_ Source: _Volume 39, Issue 2, pp 139 - 164 The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with their disorder, giving meaning to life as well as a relationship to a sacred figure. However, (...) their religiousness often contained religious omnipotent delusions, and built on hallucinations, displayed an unsecure relationship to the sacred figure. From a psychiatric point of view, the misinterpretation of hallucinations as mystical experiences may reinforce their delusional system and cause an obstacle to recovery. This misinterpretation may also cause problems for patients’ religious coping. Our findings underline the importance of taking patients’ religiousness into account in psychotherapy. (shrink)

_Background:_ Literature has documented the role of family in the outcome of chronic schizophrenia. In the light of this, family interventions (FIs) are becoming an integral component of treatment for psychosis. The First Episode of Psychosis (FEP) is the period when most of the changes in family atmosphere are observed; unfortunately, few studies on the relatives are available. _Objective:_ To explore burden of care and emotional distress at baseline and at 9-month follow-up and the levels of (...) service satisfaction at follow-up in the two groups of relatives (experimental treatment EXP vs. treatment as usual TAU) recruited in the cluster-randomized controlled GET UP PIANO trial. _Methods:_ The experimental treatment was provided by routine public Community Mental Health Centers (Italian National Health Service) and consisted of Treatment as Usual plus evidence-based additional treatment (Cognitive Behavioral Therapy for psychosis for patients, Family Intervention for psychosis, and Case Management). TAU consisted of personalized outpatient psychopharmacological treatment, combined with non-specific supportive clinical management and informal support/educational sessions for families. The outcomes on relatives were assessed by the Involvement Evaluation Questionnaire (IEQ-EU), the General Health Questionnaire (GHQ-12), and the Verona Service Satisfaction Scale (VSSS-EU). Differences within and between groups were evaluated. _Results:_ At baseline, 75 TAU and 185 EXP caregivers were assessed. In the experimental group 92% of relatives participated in at least 1 family session. At follow-up both groups experienced improvement in all IEQ and GHQ items, but caregivers belonging to the EXP arm experienced a significantly greater change in 10 IEQ items (mainly pertaining to the “Tension” dimension) and in GHQ items. Due to the low sample size, a significant effectiveness was only observed for 2 IEQ items and 1 GHQ-12 item. With respect to VSSS data at follow-up, caregivers in the EXP arm experienced significantly greater satisfaction in 8 items, almost all pertaining to the dimensions “Relatives' Involvement” and “Professionals' Skills and Behavior.” _Conclusions:_ The Family intervention for psychosis delivered in the GET UP PIANO trial reduced family burden of illness and improved emotional distress and satisfaction with services. These results should encourage to promote FIs on caregivers of first-episode psychosis patients. (shrink)

Understanding the neural basis of schizophrenia (SZ) is important for shedding light on the neurobiological mechanisms underlying this mental disorder. Structural and functional alterations in the anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), hippocampus, and medial prefrontal cortex (MPFC) have been implicated in the neurobiology of SZ. However, the effective connectivity among them in SZ remains unclear. The current study investigated how neuronal pathways involving these regions were affected in first-episode SZ using functional magnetic resonance imaging (fMRI). (...) Forty-nine patients with a first-episode of psychosis and diagnosis of SZ—according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision—were studied. Fifty healthy controls (HCs) were included for comparison. All subjects underwent resting state fMRI. We used spectral dynamic causal modeling (DCM) to estimate directed connections among the bilateral ACC, DLPFC, hippocampus, and MPFC. We characterized the differences using Bayesian parameter averaging (BPA) in addition to classical inference (t-test). In addition to common effective connectivity in these two groups, HCs displayed widespread significant connections predominantly involved in ACC not detected in SZ patients, but SZ showed few connections. Based on BPA results, SZ patients exhibited anterior cingulate cortico-prefrontal-hippocampal hyperconnectivity, as well as ACC-related and hippocampal-dorsolateral prefrontal-medial prefrontal hypoconnectivity. In summary, spectral DCM revealed the pattern of effective connectivity involving ACC in patients with first-episode SZ. This study provides a potential link between SZ and dysfunction of ACC, creating an ideal situation to associate mechanisms behind SZ with aberrant connectivity among these cognition and emotion-related regions. (shrink)

AimWhite matter changes in individuals at ultra-high risk for psychosis (UHR) may be involved in the transition to psychosis. Sleep-wake disturbances commonly precede the first psychotic episode and predict development of psychosis. We examined associations between white matter microstructure and sleep-wake disturbances in UHR individuals compared to healthy controls (HC), as well as explored the confounding effect of medication, substance use, and level of psychopathology.MethodsSixty-four UHR individuals and 35 HC underwent clinical interviews and diffusion weighted (...) imaging. Group differences on global and callosal mean fractional anisotropy (FA) was tested using general linear modeling. Sleep-wake disturbances were evaluated using the subjective measures disturbed sleep index (DSI) and disturbed awakening index (AWI) from the Karolinska Sleep Questionnaire, supported by objective sleep measures from one-night actigraphy. The primary analyses comprised partial correlation analyses between global FA/callosal FA and sleep-wake measures. Secondary analyses investigated multivariate patterns of covariance between measures of sleep-wake disturbances and FA in 48 white matter regions of interest using partial least square correlations.ResultsUltra-high risk for psychosis individuals displayed lower global FA (F = 14.56, p < 0.001) and lower callosal FA (F = 11.34, p = 0.001) compared to HC. Subjective sleep-wake disturbances were significantly higher among the UHR individuals (DSI: F = 27.59, p < 0.001, AWI: F = 36.42, p < 0.001). Lower callosal FA was correlated with increased wake after sleep onset (r = −0.34, p = 0.011) and increased sleep fragmentation index (r = −0.31, p = 0.019) in UHR individuals. Multivariate analyses identified a pattern of covariance in regional FA which were associated with DSI and AWI in UHR individuals (p = 0.028), but not in HC. Substance use, sleep medication and antipsychotic medication did not significantly confound these associations. The association with objective sleep-wake measures was sustained when controlling for level of depressive and UHR symptoms, but symptom level confounded the covariation between FA and subjective sleep-wake measures in the multivariate analyses.ConclusionCompromised callosal microstructure in UHR individuals was related to objectively observed disruptions in sleep-wake functioning. Lower FA in ventrally located regions was associated with subjectively measured sleep-wake disturbances and was partly explained by psychopathology. These findings call for further investigation of sleep disturbances as a potential treatment target. (shrink)

