integración de ambas. Objetivo: Este artículo plantea que la hipótesis de la saliencia aberrante es un buen candidato para unificar la tradición fenomenológica y la neuropsiquiátrica en el estudio de la esquizofrenia. Procedimiento: Luego de examinar la hipótesis en cuestión en profundidad, exploramos la forma en que podría explicar algunos de los síntomas positivos de la esquizofrenia de forma consistente con sus descripciones fenomenológicas. Conclusiones: Finalmente, se ofrecen algunas consideraciones generales respecto de las consecuencias de nuestro análisis para el campo de la psicopatología.

The concept of psychotic arousal and its relevance to abnormal subjective experiences in schizophrenia. A hypothesis for the formation of primary delusions

The presence of abnormal subjective experiences in the prodromal stages of schizophrenia as well as their contribution to delusional formation have been highlighted in psychiatric literature, but their nature and their involvement in the transition and establishment of full-blown psychosis remains elusive. In this paper, we venture to form a coherent hypothesis for the formation of primary delusions by attributing importance to the emotional and affective symptoms experienced by patients during the acute state of psychosis. We underline the presence of abnormal subjective experiences described as ‘feelings’ in patients’ narratives, their co-occurrence with discernible emotional manifestations and symptoms, and their rather simultaneous retreat from the clinical picture shortly after the effective administration of antipsychotic treatment. We further distinguish them from their enveloping thought content, on the base of their different course pattern and natural characteristics. We argue that this composite emotional picture – which we call “psychotic arousal” – though resembling the acknowledged “delusional mood”, traverses the acute state of psychosis to a greater extent and intensity, as long as we observe delusions flourishing and expanding. We specifically suggest that altered subjective experiences can be seen as emotional in nature and best described as “experiential feelings”. Consequently, we reflect upon neuroscientific theories and models supporting a layered concept for the formation of consciousness that attribute a paramount role on emotions as a representation of neural maps of the material body’s state. We explore patients’ “experiential feelings” as the morbid outcome of an otherwise normal process and we provide a theoretical solution for the psychotic transition and the formation of primary delusions. Our hypothesis, eventually, responds to long-standing questions regarding the content of the delusions, their abrupt appearance, their self-referential character, their selectivity and specificity, as well as their impact on awareness and the erroneous deployment of extended consciousness. We suggest that further enquiry of the proposed hypothesis could elucidate more deeply the phenomenology of schizophrenia and benefit both psychopathology and neuroscience of self.

P502. The Role of the Insula in Cognitive Impairment of Schizophrenia

The insula is an extensively connected brain region whose dysfunction plays a vital role in the neurobiology and clinical phenomenology of Schizophrenia (SZ). The insula is central to many tasks and brain networks. Insular pathology has been implicated in delusions and hallucinations, neurocognition and social cognition, and sensorimotor deficits.

Bodily Self-Disturbances in Schizophrenia: A Comparative Study of South Korea and the USA

Background: Bodily self-disturbances are highly salient to the phenomenology of schizophrenia (SZ) but difficult to quantify owing to the subjective nature of these experiences that challenge verbal descriptions. The Benson et al. [PsyCh J. 2019 Mar;8(1):110–21] Body Disturbances Inventory (B-BODI) provides visual aids to help participants access the frequency, distressfulness, and vividness of subjective self-experiences with good reliability and validity in North American samples. However, the concept of the self and, accordingly, the conceptualization of self-disorders are influenced by culture. Therefore, we examined self-disturbances in individuals with SZ and control (CO) participants in 2 distinct cultures. Methods: B-BODI was administered to South Korean and North American participants, with and without SZ. Severity of symptoms in diagnosed individuals with SZ and schizotypy in CO was assessed. We also assessed perceived social isolation and mood in all participants. Results: Endorsement and frequency of bodily self-disturbances in SZ were similar in both cultures. In contrast, there were significant cultural differences in the degree of distress and vividness of self-disturbances. Bodily self-disturbances were experienced as more vivid and distressing to Americans than Koreans, regardless of diagnosis. For both cultures, B-BODI scores were associated with positive, but not negative, symptoms in SZ. For CO, elevated schizotypy was associated with B-BODI scores. Mood and loneliness were not associated with B-BODI scores. Conclusion: SZ reported overall increased levels of bodily self-disturbances compared with CO, regardless of culture. However, there were cultural differences in one’s emotional reaction to these experiences. Americans were more distressed by self-disturbances and experienced them more vividly than Koreans. These findings suggest that Americans may be less accepting of anomalous bodily self-experiences relative to Koreans. Last, B-BODI appears to be a useful tool for future cross-cultural studies of SZ phenomenology.

