Schizophrenia in adolescents and the family system Empirical research shows that chronic diseases have specific, idiosyncratic functions in the family, and give real, psychosocial advantages. This leaves the question - can schizophrenic disorders have similar function in the family system as a chronic somatic disease? We have analyzed systemic family traits in families with schizophrenic young patients. The reference samples were two kinds of families: families with schizophrenic adults and families without any chronic disease or chronic illness. (...) The subjects of analysis were coefficients of the systemic features, identified by factor analysis according to author's proposal. Oneway Anova was used to compare indexes between three groups of families. The results show that mental disorder in adolescents participates in the life of the whole family, having similar functions to the functions of chronic somatic diseases. They also suggest that, from the family members' point of view, schizophrenic disorders in a teenagers has different quality compared to schizophrenic disorders in an adult. (shrink)

Schizophrenia is a serious mental disease whose pathogenesis has not been fully elucidated. Its clinical evaluation and diagnosis still highly depend on the clinical experience of doctors. It is of great scientific value and clinical significance to study the inducing factors and neuropathological mechanism of schizophrenia. Based on the four research problems of schizophrenia, this paper analyzes the data types that need to be stored in clinical trials and scientific research, including basic information, case report data, neuropsychological (...) and cognitive function evaluation, magnetic resonance data, electroencephalogram data, and intestinal flora data. Through the demand analysis of the system, including the data management part, data analysis part, the functional demand of the system management part, and the overall nonfunctional demand of the system, the overall architecture design, functional module division, and database table structure design of the system are completed. Adopting Browser/Server architecture and front-end and back-end separation mode and applying Java and Python programming language, based on spring framework and database, a multidimensional information management system for schizophrenia is designed and implemented, which includes four modules: data analysis, data management, system management, and security control. In addition, each functional module of the system is designed and implemented in detail, and the software operation flow of each module is illustrated with the sequence diagram. Finally, the multidimensional data of schizophrenia collected in our laboratory were used for system test to verify whether the system can meet the needs of clinical big data management of schizophrenia and the multidimensional information management system of schizophrenia can meet the needs of clinical big data management. The information management system helps schizophrenic researchers to carry out data management and data analysis. It also has advantages that are easy to use, safe, and efficient and has strong scalability in data management, data analysis, and scalability. It reflects the innovation of the system and provides a good platform for the management, research, and analysis of clinical big data of schizophrenia. (shrink)

I begin by examining how genetics drivesschizophrenia research, and raise both familiar andrelatively novel criticisms of the evidence putativelysupporting the genetic basis of schizophrenia. Inparticular, I call attention to a set of concernsabout the effects of placentation on concordance ratesof schizophrenia in monozygotic twins, which furtherweakens the case for schizophrenia''s so-called stronggenetic component. I then underscore two criticalpoints. First, I emphasize the importance of takingseriously considerations about the complexity of bothontogenesis and the development of hereditarydiseases. The recognition (...) of developmentalconstraints and supports is crucial, for attention todevelopment exposes the naivete of too many models ofgene action in the aetiology of disease. Secondly, Iattend to those schizophreniologists who ignoremethodological criticisms and thus presume a geneticbasis for schizophrenia, and then seek the schizophrenic genotype lacking an adequatephenotype. In response I attempt to demonstrate thenecessity of a sustained effort at characterizing thephenotype of schizophrenia as an enabling conditionfor the whole enterprise of psychiatric genetics – andfor psychiatry itself. Without the organism-levelphenotype, research at the level of genes will remainunproductive – assuming of course that research at thegenetic level is appropriate at all. (shrink)

With ever more detailed models of the neurobiological and social systems out of which schizophrenia is born, it is possible to overlook how suffering persons actually experience their symptoms.This book examines the experiences of persons who suffer from schizophrenia. It provides a highly readable and humane examination of this common condition.

This article examines the supposedly incomprehensibility of schizophrenic delusions. According to the contemporary classificatory systems (DSM-IV-TR and ICD-10), some delusions typically found in schizophrenia are considered bizarre and incomprehensible. The aim of this article is to discuss the notion of understanding that deems these delusions incomprehensible and to see if it is possible to comprehend these delusions if we apply another notion of understanding. First, I discuss the contemporary schizophrenia definitions and their inherent problems, and I argue that (...) the notion of incomprehensibility in these definitions rests heavily on Jaspers’ notions of understanding and empathy. Secondly, I discuss two Wittgensteinian attempts to comprehend bizarre delusions: (a) Campbell’s proposal to conceive delusions as framework propositions and (b) Sass’s suggestion to interpret delusions in the light of solipsism. Finally, I discuss the phenomenological conception of schizophrenia, which conceives delusion formation as resulting from alterations of the structure of experiencing and from underlying self-disorders. I argue that although a psychological understanding that seeks to grasp meaning in terms of motivations, desires, and other more straightforward psychological connections between mental states is impossible in schizophrenia, we can in fact have a philosophical understanding of the schizophrenic world and of the emergence of delusions typically found in schizophrenia. (shrink)