The article draws from a personal clinical experience of two suicides, not far removed from each other in time. The first patient was a 33-year-old intellectual suffering from depression with narcissistic traits but no psychotic elements, while the second patient was a 21-year-old student with a manifest psychotic episode behind him and with characteristics of post-psychotic depression at the time of suicide. The two suicides had very different impacts on the therapist: the first left open some “space” (...) for reflection, communication, and working-through, while the second closed such a “space,” leaving only a tiny door to the existential roots of human beings and suffering. The therapist was able to find some “shelter” by talking to supervisors, colleagues, and friends in the first case; in the second, the only possible “shelter” was glimpsed in the philosophy of groundlessness (Ungrund) of the Russian existentialist Nicolai Berdyaev. The personal experiences of the therapist, along with some theoretical interpretations of the after-effects of both suicides, are presented using a psychodynamic and existential–phenomenological understanding of the therapeutic relationship with a psychotic and a non-psychotic patient. The main dilemmas exposed by a patient’s suicide, especially if the patient suffers from psychosis, are difficult to deal with in the usual clinical settings and call for resources beyond it. The authors propose that these can be found in philosophical and theological insights. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:ADOLESCENCE, INDIFFERENTIATION, AND THE ONSET OF PSYCHOSIS Henri Grivois Hôtel-Dieu, Paris The onset of psychosis happens, by definition, only once. The first psychotic episode is unforeseeable and risks being overlooked. Left to itself its future is uncertain, and the prognosis is potentially unfavorable. The variety of its manifestations as well as its thymic and cognitive instability explains why so little is written on this subject. (...) The psychiatric literature, by its almost exclusive reference to evolved psychoses, has not distinguished the qualities peculiar to the onset of psychosis (nascent psychosis). Yet recent research reflects an interest in early diagnosis of psychosis to secure qualitative improvements and the chance ofa favorable outcome for patients. A special approach must be used for patients during the stage of nascent psychosis. Something must be done, but early treatment is not enough. Psychotropic medication has no more than a sedative effect and there are few specifics at this stage (Swain 175). Further, one risks obliterating the patient's lived experience. The entire battery of interventions, above all the first consultations, must follow from a rigorously organized and intensive strategy to directly engage with this subjective experience. For many years at l'Hôtel-Dieu, a general hospital situated in the center of Paris, we have harnessed ourselves to this task. First I shall describe the existence of centrality. It constitutes the most characteristic and permanent trait of the onset of psychosis. From the concept of concernment, I propose a phenomenological morphogenesis of the initial sequence of psychosis. Next I turn to the state of indifferentiation that overcomes the subject, and then to the vulnerability peculiar to adolescents. I shall end with some fundamental epidemiological data. Henri Grivois1 05 Centrality To be mad is not only the feeling of being uniquely in contact with all humanity, whether as alienated from it or as uniting all of it in oneself conceived as the only member of the species. It is this certainly but also more than this. It is to infer that one occupies a unique place in the human world. It is the feeling of being encircled by everyone. Without being responsible, the patient is placed in the forefront of some grandiose project. His centrality, whatever the mode ofexpression, orients him towards a form of mental disorder. As a general rule, at the beginning, centrality is never explicit and passes unnoticed. The physical and verbal behavior of the patient suffice to accuse him, without any further investigation, of unintelligibility and incoherence. Centrality is above all an emotion about which we should admit that we know almost nothing. People with nascent psychosis are the prey of intuitions impossible to comprehend. Like Rimbaud's drunken boat, they flee, drifting or hiding themselves, coming back and taking offagain. They are therefore incapable, wherever they go, of living an instant of unconcern. Incapable of expressing their singular rapport with the world, they keep silent. Very soon nevertheless centrality engenders a torrent of questions. Silently, voicelessly, patients apprehend in an almost automatic manner the responses to these questions in the verbal and gestural behavior of others. Since Esquirol (Gauchet and Swain 464) identified hallucinatory phenomena as the cause of psychosis, they have occupied a disproportionate place in mental science for 200 years. This construction of the concept of hallucination in psychiatry, key to the orthodox vision of psychosis, assures a watchful vigilance to rule out every non-symptomatic treatment ofpatients. Hours or perhaps days later, no longer capable of abstaining from interpretation, patients begin to sketch out an explanation ofthe prodigious situation which they have experienced. They interrogate their relation to others and the intentions and the degree of unanimity of people towards them. Invoking demons and monsters often gives their explanations a first coherence which is in harmony with the scale of their experience. On their side the psychiatrists, to facilitate verbalizing the experience, suggest paraphrases of a general order: influence, mental automatism, exterior action, xenopathia, etc. To mask centrality, to get away from it, or in response to the gravity of the event, the patients, in search of some responsibility, envisage more elaborate scenarios: mission, conspiracy, trial, condemnation. A political vocabulary, more plausible but less universal than a... (shrink)

