Disrupted Sense of Agency as a State Marker of First-Episode Schizophrenia: A Large-Scale Follow-Up Study

Abstract

Background: Schizophrenia is often characterized by a general disruption of self-processing and self-demarcation. Previous studies have shown that self-monitoring and sense of agency (SoA, i.e., the ability to recognize one's own actions correctly) are altered in schizophrenia patients. However, research findings are inconclusive in regards to how SoA alterations are linked to clinical symptoms and their severity, or cognitive factors.Methods: In a longitudinal study, we examined 161 first-episode schizophrenia patients and 154 controls with a continuous-report SoA task and a control task testing general cognitive/sensorimotor processes. Clinical symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS).Results: In comparison to controls, patients performed worse in terms of recognition of self-produced movements even when controlling for confounding factors. Patients' SoA score correlated with the severity of PANSS-derived “Disorganized” symptoms and with a priori defined symptoms related to self-disturbances. In the follow-up, the changes in the two subscales were significantly associated with the change in SoA performance.Conclusion: We corroborated previous findings of altered SoA already in the early stage of schizophrenia. Decreased ability to recognize self-produced actions was associated with the severity of symptoms in two complementary domains: self-disturbances and disorganization. While the involvement of the former might indicate impairment in self-monitoring, the latter suggests the role of higher cognitive processes such as information updating or cognitive flexibility. The SoA alterations in schizophrenia are associated, at least partially, with the intensity of respective symptoms in a state-dependent manner.

The cognitive neuroscience of self‐awareness: Current framework, clinical implications, and future research directions

“…They found that, although both groups experienced agency when consciously determining the final resting place of the square, the schizophrenia group were significantly less likely to experience agency when the final resting place was unconsciously primed by 17‐ms subliminal displays (Renes et al, 2013). These findings have been replicated by other researchers (Prikken et al, 2018), and this impaired sense of agency has also been shown to be present from very early on in the illness (Kozáková et al, 2020).…”

The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains

“…Excessive emotional resonance with others and arising difficulties with self-other distinction could have a broader effect on conscious experience of cognitive mental states including judgments about the origin of these. Difficulty knowing whether a thought or intention arose from the self explains many symptoms of psychosis [e.g., ( 155 )] including delusions relating to thought transfer and telepathy. Incorrect assumptions that one is aware of the cognitive mental state of another could also reduce mentalizing leading to egocentric errors ( 289 ).…”

Agency in schizophrenia and autism: a systematic review

“…A possible explanation for this mixed/inconsistent association between symptomatology and agentic experience is the relationship between stage of illness progression and severity of altered agency. Although the number of studies investigating this relationship are limited, three studies have suggested a unified story that agency alterations increase across stage of disorder from prodromal ultrahigh risk (where negative symptoms and attenuated positive symptoms predominate the clinical presentation) to the acute phase of first-episode psychosis (where previously attenuated symptoms have crystallized into full-blown positive and negative psychotic symptoms) (Wilquin and Delevoye-Turrell, 2012;Kozáková et al, 2020;Nelson et al, 2020). The severity of altered agency appears related to the severity of positive symptoms reflected by stage of illness.…”