The unbalanced reorganization of weaker functional connections induces the altered brain network topology in schizophrenia

Network neuroscience shed some light on the functional and structural modifications occurring to the brain associated with the phenomenology of schizophrenia. In particular, resting-state functional networks have helped our understanding of the illness by highlighting the global and local alterations within the cerebral organization. We investigated the robustness of the brain functional architecture in 44 medicated schizophrenic patients and 40 healthy comparators through an advanced network analysis of resting-state functional magnetic resonance imaging data. The networks in patients showed more resistance to disconnection than in healthy controls, with an evident discrepancy between the two groups in the node degree distribution computed along a percolation process. Despite a substantial similarity of the basal functional organization between the two groups, the expected hierarchy of healthy brains' modular organization is crumbled in schizophrenia, showing a peculiar arrangement of the functional connections, characterized by several topologically equivalent backbones. Thus, the manifold nature of the functional organization’s basal scheme, together with its altered hierarchical modularity, may be crucial in the pathogenesis of schizophrenia. This result fits the disconnection hypothesis that describes schizophrenia as a brain disorder characterized by an abnormal functional integration among brain regions.

Altered Peripersonal Space and the Bodily Self in Schizophrenia: A Virtual Reality Study.

Self-disturbances such as an anomalous perception of one's own body boundary are central to the phenomenology of schizophrenia (SZ), but measuring the spatial parameters of the hypothesized self-other boundary has proved to be challenging. Peripersonal space (PPS) refers to the immediate zone surrounding the body where the self interacts physically with the environment; the space that corresponds to hypothesized self-other boundary. PPS is represented by enhanced multisensory integration and faster reaction time (RT) for objects near the body. Thus, multisensory RT tasks can be used to estimate self-other boundary. We aimed to quantify PPS in SZ using an immersive virtual reality visuotactile RT paradigm. Twenty-four participants with SZ and 24 demographically matched controls (CO) were asked to detect tactile vibration while watching a ball approaching them, thrown by either a machine (nonsocial condition) or an avatar (social condition). Parameters of PPS were estimated from the midpoint of the spatial range where the tactile RT decreased most rapidly (size) and the gradient of the RT change at this midpoint (slope). Overall, PPS was smaller in participants with SZ compared with CO. PPS slope for participants with SZ was shallower than CO in the social but not in nonsocial condition, indicating an increased uncertainty of self-other boundary across an extended zone in SZ. Social condition also increased false alarms for tactile detection in SZ. Clinical symptoms were not clearly associated with PPS parameters. These findings suggest the context-dependent nature of weakened body boundary in SZ and underscore the importance of reconciliating objective and subjective aspects of self-disturbances.

DO BIPOLAR PATIENTS LACK MIND READING; AN ATTEMPT TO ASSESS THROUGH PICTURE SEQUENCING TASK

Background: This paper reports the performance of ICD-10 diagnosed Bipolar affective disorder (BPAD) patients on a well recognised measure of theory of mind (ToM) that commonly elicits group related differences in schizophrenia research.
 Aims: (1) To assess Theory of mind in patients of Bipolar Affective Disorder. 
 (2) To examine effect of mood on Theory of Mind.
 Method: Three groups were formed namely Control, BPAD (M) and BPAD (D). Each group was socio-demographically suitably matched and had 30 participants. Active symptomatology was assessed by using YMRS and MADRS in BPAD(M) and BPAD(D) cases respectively. Theory of mind was calculated using Landon and Clotheart (1999) Picture Sequencing Task.
 Results: Relative to controls, bipolar patients performed significantly worse on the ToM relevant false belief script in picture sequencing task but not on other types of task stories. No significant difference was observed in the ToM performance between the phase of bipolarity.
 Conclusion: The results support previous evidence of ToM deficit in BPAD and indicate a potential endophenotypic overlap in the phenomenology of both Schizophrenia and BPAD.
 Keywords: Theory of Mind, YMRS, MADRS, Picture Sequence Task

Upregulation of the Intestinal Paracellular Pathway with Breakdown of Tight and Adherens Junctions in Deficit Schizophrenia.

