Abstract
According to current findings, deficits of self-awareness and conscious experience play an important role in psychobiology of schizophrenia, and therefore, schizophrenia is recently understood as a disorder characterized by distortions of the acts of awareness, self-consciousness, or self-monitoring. These findings are consistent with other studies suggesting that thought disorder and disorganization in schizophrenia are caused by deficits in brain integrative functions reflected by disturbed gamma synchrony reported in patients with schizophrenia, which remind original Bleuler’s concept of splitting. Main implications of these findings suggest that mental disorganization in schizophrenia may reflect brain disintegration which might provide new perspectives for understanding relationships between clinical symptoms and pathophysiological mechanisms of schizophrenia.
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References
Baars, B. J. (2002). The conscious access hypothesis: origins and recent evidence. Trends in Cognitive Sciences, 6(1), 47–52.
Bedford, N. J., Surguladze, S., Giampietro, V., Brammer, M. J., & David, A. S. (2012). Self-evaluation in schizophrenia: an fMRI study with implications for the understanding of insight. BMC Psychiatry, 12, 106. https://doi.org/10.1186/1471-244X-12-106.
Bell, M. D., Lysaker, P. H., Beam-Goulet, J. L., Milstein, R. M., & Lindenmayer, J. P. (1994). Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale. Psychiatry Research, 52(3), 295–303.
Bhattacharya, J., & Petsche, H. (2002). Shadows of artistry: cortical synchrony during perception and imagery of visual art. Brain Research. Cognitive Brain Research, 13(2), 179–186.
Bleuler, E. (1950). Dementia Praecox or the Group of Schizophrenias. (Trans. J. Zinkin) Zinkin J, editor. (p. 8). New York, NY: International Universities Press.
Bleuler, E., & Brill, A. A. (1924). Textbook of Psychiatry. (p. 138). New York: Macmillan.
Bowden, E. M., Jung-Beeman, M., Fleck, J., & Kounios, J. (2005). New approaches to demystifying insight. Trends in Cognitive Sciences, 9(7), 322–328. https://doi.org/10.1016/j.tics.2005.05.012.
Bucci, P., Mucci, A., Merlotti, E., Volpe, U., & Galderisi, S. (2007). Induced gamma activity and event-related coherence in schizophrenia. Clinical EEG and Neuroscience, 38(2), 96–104. https://doi.org/10.1177/155005940703800212.
Buckner, R. L., Andrews-Hanna, J. R., & Schacter, D. L. (2008). The brain’s default network: anatomy, function, and relevance to disease. Annals of the New York Academy of Sciences, 1124, 1–38. https://doi.org/10.1196/annals.1440.011.
Burns, J., Job, D., Bastin, M. E., Whalley, H., Macgillivray, T., Johnstone, E. C., & Lawrie, S. M. (2003). Structural disconnectivity in schizophrenia: a diffusion tensor magnetic resonance imaging study. The British Journal of Psychiatry, 182, 439–443.
Chen, C. M., Stanford, A. D., Mao, X., Abi-Dargham, A., Shungu, D. C., Lisanby, S. H., et al. (2014). GABA level, gamma oscillation, and working memory performance in schizophrenia. Neuroimage Clin, 4, 531–539. https://doi.org/10.1016/j.nicl.2014.03.007.
Chen, E. Y. (1998). Insight and symptoms of psychosis: a prospective inpatient study. Schizophrenia Research, 29(1), 34.
Cuesta, M. J., Peralta, V., & Zarzuela, A. (1998). Psychopathological dimensions and lack of insight in schizophrenia. Psychological Reports, 83(3 Pt 1), 895–898. https://doi.org/10.2466/pr0.1998.83.3.895.
Cuesta, M. J., Peralta, V., & Zarzuela, A. (2000). Reappraising insight in psychosis. Multi-scale longitudinal study. The British Journal of Psychiatry, 177, 233–240.
Dan’ko, S. G., Shemiakina, N. V., Nagornova Zh, V., & Starchenko, M. G. (2009). Comparison of the effects of the subjective complexity and creativity of verbal activity on the EEG power spectral parameters. Fiziologiia Cheloveka, 35(3), 132–134.
