Schizophrenic Psychopathology Research Articles

Suicidal ideation in schizophrenia: A cross-sectional study in a tertiary mental hospital in North-East India.

Introduction:Suicide is a leading cause of mortality in schizophrenia. The study attempts to find an association of suicidal ideation, a less studied entity than suicide attempt, with various sociodemographic and clinical profiles in patients with schizophrenia.Materials and Methods:It is a cross-sectional study involving 140 patients diagnosed as schizophrenia. Sociodemographic and clinical profiles were collected using a semi-structured proforma. Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, InterSePT Scale for Suicidal Thinking, and Drug Attitude Inventory-10 were applied to assess psychopathology, depressive symptoms, suicidal ideas, and attitude toward psychotropics, respectively. The analysis was done using appropriate statistics.Results:Majority of the study sample were Hindus, male, unmarried, literate, unemployed, and belonging from lower socioeconomic class. About 25.7% attempted suicide earlier and 29.3% currently have suicidal ideation. A previous suicide attempt, family history of psychiatric illness and that of suicide and comorbid substance use, significantly predicted (p < 0.05) a current suicidal ideation. Ideation has also been found to be significantly correlated to comorbid depression and the positive, negative, emotional, and excitement domains of schizophrenic psychopathology.Conclusion:The current study shows suicidal ideations in schizophrenia patients to be significantly related to schizophrenic psychopathology and comorbid depression, thus calling for a holistic management in preventing a fatal outcome.

Decreased Plasma Levels of Growth Differentiation Factor 11 in Patients With Schizophrenia: Correlation With Psychopathology and Cognition.

Schizophrenia is linked with abnormal neurodevelopment, on which growth differentiation factor 11 (GDF-11) has a great impact. However, a direct evidence linking GDF-11 to the pathophysiology of schizophrenia is still lacking. The current study aimed to investigate the relationship between plasma GDF-11 levels and both psychopathological symptoms and cognitive function in schizophrenia. Eighty-seven schizophrenia patients and 76 healthy controls were enrolled in the present study. The symptomatology of schizophrenia was evaluated using the Positive and Negative Syndrome Scale (PANSS). Cognitive function was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) including twelve neurocognitive tests in five aspects of cognitive function. Plasma GDF-11 levels were determined by enzyme-linked immunosorbent assay (ELISA). We found that plasma levels of GDF-11 were significantly lower in schizophrenia patients relative to healthy controls. Correlation analysis showed significant negative correlations between the GDF-11 levels and the PANSS total score, the positive symptoms score, the negative symptoms score or the general score. Additionally, positive associations were observed between plasma GDF-11 levels and the visuospatial/constructional, attention, immediate memory, or delayed memory in patients. Partial correlation analysis showed that these correlations were still significant after adjusting for age, gender, education years, body mass index, duration of illness, and age of onset except for the visuospatial/constructional and attention index. Multiple regression analysis revealed that GDF-11 was an independent contributor to the immediate memory, delayed memory and RBANS total score in patients. Collectively, the correlations between plasma GDF-11 and psychopathological and cognitive symptoms suggest that abnormal GDF-11 signaling might contribute to schizophrenic psychopathology and cognitive impairments and GDF-11 could be a potential and promising biomarker for schizophrenia.

Application of Region Efficiency Index in Functional Connectivity Analysis of Schizophrenia.

Functional connections (FCs) methodology based on functional MRI data is an effective lever to investigate macroscopic neural activity patterns underlying critical aspects of cognition and behavior in schizophrenia (SZs). Dysconnectivity hypothesis are important features of SZs. However, region properties of brain network have been less investigated by special markers of graph indexes in general mental disorders. Region efficiency index are introduced to explore the information integration capacity among different regions and subsystems. The important process is to uncover noticeable edge weight and region efficiency of FCs in 67 healthy controls and 53 chronic schizophrenia (SZs) patients. Forty-five abnormal edges with significant P-values of FCs weight scores are discovered. There is abnormal thalamic-cortical FCs in SZs. Importantly, hippocampus L, hippocampus R, and parahippocampal gyrus L are endowed with significantly different node efficiency scores in SZs patients. The scores of hippocampus L is consistent with motor retardation, lack of judgment and insight, and poor impulse control. Though strict contrastive study, it can be infer that the brain information integration is dysfunction in schizophrenia. Meanwhile, it is worth stressing that efficiency is a meaningful biological marker to excavating schizophrenic psychopathology.