Based on recent insight into the thalamocortical system and its role in perception and conscious experience, a unified pathophysiological framework for hallucinations in neurological and psychiatric conditions is proposed, which integrates previously unrelated neurobiological and psychological findings. Gamma-frequency rhythms of discharge activity from thalamic and cortical neurons are facilitated by cholinergic arousal and resonate in networks of thalamocortical circuits, thereby transiently forming assemblies of coherent gamma oscillations under constraints of afferent sensory input and prefrontal attentional mechanisms. If perception is (...) based on synchronisation of intrinsic gamma activity in the thalamocortical system, then sensory input to specific thalamic nuclei may merely play a constraining role. Hallucinations can be regarded as underconstrained perceptions that arise when the impact of sensory input on activation of thalamocortical circuits and synchronisation of thalamocortical gamma activity is reduced. In conditions that are accompanied by hallucinations, factors such as cortical hyperexcitability, cortical attentional mechanisms, hyperarousal, increased noise in specific thalamic nuclei, and random sensory input to specific thalamic nuclei may, to a varying degree, contribute to underconstrained activation of thalamocortical circuits. The reticular thalamic nucleus plays an important role in suppressing random activity of relay cells in specific thalamic nuclei, and its dysfunction may be implicated in the biological vulnerability to hallucinations in schizophrenia. Combined with general activation during cholinergic arousal, this leads to excessive disinhibition in specific thalamic nuclei, which may allow cortical attentional mechanisms to recruit thalamic relay cells into resonant assemblies of gamma oscillations, regardless of their actual sensory input, thereby producing an underconstrained perceptual experience. Key Words: Charles Bonnet syndrome; gamma oscillations; hallucinations; late paraphrenia; Lewy body dementia; perception; schizophrenia; thalamocortical system. (shrink)

All mammals have social brains, and there is presently no evidence that humans have relatively more genetically dictated social brain circuitry than other species. The postulation that schizophrenia arises from disruption of brains systems uniquely devoted to social traits is obviated not only by the large number of anatomical and biochemical brain differences, but also by nonsocial symptoms of schizophrenic disorders.

Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, (...) and behavioral modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches. (shrink)

Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, (...) and behavioral modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches. (shrink)

Experience of agency in patients with schizophrenia involves an interesting dissociation; these patients demonstrate that one can have a thought or perform an action consciously without being conscious of thinking or acting as the motivated agent, author of that thought or of that action. This chapter examines several interesting accounts of this dissociation, and aims at showing how they can be generalized to thought insertion phenomena. It is argued that control theory allows such a generalization; three different comparators need (...) to be distinguished: the sense of subjectivity relies on a comparator in which motivation and emotion play a structuring role. The sense of agency emerges in a system that delivers a rough categorization of self-generated – versus other- generated – actions and mental activities. A third system specializes in the social evaluation of the effects of an action, intention or other thought process, given certain goals in self or in others. (shrink)

Psychiatric diagnosis serves many functions in the struggle for recognition, such as access to public mental health systems and legal compensation, but it is not necessarily well-equipped for the task of self-understanding and reconfiguration of personal values in the recovery process – and the likelihood of optimal outcome that is geared to the individual person's quality of life. Call this the transformative dimension of recognition in the complex journey from diagnosis to therapeutic empathy in the doctor–patient relationship.Patients who are diagnosed (...) with a serious and enduring mental health condition often find it difficult to make sense of themselves in relation to their... (shrink)

Introduction: More than half a century after the introduction of effective pharmacotherapy for the illness, in most patients schizophrenia remains a chronic, relapsing condition with poor long-term outcomes. Methods: We examine the pharmacological treatment of schizophrenia from different perspectives to understand why there have not been significant advances, and to consider what the future might hold in store. Results: We argue that the treatment of schizophrenia addresses the phenotype and not the cause; that the causes may not (...) be treatable even if identifiable; that secondary prevention approaches involving treating the phenotype before full-fledged illness develops have, so far, not yielded promising results; and that shifting the focus of treatment from dopamine to other neurotransmitter systems is merely a tertiary prevention approach which will not reverse the extensive structural and functional pathology of schizophrenia. Conclusions: We believe that, given the current state of our knowledge of the illness, the future of the pharmacotherapy of schizophrenia looks bleak. (shrink)

Contemporary psychiatry is becoming more biologically oriented in the attempt to elicit a biological rationale of mental diseases. Although mental disorders comprise mostly functional abnormalities, there is a substantial overlap between neurology and psychiatry in addressing cognitive disturbances. In schizophrenia, the presence of cognitive impairment prior to the onset of psychosis and early after its manifestation suggests that some neurocognitive abnormalities precede the onset of psychosis and may represent a trait marker. These cognitive alterations may arise from functional disconnectivity, (...) as no significant brain damage has been found. In this review we aim to revise A.R. Luria’s systematic approach used in the neuropsychological evaluation of cognitive functions, which was primarily applied in patients with neurological disorders and in the cognitive evaluation in schizophrenia and other related disorders. As proposed by Luria, cognitive processes, associated with higher cortical functions, may represent functional systems that are not localized in narrow, circumscribed areas of the brain, but occur among groups of concertedly working brain structures, each of which makes its own particular contribution to the organization of the functional system. Current developments in neuroscience provide evidence of functional connectivity in the brain. Therefore, Luria’s approach may serve as a frame of reference for the analysis and interpretation of cognitive functions in general and their abnormalities in schizophrenia in particular. Having said that, modern technology, as well as experimental evidence, may help us to understand the brain better and lead us towards creating a new classification of cognitive functions. In schizophrenia research, multidisciplinary approaches must be utilized to address specific cognitive alterations. The relationships among the components of cognitive functions derived from the functional connectivity of the brain may provide an insight into cognitive machinery. (shrink)

Suggests an open system of psychological exploration to cut through accepted norms of morality, language, and politics.