Dauvermann, M. R., Moorhead, T. W., Watson, A. R., Duff, B., Romaniuk, L., Hall, J., ... & Whitcher, B. (2017). Verbal working memory and functional large-scale networks in schizophrenia. Psychiatry Research: Neuroimaging, 270, 86–96.
Dietrich, A., & Kanso, R. (2010). A review of EEG, ERP, and neuroimaging studies of creativity and insight. Psychological Bulletin, 136(5), 822–848. https://doi.org/10.1037/a0019749.
Edelman, G. M., Gally, J. A., & Baars, B. J. (2011). Biology of consciousness. Frontiers in Psychology, 2, 4. https://doi.org/10.3389/fpsyg.2011.00004.
Frith, C. D. (1987). The positive and negative symptoms of schizophrenia reflect impairments in the perception and initiation of action. Psychological Medicine, 17(3), 631–648.
Gallagher, I. I. (2000). Philosophical conceptions of the self: implications for cognitive science. Trends in Cognitive Sciences, 4(1), 14–21.
Gaweda, L., Woodward, T. S., Moritz, S., & Kokoszka, A. (2013). Impaired action self-monitoring in schizophrenia patients with auditory hallucinations. Schizophrenia Research, 144(1–3), 72–79. https://doi.org/10.1016/j.schres.2012.12.003.
Gharabawi, G. M., Lasser, R. A., Bossie, C. A., Zhu, Y., & Amador, X. (2006). Insight and its relationship to clinical outcomes in patients with schizophrenia or schizoaffective disorder receiving long-acting risperidone. International Clinical Psychopharmacology, 21(4), 233–240.
Green, M. F., Kern, R. S., & Heaton, R. K. (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research, 72(1), 41–51. https://doi.org/10.1016/j.schres.2004.09.009.
Grutzner, C., Wibral, M., Sun, L., Rivolta, D., Singer, W., Maurer, K., & Uhlhaas, P. J. (2013). Deficits in high- (>60 Hz) gamma-band oscillations during visual processing in schizophrenia. Frontiers in Human Neuroscience, 7, 88. https://doi.org/10.3389/fnhum.2013.00088.
Gusnard, D. A., Raichle, M. E., & Raichle, M. E. (2001). Searching for a baseline: functional imaging and the resting human brain. Nature Reviews. Neuroscience, 2(10), 685–694. https://doi.org/10.1038/35094500.
Hardy-Bayle, M. C., Sarfati, Y., & Passerieux, C. (2003). The cognitive basis of disorganization symptomatology in schizophrenia and its clinical correlates: toward a pathogenetic approach to disorganization. Schizophrenia Bulletin, 29(3), 459–471.
Jones, M. W. (2010). Errant ensembles: dysfunctional neuronal network dynamics in schizophrenia. Biochemical Society Transactions, 38(2), 516–521. https://doi.org/10.1042/BST0380516.
Jung-Beeman, M., Bowden, E. M., Haberman, J., Frymiare, J. L., Arambel-Liu, S., Greenblatt, R., et al. (2004). Neural activity when people solve verbal problems with insight. PLoS Biology, 2(4), E97. https://doi.org/10.1371/journal.pbio.0020097.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276.
Kircher, T. T., & Leube, D. T. (2003). Self-consciousness, self-agency, and schizophrenia. Consciousness and Cognition, 12(4), 656–669.
Kjaer, T. W., Nowak, M., & Lou, H. C. (2002). Reflective self-awareness and conscious states: PET evidence for a common midline parietofrontal core. NeuroImage, 17(2), 1080–1086.
Kounios, J., Fleck, J. I., Green, D. L., Payne, L., Stevenson, J. L., Bowden, E. M., & Jung-Beeman, M. (2008). The origins of insight in resting-state brain activity. Neuropsychologia, 46(1), 281–291. https://doi.org/10.1016/j.neuropsychologia.2007.07.013.