In 2001, the first author of this paper reported that schizophrenia is associated with an increased frequency of the haptoglobin (Hp)-2 gene. The precursor of Hp-2 is zonulin, a molecule that affects intercellular tight junction integrity. Recently, we reported increased plasma IgA/IgM responses to Gram-negative bacteria in deficit schizophrenia indicating leaky gut and gut dysbiosis. The current study was performed to examine the integrity of the paracellular (tight and adherens junctions) and transcellular (cytoskeletal proteins) pathways in deficit versus non-deficit schizophrenia. We measured IgM responses to zonulin, occludin, E-cadherin, talin, actin, and vinculin in association with IgA responses to Gram-negative bacteria, CCL-11, IgA responses to tryptophan catabolites (TRYCATs), immune activation and IgM to malondialdehyde (MDA), and NO-cysteinyl in 78 schizophrenia patients and 40 controls. We found that the ratio of IgM to zonulin + occludin/talin + actin + viculin (PARA/TRANS) was significantly greater in deficit than those in non-deficit schizophrenia and higher in schizophrenia than those in controls and was significantly associated with increased IgA responses to Gram-negative bacteria. IgM responses to zonulin were positively associated with schizophrenia (versus controls), while IgM to occludin was significantly associated with deficit schizophrenia (versus non-deficit schizophrenia and controls). A large part of the variance (90.8%) in negative and PHEM (psychosis, hostility, excitation, and mannerism) symptoms was explained by PARA/TRANS ratio, IgA to Gram-negative bacteria, IgM to E-cadherin and MDA, and memory dysfunctions, while 53.3% of the variance in the latter was explained by PARA/TRANS ratio, IgA to Gram-negative bacteria, CCL-11, TRYCATs, and immune activation. The results show an upregulated paracellular pathway with breakdown of the tight and adherens junctions and increased bacterial translocation in deficit schizophrenia. These dysfunctions in the intestinal paracellular route together with lowered natural IgM, immune activation, and production of CCL-11 and TRYCATs contribute to the phenomenology of deficit schizophrenia.

Functional Connectivity of the Caudate in Schizophrenia Evaluated with Simultaneous Resting-State Functional MRI and Electroencephalography Recordings

Background: Aberrant functional connectivity (FC) is increasingly implicated in the clinical phenomenology of schizophrenia. This study focused on the FC of the cortico-striatal network, which is thought to be disrupted in schizophrenia and to contribute to its clinical manifestations. Methods: We used simultaneous resting-state functional magnetic resonance imaging (rsfMRI) and electroencephalography (EEG) recordings to investigate FC in patients with schizophrenia. The study included 20 patients with schizophrenia and 20 healthy controls (HCs). Simultaneously recorded rsfMRI and EEG data were collected with an MR-compatible amplifier, and rsfMRI data were analyzed with the CONN toolbox to calculate FC. The study focused on the caudate, which was defined as the seed. We also performed between-group comparisons of standardized low-resolution electromagnetic tomography intracortical lagged coherence for each EEG frequency band. Results: Compared to HCs, patients with schizophrenia showed enhanced FC between the caudate nucleus and the posterior cingulate cortex, temporal, and occipital regions on rsfMRI. It is thus possible that HCs have negative FC between these regions, whereas patients with schizophrenia have non-negative FC. The EEG results showed no significant differences in oscillations or in FC between the groups in any frequency band in any region. Conclusions: Increased FC in the caudate may represent aberrant between-network FC resulting from the disruption of segregation between networks.

Gender differences in the relationship of childhood trauma and the course of illness in schizophrenia

IntroductionDifferent types of childhood trauma have been repeatedly shown to contribute to psychotic symptoms. Gender differences in schizophrenia are well known. Some studies argue that trauma history means a significantly higher risk of psychosis for women than men. However, there is evidence of early adverse life events to be associated with higher stress-sensitivity in men. Little is known about the connection of specific type of trauma and specific psychotic symptoms as well as the course of illness with explicit regard to gender differences. Methods102 men and women with schizophrenia spectrum disorder were tested using Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Scale for Assessing Positive Symptoms, Early Trauma Inventory-SR. ResultsAlthough, women had a later age at onset without regarding trauma history (d = 0.74), this difference became non-significant when introducing trauma variables. Patients reporting physical abuse had a significantly earlier age at onset, regardless of their sex (V = 0.13, F = 3.11, p = 0.03. Physical abuse predicted an earlier age at onset only in women (R2 = 0.23). History of general trauma predicted more frequent hospitalizations only in men (R2 = 0.55). ConclusionsAlthough women generally tend to have a more favorable course of illness including a later age at onset men, women with CPA seem to lose this “advantage”. It is necessary to investigate the contribution of gender interacting with adverse life events in contribution to the phenomenology and etiology of schizophrenia.

Dissociation, Delusion and the Splitting of the Self in The Trial by Franz Kafka: Phenomenology and Neurobiology of Schizophrenia.