While the implementation of digital technology in psychiatry appears promising, there is an urgent need to address the implications of the absence of ethical design in the early development of such technologies. Some authors have noted the gap between technology development and ethical analysis and have called for an upstream examination of the ethical issues raised by digital technologies. In this paper, we address this suggestion, particularly in relation to digital healthcare technologies for patients with schizophrenia spectrum disorders. The (...) introduction of digital technologies in psychiatry offers a broad spectrum of diagnostic and treatment options tailored to the health needs and goals of patients’ care. These technologies include wearable devices, smartphone applications for high-immersive virtual realities, smart homes, telepsychiatry and messaging systems for patients in rural areas. The availability of these technologies could increase access to mental health services and improve the diagnostics of mental disorders.Additional Instruction AbstractIn this descriptive review, we systematize ethical concerns about digital technologies for mental health with a particular focus on individuals suffering from schizophrenia. There are many unsolved dilemmas and conflicts of interest in the implementation of these technologies, such as (1) the lack of evidence on efficacy and impact on self-perception; (2) the lack of clear standards for the safety of their daily implementation; (3) unclear roles of technology and a shift in the responsibilities of all parties; (4) no guarantee of data confidentiality; and (5) the lack of a user-centered design that meets the particular needs of patients with schizophrenia. mHealth can improve care in psychiatry and make mental healthcare services more efficient and personalized while destigmatizing mental health disorders. To ensure that these technologies will benefit people with mental health disorders, we need to heighten sensitivity to ethical issues among mental healthcare specialists, health policy makers, software developers, patients themselves and their proxies. Additionally, we need to develop frameworks for furthering sustainable development in the digital technologies industry and for the responsible usage of such technologies for patients with schizophrenia in the clinical setting. We suggest that digital technology in psychiatry, particularly for schizophrenia and other serious mental health disorders, should be integrated into treatment with professional supervision rather than as a self-treatment tool. (shrink)

Empirical approaches on topics such as consciousness, self-awareness, or introspective perspective, need a conceptual framework so that the emerging, still unconnected findings can be integrated and put into perspective. We introduce a model of self-consciousness derived from phenomenology, philosophy, the cognitive, and neurosciences. We will then give an overview of research data on one particular aspect of our model, self-agency, trying to link findings from cognitive psychology and neuroscience. Finally, we will expand on pathological aspects of self-agency, and in particular (...) on psychosis in schizophrenia. We show, that a deficient self-monitoring system underlies, in part, hallucinations and formal thought (language) disorder in schizophrenia. We argue, that self-consciousness is a valid construct and can be studied with the instruments of cognitive and neuroscience. (shrink)

There is evidence that people with schizophrenia have difficulties in some (recently evolved) competencies for processing social information. However, a case can be made that vulnerabilities can also lie in (previously evolved) threat and safeness processing systems. Evolutionary models may need to consider interactions between genetic sensitivities, early experiences of threat/safeness, and later cognitive vulnerabilities. Psychological treatments must address issues of experienced threat and safeness before working on more cognitive competencies.

Phillips & Silverstein's focus on schizophrenia as a failure of “cognitive coordination” is welcome. They note that a simple hypothesis of reduced Gamma synchronisation subserving impaired coordination does not fully account for recent observations. We suggest that schizophrenia reflects a dynamic compensation to a core deficit of coordination, expressed either as hyper- or hyposynchronisation, with neurotransmitter systems and arousal as modulatory mechanisms.

In the field of clinical practice, there does not seem to be too much contention about what schizophrenia is, at least from a high level. After all, there are various diagnostic systems and guidelines, all of which point toward schizophrenia as a psychotic syndrome which likely forms a continuum with other psychotic disorders. It may sound obvious that, according to the current definitions, the major commonality between schizophrenia and all other psychoses is psychotic symptoms; more precisely, delusions (...) and hallucinations. Any description, or ‘phenomenology’ as most clinicians view it, can be found in these diagnostic manuals. However, is there anything at all that sets schizophrenia apart from the other... (shrink)

The study argues that linguistic/communication dysfunctions present in disorganized schizophrenia may stem, at least in part, from an impaired theory of mind. Using pragmatics and systemic linguistic theory, the study examined speech samples of two disorganized schizophrenic patients and attempted to determine if their communicative failures are because they lack theory of mind in the sense that they do not take into account the interlocutor's mind, i.e., the interlocutor's intentions, dispositions, and knowledge; or because they have a hyper-theory of (...) mind through which they over-attribute mental states to their interlocutor, i.e., assume that their interlocutor has access to their intentions, dispositions, and knowledge. The study indicates that disorganized schizophrenics are unlikely to be characterized as lacking a theory of mind; rather they seem to have a hyper-theory of mind, to which the psychopathological symptoms of hallucinations, delusions of reference and incoherent speech can be attributed. (shrink)

The study argues that linguistic/communication dysfunctions present in disorganized schizophrenia may stem, at least in part, from an impaired theory of mind. Using pragmatics and systemic linguistic theory, the study examined speech samples of two disorganized schizophrenic patients and attempted to determine if their communicative failures are because they lack theory of mind in the sense that they do not take into account the interlocutor's mind, i.e., the interlocutor's intentions, dispositions, and knowledge; or because they have a hyper-theory of (...) mind through which they over-attribute mental states to their interlocutor, i.e., assume that their interlocutor has access to their intentions, dispositions, and knowledge. The study indicates that disorganized schizophrenics are unlikely to be characterized as lacking a theory of mind; rather they seem to have a hyper-theory of mind, to which the psychopathological symptoms of hallucinations, delusions of reference and incoherent speech can be attributed. (shrink)

Auditory verbal hallucinations form an essential criterial feature in the schizophrenia definition in the Diagnostic and Statistical Manual of Mental Disorders -IV and International Classification of Diseases -10. In both classificatory systems, the presence of a hallucinatory voice that continuously comments the patient’s behavior or thoughts, or the presence of several voices that discuss the patient with each other, is a sufficient criterion to diagnose schizophrenia. The DSM-IV defines a hallucination as “a sensory perception that has the..