IntroductionSymptoms of schizophrenia are closely related to aberrant language comprehension and production. Macroscopic brain changes seen in some patients with schizophrenia are suspected to relate to impaired language production, but this is yet to be reliably characterized. Since heterogeneity in language dysfunctions, as well as brain structure, is suspected in schizophrenia, we aimed to first seek patient subgroups with different neurobiological signatures and then quantify linguistic indices that capture the symptoms of “negative formal thought disorder”.MethodsAtlas-based cortical thickness values of (...) 66 patients with first-episode psychosis and 36 healthy controls were analyzed with hierarchical clustering algorithms to produce neuroanatomical subtypes. We then examined the generated subtypes and investigated the quantitative differences in MRS-based glutamate levels [in the dorsal anterior cingulate cortex ] as well as in three aspects of language production features: fluency, syntactic complexity, and lexical cohesion.ResultsTwo neuroanatomical subtypes among patients were observed, one with near-normal cortical thickness patterns while the other with widespread cortical thinning. Compared to the subgroup of patients with relatively normal cortical thickness patterns, the subgroup with widespread cortical thinning was older, with higher glutamate concentration in dACC and produced speech with reduced mean length of T-units and lower repeats of content words, despite being equally fluent.ConclusionWe characterized a patient subgroup with thinner cortex in first-episode psychosis. This subgroup, identifiable through macroscopic changes, is also distinguishable in terms of neurochemistry and language behavior. This study supports the hypothesis that glutamate-mediated cortical thinning may contribute to a phenotype that is detectable using the tools of computational linguistics in schizophrenia. (shrink)

Machine generated contents note: -- Notes on Contributors -- Preface; R.Dallos -- Carving Nature at its Joints? DSM and the Medicalization of Everyday Life; M.Rapley, J.Moncrieff&J.Dillon -- Dualisms and the Myth of Mental Illness; P.Thomas&P.Bracken -- Making the World Go Away, and How Psychology and Psychiatry Benefit; M.Boyle -- Cultural Diversity and Racism: An Historical Perspective; S.Fernando -- The Social Context of Paranoia; D.J.Harper -- From 'Bad Character' to BPD: The Medicalization of 'Personality Disorder'; J.Bourne -- Medicalizing Masculinity; S.Timimi -- (...) Can Traumatic Events Traumatise People? Trauma, Madness and 'Psychosis'; L.Johnstone -- Children Who Witness Violence at Home; A.Vetere -- Discourses of Acceptance and Resistance: Speaking Out About Psychiatry; E.Speed -- The Personal Is the Political; J.Dillon -- 'I'm Just, You Know, Joe Bloggs': The Management of Parental Responsibility for First-Episode Psychosis; C.Coulter&M.Rapley -- The Myth of the Antidepressant: An Historical Analysis; J.Moncrieff -- Antidepressants and the Placebo Response; I.Kirsch -- Why Were Doctors so Slow to Recognise Antidepressant Discontinuation Problems?; D.Double -- Toxic Psychology; C.Newnes -- Psychotherapy: Illusion With No Future?; D.Smail -- The Psychologization of Torture; N.Patel -- What Is To Be Done?; J.Moncrieff, J.Dillon&M.Rapley -- Figure: Papers Using Term 'Antidepressant' On Medline 1957-1965 -- Index. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryChua Hong Choon, Adjunct Associate ProfessorThe case for commentary describes a difficult, and yet not uncommon, clinical situation faced by clinicians at the Institute of Mental Health (IMH) in the course of their work. Based on the information provided on the case, the patient is likely to be suffering from the paranoid subtype of schizophrenia, and his illness is characterised by hostile and aggressive behaviour during episodes of (...) relapse.Although aggressive behaviour is known to be associated with young, male patients with paranoid delusions, auditory hallucinations and lack of insight,1 it is still necessary to exclude other causes of aggressive behaviour in this young man. Two causes of aggressive behaviour that are sometimes misattributed to schizophrenia are antisocial personality disorder and substance abuse. However, Mr. T did not have a history of conduct or behavioural problems prior to the onset of his psychotic illness, and he was also not reported to be violent or disruptive during the periods when he was on regular medication. There was also no history of illicit drug use.The initial onset of Mr. T’s illness while he was serving his National Service is a fairly common presentation of the first episode of schizophrenia in Singaporean males. While traits apparent prior to National Service such as his academic difficulties and inability to make friends are associated with the development of schizophrenia,2 the stress of regimented life and military drills might be more closely associated with his initial full-blown psychotic episode with prominent paranoid (and persecutory) delusions.The systematised nature of Mr. T’s delusions and the prominent threatening auditory hallucinations significantly increase his risk of [End Page 217] dangerousness,3 and when his wife became “incorporated” into his delusional beliefs, he began to threaten her physically during episodes of relapse. Despite being only 28 years old, Mr. T has already been hospitalised numerous times for inpatient treatment, due to frequent relapses of his illness. While relapses in schizophrenia may be attributed to various factors, including lack of social support, substance abuse, poor (or partial) response to medication and psychosocial stressors, Mr. T’s multiple relapses were primarily due to the stopping of his medication and his refusal to continue with any form of psychiatric treatment.The key problem to be addressed in this case is therefore the patient’s severe lack of insight which leads to recurrent episodes of treatment non-adherence and subsequent relapses.Mr. T’s wife has come to the clinic to ask for medication to secretly put into his food. Although the patient is apparently in remission of his condition (having just been treated and discharged from hospital), he has again stopped his medication, and she is justifiably afraid that he will become unwell again. Recognising that the patient’s lack of insight is the main (and possibly only) reason for his refusal to take medication, it would be prudent to first consider if all possible actions had been taken to create an awareness and to help the patient gain insight into his illness and the need to take medication. This may yet be possible in the window of opportunity that exists when the patient is in remission of his illness (and is therefore not disturbed by the symptoms of his psychotic disorder).Recent studies have demonstrated that psycho-education is able to reduce self-stigmatisation in individuals with schizophrenia, and also significantly improve insight 4 (as measured by the Birchwood’s Psychosis Insight Scale). A 2011 Cochrane Review 5 also concluded psycho-education does seem to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stays in patients with schizophrenia. In this case, psycho-education could be given to Mr. T even after he has been discharged from hospital; he might not want to continue with medication, but he might consider seeing a trained clinician (case manager, nurse or medical social worker) to make sense of his life experiences. Engaging Mr. T through psycho-education may result in sufficient insight for him to consider resuming medication voluntarily, at least in the short term.Although there is a paucity of studies examining specific psycho-therapies (including cognitive behavioural therapy... (shrink)