In this essay, we propose an association between Franz Kafka's novel, The Trial, and phenomenological and neurobiological processes in schizophrenia. We begin by presenting a summary of the plot, pointing to some of its remarkable literary aspects. We next compare the mental processes of dissociation, disorientation and delusion as represented in the novel with phenomenological processes that take place in the prodromal states of schizophrenia. We discuss how such disorders of the self and disorders of thought, both crucial aspects of the schizophrenic experience, appear in The Trial and in other literary and private writings by Franz Kafka. We relate how these disorders may arise from the false attribution of salience and false associative learning caused by hyperactivity of dopaminergic function associated with chaotic firing of dopaminergic neurons. Finally, we show how Kafka leads not just the protagonist of The Trial, but even more the reader to experience a quasi-delusional state. We discuss the relationship between the perturbation of thought and disorientation of mind evoked by the novel in the reader and the need of our brains for empathy and predictability.

Are negative symptoms in schizophrenia a distinct therapeutic target?

Background and aimsThe relationship between negative symptoms and cognition in schizophrenia is not clear, inconsistent findings have been reported by multiple authors and meta analyses. The aim of this study was to investigate the relationship between cognition and primary negative symptoms.Methods67 outpatients diagnosed with schizophrenia were evaluated using PANSS and the NSA-16 scale. Correlation and regression analyses were used in the present study to investigate the relationship between the primary negative symptoms and cognition.ResultsNo relationship was found between the PANSS Cognitive factor and Negative factor, but when investigating the relationship of the Cognitive PANSS factor with the negative symptoms evaluated with the NSA-16 scale, it was shown that there is a significant association between cognition and motor retardation.ConclusionsOur study reveals the relative independence of cognitive factor from the global negative domain of the psychopathology, even though the association with motor retardation was clear. These findings also support the need of using appropriate assessment tools in order to gain a more refined understanding of the phenomenology of schizophrenia.

A New Division of Schizophrenia Revealed Expanded Bilateral Brain Structural Abnormalities of the Association Cortices

The phenomenological and, consequently, pathophysiological heterogeneity of schizophrenia may be substantially decreased by determining etiologically valid subgroups. In a cross-sectional study, we analyzed the brain structural impairments of outpatients with schizophrenia using concurrent subgrouping methods, partly to enhance the extensity of exploration, and partly to estimate the validation of the divisions. High resolution T1-weighted MR images were obtained for 21 patients and 13 healthy controls. Localized gray matter volumetric deficits were defined with optimized voxel-based morphometry. Employing two concurrent methods (i.e., the widely known deficit-non-deficit division vs. the neurocognitive clusters we identified earlier) the patient group was iteratively divided into two subgroups, and their volumetric peculiarities were compared with one another and with healthy controls. Our division revealed more significant differences demonstrating bilateral brain structural deficits, which affected the association cortices, primarily the heteromodal fields and partly the unimodal fields. This is the first study that showed that abnormalities of the association cortices can be bihemispherial and expanded in schizophrenia, even in the cases of outpatients living integrated in society. Our result suggests that the extended association cortex abnormalities could constitute substantial and determining neurological substrates in the phenomenology and aetiopathogenesis of schizophrenia, at least in a subgroup of patients with more unfavorable neurocognitive characteristics.

Psychoanalytic phenomenology of schizophrenia: Synthetic metacognition as a construct for guiding investigation.

A review of psychoanalytic writings reveals a vibrant but overlooked history of descriptions of the phenomenology of schizophrenia. In this paper we suggest that neglect of these important psychoanalytic contributions to the understanding of alterations of self-experience in schizophrenia is at least partially due to an absence of sufficient operational definitions by which to study these constructs. We then detail an emergent line of research from the neurosciences investigating processes, referred to as metacognition, by which persons develop, evolve, and reflect upon mental representations of self and others. The findings from this growing line of research are convergent with psychoanalytic descriptions of self-experience in schizophrenia, and may provide a method to guide investigation of concepts found in psychoanalytic literature. This convergence presents a number of implications for both contemporary understandings of schizophrenia, future research, as well as psychoanalytically and nonpsychoanalytically informed treatments of schizophrenia.

Review of Jay A. Hamm, Bethany L. Leonhardt, Rebecca L. Fogley and Paul H. Lysaker’s “Literature as an Exploration of the Phenomenology of Schizophrenia: Disorder and Recovery in Denis Johnson’s Jesus’ Son”

Review of Jay A. Hamm, Bethany L. Leonhardt, Rebecca L. Fogley and Paul H. Lysaker’s “Literature as an Exploration of the Phenomenology of Schizophrenia: Disorder and Recovery in Denis Johnson’s Jesus’ Son”

Neurobiological background of negative symptoms.