Activity-dependent neuroprotective protein, discovered in our laboratory in 1999, has been characterized as a master gene vital for mammalian brain formation. ADNP de novo mutations in humans result in a syndromic form of autism-like spectrum disorder, including cognitive and motor deficits, the ADNP syndrome. One of the most important cellular processes associated with ADNP is the autophagy pathway, recently discovered by us as a key player in the pathophysiology of schizophrenia. In this regard, given the link between the microtubule (...) and autophagy systems, the ADNP microtubule end binding protein motif, namely, the neuroprotective NAP, was found to enhance autophagy while protecting microtubules and augmenting ADNP's association with both systems. Thus, linking autophagy and ADNP is proposed as a major target for intervention in brain diseases from autism to Alzheimer's disease and our findings introduce autophagy as a possible novel target for treating schizophrenia. Activity-dependent neuroprotective protein binds to microtubule-associated protein light chain 3, which forms the membrane of the autophagosome, a key organelle in the autophagy process and regulates beclin1 formation, an inducer of autophagy. Autophagy plays a major role in Alzheimer's disease and as recently discovered in schizophrenia and autism. (shrink)

Recent studies suggest that the tetracycline antibiotic minocycline, or its cousins, hold therapeutic potential for affective and psychotic disorders. This is proposed on the basis of a direct effect on microglia‐mediated frontocortical synaptic pruning (FSP) during adolescence, perhaps in genetically susceptible individuals harboring risk alleles in the complement component cascade that is involved in this normal process of CNS circuit refinement. In reviewing this field, it is argued that minocycline is actually probing and modulating a deeply evolved and intricate (...) class='Hi'>system wherein psychosocial stimuli sculpt the circuitry of the “social brain” underlying adult behavior and personality. Furthermore, this system can generate psychiatric morbidity that is not dependent on genetic variation. This view has important ramifications for understanding “pathologies” of human social behavior and cognition as well as providing long‐sought potential mechanistic links between social experience and susceptibility to mental and physical disease. (shrink)

If both waking and dreaming consciousness are functional, their de-differentiation would be doubly detrimental. Differentiation between waking and dreaming is achieved through neuromodulation. During dreaming, without external sensory data and with mesolimbic dopaminergic input, hyper-cholinergic input almost totally suppresses the aminergic system. During waking, with sensory gates open, aminergic modulation inhibits cholinergic and mesocortical dopaminergic suppresses mesolimbic. These neuromodulatory systems are reciprocally interactive and self-organizing. As a consequence of neuromodulatory reciprocity, phenomenologically, the self and the world that appear during (...) dreaming differ from those that emerge during waking. As a result of self-organizing, the self and the world in both states are integrated.Some loss of self-organization would precipitate a degree of de-differentiation between waking and dreaming, resulting in a hybrid state which would be expressed heterogeneously, both neurobiologically and phenomenologically. As a consequence of progressive de-differentiation, certain identifiable psychiatric disorders may emerge. Ultimately, schizophrenia, a disorganized-fragmented self, may result. (shrink)

Here we defend the view that one ought to categorize and classify at least some mental disorders as clusters of interrelated dysfunctions of (usually, several) cognitive capacities – that is, the kinds of capacities that are postulated in cognitive science; capacities that are understood as entities that are primarily individuated in cognitive-functional terms (CF-systems); systems that have a set of peculiar properties in their manner of operation when processing information or representations. Usually, some of the mental disorders postulated in psychiatry (...) are clinically heterogeneous with respect to their symptoms, and tend to be comorbid – that is, one disorder is often accompanied by other disorders – for example, schizophrenia often comes with major depression. We argue that describing the manner in which CF-systems operate within themselves and with other CF-systems as well as with stimuli and other kinds of information can best explain why certain mental disorders are very heterogeneous with respect to their symptoms, and why comorbidity is so frequent among these disorders. A consequence is that both within-category heterogeneity and comorbodity are not necessarily indications of defective classifications but are rather a consequence of the actual cognitive functional architecture itself and are therefore to be expected in these cases. (shrink)

Thomas & Karmiloff- Smith ’ argument that the Residual Normality assumption is not valid for developmental disorders has implications for models of cognition in schizophrenia, a disorder that may involve a neurodevelopmental pathogenesis. A limiting factor for such theories is the lack of understanding about the nature of the cognitive system. Moreover, it is unclear how the proposal that modularization emerges from developmental processes would change that fundamental question.

In this paper, we describe the challenges of collecting data in the Māori population for automatic detection of schizophrenia using natural language processing (NLP). Existing psychometric tools for detecting are wide ranging and do not meet the health needs of indigenous persons considered at risk of developing psychosis and/or schizophrenia. Automated methods using NLP have been developed to detect psychosis and schizophrenia but lack cultural nuance in their designs. Research incorporating the cultural aspects relevant to indigenous communities (...) is lacking in the design of existing automatic prediction tools and one of the main reasons is the scarcity of data from indigenous populations. This paper explores the current design of the New Zealand health care system and its potential impacts on access and inequities in the Māori population and details the methodology used to collect speech samples of Māori at risk of developing psychosis and schizophrenia. The paper also describes the major obstacles faced during speech data collection, key findings, and probable solutions. (shrink)

