Schizophrenia, dissociation, and consciousness

Current thinking suggests that dissociation could be a significant comorbid diagnosis in a proportion of schizophrenic patients with a history of trauma. This potentially may explain the term “schizophrenia” in its original definition by Bleuler, as influenced by his clinical experience and personal view. Additionally, recent findings suggest a partial overlap between dissociative symptoms and the positive symptoms of schizophrenia, which could be explained by inhibitory deficits. In this context, the process of dissociation could serve as an important conceptual framework for understanding schizophrenia, which is supported by current neuroimaging studies and research of corollary discharges. These data indicate that the original conception of “split mind” may be relevant in an updated context. Finally, recent data suggest that the phenomenal aspects of dissociation and conscious disintegration could be related to underlying disruptions of connectivity patterns and neural integration.     

The dreaming brain/mind, consciousness and psychosis

Several independent lines of research in neurobiology seem to support the phenomenologically-grounded view of the dreaming brain/mind as a useful model for psychosis. Hallucinatory phenomena and thought disorders found in psychosis share several peculiarities with dreaming, where internally generated, vivid sensorimotor imagery along with often heightened and incongruous emotion are paired with a decrease in ego functions which ultimately leads to a severe impairment in reality testing. Contemporary conceptualizations of severe mental disorders view psychosis as one psychopathological dimension that may be found across several diagnostic categories. Some experimental data have shown cognitive bizarreness to be equally elevated in dreams and in the waking cognition of acutely psychotic subjects and in patients treated with pro-dopaminergic drugs, independent of the underlying disorder. Further studies into the neurofunctional underpinnings of both conditions will help to clarify the use and validity of this model.     

Sense of agency, associative learning, and schizotypy

Despite the fact that the role of learning is recognised in empirical and theoretical work on sense of agency (SoA), the nature of this learning has, rather surprisingly, received little attention. In the present study we consider the contribution of associative mechanisms to SoA. SoA can be measured quantitatively as a temporal linkage between voluntary actions and their external effects. Using an outcome blocking procedure, it was shown that training action–outcome associations under conditions of increased surprise augmented this temporal linkage. Moreover, these effects of surprise were correlated with schizotypy scores, suggesting that individual differences in higher level experiences are related to associative learning and to its impact on SoA. These results are discussed in terms of models of SoA, and our understanding of disrupted SoA in certain disorders.     

Understanding the executive functioning heterogeneity in schizophrenia

Schizophrenia is characterized by heterogeneous brain abnormalities involving cerebral regions implied in the executive functioning. The dysexecutive syndrome is one of the most prominent and functionally cognitive features of schizophrenia. Nevertheless, it is not clear to what extend executive deficits are heterogeneous in schizophrenia patients. Furthermore, it is still unknown if the executive impairments observed in schizophrenia are better characterized as specific or as reflecting generalized cognitive factors. The four executive processes (i.e. updating, inhibition, shifting and divided attention) described in Miyake et al.'s (2000) theoretical model were examined in 62 individuals with schizophrenia and 49 healthy controls. At group level, impairments in all four executive processes confirmed the marked impairment in executive functioning in patients with schizophrenia. Statistical analysis indicated that executive performances in schizophrenia patients were more heterogeneous than in healthy controls. Compared with standardized norms, 94% of patients exhibited impairment in at least one of the executive tasks. Twenty-one percent of patients exhibited impairment in one executive task, 27% in two tasks, 23% in three executive tasks and 23% exhibited impairments in the four executive tasks. Six percent of patients had normal executive profile. Regression analysis indicated that only premorbid intellectual quotient and a general slowing in processing speed predicted the executive dysfunction severity. Executive functioning was not affected by age, duration of illness, psychotic status, or by antipsychotic dosage. Our results emphasize the heterogeneity of the dysexecutive syndrome in schizophrenia when individual profile analysis is considered, and extend the view that individual cognitive differences in schizophrenia are largely underlined by general cognitive factors such as intellectual level and general processing speed.     

The Influence of Maternal Schizotypy on the perception of Facial Emotional Expressions during Infancy: an Event-Related Potential Study

Parenting directly affects the developmental and clinical outcomes of children. How parental personality relates to perceptual and cognitive mechanisms during early development is not clear. For parents with traits of the personality dimension schizotypy, would their infant display brain responses similar to those on the schizophrenia-spectrum? This study investigates whether maternal personality influences early social-cognitive awareness during the first 6 postnatal months.Schizotypy is a dimension of personality within the general population. If deficits contribute to the development of schizophrenia-spectrum disorders by influencing the development of symptom-like characteristics, they may be observable in neurotypical individuals with schizotypal characteristics. Parents and their infants were shown standardised positive and negative faces and event-related potential responses were assessed. It was hypothesised that the infants of schizotypic mothers would display differential Negative-central event-related potentials for the happy and fearful expressions when compared to infants of non-schizotypic mothers.Results support prior literature; indicating 6-month-old infants allocate more attentional resources to fearful when contrasted to happy faces. The adult cohort displays this same ability. In addition, schizotypic mothers displayed comparable amplitudes for both expressions in comparison to the control mothers who exhibited larger amplitudes towards the fearful compared to the happy expression. Infants of schizotypic mothers did not show a greater sensitivity to facial expressions at 6-months, but schizotypic mothers showed a generalised response towards facial expressions compared to the typical P600 response illustrated by the control mothers. The present study suggests that development in the higher cognitive domains, such as the allocation of attention to novel stimuli, are not affected at 6 months of age by maternal personality related to schizotypy when examined at the group level. Implications for personality development, maternal-infant interactions and cognitive neuroscience methodologies are discussed.     

