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Schizophrenia: Neuronal Correlates of Self-Disturbance and Neurocognitive Impairments as Potiential Predictors for Psychosis Risk


Metzler, S. Schizophrenia: Neuronal Correlates of Self-Disturbance and Neurocognitive Impairments as Potiential Predictors for Psychosis Risk. 2014, University of Zurich, Faculty of Arts.

Abstract

Schizophrenia is a severe mental disorder characterized by an often devastating course leading to disability and to substantial costs for the mental health system. In recent years, an increased interest in the early phase of schizophrenia and other psychotic disorders has emerged. This is due to several reasons. Foremost, early signs of the illness are rather non-specific and develop in a subtle manner and as a result, there is often a substantial delay until a diagnosis is specified and therapies will be initiated. Then, already in the prodrome, a combination of agonizing symptoms, associated neurocognitive deficits, educational crisis and a loss of social embedment may lead to a downward spiral. The only young individuals may lose the chance for rehabilitation after recovery from the illness. A long duration of untreated prodrome and psychosis has further been linked to more negative outcomes. Subsequently, prospective studies demonstrated that in many cases early detection of the disorder is possible. Today it is accepted, that early intervention and prevention strategies may enhance the course and the prognosis of the disorder. However, the identification of a prodrome and of “true positive” individuals at risk for psychosis has proven to be challenging. Besides, the identification and treatment of “false positive” may produce unnecessarily self-perceived stigma and discrimination. Research related to early detection therefore tries to optimize the prediction accuracy in risk assessments by including different measurements of putative biological or trait markers of underlying vulnerability to psychosis.
Ego-pathology symptoms seen in schizophrenia are often denotated as Schneiderian first-rank symptoms and are thought to contain a high positive predictive value for the disorder. Theoretical and empirical work indicates that the self-disturbance in schizophrenia occurs on a basic pre-reflective level, while affecting additionally higher cognitive processes. Neurocognitive research has shown that on the one hand, source or self-monitoring deficits may particularly contribute to disturbances in the feeling of ownership. On the other hand, aberrant salience and associated disturbances of memory and attention processes may contribute to hyper-reflexivity and to a failure in intuitive social understanding. Only recently it has been suggested that a subtle self-disturbance is already present in the prodrome and may serve as marker, helping to optimize the prediction of who is truly at-risk. The neurodevelopmental model of schizophrenia assumes a genetic-biological determined vulnerability that is associated with neurocognitive impairments that are detectable before the initial onset of the illness. Studies on at-risk psychosis individuals matched with healthy controls found small to medium impairments across most neurocognitive domains in at-risk subjects that are at intermediate level between that of healthy individuals and those diagnosed with schizophrenia. At-risk individuals who later converted to psychosis exhibited more severe neurocognitive deficits at baseline than non-converter in almost all domains, but especially in the domains of speed, verbal fluency and memory. However, due to methodological issues the findings were often inconsistent. Furthermore, only few studies have addressed the appearance of deficits in an early (High-Risk) and late at-risk (Ultra-High-Risk) state so far.

Abstract

Schizophrenia is a severe mental disorder characterized by an often devastating course leading to disability and to substantial costs for the mental health system. In recent years, an increased interest in the early phase of schizophrenia and other psychotic disorders has emerged. This is due to several reasons. Foremost, early signs of the illness are rather non-specific and develop in a subtle manner and as a result, there is often a substantial delay until a diagnosis is specified and therapies will be initiated. Then, already in the prodrome, a combination of agonizing symptoms, associated neurocognitive deficits, educational crisis and a loss of social embedment may lead to a downward spiral. The only young individuals may lose the chance for rehabilitation after recovery from the illness. A long duration of untreated prodrome and psychosis has further been linked to more negative outcomes. Subsequently, prospective studies demonstrated that in many cases early detection of the disorder is possible. Today it is accepted, that early intervention and prevention strategies may enhance the course and the prognosis of the disorder. However, the identification of a prodrome and of “true positive” individuals at risk for psychosis has proven to be challenging. Besides, the identification and treatment of “false positive” may produce unnecessarily self-perceived stigma and discrimination. Research related to early detection therefore tries to optimize the prediction accuracy in risk assessments by including different measurements of putative biological or trait markers of underlying vulnerability to psychosis.
Ego-pathology symptoms seen in schizophrenia are often denotated as Schneiderian first-rank symptoms and are thought to contain a high positive predictive value for the disorder. Theoretical and empirical work indicates that the self-disturbance in schizophrenia occurs on a basic pre-reflective level, while affecting additionally higher cognitive processes. Neurocognitive research has shown that on the one hand, source or self-monitoring deficits may particularly contribute to disturbances in the feeling of ownership. On the other hand, aberrant salience and associated disturbances of memory and attention processes may contribute to hyper-reflexivity and to a failure in intuitive social understanding. Only recently it has been suggested that a subtle self-disturbance is already present in the prodrome and may serve as marker, helping to optimize the prediction of who is truly at-risk. The neurodevelopmental model of schizophrenia assumes a genetic-biological determined vulnerability that is associated with neurocognitive impairments that are detectable before the initial onset of the illness. Studies on at-risk psychosis individuals matched with healthy controls found small to medium impairments across most neurocognitive domains in at-risk subjects that are at intermediate level between that of healthy individuals and those diagnosed with schizophrenia. At-risk individuals who later converted to psychosis exhibited more severe neurocognitive deficits at baseline than non-converter in almost all domains, but especially in the domains of speed, verbal fluency and memory. However, due to methodological issues the findings were often inconsistent. Furthermore, only few studies have addressed the appearance of deficits in an early (High-Risk) and late at-risk (Ultra-High-Risk) state so far.

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Additional indexing

Item Type:Dissertation (monographical)
Referees:Jäncke Lutz, Rössler W
Communities & Collections:06 Faculty of Arts > Institute of Psychology
Dewey Decimal Classification:150 Psychology
Uncontrolled Keywords:DoktoratPSYCH Erstautor
Language:English
Date:2014
Deposited On:10 Mar 2014 10:18
Last Modified:11 Apr 2019 03:10
OA Status:Green

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