This paper contains a preliminary investigation of an experimental, first-order logic with identity which encodes as an inference rule the faulty reasoning which Von Domarus (1944) suggested underwrote much of the bizarre thinking seen in certain forms of schizophrenia. I begin with a discussion of the "Von Domarus thesis," note its fate under statistical testing, and remark on its continued explanatory power in the hands of certain psychiatrists. I next discuss a proof calculus which contains a rule representing Von (...) Domarus reasoning — the phrenetic calculus — and present several nonstandard theorems which are provable in this system. In an appendix the phrenetic calculus is proven to be absolutely consistent, but unsound, yet complete. After a brief aside which addresses certain caveats and restrictions required in order to avoid rendering the calculus trivial, I close with a discussion of three of the nonstandard theorems, each of which are consistent in interesting ways with known schizophrenic cognitive deficits. (shrink)

Strong recent selection for social cognition may well explain the persistence of genes that predispose to schizophrenia. The specific mechanism responsible may be a skewed fitness function in which selection pushes the mean for advantageous mental traits perilously close to a “fitness cliff” where the system fails catastrophically in some individuals.

IntroductionMentalizing is a key aspect of social cognition. Several researchers assume that mentalization has two systems, an explicit one and an implicit one. In schizophrenia, several studies have confirmed the deficit of explicit mentalizing, but little data are available on non-explicit mentalizing. However, increasing research activity can be detected recently in implicit mentalizing. The aim of this systematic review and meta-analysis is to summarize the existing results of implicit mentalizing in schizophreniaMethodsA systematic search was performed in four major databases: (...) MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science. Eleven publications were selected. Five studies were found to be eligible for quantitative synthesis, and 9 studies were included in qualitative synthesis.ResultsThe meta-analysis revealed significantly lower accuracy, slower reaction time during implicit mentalizing in patients with schizophrenia. The systematic review found different brain activation pattern, further alterations in visual scanning, cue fixation, face looking time, and difficulties in perspective taking.DiscussionOverall, in addition to the deficit of explicit mentalization, implicit mentalization performance is also affected in schizophrenia, if not to the same extent. It seems likely that some elements of implicit mentalization might be relatively unaffected, but the effectiveness is limited by certain neurocognitive deficits. These alterations in implicit mentalizing can also have potential therapeutic consequences.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42021231312. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Notes on Psychodramatic Treatment of a Person with SchizophreniaJonathan D. Moreno, PhD (bio)I have enjoyed reflecting on Mr. Chapy’s account of work in psychodrama with a patient with schizophrenia.Although at one time many years ago I was interested in phenomenological psychiatry, and especially the writings of Ludwig Binswanger and Medard Boss, I am not an authority on dasein-analysis, so I have nothing to add to the discussion. I (...) should say, however, that my father had little interest in this approach, which was far too abstract for his taste. He proceeded from the standpoint of the theater, of action and enactment. He believed that the drama itself provided the insight.For the purposes of this response, I take it as a given that the patient in question has been accurately diagnosed, although in the description of the scene with his father he does not exhibit the usual symptoms, such as auditory hallucinations. People with schizophrenia often find it difficult to manage the voices they are hearing without substantial preparation for a psychodrama. According to psychodramatic method, one way to prepare them is to externalize the voices, allowing a different therapist to take the role of each one as the protagonist instructs them how to play that role. Chair may be set up so that each “voice,” personified by an auxiliary ego, can sit in each chair in an array. This preparation may require a number of sessions. If the scene is to be enacted with a significant other, like the father in this instance, the patient may not be able to warm up to a direct encounter, especially with all the different voices competing for his internal attention. So he may be directed to observe each voice in the encounter with his father, preferably played by a therapist of his choosing and trained for the role, usually by giving the father-player certain lines so that they can learn something about the father and the way he addresses his son.Or consider the patient whose illness manifests itself as delusions, often of a megalomaniac character. They may be a messiah, for example, or the rightful heir of a royal line whose identity is being suppressed by governmental forces. The patient might be invited to choose key therapists to play the roles of key members of their circle, [End Page 225] enacting critical scenes like the sermon on the mount or speeches to their oppressed followers. In this way the patient’s “act hunger” may be to some degree satiated and have a calming effect on their anxiety and irritation with the frustrating world around them that refuses to accept their “authentic” identity and belief system.In these ways, psychodrama therapy can take advantage of one of the remarkable advantages of this method for such patients, who are generally recalcitrant to talk therapy alone and for whom medication is at best modestly effective. Still, these disorders are among the most challenging for psychotherapists. Although the process of treating them may open up insights into the nature of the human mind, as Chapy has pursued in this paper, we await the neuroscience that can affect the kind of long-term remission they and their families so desperately wish. [End Page 226]Jonathan D. MorenoUniversity of Pennsylvania [email protected] D. Moreno Jonathan D. Moreno is a philosopher and historian who specializes in the intersection of bioethics, culture, science, and national security, and has published seminal works on the history, sociology and politics of biology and medicine. He is an elected member of the National Academy of Medicine.submitted on January 27, 2023Accepted on January 30, 2023Copyright © 2023 Johns Hopkins University Press... (shrink)