Objectives: The mental health legislation of most developed countries includes either a dangerousness criterion or an obligatory dangerousness criterion (ODC). A dangerousness criterion holds that mentally ill people may be given treatment without consent if they are deemed to be a risk to themselves or others. An ODC holds that mentally ill people may be given treatment without consent only if they are deemed to be a risk to themselves or others. This paper argues that the dangerousness criterion is unnecessary, (...) unethical and, in the case of the ODC, potentially harmful to mentally ill people and to the rest of the community. Methods: We examine the history of the dangerousness criterion, and provide reasoned argument and empirical evidence in support of our position. Results: Dangerousness criteria are not required to balance the perceived loss of autonomy arising from mental health legislation. Dangerousness criteria unfairly discriminate against the mentally ill, as they represent an unreasonable barrier to treatment without consent, and they spread the burden of risk that any mentally ill person might become violent across large numbers of mentally ill people who will never become violent. Mental health legislation that includes an ODC is associated with a longer duration of untreated psychosis, and probably contributes to a poorer prognosis and an increase risk of suicide and violence in patients in their first episode of psychosis. Conclusions: Dangerousness criteria should be removed from mental health legislation and be replaced by criteria that focus on a patient’s capacity to refuse treatment. (shrink)

We examined amygdala subregion volumes in patients with a first episode of major depression and in healthy subjects. Covariate-adjusted linear regression was performed to compare the MD and healthy groups, and adjustments for age, gender, and total estimated intracranial volume showed no differences in amygdala subregion volumes between the healthy and MD groups. Within the MD group, we examined the association between amygdala subregion volume and the 17-item Hamilton Rating Scale for Depression score and the HAMD subscale score, (...) and found no association in the left amygdala. In the right amygdala, however, there was an inverse linear association between the HAMD total and the HAMD core and lateral nucleus and anterior-amygdaloid-regions. Furthermore, an inverse linear association was seen between the HAMD psychic and the lateral nucleus, anterior-amygdaloid-regions, transition, and whole amygdala. The findings of this study suggest that the severity of MD and some symptoms of MD are associated with right amygdala volume. There have been few reports on the relationship between MD and amygdala subregional volume, and further research is needed to accumulate more data for further validation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Anthony Storr (bio)Many psychiatrists, including myself, are deeply dissatisfied with current psychiatric taxonomy. Grossly abnormal people like multiple murderers are often deemed sane in law, because they do not happen to exhibit the symptoms of recognized mental illnesses like schizophrenia or manic-depressive psychosis. In contrast, some of those who do exhibit such symptoms, and who therefore risk being labeled psychotic, cannot be considered (...) to be “ill,” and are in fact mentally robust. There is considerable overlap between experiences which psychiatrists call psychotic, and experiences which are generally called spiritual by those who have them.In order to illustrate this overlap, the authors quote three cases of people describing a variety of delusions and hallucinations which would certainly prompt the diagnosis of psychosis—usually some variety of schizophrenia—were it not for the fact that all three claimed that their experiences had been of considerable benefit to them.It is noteworthy that, in each case, the psychotic/spiritual experiences followed a period of stress. The first subject was threatened by legal action; the second had surmounted an episode of depression, but was questioning whether she could continue her career in business; the third was unemployed, in debt, and suspected that he had multiple sclerosis. The first subject developed both grandiose and religious delusions; but the revelations which he claimed were a sign of God’s special grace toward him enabled him to win his law case and set up a charitable institution. The second heard the voice of Jesus summoning her to work for him. She became convinced that she was specially gifted in various parapsychological fields, and became a religious counselor. As the authors point out, “Her experiences, if delusional and hallucinatory, were overwhelmingly positive in their content and fruits.” The third subject also experienced hallucinatory voices which were intensely reassuring, gave him new insight into the nature of reality, and guided his further progress. As a result, he believed that he had such support that “nothing in this world can worry me.” In each case, the psychotic experience proved to be a solution to the subject’s problem, rather than a breakdown ending in admission to a mental hospital. This raises a variety of intellectual problems.The authors suggest that psychotic phenomena may be good or bad, and label the good phenomena “spiritual” and the bad phenomena “pathological.” According to this point of view, psychotic experience need not be considered pathological, especially if consideration is given to the structure of values and beliefs professed by the individual concerned. [End Page 83]I am not happy with this distinction. I entirely agree that psychotic experience may be a solution to a subject’s problems; but whether it is considered spiritual or pathological depends partly upon the nature of the experience, and even more upon the social setting in which it occurs. A grandiose delusion that one is especially selected and addressed by God may cure the depression of someone who has so far considered himself a nonentity if it is accepted by others. In my study of gurus, Feet of Clay (1996), I make the point that a guru seeks disciples because they reinforce his delusions and may, in some instances, keep him out of hospital. Of the three cases described in this paper, the first told “various friends and ministers about them.” The second confided in her priest and was told that her experiences were authentic within their shared Christian belief system. The third did not apparently share his hallucinatory experience with friends; but, when he responded to the invitation to write to the Alister Hardy Research Centre, wrote, “It is fascinating to find I’m not on my own in this. I have naturally queried my own sanity, and generally don’t discuss it....”Medical diagnosis and psychiatric diagnosis are not strictly comparable. If I as a doctor find that X is suffering from diabetes, I can treat X as an isolated entity displaying symptoms and signs of a well-known disease. I cannot do this when X is displaying “psychotic” symptoms; for whether or not those symptoms are regarded as pathological depends upon the social setting in which they... (shrink)

