Anomalous self-experience in schizophrenia : Associations with diagnosis, suicidality and neurocognition
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AbstractIncreasing and robust empirical evidence indicates that certain anomalous subjective experiences in the form of non-psychotic disturbances of the basic sense of self (i.e. self-disorders, SDs) might be specific vulnerability markers for schizophrenia spectrum disorders (Møller and Husby, 2000;Parnas et al., 1998;Raballo, 2009;Raballo et al., 2011;Parnas et al., 2003). The term selfdisorders (SDs) indicates that these phenomena are basic disturbances of the person’s subjective experience of his own identity or “self” (Sass and Parnas, 2003). The main purpose of this study is to contribute to more knowledge about the phenomenon of SDs in the early stages of psychosis. We wanted to study the more basic phenomena of psychotic psychopathology trough assessing occurrence, level and type of SDs close to the onset of psychosis, and subsequently linking the disorders to differences in clinical presentation. Early diagnostics and treatment is of importance in psychotic disorders. Current diagnostic manuals (e.g. DSM-IV and ICD-10) do not differentiate clearly between different psychotic disorders in the early stages of the illnesses due to overlap in clinical symptoms and behavioural manifestations. Thus, one purpose of this study is to contribute to better diagnostic precision in these early stages of psychosis through more knowledge about the phenomenon of SDs. Additionally, we know that one of the major complications associated with schizophrenia is suicidal behaviour, and the risk factors identified until now cannot explain why the suicide risk is particularly high in the early phases of the disorder. Suicidality is multidetermined and our hypothesis is that suicidality may be partly motivated by SDs. Finally, both SDs and neurocognitive deficits have been suggested to be core features of schizophrenia, so we also wanted to study tentative relationships between them.
We therefore posed the following questions: Can SDs discriminate between schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), bipolar disorders (bipolar disorder I and NOS) (BD) and other psychotic disorders usually classified outside of the (narrow) schizophrenia spectrum (delusional disorder, brief psychotic disorder and psychosis NOS) (OP) in the early phase of the treated course of psychotic disorders? Is current suicidality related to SDs in first treatment schizophrenia patients, and how is the relationship between suicidality, depression and SDs in these patients? Is there any relationship between neurocognitive dysfunctions and SDs in the early phase of schizophrenia?
The study involved all treatment facilities in two neighbouring Norwegian counties. Inclusion criteria was being between 18 to 65 years, and being consecutive in- or outpatient referred to first adequate treatment (FAT) for psychosis. During 2008 and 2009 a total of 91 patients early in their treatment course completed the full protocol including clinical assessments and neurocognitive assessments. SDs were assessed according to the EASE (Examination of Anomalous Self-Experience) manual (Parnas et al., 2005b). Because EASE is a relatively new instrument, we also wanted to test if it is a reliable and internally consistent clinical tool for the assessment of anomalous subjective experience in patients referred to (FAT) for psychosis.
We believe that the additional perspective of SDs has large potentials to improve diagnostic validity in the early course of illness, and thus contribute to an earlier and more targeted treatment of psychotic disorders. Suicide prevention in patients with first episode schizophrenia is important, and these results can shed some light in the search for risk factors for suicide in this patient group. More knowledge about the relationship between neurocognitive deficits and the person’s experience of his/hers thinking processes might improve the communication with the patients about their neurocognitive deficits and aid treatment.
List of papers. The papers are removed from the thesis due to copyright restrictions.
Paper I Møller P, Haug E, Raballo A, Parnas J, Melle I. Examination of anomalous Self-Experience in First-Episode Psychosis: Inter-Rater Reliability Psychopathology. 2011;44(6):386-90. doi:10.1159/000325173
Paper II Haug E, Lien L, Raballo A, Bratlien U, Oie M, Andreassen OA, Melle I, Møller P. Selective aggregation of self-disorders in first treatment DSM-IV schizophrenia spectrum disorders J Nerv Ment Dis. 2012 Jul;200(7):632-6. doi:10.1097/NMD.0b013e31825bfd6f
Paper III Haug E, Melle I, Andreassen OA, Raballo A, Bratlien U, Øie M, Lien L, Møller P. The association between anomalous self-experience and suicidality in first episode schizophrenia seems mediated by depression Compr Psychiatry. 2012 Jul;53(5):456-60 doi:10.1016/j.comppsych.2011.07.005
Paper IV Haug E, Øie M, Melle I, Andreassen OA, Raballo A, Bratlien U, Lien L, Møller P. The association between Self-Disorders and Neurocognitive Dysfunction in Schizophrenia. Schizophr Res. 2012 Mar;135(1-3):79-83 doi:10.1016/j.schres.2011.11.015