In this paper we focus on the psychiatric approach of Open Dialogue and seek to explain why the intersubjective process of dialogue, one of OD’s core clinical principles, is effective in schizophrenia treatment. We address this question from an interdisciplinary viewpoint, by linking the OD approach with a theoretical account of the self as endorsed by enactive cognitive science. The paper is structured as follows: first, we introduce the OD approach and focus in particular on the principles that are (...) characteristic of the dialogical therapeutic attitude. Second, we clarify our stance on the concept of schizophrenia by relying on insights from phenomenological psychiatry. Third, we introduce an enactive perspective on mental disorders, which elaborates on phenomenological psychiatry and conceives of the self as a self-organizing system, brought forth through interactional processes. Based on this enactive approach, we draw clinical implications for schizophrenia. In the fourth and final part, we propose conceptual bridges between the OD and the enactive approach by bringing to attention the intersubjective nature of the human self and the inherent vulnerability entailed in both the self’s maintenance and in the practice of dialogue. We then propose that the dialogical stance adopted by OD is effective in supporting the recovery of a balanced sense of self precisely because it provides an intersubjective space in which clients can safely experience and maintain the basic structures underlying the socially constituted self. Since our analysis touches upon fundamental structures of the therapeutic relationship, we hope that it will also be useful to inform general psychiatric practice and help advancing a more integrative understanding of psychotherapy for schizophrenia. (shrink)

In his essay on Herman Melville, Gilles Deleuze writes about an affirmation of the world as process and as archipelago. What does this mode of affirmation mean not only for the philosophy of Deleuze, but also for us all who live in this world today? This is the principal issue which I try to take up in my paper. Already in his text on David Hume, the young Deleuze was obliged to confront the problematics of the becoming-system of collection, (...) which would accompany him throughout his life. This essay discusses the ways in which Deleuze's central concepts including ‘transcendental empiricism', ‘difference/repetition', ‘schizophrenia’, ‘chaosmos', ‘thousand plateaus', ‘and’ and ‘line of flight’ are interconnected within his notion of archipelagic system. (shrink)

The article provides an argument on the Soviet system of the early post-Stalinist years reflected in Haidamaky by Yurii Mushketyk. Through the concept of “body economy” inspired by Deleuze and Guattari’s schizoanalysis, it investigates the case of the female corporeality hidden in the novel. The article contests that the female body is part of the economy of desire flows which connected it to the male body. It also states that, after the death of Stalin, the reorganised Soviet regime demonstrates (...) schizophrenic states as reflected in Mushketyk’s Haidamaky. (shrink)

This paper offers a framework for consciousness of internal reality. Recent PET experiments are reviewed, showing partial overlap of cortical activation during self-produced actions and actions observed from other people. This overlap suggests that representations for actions may be shared by several individuals, a situation which creates a potential problem for correctly attributing an action to its agent. The neural conditions for correct agency judgments are thus assigned a key role in self/other distinction and self-consciousness. A series of behavioral experiments (...) that demonstrate, in normal subjects, the poor monitoring of action-related signals and the difficulty in recognizing self-produced actions are described. In patients presenting delusions, this difficulty dramatically increases and actions become systematically misattributed. These results point to schizophrenia and related disorders as a paradigmatic alteration of a ''Who?'' system for self-consciousness. (shrink)

The neuropsychology of religious activity in normal and selected clinical populations is reviewed. Religious activity includes beliefs, experiences, and practice. Neuropsychological and functional imaging findings, many of which have derived from studies of experienced meditators, point to a ventral cortical axis for religious behavior, involving primarily the ventromedial temporal and frontal regions. Neuropharmacological studies generally point to dopaminergic activation as the leading neurochemical feature associated with religious activity. The ventral dopaminergic pathways involved in religious behavior most closely align with the (...) action-extrapersonal system in the model of 3-D perceptual–motor interactions proposed by Previc . These pathways are biased toward distant space and also mediate related extrapersonally dominated brain functions such as dreaming and hallucinations. Hyperreligiosity is a major feature of mania, obsessive-compulsive disorder, schizophrenia, temporal-lobe epilepsy and related disorders, in which the ventromedial dopaminergic systems are highly activated and exaggerated attentional or goal-directed behavior toward extrapersonal space occurs. The evolution of religion is linked to an expansion of dopaminergic systems in humans, brought about by changes in diet and other physiological influences. (shrink)