Several functional magnetic resonance imaging studies have demonstrated abnormalities in static intra- and interhemispheric functional connectivity among diverse brain regions in patients with major depressive disorder. However, the dynamic changes in intra- and interhemispheric functional connectivity patterns in patients with MDD remain unclear. Fifty-eight first-episode, drug-naive patients with MDD and 48 age-, sex-, and education level-matched healthy controls underwent resting-state fMRI. Whole-brain functional connectivity, analyzed using the functional connectivity density approach, was decomposed into ipsilateral and contralateral functional connectivity. (...) We computed the intra- and interhemispheric dynamic FCD using a sliding window analysis to capture the dynamic patterns of functional connectivity. The temporal variability in functional connectivity was quantified as the variance of the dFCD over time. In addition, intra- and interhemispheric static FCD patterns were calculated. Associations between the dFCD variance and sFCD in abnormal brain regions and the severity of depressive symptoms were analyzed. Compared to HCs, patients with MDD showed lower interhemispheric dFCD variability in the inferior/middle frontal gyrus and decreased sFCD in the medial prefrontal cortex/anterior cingulate cortex and posterior cingulate cortex/precuneus in both intra- and interhemispheric comparisons. No significant correlations were found between any abnormal dFCD variance or sFCD at the intra- and interhemispheric levels and the severity of depressive symptoms. Our results suggest intra- and interhemispheric functional connectivity alterations in the dorsolateral prefrontal cortex and default mode network regions involved in cognition, execution and emotion. Furthermore, our study emphasizes the essential role of altered interhemispheric communication dynamics in the DLPFC in patients with MDD. These findings contribute to our understanding of the pathophysiology of MDD. (shrink)

Current research suggests that stressful life experiences and situations create a substantive effect in the development of the initial manifestations of psychotic disorders and may influence temporo-limbic epileptic-like activity manifesting as cognitive and affective seizure-like symptoms in non-epileptic conditions. The current study assessed trauma history, hair cortisol levels, epileptic-like manifestations and other psychopathological symptoms in 56 drug naive adult young women experiencing their initial occurrence of psychosis. Hair cortisol levels among patients experiencing their initial episode of psychosis, (...) were significantly correlated with stress symptoms measured by Trauma Symptom Checklist-40, and complex partial seizure-like symptoms measured by the Complex Partial Seizure-Like Symptoms Inventory and LSCL-33. Hair cortisol levels were not found to be significantly correlated with symptoms of anxiety and depression measured by Beck depression Inventory and Zung Anxiety Scale. These findings suggest a significant relationship between epileptic-like symptoms and stress responses demonstrated by patients in their first psychotic episode. These findings may suggest the potential for research to explore usefulness of anticonvulsant treatment in patients who do not respond to usual psychotropic medication. (shrink)

Nietzsche’s cardinal ideas - God is Dead, Übermensch and Eternal Return of the Same - are approached here from the perspective of psychiatric phenomenology rather than that of philosophy. A revised diagnosis of the philosopher’s mental illness as manic-depressive psychosis forms the premise for discussion. Nietzsche conceived the above thoughts in close proximity to his first manic psychotic episode, in the summer of 1881, while staying in Sils-Maria (Swiss Alps). It was the anniversary of his father’s death, (...) and also of the break-up of his friendship with Wagner, the most important relationship in his life. Despite having been acquainted with these ideas from reading philosophy and literature, Nietzsche created them de novo and imbued them with very personal meaning. Surprisingly, he never defined or explained his cardinal thoughts in his published writings, perhaps because rationally he could not. A resultant hermeneutic vacuum provoked an avalanche of interpretations in secondary literature. But could these ideas be delusions? A current definition of delusion is challenged, and an attempt is made at a limited comparison between delusion, scientific/philosophical doctrine and poetic creation. It is also argued that psychosis is a way of re-living trauma, and delusions can therefore be seen as a form of reasoning that helps to make sense of the world in a state of psychotic disintegration. Far from being false beliefs, delusions are a true expression of one’s innermost feelings and pain, albeit indirectly. The relationship between early parental loss and repeated trauma, psychosis and creativity is also explored. Indo-Pacific Journal of Phenomenology , Volume 8, Edition 1 May 2008. (shrink)