Studies investigating neurobiological bases of negative symptoms of schizophrenia failed to provide consistent findings, possibly due to the heterogeneity of this psychopathological construct. We tried to review the findings published to date investigating neurobiological abnormalities after reducing the heterogeneity of the negative symptoms construct. The literature in electronic databases as well as citations and major articles are reviewed with respect to the phenomenology, pathology, genetics and neurobiology of schizophrenia. We searched PubMed with the keywords "negative symptoms," "deficit schizophrenia," "persistent negative symptoms," "neurotransmissions," "neuroimaging" and "genetic." Additional articles were identified by manually checking the reference lists of the relevant publications. Publications in English were considered, and unpublished studies, conference abstracts and poster presentations were not included. Structural and functional imaging studies addressed the issue of neurobiological background of negative symptoms from several perspectives (considering them as a unitary construct, focusing on primary and/or persistent negative symptoms and, more recently, clustering them into factors), but produced discrepant findings. The examined studies provided evidence suggesting that even primary and persistent negative symptoms include different psychopathological constructs, probably reflecting the dysfunction of different neurobiological substrates. Furthermore, they suggest that complex alterations in multiple neurotransmitter systems and genetic variants might influence the expression of negative symptoms in schizophrenia. On the whole, the reviewed findings, representing the distillation of a large body of disparate data, suggest that further deconstruction of negative symptomatology into more elementary components is needed to gain insight into underlying neurobiological mechanisms.

Literature as an exploration of the phenomenology of schizophrenia: disorder and recovery in Denis Johnson's Jesus’ Son

When read as a fictional psychosis narrative, Jesus’ Son, a collection of short stories by Denis Johnson, reveals important elements of the phenomenology of schizophrenia and recovery. It is possible...

Jung's views on causes and treatments of schizophrenia in light of current trends in cognitive neuroscience and psychotherapy research I. Aetiology and phenomenology

Jung's writings on schizophrenia are almost completely ignored or forgotten today. The purpose of this paper, along with a follow-up article, is to review the primary themes found in Jung's writings on schizophrenia, and to assess the validity of his theories about the disorder in light of our current knowledge base in the fields of psychopathology, cognitive neuroscience and psychotherapy research. In this article, five themes related to the aetiology and phenomenology of schizophrenia from Jung's writings are discussed:1) abaissement du niveau mental; 2) the complex; 3) mandala imagery; 4) constellation of archetypes and 5) psychological versus toxic aetiology. Reviews of the above areas suggest three conclusions. First, in many ways, Jung's ideas on schizophrenia anticipated much current thinking and data about the disorder. Second, with the recent (re)convergence of psychological and biological approaches to understanding and treating schizophrenia, the pioneering ideas of Jung regarding the importance of both factors and their interaction remain a useful and rich, but still underutilized resource. Finally, a more concerted effort to understand and evaluate the validity of Jung's concepts in terms of evidence from neuroscience could lead both to important advances in analytical psychology and to developments in therapeutic approaches that would extend beyond the treatment of schizophrenia.

Disruption of structure-function coupling in the schizophrenia connectome.

Neuroimaging studies have demonstrated that the phenomenology of schizophrenia maps onto diffuse alterations in large-scale functional and structural brain networks. However, the relationship between structural and functional deficits remains unclear. To answer this question, patients with established schizophrenia and matched healthy controls underwent resting-state functional and diffusion weighted imaging. The network-based statistic was used to characterize between-group differences in whole-brain functional connectivity. Indices of white matter integrity were then estimated to assess the structural correlates of the functional alterations observed in patients. Finally, group differences in the relationship between indices of functional and structural brain connectivity were determined. Compared to controls, patients with schizophrenia showed decreased functional connectivity and impaired white matter integrity in a distributed network encompassing frontal, temporal, thalamic, and striatal regions. In controls, strong interregional coupling in neural activity was associated with well-myelinated white matter pathways in this network. This correspondence between structure and function appeared to be absent in patients with schizophrenia. In two additional disrupted functional networks, encompassing parietal, occipital, and temporal cortices, the relationship between function and structure was not affected. Overall, results from this study highlight the importance of considering not only the separable impact of functional and structural connectivity deficits on the pathoaetiology of schizophrenia, but also the implications of the complex nature of their interaction. More specifically, our findings support the core nature of fronto-striatal, fronto-thalamic, and fronto-temporal abnormalities in the schizophrenia connectome.