Frequency and characterization of depression in schizophrenia

Context and Aims: The prevalence of depression in schizophrenia has been reported to be varying according to the stage of illness (early vs. chronic) and state (acute or postpsychotic). The presence of positive symptoms, extrapyramidal side effects, and insight have been said to predispose depression in a stable patient with schizophrenia. However, not many Indian studies have examined depression in patients with stable schizophrenic symptoms. Thus, we aimed to study the prevalence of depression and its correlates in a sample of stable patients with schizophrenia. Subjects and Methods: Eighty subjects of both genders, attending a tertiary care center, were consecutively taken up for the assessment. A semistructured pro forma was administered for all the subjects after getting informed consent. Positive and Negative Symptom Scale, Calgary Depression Scale for Schizophrenia (CDSS), Hamilton Depression (HAMD) Rating Scale, Extrapyramidal Symptom Rating Scale, Schedule for Assessment of Insight (SAI), and Global Assessment of Functioning Scale (GAF) were used to assess the patients. Results: In this study population, 34.5% had depressive symptoms. The study group had mild depression associated with schizophrenic psychopathology. The study populations did not have significant extrapyramidal symptoms during the assessment. The CDSS score and HAMD score had a significant positive correlation with SAI score. HAMD score had a negative correlation with GAF. Conclusions: This study demonstrates that patients with schizophrenia have significant depressive symptoms. These depressive symptoms appear to be independent of extrapyramidal symptoms and correlate positively to schizophrenic psychopathology. Poor insight may have led to low severity of reported depressive symptoms.

A randomized controlled trial of mindfulness in patients with schizophrenia✰

Cognitive Behavioral Therapy (CBT) is frequently used to attenuate the severity of positive schizophrenia symptoms; however, few studies have focused on attenuating negative symptoms. Recently, researchers have become interested in the effects of mindfulness-based intervention (MBI) on schizophrenia, but the lack of evidence-based results from random clinical trials (RCTs) has limited their effectiveness. Moreover, longitudinal data must be examined using appropriate study designs. We recruited 60 schizophrenia patients and randomly assigned them to an MBI or to a treatment-as-usual group. Negative symptoms, positive symptoms, mindfulness, and depression were assessed at baseline, post-course, and at a 3-month follow-up. Descriptive analysis and generalized estimating equations (GEEs) were used to examine the effects of MBI. We found that MBI mitigated the severity of negative symptoms and of general schizophrenic psychopathology except for the positive symptoms and for those of depression. Unexpectedly, we did not find long-term effect of mindfulness on negative symptoms. Larger sample sizes, long-term practical course, more rigorous study procedures, and a double-blind design should be considered in future studies.

Abnormal regions in functional connectivity of chronic schizophrenia

Objectives：Schizophrenia is a predominant product of pathological alterations distributed throughout interconnected neural systems. Functional connections (FCs) methodology is an effective lever to investigate macroscopic neural activity patterns underlying critical aspects of cognition and behaviour. However, region properties of brain architecture have been less investigated by special markers of dynamical graph in general mental disorders.Methods：Embracing the eigenvector centrality in holism significance, our important process is to uncover noticeable edges and regions with antagonistic stance between morbid and normal FCs of 67 healthy controls (HCs) and 53 chronic schizophrenia patients (SZs).Results: Results suggest that, there are 12 abnormal edges with significant p value of FCs weight, such as lingual gyrus L versus cuneus L, thalamus L versus middle frontal gyrus R, superior temporal gyrus R versus thalamus R. Importantly, SZs’ superior temporal gyrus R, parahippocampal gyrus L and parahippocampal gyrus R are endowed with different eigenvector centrality scores.Conclusion: Consistent with SZs’ positive symptoms of hallucinations, and negative symptoms of thinking impairment, it can be infer that the functional separation and integration are destroyed in schizophrenia. Thought the strict contrastive study, it is worth stressing that eigenvector centrality is a meaningful biological marker to excavating schizophrenic psychopathology.