Objective: The dopamine hypothesis is one of the most influential theories of the neurobiological background of schizophrenia (SCZ). However, direct evidence for abnormal dopamine-related subcortical-cortical circuitry disconnectivity is still lacking. The aim of this study was therefore to test dopamine-related substantia nigra (SN)-based striato-thalamo-cortical resting-state functional connectivity (FC) in SCZ. Method: Based on our a priori hypothesis, we analyzed a large sample resting-state functional magnetic resonance imaging (fMRI) dataset from first-episode drug-naïve SCZ patients (n = 112) and healthy (...) controls (n = 82) using the SN as the seed region for an investigation of striato-thalamo-cortical FC. This was done in the standard band of slow frequency oscillations and then in its subfrequency bands (Slow4 and Slow5). Results: The analysis showed in SCZ: (1) reciprocal functional hypo-connectivity between SN and striatum, with differential patterns for Slow5 and Slow4; (2) functional hypo-connectivity between striatum and thalamus, as well as functional hyper-connectivity between thalamus and sensorimotor cortical areas, specifically in Slow4; (3) correlation of thalamo-sensorimotor functional hyper-connectivity with psychopathological symptoms. Conclusions: We demonstrate abnormal dopamine-related SN-based striato-thalamo-cortical FC in slow frequency oscillations in first-episode drug-naive SCZ. This suggests that altered dopaminergic function in the SN leads to abnormal neuronal synchronization (as indexed by FC) within subcortical-cortical circuitry, complementing the dopamine hypothesis in SCZ on the regional level of resting-state activity. (shrink)

Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry about everyday life. Prior neuroimaging studies have demonstrated that GAD is associated with disruptions in specific brain regions; however, little is known about the global functional connectivity maps in adolescents with GAD. Here, first-episode, medication-naive, adolescent GAD patients ( N = 36) and healthy controls ( N = 28) (HCs) underwent resting-state functional MRI (R-fMRI) and completed a package of questionnaires to assess clinical symptoms. Functional connectivity strength (...) and seed-based functional connectivity were employed to investigate the functional connectivity architecture. GAD patients showed reduced functional connectivity strength in right supramarginal gyrus (SMG) and right superior parietal gyrus (SPG) compared with HCs. Further seed-based functional connectivity analysis revealed that GAD patients displayed decreased functional connectivity between right SMG and left fusiform gyrus, inferior temporal gyrus, parahippocampal gyrus, bilateral precuneus and cuneus, and between right SPG and bilateral supplementary motor area and middle cingulate gyrus, as well as between the SMG-based network and the SPG-based network. Moreover, the disrupted intra-network connectivity (i.e., the SMG-based network and the SPG-based network) and inter-network connectivity between the SMG-based network and the SPG-based network accounted for 25.5% variance of the State and Trait Anxiety Inventory (STAI) and 39.5% variance of the trait subscale of STAI. Our findings highlight the abnormal functional architecture in the SMG-based network and the SPG-based network in GAD, providing novel insights into the pathological mechanisms of this disorder. (shrink)

When interacting with other people, we assume that they have their reasons for what they do and believe, and experience recognizable feelings and emotions. When people act from weakness of will or are otherwise irrational, what they do can still be comprehensible to us, since we know what it is like to fall for temptation and act against one’s better judgment. Still, when someone’s experiences, feelings and way of thinking is vastly different from our own, understanding them becomes increasingly difficult. (...) Delusions and psychosis are often seen as marking the end of intelligibility. In this paper, I argue first for the importance of seeing other people as intelligible as long as this is at all possible. Second, I argue, based on both previous literature and my own lived experience, that more psychotic phenomena than previously thought can be rendered at least somewhat intelligible. Besides bizarre experiences like illusions, hallucinations and intense feelings of significance, I also explain what it is like to lose one’s bedrock, and how this loss impacts which beliefs one has reason to reject. Finally, I give an inside account of some disturbances of reason, and show that there are important similarities between certain psychotic reasoning problems and common non-pathological phenomena. (shrink)

The term 'episodic memory' refers to our memory for unique, personal experiences, that we can date at some point in our past - our first day at school, the day we got married. It has again become a topic of great importance and interest to psychologists, neuroscientists, and philosophers. How are such memories stored in the brain, why do certain memories disappear (especially those from early in childhood), what causes false memories (memories of events we erroneously believe have really (...) taken place)? Since Endel Tulving's classic book 'Episodic memory' (OUP, 1983) very few books have been published on this topic. In recent years however, many of the assumptions made about episodic memory have had to be reconsidered as a result of new techniques, which have allowed us a far deeper understanding of episodic memory. In 'Episodic memory: new directions in research' three of the worlds leading researchers in the topic of memory have brought together a stellar team of contributors from the fields of cognitive psychology, neuropsychology, and neuroscience, to present an account of what we now know about about this fundamentally important topic. The list of contributors includes, amongst others, Daniel Schacter, Richard Morris, Fareneh Vargha-Khadem, and Endel Tulving. The work presented within this book will have a profound effect on the direction that future research in this topic will take. (shrink)

