Anomalous Subjective Experience among First-Admitted Schizophrenia Spectrum Patients: Empirical Investigation

Abstract

Our research group has for several years conducted philosophically informed, phenomenological-empirical studies of morbid alterations of conscious experience (subjectivity) in schizophrenia (Sz) and its spectrum of disorders. Some of these experiential alterations constitute, in our view, the vulnerability markers to Sz – indicators that are intrinsic to this disorder and which were historically considered as constituting the phenotypic anchor of the very concept and the diagnostic validity of Sz spectrum disorders. In a more pragmatic clinical context, these indicators, considered here as symptoms, may be potentially effective for early differential diagnosis. In this study, 151 consecutive first-admitted patients (with bipolar, melancholic and organic patients excluded) diagnosed according to the ICD-10, were evaluated on a number of expressive and experiential psychopathological dimensions, with special emphasis on the experiences of perplexity, disorders of self-awareness, perceptual disorders and anomalous bodily experiences. The a priori scales derived from the item pool of a slightly modified OPCRIT and BSABS were used for analyses. Sz and schizotypal disorder scored equally on the subjective dimensions, suggesting a basic phenomenological affinity of these disorders. In contrast, anomalies of subjective experience were clearly more pronounced among the patients within, as compared to those outside the Sz spectrum.

Towards integrating phenomenology and neurocognition: Possible neurocognitive correlates of basic self-disturbance in schizophrenia

“…A body of phenomenological research, combining clinical exploration, empirical studies and philosophical perspectives, indicates that a disturbance of the basic sense of self is at the clinical core of the schizophrenia spectrum and may therefore function as a phenotypic trait marker of these disorders, including vulnerability not (yet) expressed at diagnosable levels [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. What exactly is being referred to "basic" sense of self?…”

Premorbid self‐disorders and lifetime diagnosis in the schizophrenia spectrum: a prospective high‐risk study

“…10 A series of subsequent systematic empirical studies demonstrated that SDs aggregate selectively in first-admission schizophrenia and schizotypal disorders [11][12][13] but not in bipolar psychosis. 14,15 SDs are detectable in populations at high-genetic risk for schizophrenia 13 and are associated with prodromal symptoms among help-seeking, non-psychotic adolescents.…”

“…Importantly, SDs are shared by schizophrenia and schizotypal disorders, with no significant differences between these two diagnostic groups. 11,12,27 In the Copenhagen Linkage Study, SDs distinguished healthy high-risk individuals who exhibited few schizotypal features from healthy high-risk subjects with no schizotypal features. 40 In sum, our results, in conjunction with other SD studies, strengthen the rationale for a further exploration of the SDs as a potentially core phenotype of schizophrenia-spectrum disorders and its predictive utility in the prodromal research.…”

Clinical Manifestations of Self-disorders in Schizophrenia Spectrum Conditions

“… Self-disorders hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders [39][40][41][42][43]  There is no statistical difference in the level of selfdisorders among patients with schizophrenia and patients with the schizotypal disorder [41,43]  Self-disorders differentiate between first-admitted cases with bipolar psychosis and schizophrenia [42] and self-disorders occur more frequently in residual schizophrenia than in remitted bipolar psychosis [44]  Self-disorders occur in genetically high-risk individuals [45]  Self-disorders are detectable in community samples of adolescent diagnosed as suffering from "at-risk mental state" [46] and in clinical samples of young adults at Clinical High Risk for psychosis [47]  Prospective studies indicate that self-disorders predict transition to psychosis in an Ultra-High Risk for psychosis sample [48] and that high baseline scores of self-disorders predict later transition to a schizophrenia spectrum diagnosis [49,50]  Positive correlations have been found between self-disorders and positive symptoms, negative symptoms, formal thought disorders, and perceptual disturbances, respectively [43]  Correlations have been found between selfdisorders and social dysfunction [51] and suicidality [52,53], respectively  No correlations have been found between selfdisorders and IQ or neurocognitive measures [43,54,55], except for impaired verbal memory [54]  Self-disorders have been found to be temporarily stable over a 5-year period [56] …”