Abnormal cortical region and subsystem complexity in dynamical functional connectivity of chronic schizophrenia: A new graph index for fMRI analysis

Objectives: Schizophrenia is a predominant product of pathological alterations distributed throughout interconnected neural systems. Designing new objectively diagnostic methods are burning questions. Dynamical functional connectivity (DFCs) methodology based on fMRI data is an effective lever to investigate changeability evolution in macroscopic neural activity patterns underlying critical aspects of cognition and behavior. However, region properties of brain architecture have been less investigated by special indexes of dynamical graph in general mental disorders.Methods: Embracing the network dynamics concept, we introduce topology entropy index (TE-scores) which is focused on time-varying aspects of FCs, hence develop a new framework for researching the dysfunctional roots of schizophrenia in holism significance. In this work, the important process is to uncover noticeable regions endowed with antagonistic stance in TE-scores of between morbid and normal DFCs of 63 healthy controls (HCs) and 57 chronic schizophrenia patients (SZs).Results: For the whole brain region levels, right olfactory, right hippocampus, left parahippocampal gyrus, right parahippocampal gyrus, left amygdala, and left cuneus in SZs are endowed with significantly different TE-scores. At brain subsystems level, TE-scores in DMN are abnormal in the SZs.Comparison with existing method(s): Topology entropy in DFCs is introduced to explore the dynamical information organization of diverse regions and their abnormal changes in mental illness. Several classical graph indexes (such as degree strength, betweenness, centrality) in the static brain network measure the region importance of FCs under senses of information integration and separation process. Although highly related to degree strength by comparing the corresponding values, topology entropy further explores the regions’ aberrant adaptability of functional contact and function switching.Conclusion: TE-scores of abnormal regions in SZs are associated to the passive apathetic social withdrawal, unusual thought content, disturbance of volition, preoccupation, active social avoidance and hallucinatory symptoms. Thought the strict contrastive study, it is worth stressing that topology entropy is a meaningful biological marker to excavating schizophrenic psychopathology.

Expression of catecholaminergic genes in the midbrain and prepulse inhibition in rats with a genetic catatonia

The GC rat strain (from the words “genetic” and “catatonia”) was created by selection for predisposition to passive-defensive reaction of catatonic freezing in response to stressing stimuli. Rats of the GC strain have previously demonstrated a number of biochemical and behavioral properties similar to those of patients with schizophrenia and depression. Prepulse inhibition (PPI) is widely explored as an important indicator, a decrease of which may be indicative of psychopathology, including schizophrenia. It has been established that the brain noradrenergic system influences the manifestation of PPI, in particular through the activation of central alpha-adrenoreceptors. Also known is the association between PPI and expression of catechol-O-methyltransferase. This study focuses on the reaction of prepulse inhibition in rats of the inbred GC strain, being considered as a hypothetical model of schizophrenia, as well as on the relation of prepulse inhibition to mRNA expression of tyrosine hydroxylase, catechol-O-methyltransferase, alpha1A- and alpha2Aadrenergic receptors in the midbrain of GC rats. For the first time, a decrease of PPI in GC rats compared with WAG rats was shown, both with a prepulse power of 75 dB and at 85 dB, which may indicate a violation of filtration of sensorimotor information into the central nervous system in GC rats. Real-time PCR showed a decrease in mRNA level of Adra1A in intact rats with genetic catatonia when compared to control WAG rats. There was observed no correlation between the expression of mRNA of the Adra1A, Adra2A, Th, and Comt genes in the midbrain and the PPI reaction in GC rats. The reduction of prepulse inhibition in GC rats indicates functional similarity of this genetic model of schizophrenic psychopathology with a prototype.