This paper aims to outline, and argue for, an approach to episodic memory broadly in the spirit of knowledge-first epistemology. I discuss a group of influential views of epsiodic memory that I characterize as ‘two-factor accounts’, which have both proved popular historically and have also seen a resurgence in recent work on the philosophy of memory. What is common to them is that they try to give an account of the nature of episodic memory in which the concept of (...) knowledge plays no explanatory role. I highlight some parallels between these two-factor accounts and attempts to give a reductive definition of knowledge itself. I then discuss some problems two-factor accounts of episodic memory face in explaining the distinctive sense in which episodic recollection involves remembering personally experienced past events, before sketching an alternative approach to episodic memory, which takes as basic the idea that episodic memory involves the retention of knowledge. I argue that we can give an exhaustive constitutive account of what episodic memory is, and how it differs from other types of mental states, by considering what particular type of knowledge is retained in episodic memory, and what exactly having that knowledge consists in. (shrink)

In the literature on episodic memory, one claim that has been made by a number of psychologists, and that is also at least implicit in some of the accounts given by philosophers, is that being able to recollect particular past events in the distinctive way afforded by episodic memory requires the possession of aspects of a theory of mind, such as a grasp of the relationship between one’s present recollective experience and one’s own past perceptual experience of the remembered event. (...) In this paper, I re-examine what connection, if any, there is between episodic memory and theory of mind. I first criticize the dominant way in which this connection has been construed theoretically, which – perhaps influenced by other aspects of theory of mind research – has sought to link the possession of episodic memory primarily with a grasp of the idea of representation, or the idea of informational access. I then argue for a novel, alternative, way of connecting episodic memory and theory of mind, which focuses on the category of an experience, and on the role a grasp of that category might be seen to play in episodic recollection. In doing so, I also draw attention to a dimension of our understanding of the mental which remains as yet underexplored in the literature on theory of mind. (shrink)

Although episodic memory is a widely studied form of memory both in philosophy and psychology, it still raises many burning questions regarding its definition and even its acceptance. Over the last two decades, cross-disciplinary discussions between these two fields have increased as they tackle shared concerns, such as the phenomenology of recollection, and therefore allow for fruitful interaction. This editorial introduction aims to provide a comprehensive and up-to-date presentation of the main existing conceptions and issues on the topic. After delineating (...) Tulving’s chief theoretical import and multifaceted legacy, it goes on to chart the different attempts to capture the episodicity feature of memory according to three categories: a first approach aims to show the cognitive abilities required for a subject to episodically remember; the second defines episodicity as a stage-specific feature; the last explains episodicity in terms of the epistemological properties of episodic memory. This state of the art thereby sets the stage for the contributions of the present volume, which will be introduced in conclusion. (shrink)

The study of the neuroscience and genomics of mental illness are increasingly intertwined. This is mostly due to the translation of medical technologies into psychiatry and to technological convergence. This article focuses on psychosis. I argue that the convergence of neuroscience and genomics in the context of psychosis is morally problematic, and that ethics scholarship should go beyond the identification of a number of ethical, legal, and social issues. My argument is composed of two strands. First, I (...) argue that we should respond to technological convergence by developing an integrated, patient-centred approach focused on the assessment of individual vulnerabilities. Responding to technological convergence requires that we integrate insights from several areas of ethics, translate bioethical principles into the mental health context, and proactively try to anticipate future ethical concerns. Second, I argue that a nuanced understanding of the concept of vulnerability might help us to accomplish this task. I borrow Florencia Luna’s notion of ‘layers of vulnerability’ to show how potential harms or wrongs to individuals who experience psychosis can be conceptualised as stemming from different sources, or layers, of vulnerability. I argue that a layered notion of vulnerability might serve as a common ground to achieve the ethical integration needed to ensure that biomedical innovation can truly benefit, and not harm, individuals who suffer from psychosis. (shrink)

Recent work on the early development of episodic memory in my laboratory has been fuelled by the following assumption: if episodic memory is re-experiential memory then Kant’s analysis of the spatiotemporal nature of experience should constrain and positively influence theories of episodic memory development. The idea is that re-experiential memory will “inherit” these spatiotemporal features. On the basis of this assumption, Russell and Hanna (Mind and Language 27(1):29–54, 2012) proposed that (a) the spatial element of re-experience is egocentric and (b) (...) that the temporal element of re-experiencing involves order/simultaneity. The first of these assumptions is immediately problematic for two reasons. In the first place, if we assume that early episodic recall mediated by processing in the hippocampus, then (a) is clearly in tension with the fact that spatial coding in the hippocampus is allocentric/environment-centred. Second, two of our own recent experiments (described here) show that when only egocentric cues are available in a What/When/Where episodic memory task it is not possible to distinguish young children’s performance from semantic memory. I argue that this tension should be resolved by recognising that the egocentric coding of the original experience as being of an objective scene relies upon allocentric representations and these are preserved in re-experiential memory, allowing a recollection of the objective nature of the scene on which one takes a subjective view. (shrink)

