Abstract
Disturbed self-experience has been reported as a characteristic feature of schizophrenia since the first formulation of its diagnostic concept; however, only in the last 2 decades an ...explicit notion of basic Self-disturbance, or Self-Disorders (SD), has emerged as target for a systematic research program. We conducted systematic searches in bibliographical databases to identify cross-sectional studies that explored SD across different diagnostic groups and explored diagnostic ascription within or outside schizophrenia spectrum disorders (SSD) as main outcome. Data were pooled using fixed- and random-effects meta-analysis models. Heterogeneity was assessed using stratified meta-analyses and meta-regression. Of 218 identified studies, 32 were included in the systematic review and 27 in the meta-analysis. Patients diagnosed with SSD scored higher on measures of SD than healthy controls (HC) (Hedges’ g = 1.8; 95% CI = 1.5 to 2.0), individuals diagnosed with other mental illness (OMI) (1.9; 1.6 to 2.2), bipolar or affective disorders (1.8; 1.4 to 2.2), and clinical high risk for psychosis (CHR) (1.6; 0.9 to 2.4). Patients with schizotypy or schizotypal personality disorder scored higher on measures of SD than OMI (1.5; 1.3 to 1.8) and HC (1.4; 1.1 to 1.7). Patients with first-episode psychosis scored higher on measures of SD than HC (2.5; 2.1 to 2.9) and OMI (1.6; 1.2 to 2.1). Subjects at CHR scored higher on measures of SD than HC (2.0; 1.7 to 2.2) and OMI (19; 1.6 to 2.2). Overall, heterogeneity ranged from negligible to high, especially in comparisons of the target group with OMI, probably as a reflection of the immanent diagnostic heterogeneity of this group. The findings suggest that SD selectively aggregate within schizophrenia spectrum disorders as compared to other mental disorders and that they could be a central phenotypic marker of vulnerability to schizophrenia across the different shades of severity of its spectrum of disorders.
The paper reviews of all of the current evidence on Theory of Mind (ToM) abilities in patients with neurodegenerative diseases. ToM refers to the abilities to attribute mental states to others. Two ...neural systems are involved in processing other people's beliefs and intentions (cognitive component) and others' emotions and feelings (affective component). We hypothesize that patients with different neurodegenerative diseases may present different patterns of ToM deficits on the basis of how different neuropathological processes affect the neural bases of ToM components during the progression of a disease. The studies we reviewed provided evidence of a deficit of the cognitive ToM component in cortical (Alzheimer's disease and frontotemporal dementia) and frontal-subcortical (amyotrophic lateral sclerosis and basal ganglia disorders) neurodegenerative diseases. As regards the affective ToM component, it resulted markedly impaired in frontotemporal dementia; it also resulted that performances in tasks assessing this process are heterogeneous in Parkinson's disease and amyotrophic lateral sclerosis. The findings presented support the opportunity to introduce validated ToM tasks in the neuropsychological assessment of neurodegenerative diseases.
Meta-analytic evidence indicates that baseline exposure to antipsychotics (AP) in individuals at clinical high-risk for psychosis (CHR-P) is associated with an even higher risk of transition to ...psychosis. However, the temporal dynamics of such prognostic effect have not been clarified yet. This study was therefore designed to address this knowledge gap. We performed a systematic review and meta-analysis of all longitudinal studies published up to 31 December 2021 on CHR-P individuals identified according to a validated diagnostic procedure and reporting numeric data of transition to psychosis according to baseline antipsychotic exposure. 28 studies covering a total of 2405 CHR-P were included. 554 (23.0%) were exposed to AP at baseline, whereas 1851 (77.0%) were not. At follow-up (12 to 72 months), 182 individuals among AP-exposed (32.9%; 95% CI: 29.4% to 37.8%) and 382 among AP-naive CHR-P (20.6%; 18.8% to 22.8%) developed psychosis. Transition rates increased over time, with the best-fit for an ascending curve peaking at 24 months and reaching then a plateau, with a further increase at 48 months. Baseline AP-exposed CHR-P had higher transition risk at 12 months and then again at 36 and 48 months, with an overall higher risk of transition (fixed-effect model: risk ratio = 1.56 95% CI: 1.32-1.85; z = 5.32; p < 0.0001; Random-effect model: risk ratio = 1.56 95% CI: 1.07-2.26; z = 2.54; p = 0.0196). In conclusion, the temporal dynamics of transition to psychosis differ in AP-exposed vs. AP-naive CHR-P. Baseline AP exposure in CHR-P is associated with a persistently higher risk of transition at follow up, supporting the rationale for more stringent clinical monitoring in AP-exposed CHR-P. The insufficiency of more granular information in available primary literature (e.g., temporal and quantitative details of AP exposure as well as psychopathological dimensions in CHR-P) did not allow the testing of causal hypotheses on this negative prognostic association.