Early-Onset Schizophrenia: Exploring the Contribution of the Thought Disorder Index to Clinical Assessment

Abstract Background: Differentiating diagnostically between schizophrenia and emotional and personality disorders with psychotic or psychotic-like symptoms is a challenging task. It is especially difficult when working with adolescent patients, because their symptoms tend to manifest at lower levels as compared with adult patients. Thought disorder is a core symptom of schizophrenia, and the Rorschach Inkblot Method is widely used for the assessment of formal thought disorder. Objective: In this study, which is situated within ongoing clinical practice, we investigated whether the Rorschach test is helpful for assessing early-onset schizophrenia due to its ability to detect thought disorder. We also wanted to examine whether the Thought Disorder Index (TDI) is superior to the Comprehensive System (CS) for differentiating between patients with early-onset schizophrenia and non-psychotic patients experiencing auditory and visual hallucinations. An additional aim was to examine whether the TDI correlated with the Positive and Negative Syndrome Scale (PANSS). Methods: Twenty-three subjects between the ages of 12 and 18 years were examined with the use of the Rorschach test, and the protocols were scored according to both the TDI and the CS. All subjects were also assessed with the Positive and Negative Syndrome Scale. The sample included 14 subjects who fulfilled the criteria for schizophrenia and 9 subjects who were experiencing hallucinations that emanated from severe emotional and relational problems but who had different non-psychotic disorders. Results: Although the two groups could not be distinguished with regard to their total scores for thought disorder, the identification of specific thought disorder types proved useful for differential diagnosis. Verbalizations that were categorized by the TDI as “absurd responses,” “fluidity,” “contamination,” “autistic logic,” and “word-finding difficulty” were only given by patients who had been diagnosed with schizophrenia. When patients’ responses were scored with the use of the CS, the “contamination” score was the only one found to be specific to schizophrenia. Conclusions: Although the sample size limits the conclusions that can be drawn, the results indicate that the TDI may be superior to the CS for the identification of thought disorder specific to—but not always present in—adolescents with schizophrenia. In other words, the absence of severe thought disorder is not synonymous with the absence of severe psychopathology, but the presence of the most severe thought disorder types (i.e., “absurd responses,” “fluidity,” “incoherence,” “contamination,” and “autistic logic”) seems to be a strong indicator of schizophrenic psychopathology.

Correlations between self‐rating and observer‐rating of psychopathology in at‐risk mental state and first‐episode psychosis patients: influence of disease stage and gender

Research findings on the correlations between self-rating and observer-rating of schizophrenic psychopathology are inconsistent and have rarely considered first-episode psychosis (FEP) and at-risk mental state (ARMS) for psychosis patients. This study investigates these correlations in ARMS and FEP patients and how they are moderated by disease stage and gender. In the Basel Früherkennung von Psychosen (FePsy) study, positive and negative psychotic and affective symptoms were rated in 126 ARMS and 94 FEP patients using two observer- and three self-rating scales. The agreement between self-rating and observer-rating and the moderating influence of disease stage and gender was quantified using Pearson correlation and multiple regression models. Correlations between self- and observer-rated subscales covering the same symptom dimension were low and mostly non-significant except for one correlation of positive and one of negative symptoms. There was no moderating influence of disease stage and gender on the correlations between self-rating and observer-rating except for one higher association in positive symptoms in FEP compared to ARMS and in women compared to men. However, these significant interaction effects did not withstand correction for multiple testing. This study suggests that the agreement between self-rating and observer-rating in FEP and ARMS patients is rather low, similar across symptom dimensions, and only partially dependent on disease stage and gender. However, low correlations between self-rating and observer-rating do not necessarily indicate that these patients have difficulties reporting their symptoms. They could also have occurred because the scales did not exactly cover the same symptom dimensions.

Schizophrenia symptoms and brain network efficiency: A resting-state fMRI study

Schizophrenia is a condition marked by a disrupted brain functional network. In schizophrenia, the brain network is characterized by reduced distributed information processing efficiency; however, the correlation between information processing efficiency and the symptomatology of schizophrenia remains unclear. Few studies have examined path length efficiencies in schizophrenia. In this study, we examined small-world network metrics computed from resting state functional magnetic resonance imaging data collected from 49 patients with schizophrenia and 28 healthy people. We calculated brain network efficiency using graph theoretical analysis of the networks of brain areas, as defined by the Automated Anatomical Labeling parcellation scheme, and investigated efficiency correlations by using the 5-factor model of psychopathology, which considers the various domains of schizophrenic symptoms and might also consider discrete pathogenetic processes. The global efficiency of the resting schizophrenic brains was lower than that of the healthy controls, but local efficiency did not differ between the groups. The severity of psychopathology, negative symptoms, and depression and anxiety symptoms were correlated with global efficiency in schizophrenic brains. The severity of psychopathology was correlated with increased network efficiency from short-range connections, but not networks from long-range connections. Our findings indicate that schizophrenic psychopathology is correlated with brain network information processing efficiency.