Direct realists about episodic memory claim that a rememberer has direct contact with a past event. However, how is it possible to be acquainted with an event that ceased to exist? That is the so-called cotemporality problem. The standard solution, proposed by Sven Bernecker, is to distinguish between the occurrence of an event and the existence of an event: an event ceases to occur without ceasing to exist. That is the eternalist solution for the cotemporality problem. Nevertheless, some philosophers of (...) memory claim that the adoption of an eternalist metaphysics of time would be too high a metaphysical price to pay to hold direct realist intuitions about memory. Although I agree with these critics, I will make two claims. First, that this kind of common sense argument is far from decisive. Second, that Bernecker’s proposal remains the best solution to the cotemporality problem. (shrink)

In a recent paper, Cheng and Werning (2016) argue that the class of episodic memories constitutes a natural kind. Endorsing the homeostatic property cluster view of natural kinds, they suggest that episodic memories can be characterized by a cluster of properties unified by an underlying neural mechanism for coding sequences of events. Here, I argue that Cheng & Werning’s proposal faces some significant, and potentially insurmountable, difficulties. Two are described as most prominent. First, the proposal fails to satisfy an (...) important normative constraint on natural kind theorizing, not providing the requisite theoretical resources for arbitration between rival taxonomies of memory. Second, the proposal is in a direct tension with a foundational principle of the HPC view: the rejection of essentialism. This has far-reaching consequences, threatening to undermine the coherence of the proposal. (shrink)

We describe a novel computational theory of how individuals segment perceptual information into representations of events. The theory is inspired by recent findings in the cognitive science and cognitive neuroscience of event segmentation. In line with recent theories, it holds that online event segmentation is automatic, and that event segmentation yields mental simulations of events. But it posits two novel principles as well: first, discrete episodic markers track perceptual and conceptual changes, and can be retrieved to construct event models. (...) Second, the process of retrieving and reconstructing those episodic markers is constrained and prioritized. We describe a computational implementation of the theory, as well as a robotic extension of the theory that demonstrates the processes of online event segmentation and event model construction. The theory is the first unified computational account of event segmentation and temporal inference. We conclude by demonstrating now neuroimaging data can constrain and inspire the construction of process-level theories of human reasoning. (shrink)

Episodic memory often is conceptualized as a uniquely human system of long-term memory that makes available knowledge accompanied by the temporal and spatial context in which that knowledge was acquired. Retrieval from episodic memory entails a form of first–person subjectivity called autonoetic consciousness that provides a sense that a recollection was something that took place in the experiencer’s personal past. In this paper I expand on this definition of episodic memory. Specifically, I suggest that (a) the core features assumed (...) unique to episodic memory are shared by semantic memory, (b) episodic memory cannot be fully understood unless one appreciates that episodic recollection requires the coordinated function of a number of distinct, yet interacting, “enabling” systems. Although these systems – ownership, self, subjective temporality, and agency – are not traditionally viewed as memorial in nature, each is necessary for episodic recollection and jointly they may be sufficient, and (c) the type of subjective awareness provided by episodic recollection (autonoetic) is relational rather than intrinsic – i.e., it can be lost in certain patient populations, thus rendering episodic memory content indistinguishable from the content of semantic long-term memory. (shrink)

This study explored spatial navigation alongside several other cognitive abilities that are thought to share common underlying neurocognitive mechanisms (e.g., the capacity for self-projection, scene construction, or mental simulation), and which we hypothesised may be impaired in autism spectrum disorder (ASD). Twenty intellectually high-functioning children with ASD (with a mean age of ~8 years) were compared to 20 sex, age, IQ, and language ability matched typically developing children on a series of tasks to assess spatial navigation, episodic memory, episodic future (...) thinking (also known as episodic foresight or prospection), theory of mind, relational memory, and central coherence. This is the first study to explore these abilities concurrently within the same sample. Spatial navigation was assessed using the “memory island” task, which involves finding objects within a realistic, computer simulated, three-dimensional environment. Episodic memory and episodic future thinking were assessed using a past and future event description task. Theory of mind was assessed using the “animations” task, in which children were asked to describe the interactions between two animated triangles. Relational memory was assessed using a recognition task involving memory for items (line drawings), patterned backgrounds, or combinations of items and backgrounds. Central coherence was assessed by exploring differences in performance across segmented and unsegmented versions of block design. Children with ASD were found to show impairments in spatial navigation, episodic memory, episodic future thinking, and central coherence, but not theory of mind or relational memory. Among children with ASD, spatial navigation was found to be significantly negatively related to number of repetitive behaviours. In other words, children who showed more repetitive behaviours showed poorer spatial navigation. The theoretical and practical implications of the results are discussed. (shrink)

Words become associated following repeated co-occurrence episodes. This process might be further determined by the semantic characteristics of the words. The present study focused on how semantic and episodic factors interact in incidental formation of word associations. First, we found that human participants associate semantically related words more easily than unrelated words; this advantage increased linearly with repeated co-occurrence. Second, we developed a computational model, SEMANT, suggesting a possible mechanism for this semantic-episodic interaction. In SEMANT, episodic associations are implemented (...) through lateral connections between nodes in a pre-existent self-organized map of word semantics. These connections are strengthened at each instance of concomitant activation, proportionally with the amount of the overlapping activity waves of activated nodes. In computer simulations SEMANT replicated the dynamics of associative learning in humans and led to testable predictions concerning normal associative learning as well as impaired learning in a diffuse semantic system like that characteristic of schizophrenia. (shrink)