How do I know that I am the person who is moving? According to Wittgenstein (1958), the sense of agency involves a primitive notion of the self used as subject, which does not rely on any prior perceptual identification and which is immune to error through misidentification. However, the neuroscience of action and the neuropsychology of schizophrenia show the existence of specific cognitive processes underlying the sense of agency—the ‘‘Who'' system (Georgieff & Jeannerod, 1998) which is disrupted in (...) delusions of control (Frith, 1992). Yet, we have to be careful in the interpretation of such clinical symptoms, which cannot be so easily reduced to deficit of action monitoring or to lack of action awareness. Moreover, we should refine the definition of the sense of agency by distinguishing the sense of initiation and the sense of one's own movements. A conceptual analysis of the empirical data will lead us to establish the taxonomy of the different levels of action representations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.4 (2001) 391-400 [Access article in PDF] Bioethics Inside the Beltway A Shooting on Capitol Hill: "The Ruby Satellite System," Mental Illness, and Failure of the American Legal System Peter J. Cohen On 24 July 1998, Russell Eugene Weston, Jr., stormed the United States Capitol, forced his way through a security checkpoint, bypassed a metal detector, and entered the office complex of (...) Representative Tom DeLay (R-TX), the House Majority Whip (Weil 1998). During this period of terror, he shot and killed two officers of the Capitol Police and seriously wounded another as they attempted to end his foray. 1 Weston was severely wounded by several Capital police officers and taken into custody. After being treated for his injuries, he was incarcerated in the District of Columbia. 2On 5 May 1999, Weston was transferred to the Federal Correctional Institute in Butner, North Carolina (United States v. Weston, 69 F. Supp. 2d 99 (D.D.C. 1999), 103), where he remains to this day. He has neither been brought to trial nor received appropriate psychiatric therapy, but continues to be warehoused "in solitary confinement under constant observation... in a psychotic state (United States v. Weston, 255 F.3d 873; LEXIS 16851 (U.S. App. 2001b), 3-4 [LEXIS]). I will briefly detail the legal events responsible for this mad situation and suggest alternative actions that should have been taken at the very onset of the case. Early Chronology Although overtly the crime appeared to be senseless and without any conceivable motivation, Weston believed that his acts were justified and necessary. The story he told to the court-appointed forensic psychiatrist, Sally C. Johnson, M.D., 3 was that while working for NASA in the early 1980s, he had developed a "Ruby Satellite System," a powerful machine that could reverse time. With access to this system, nothing was permanent--the user could simply reverse time and exit from the current scene. However, the "System" was now controlled by cannibals who were developing and spreading "Black Heva," the deadliest disease known to [End Page 391] humankind, similar to HIV or the plague. It resulted from human corpses rotting and turning black. Time was running out, and Weston believed he had to return to override the "Ruby Satellite System" in the Capitol so that he could stem the spread of "Black Heva" and prevent world calamity. He believed that if he were tried, convicted, and even executed, he could simply time reverse himself, place himself in a safe within the Capitol, and subsequently resume his life at whatever point he chose (United States v. Weston, 206 F.3d 9 (D.C. Cir. 2000), 19-20).On 22 April 1999, the district court accepted Dr. Johnson's diagnosis that Weston suffered from paranoid schizophrenia, the symptoms of which were so severe that he would be incapable of understanding the proceedings against him and of assisting in his own defense. On this basis, the court had no difficulty in finding him incompetent to stand trial (U.S. v. Weston 1999, 102).At Weston's initial hearing, Dr. Johnson had testified that medication would be efficacious in treating Weston's delusions: [T]he standard of care in someone suffering from this type of symptom picture would be to treat them with medication.... [T]here is a good likelihood that he'll have a positive response, positive in the sense that his symptoms will diminish in response to treatment.... The potential benefits to treating the defendant far outweigh the risks.... (U.S. v. Weston 1999, 108) The defense presented no expert testimony refuting Dr. Johnson's presentation. The district court then ordered that Weston begin receiving medication in order to render him nondangerous and competent for trial (U.S. v. Weston 1999, 108-9). The Problem Weston refused to be medicated! 4 He has continued to claim that the administration of antipsychotic drugs against his will would violate his Fifth Amendment due process liberty interest in avoiding unwanted bodily intrusion and implicated... (shrink)

Drawing on previous models of anxiety, intermediate memory, the positive symptoms of schizophrenia, and goal-directed behaviour, a neuropsychological hypothesis is proposed for the generation of the contents of consciousness. It is suggested that these correspond to the outputs of a comparator that, on a moment-by-moment basis, compares the current state of the organism's perceptual world with a predicted state. An outline is given of the information-processing functions of the comparator system and of the neural systems which mediate them. (...) The hypothesis appears to be able to account for a number of key features of the contents of consciousness. However, it is argued that neitherthis nor any existing comparable hypothesis is yet able to explain why the brain should generate conscious experience of any kind at all. (shrink)

This target article considers the relation of fluid cognitive functioning to general intelligence. A neurobiological model differentiating working memory/executive function cognitive processes of the prefrontal cortex from aspects of psychometrically defined general intelligence is presented. Work examining the rise in mean intelligence-test performance between normative cohorts, the neuropsychology and neuroscience of cognitive function in typically and atypically developing human populations, and stress, brain development, and corticolimbic connectivity in human and nonhuman animal models is reviewed and found to provide evidence of (...) mechanisms through which early experience affects the development of an aspect of cognition closely related to, but distinct from, general intelligence. Particular emphasis is placed on the role of emotion in fluid cognition and on research indicating fluid cognitive deficits associated with early hippocampal pathology and with dysregulation of the hypothalamic-pituitary-adrenal axis stress-response system. Findings are seen to be consistent with the idea of an independent fluid cognitive construct and to assist with the interpretation of findings from the study of early compensatory education for children facing psychosocial adversity and from behavior genetic research on intelligence. It is concluded that ongoing development of neurobiologically grounded measures of fluid cognitive skills appropriate for young children will play a key role in understanding early mental development and the adaptive success to which it is related, particularly for young children facing social and economic disadvantage. Specifically, in the evaluation of the efficacy of compensatory education efforts such as Head Start and the readiness for school of children from diverse backgrounds, it is important to distinguish fluid cognition from psychometrically defined general intelligence. (Published Online April 5 2006) Key Words: cognition; cognition-emotion reciprocity; developmental disorders; emotion; fluid cognition; Flynn effect; general intelligence; limbic system; neuroscience; phenylketonuria; prefrontal cortex; psychometrics; schizophrenia. (shrink)

Behaving presents an overview of the recent history and methodology of behavioral genetics and psychiatric genetics, informed by a philosophical perspective. Kenneth F. Schaffner addresses a wide range of issues, including genetic reductionism and determinism, "free will," and quantitative and molecular genetics. The latter covers newer genome-wide association studies that have produced a paradigm shift in the subject, and generated the problem of "missing heritability." Schaffner also presents cases involving pro and con arguments for genetic testing for IQ and for (...) Attention Deficit Hyperactivity Disorder. Schaffner examines the nature-nurture controversy and Developmental Systems Theory using C. elegans or "worm" studies as a test case, concluding that genes are special and provide powerful tools, including "deep homology," for investigating behavior. He offers a novel account of biological knowledge emphasizing the importance of models, mechanisms, pathways, and networks, which clarifies how partial reductions provide explanations of traits and disorders. The book also includes examinations of personality genetics and of schizophrenia and its etiology, alongside interviews with prominent researchers in the area, and discusses debates about psychosis that led to changes in the DSM-5 in 2013.Schaffner concludes by discussing additional philosophical implications of the genetic analyses in the book, some major worries about "free will," and arguments pro and con about why genes and DNA are so special. Though genes are special, newer perspectives presented in this book will be needed for progress in behavioral genetics- perspectives that situate genes in complex multilevel prototypic pathways and networks. With a mix of optimism and pessimism about the state of the field and the subject, Schaffner's book will be of interest to scholars in the history and philosophy of science, medicine, and psychiatry. (shrink)