Compromised small-world efficiency of structural brain networks in schizophrenic patients and their unaffected parents.

Several lines of evidence suggest that efficient information integration between brain regions is disrupted in schizophrenia. Abnormalities in white matter tracts that interconnect brain regions may be directly relevant to this pathophysiological process. As a complex mental disorder with high heritability, mapping abnormalities in patients and their first-degree relatives may help to disentangle the risk factors for schizophrenia. We established a weighted network model of white matter connections using diffusion tensor imaging in 25 nuclear families with schizophrenic probands (19 patients and 41 unaffected parents) and two unrelated groups of normal controls (24 controls matched with patients and 26 controls matched with relatives). The patient group showed lower global efficiency and local efficiency. The decreased regional efficiency was localized in hubs such as the bilateral frontal cortices, bilateral anterior cingulate cortices, and left precuneus. The global efficiency was negatively correlated with cognition scores derived from a 5-factor model of schizophrenic psychopathology. We also found that unaffected parents displayed decreased regional efficiency in the right temporal cortices, left supplementary motor area, left superior temporal pole, and left thalamus. The global efficiency tended to be lower in unaffected parents. Our data suggest that (1) the global efficiency loss in neuroanatomical networks may be associated with the cognitive disturbances in schizophrenia; and (2) genetic vulnerability to schizophrenia may influence the anatomical organization of an individual's brain networks.

Insight controlled for cognition in deficit and nondeficit schizophrenia

Patients with deficit schizophrenia have worse cognition and poorer social functioning compared to the nondeficit ones. Insight is another domain in which these two groups might differ, but data on insight impairment in deficit versus nondeficit schizophrenia are still scarce. We compared 29 patients with deficit schizophrenia to 44 nondeficit patients and found a tendency to poorer insight in the deficit group. However such tendency disappeared when analysis was controlled for cognition, a domain in which both groups differed significantly. This finding reinforces the pressing need for simultaneous assessment of the several dimensions or domains of schizophrenic psychopathology.

COGNITIVE DEFICIT IN SCHIZOPHRENIA AND ITS REMEDIATION

Schizophrenia is a severe mental disorder characterized by a variety of signs and symptoms. Since its earliest conception as “dementia praecox“ (i.e. early onset dementia), impaired cognitive function has also been considered a core feature. Research into cognition and schizophrenia over the past years has recently been growing. Cognitive deficit is a virtually omni-present component of schizophrenic psychopathology, independent of other aspects of schizophrenia. It underlays other symptoms of schizophrenia and affects the success of therapy, ability of social adaptation and patients’ quality of life. Cognitive skills in schizophrenia predict social functioning and may serve as outcome measures in the development of effective treatment strategies. One of the possibilities of non-pharmacological improvement of cognitive function is remediation using computer rehabilitation software. It has been proved as an effective method. In our study we found global positive effect of aproximately bimonthly (20sessions) training of cognitive function in patients with schizophrenia using computer rehabilitation software PSS CogRehab. Except verbal fluency, which appears stationary during training of cognitive function, all others domains of cognitive function improved during rehabilitation using computer training of cognitive function. The biggest improvement we located in these domains: psychomotor speed, auditive reaction time and verbal learning and memory, where improvement in neuropsychological tests reached statistically significant difference.