Feasibility and acceptability of an exergame intervention for schizophrenia

ObjectivesTo evaluate the feasibility and acceptability of an exergame intervention as a tool to promote physical activity in outpatients with schizophrenia.DesignFeasibility/Acceptability Study and Quasi-Experimental Trial.MethodSixteen outpatients with schizophrenia received treatment as usual and they all completed an 8-week exergame intervention using Microsoft Kinect^® (20 min sessions, biweekly). Participants completed pre and post treatment assessments regarding functional mobility (Timed Up and Go Test), functional fitness performance (Senior Fitness Test), motor neurological soft signs (Brief Motor Scale), hand grip strength (digital dynamometer), static balance (force plate), speed of processing (Trail Making Test), schizophrenia-related symptoms (Positive and Negative Syndrome Scale) and functioning (Personal and Social Performance Scale). The EG group completed an acceptability questionnaire after the intervention.ResultsAttrition rate was 18.75% and 69.23% of the participants completed the intervention within the proposed schedule. Baseline clinical traits were not related to game performance indicators. Over 90% of the participants rated the intervention as satisfactory and interactive. Most participants (76.9%) agreed that this intervention promotes healthier lifestyles and is an acceptable alternative to perform physical activity. Repeated-measures MANOVA analyses found no significant multivariate effects for combined outcomes.ConclusionThis study established the feasibility and acceptability of an exergame intervention for outpatients with schizophrenia. The intervention proved to be an appealing alternative to physical activity. Future trials should include larger sample sizes, explore patients' adherence to home-based exergames and consider greater intervention dosage (length, session duration, and/or frequency) in order to achieve potential effects.     

In defense of the one-factor doxastic account: A phenomenal account of delusions

According to the doxastic model, delusions are beliefs. In the metacognitive model, delusions are imaginings mistaken for beliefs. I argue that endorsement of false second-order beliefs could also create unpleasant dissonance, that mentally healthy people often endorse irrational or conflicting beliefs, and that the lack of delusion-motivated action can be explained by the influence of nonbelief factors on action. The two-factor doxastic model posits irrationality as necessary, and one metric of rationality many scholars employ is whether a response is easily understood by folk psychology. A precedent for folk-psychological acceptance of contextually bizarre beliefs as a result of personal experience can already be found in the lack of imaginative resistance encountered not in response to the impossibilities portrayed in speculative fiction, but in response to the characters’ ability to incorporate these occurrences into their mental frameworks, despite them often being at odds with these characters’ bedrock understanding of the world.     

The jumping to conclusions bias associated with symptoms in schizophrenia: which factors influence this bias?

ABSTRACT

Jumping-to-conclusions (JTC) bias has been found to be associated with delusions. However, there is limited data about which other factors are related to JCT bias. The aim of the current study was to investigate the effects of psychotic, cognitive, impulsivity and anxiety symptoms on JTC bias. We compared individuals with paranoid schizophrenia, non-paranoid schizophrenia, generalized anxiety disorder and healthy individuals in terms of JTC bias. Beads task (90:10 and 60:40 versions), Tower of London task, BPRS, SAPS, SANS and BIS-11 were applied. Our results show that the factors related with JTC bias were different on each version of the Beads task. Education levels, anxiety and negative symptoms of individuals with schizophrenia were found to affect JTC bias on 90:10 version of task, whereas positive symptoms and impulsivity levels were related to JTC bias on 60:40 version. These results are important as they contribute to our understanding of this relationship.     

Typical-Atypical Interactions: One Patient’s Experience of Weight Bias in an Inpatient Eating Disorder Treatment Setting

Abstract

This article examines one patient’s experiences with weigh bias in an inpatient eating disorder treatment setting with a focus on interactions between the patient and her primary therapist. These therapeutic interactions had multiple unintended consequences, including bolstering feelings of denial, modeling of disordered behaviors, and disrupting the therapeutic alliance. Additional instances of weight bias with other treatment professionals, including an inpatient nutritionist and psychiatrist, are briefly discussed. The article ends with several brief recommendations for how clinicians can more skillfully approach issues of weight and size in the therapeutic alliance in order to resist size-related oppressions rather than reinforce them.