Offspring of individuals with serious mental illness (SMI) constitute a special population with a higher risk of developing psychiatric disorders, which is also highly prevalent among referrals to ...child and adolescent mental health services (CAMHS). They often exhibit more or less subclinical conditions of vulnerability, fueled by mutually potentiating combinations of risk factors, such as presumed genetic risk, poor or inadequate affective and cognitive parenting, and low socio-economic status. Despite this evidence, neither specific preventive programs for offspring of parents with SMI are usually implemented in CAMHS, nor dedicated supportive programs for parenting are generally available in adult mental health services (AMHS). Needless to say, while both service systems tend to focus on individual recovery and clinical management (rather than on the whole family system), these blind spots add up to frequent gaps in communication and continuity of care between CAMHS and AMHS. This is particularly problematic in an age-range in which an offspring's vulnerabilities encounter the highest epidemiological peak of incident risk of SMI. This paper offers a clinical-conceptual perspective aimed to disentangle the complex intertwine of intergenerational risk factors that contribute to the risk of developing SMI in offspring, taking schizophrenia spectrum disorders as a paradigmatic example.
Abstract Patients with Parkinson's disease (PD) typically present with motor symptoms, but several non-motor symptoms, such as cognitive impairment, autonomic dysfunction and neuropsychiatric ...symptoms, are usually also present, when adequately looked for. The objective of this paper is to provide an up-to-date, comprehensive review of the influence of affective disorders, mainly depression and apathy, on cognitive functioning of PD patients. Reviewed empirical findings suggest that, although depression and apathy have differential neurobiological bases in PD, both are associated to an increased risk of cognitive impairment, especially of executive functions, in this clinical population. The potential influence of other affective disorders, as anxiety and alexithymia, on cognitive functioning of PD patients is actually almost unknown and needs further empirical investigation. The clinical implication of these findings is that the best assessment and management of PD patients should include both neuropsychological and neuropsychiatric evaluations and the presence of non-motor symptoms as cognitive disturbances and affective features should be investigated with patients and caregivers.
The brain is increasingly viewed in contemporary neuroscience as a predictive machine; its products, such as movements and decisions, are indeed accompanied by predictions of outcomes at distinct ...levels of awareness. In this conceptual review, we focus on corollary discharge, a basic neurophysiological mechanism that is allegedly involved in sensory prediction and contributes to the distinction between self-generated and externally generated actions. Failures in corollary discharge have been hypothesized as potentially relevant for the progressive development of positive psychotic symptoms such as passivity delusions and auditory verbal hallucinations. We articulate this framework adopting three confocal lenses, namely, the neurodevelopmental, phenomenological, and clinical perspectives. Converging evidence from these research domains indicates a possible developmental cascade leading to increased lifetime risk of psychosis. That is, early childhood alterations of corollary discharge mechanisms, endophenotypically expressed in motor impairment, may concur with a progressive fading of the feeling of self-agency on one’s own experiences. Combined with other age-dependent situational challenges occurring along development, this may progressively hamper the ontogenesis of the embodied self, thereby facilitating the emergence of anomalous subjective experiences such as self-disorders (a longitudinal index of schizophrenia spectrum vulnerability) and broadly conceived clinical high-risk states. Overall, this condition increases the risk of developing passivity symptoms, phenotypically expressed in a severity gradient ranging from intrusive thoughts to passivity delusions and auditory verbal hallucinations. Empirical and clinical implications of this framework, as well as future scenarios, are discussed.
► OMPFC is involved in reinforcement learning and affective Theory of Mind. ► Reinforcement learning and affective Theory of Mind are preserved in early Parkinson’s disease. ► OMPFC functions are ...preserved in the early clinical stages of Parkinson’s disease. ► Further studies are needed on OMPFC functions in advanced stages of Parkinson’s disease.
A recent paper (Zald & Andreotti, 2010) reviewed neuropsychological tasks that assess the function of the orbital and ventromedial portions of the prefrontal cortex (OMPFC). Neuropathological studies have shown that the function of the OMPFC should be preserved in the early stages of Parkinson’s disease (PD) but becomes affected in the advanced stages of PD. This pattern has also been suggested by studies that have shown that dopaminergic drugs impair the performance of early PD patients in OMPFC tasks that involve reinforcement learning but enhance the performance of advanced PD patients. Based on these empirical findings, we reviewed the neuropsychological evidence of OMPFC functions in PD patients to test two hypotheses regarding the following: (1) OMPFC functions at different stages of PD; (2) different effects of dopaminergic drugs on OMPFC functions based on PD stage and task demand. We focused our review only on the neuropsychological tasks that were specific and sensitive to the functions of the OMPFC and that were adopted at different stages of PD, such as reversal learning tasks, the Iowa Gambling Task and the affective Theory of Mind task. We found robust empirical evidence that in early PD, OMPFC functions are preserved and dopaminergic drugs result in a detrimental effect when the task involves reinforcement learning. Further studies are needed to verify the status of OMPFC functions in non-demented, advanced PD and to describe the longitudinal course of OMPFC functions in this clinical population.
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