PW01-168 - Disturbance of intentionality: a phenomenological approach for the development of schneiderian first-rank symptoms in schizophrenia

ObjectivesIn 1950, Kurt Schneider proposed that a considerable number of schizophrenic patients develop first-rank symptoms (FRS). In such cases, patients experience third-person auditory verbal hallucinations, audible thoughts, made experiences, replaced control of will, thought insertion, broadcast and withdrawal. This group of symptoms might therefore be seen as pathognomonic of schizophrenic psychopathology. Although a number of studies tend to explain these symptoms in terms of neurobiological and neuropsychological processes, the cause and development of FRS still remains unknown.MethodsThe method applied for the development of an explanatory model of FRS consists first in the overview of psychiatric and philosophical literature and secondly in the further development of the concept of disturbed intentionality and its implication to the FRS in schizophrenia. Intentionality is understood as a basic characteristic of conscious experience as being directed towards its object and, at the same time, implying a sense of mineness. This report also reviews and discusses some generally accepted views of FRS.ResultsCurrent psychiatric research shows a significant increase of interest phenomenological explanations of FRS. In this contribution we introduce a phenomenological model of FRS based on the concept of intentionality. We also show that this concept offers an insight into the interrelatedness between particular FRS.ConclusionsWe propose that the experience of FRS in patients with schizophrenia is rooted in the disturbed and inverted intentionality of their mental and bodily actions. This theoretical model of FRS will open up new directions in psychiatric research.

Augmentation of Olanzapine by Fluphenazine Decanoate in Poorly Responsive Schizophrenia

Introduction: Evidence suggests that atypical antipsychotics affect a broader range of schizophrenic psychopathology and are generally better tolerated than conventional antipsychotics. Therefore, they have become the most commonly used class of antipsychotic drugs in clinical practice. But poor compliance and resistance is noteworthy even among those receiving atypical drugs. The objective of this study was to examine whether there could be any encouraging outcome if fluphenazine decanoate was added, as an adjuvant, to olanzapine in poorly responsive cases of schizophre nia. Method: Twenty-eight female inpatients with a diagnosis of schizophrenia, according to the Structured Clinical Interview for DSM Disorders’ diagnostic criteria, who had shown poor response to olanzapine, were entered into a twelve-week, parallel group, double-blind study for random assignment to either fluphenazine decanoate or placebo in a 1:1 ratio. Primary outcome measures of the study were changes in the mean total scores of the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). The secondary measures were the Schedule for Assessment of Insight (SAI), the Clinical Global Impressions-Severity of Illness (CGI-S) and the Simpson-Angus Scale (SAS). Treatment efficacy was analyzed by t-test, split-plot (mixed) and repeated measures analysis of variance (ANOVA) comparing both groups over twelve weeks. All secondary measures (SAS, SAI, and CGIS) were analyzed by t-test. Results: According to the findings, the mean total scores of SAPS (P<0.01), SAI (P<0.0001) and CGI-S (P<0.03) in the “fluphenazine plus olanzapine” group were decreased significantly in comparison with the “placebo plus olanzapine group.” In spite of an increase in mean total score of SANS in the target group, there was no significant difference in this regard at the study’s conclusion (P<0.09). The mean total score of SAS was also increased significantly in the augmented group (P<0.0001). Effect size (ES) analyses for changes in SAPS, SAI and CGI-S at the end of treatment indicated a large improvement with the fluphenazine augmentation. Conclusions: Adding fluphen azine decanoate to olanzapine may improve some cases of poorly responsive schizophrenia. However, it is essential that consideration be given to the emergence of extrapyramidal side effects and the strengthening of negative symptoms due to fluphenazine, and the probable pharmacokinetic interaction between the two drugs.

Anger and functioning amongst inpatients with schizophrenia or schizoaffective disorder living in a therapeutic community

This study explored the functional correlates of anger amongst therapeutic community inpatients. The sample consisted of 44 subjects diagnosed with schizophrenic/schizoaffective disorder who were involved in a community treatment program. Assessment involved administration of the Health of Nation Outcome Scales and the Global Assessment of Functioning as well as self-evaluations using the Social Adaptation Self-evaluation Scale. Psychopathology was assessed with the Positive and Negative Symptoms Scale. Angry feelings and coping skills were self-assessed with the State-Trait Anger Expression Inventory and the Symptom Checklist-90 Hostility Scale. Multiple regression analyses correlated anger with functioning, controlling for psychopathology. Angry feelings related to self-harm, hyperactivity, physical problems, and to global weight independently from Positive and Negative Symptoms Scale scores. They also predicted interest and pleasure in housekeeping, quality of social relationships and relational exchanges. Results showed that angry feelings were not merely derivations of schizophrenic psychopathology; rather, they were independently related to self-damaging behaviors, to attentional demands towards the staff, to agreement to community tasks and to low quality of social relationships. Indeed, anger was related to adaptation's level in a therapeutic community setting demonstrated by subjects with psychoses and it may represent an indirect measure of their experienced quality of life. Therapeutic and management approaches to anger amongst subjects with schizophrenia are discussed.