Four different accounts of the relationship between third-person mindreading and first-person metacognition are compared and evaluated. While three of them endorse the existence of introspection for propositional attitudes, the fourth (defended here) claims that our knowledge of our own attitudes results from turning our mindreading capacities upon ourselves. Section 1 of this target article introduces the four accounts. Section 2 develops the “mindreading is prior” model in more detail, showing how it predicts introspection for perceptual and quasi-perceptual (e.g., imagistic) mental (...) events while claiming that metacognitive access to our own attitudes always results from swift unconscious self-interpretation. This section also considers the model's relationship to the expression of attitudes in speech. Section 3 argues that the commonsense belief in the existence of introspection should be given no weight. Section 4 argues briefly that data from childhood development are of no help in resolving this debate. Section 5 considers the evolutionary claims to which the different accounts are committed, and argues that the three introspective views make predictions that are not borne out by the data. Section 6 examines the extensive evidence that people often confabulate when self-attributing attitudes. Section 7 considers “two systems” accounts of human thinking and reasoning, arguing that although there are introspectableeventswithin System 2, there are no introspectableattitudes. Section 8 examines alleged evidence of “unsymbolized thinking”. Section 9 considers the claim that schizophrenia exhibits a dissociation between mindreading and metacognition. Finally, section 10 evaluates the claim that autism presents a dissociation in the opposite direction, of metacognition without mindreading. (shrink)

This present book explores recent advances in modeling discourse processes, in particular, new approaches aimed at understanding pathological language behavior specific to schizophrenia. The contributors examine the modeling paradigm of formal semantics, which falls within the scope of both linguistics and logic while providing overlapping links with other fields such as philosophy of language and cognitive psychology. This book is based on results presented during the series of workshops on Coherence and Discourse organized by SLAM, a project developed to (...) systemize the study of pathological language processing by taking an overarching interdisciplinary approach combining psychology, linguistics, computer science and philosophy. The principle focus is on conversations produced by people with psychiatric disorders such as schizophrenia and autism. The contributions come from young and experienced researchers, and invited speakers. The book appeals to likeminded students and researchers. (shrink)

Although the cognition is significant in strategic reasoning, its role has been weakly analyzed, because only the average intelligence is usually considered. For example, prisoner's dilemma in game theory, would have different outcomes for persons with different intelligence. I show how various levels of intelligence influence the quality of reasoning, decision, or the probability of psychosis. I explain my original methodology developed for my MA thesis in clinical psychology in 1998, and grant research in 1999, demonstrating the bias of the (...) classic IQ method, and how the intelligence limits thinking. Based on that I defined Personality Model, providing insight into understanding of psychosis (schizophrenia, bi-polar), which has not been explained yet by psychology or psychiatry. In addition, it enables to analyze and assess non-linear problems, utilizable in computer programming, visualization (animation) or other fields including Baduk game. I've already applied some principles in complex information system www.each.co.uk, and video-animations exhibited in London, Germany, Tokyo. I need to mention my experience in chess composition between 1994 and 2000, winning a few international prizes and inventing a special class of fairy rules redefining the mate. The chess composition principles or patterns show the way to organize logical series to higher advanced mechanisms (like calculus), applicable to other fields. One of such principles is a logical aesthetic innovation: new strategy, defined by Italian composers. Finally I show how the simple redefinition of the classic utility concept links economics and psychology to explain irrational / destructive behavior. All presented results (from the research) can be repeated. (shrink)

As many as two million people in the United Kingdom repeatedly see people, animals, and objects that have no objective reality. Hallucinations on the border of sleep, dementing illnesses, delirium, eye disease, and schizophrenia account for 90% of these. The remainder have rarer disorders. We review existing models of recurrent complex visual hallucinations (RCVH) in the awake person, including cortical irritation, cortical hyperexcitability and cortical release, top-down activation, misperception, dream intrusion, and interactive models. We provide evidence that these can (...) neither fully account for the phenomenology of RCVH, nor for variations in the frequency of RCVH in different disorders. We propose a novel Perception and Attention Deficit (PAD) model for RCVH. A combination of impaired attentional binding and poor sensory activation of a correct proto-object, in conjunction with a relatively intact scene representation, bias perception to allow the intrusion of a hallucinatory proto-object into a scene perception. Incorporation of this image into a context-specific hallucinatory scene representation accounts for repetitive hallucinations. We suggest that these impairments are underpinned by disturbances in a lateral frontal cortex–ventral visual stream system. We show how the frequency of RCVH in different diseases is related to the coexistence of attentional and visual perceptual impairments; how attentional and perceptual processes can account for their phenomenology; and that diseases and other states with high rates of RCVH have cholinergic dysfunction in both frontal cortex and the ventral visual stream. Several tests of the model are indicated, together with a number of treatment options that it generates. Key Words: Blindness; Charles Bonnet; cholinergic; cortical release; delirium; dementia; dream intrusion; hallucination; Perception and Attention Deficit (PAD) model; schizophrenia. (shrink)