First-Rank Symptoms in Schizophrenia: Reexamining Mechanisms of Self-recognition

Disturbances of self are a common feature of schizophrenic psychopathology, with patients reporting that their thoughts and actions are controlled by external forces, as shown in first-rank symptoms (FRS). One widely accepted explanatory model of FRS suggests a deficiency in the internal forward model system. Recent studies in the field of cognitive sciences, however, have generated new insights into how complex sensory and motor systems contribute to the sense of self-recognition, and it is becoming clear that the forward model conceptualization does not have unique access to representations about the self. We briefly evaluate the forward model explanation of FRS, reassess the distinction made between the sense of agency and body ownership, and outline recent developments in 4 domains of sensory-motor control that have supplemented our understanding of the processes underlying the sense of self-recognition. The application of these findings to FRS will open up new research directions into the processes underlying these symptoms.

Art therapy may reduce schizophrenic psychopathology by strengthening the patient's sense of self

Art therapy may reduce schizophrenic psychopathology by strengthening the patient's sense of self

Orbitofrontal volume deficit in schizophrenia and thought disorder.

Orbitofrontal Cortex (OFC) structural abnormality in schizophrenia has not been well characterized, probably due to marked anatomical variability and lack of consistent definitions. We previously reported OFC sulcogyral pattern alteration and its associations with social disturbance in schizophrenia, but OFC volume associations with psychopathology and cognition have not been investigated. We compared chronically treated schizophrenia patients with healthy control (HC) subjects, using a novel, reliable parcellation of OFC subregions and their association with cognition, especially the Iowa Gambling Task (IGT), and with schizophrenic psychopathology including thought disorder. Twenty-four patients with schizophrenia and 25 age-matched HC subjects underwent MRI. OFC Regions of Interest (ROI) were manually delineated according to anatomical boundaries: Gyrus Rectus (GR); Middle Orbital Gyrus (MiOG); and Lateral Orbital Gyrus (LOG). The OFC sulcogyral pattern was also classified. Additionally, MiOG probability maps were created and compared between groups in a voxel-wise manner. Both groups underwent cognitive evaluations using the IGT, Wisconsin Card Sorting Test, and Trail Making Test (TMT). An 11% bilaterally smaller MiOG volume was observed in schizophrenia, compared with HC (F(1,47) = 17.4, P = 0.0001). GR and LOG did not differ, although GR showed a rightward asymmetry in both groups (F(1,47) = 19.2, P < 0.0001). The smaller MiOG volume was independent of the OFC sulcogyral pattern, which differed in schizophrenia and HC (chi2 = 12.49, P = 0.002). A comparison of MiOG probability maps suggested that the anterior heteromodal region was more affected in the schizophrenia group than the posterior paralimbic region. In the schizophrenia group, a smaller left MiOG was strongly associated with worse 'positive formal thought disorder' (r = -0.638, P = 0.001), and a smaller right MiOG with a longer duration of the illness (r = -0.618, P = 0.002). While schizophrenics showed poorer performance than HC in the IGT, performance was not correlated with OFC volume. However, within the HC group, the larger the right hemisphere MiOG volume, the better the performance in the IGT (r = 0.541, P = 0.005), and the larger the left hemisphere volume, the faster the switching attention performance for the TMT, Trails B (r = -0.608, P = 0.003). The present study, applying a new anatomical parcellation method, demonstrated a subregion-specific OFC grey matter volume deficit in patients with schizophrenia, which was independent of OFC sulcogyral pattern. This volume deficit was associated with a longer duration of illness and greater formal thought disorder. In HC the finding of a quantitative association between OFC volume and IGT performance constitutes, to our knowledge, the first report of this association.