Kwon, J. S., O'Donnell, B. F., Wallenstein, G. V., Greene, R. W., Hirayasu, Y., Nestor, P. G., et al. (1999). Gamma frequency-range abnormalities to auditory stimulation in schizophrenia. Archives of General Psychiatry, 56(11), 1001–1005.
Lee, K. H., Williams, L. M., Haig, A., & Gordon, E. (2003). “Gamma (40 Hz) phase synchronicity” and symptom dimensions in schizophrenia. Cognitive Neuropsychiatry, 8(1), 57–71. https://doi.org/10.1080/713752240.
Liddle, P. F. (1987). The symptoms of chronic schizophrenia. A re-examination of the positive-negative dichotomy. The British Journal of Psychiatry, 151, 145–151.
Liemburg, E. J., van der Meer, L., Swart, M., Curcic-Blake, B., Bruggeman, R., Knegtering, H., & Aleman, A. (2012). Reduced connectivity in the self-processing network of schizophrenia patients with poor insight. PLoS One, 7(8), e42707. https://doi.org/10.1371/journal.pone.0042707.
Light, G. A., Hsu, J. L., Hsieh, M. H., Meyer-Gomes, K., Sprock, J., Swerdlow, N. R., & Braff, D. L. (2006). Gamma band oscillations reveal neural network cortical coherence dysfunction in schizophrenia patients. Biological Psychiatry, 60(11), 1231–1240. https://doi.org/10.1016/j.biopsych.2006.03.055.
Lincoln, T. M., Lullmann, E., & Rief, W. (2007). Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophrenia Bulletin, 33(6), 1324–1342. https://doi.org/10.1093/schbul/sbm002.
Lou, H. C. (2012). Paradigm shift in consciousness research: the child’s self-awareness and abnormalities in autism, ADHD and schizophrenia. Acta Paediatrica, 101(2), 112–119. https://doi.org/10.1111/j.1651-2227.2011.02456.x.
Lysaker, P. H., Vohs, J., Hillis, J. D., Kukla, M., Popolo, R., Salvatore, G., & Dimaggio, G. (2013). Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches. Expert Review of Neurotherapeutics, 13(7), 785–793. https://doi.org/10.1586/14737175.2013.811150.
Metzner, C., Schweikard, A., & Zurowski, B. (2016). Multifactorial modeling of impairment of evoked gamma range oscillations in schizophrenia. Frontiers in Computational Neuroscience, 10, 89. https://doi.org/10.3389/fncom.2016.00089.
Minor, K. S., & Lysaker, P. H. (2014). Necessary, but not sufficient: links between neurocognition, social cognition, and metacognition in schizophrenia are moderated by disorganized symptoms. Schizophrenia Research, 159(1), 198–204. https://doi.org/10.1016/j.schres.2014.08.005.
Minor, K. S., Marggraf, M. P., Davis, B. J., Luther, L., Vohs, J. L., Buck, K. D., & Lysaker, P. H. (2015). Conceptual disorganization weakens links in cognitive pathways: disentangling neurocognition, social cognition, and metacognition in schizophrenia. Schizophrenia Research, 169(1–3), 153–158. https://doi.org/10.1016/j.schres.2015.09.026.
Mishara, A. L., Lysaker, P. H., & Schwartz, M. A. (2014). Self-disturbances in schizophrenia: history, phenomenology, and relevant findings from research on metacognition. Schizophrenia Bulletin, 40(1), 5–12. https://doi.org/10.1093/schbul/sbt169.
Modinos, G., Renken, R., Ormel, J., & Aleman, A. (2011). Self-reflection and the psychosis-prone brain: an fMRI study. Neuropsychology, 25(3), 295–305. https://doi.org/10.1037/a0021747.
Moskowitz, A., & Heim, G. (2011). Eugen Bleuler’s Dementia praecox or the group of schizophrenias (1911): a centenary appreciation and reconsideration. Schizophrenia Bulletin, 37(3), 471–479. https://doi.org/10.1093/schbul/sbr016.
Northoff, G., Heinzel, A., de Greck, M., Bermpohl, F., Dobrowolny, H., & Panksepp, J. (2006). Self-referential processing in our brain—a meta-analysis of imaging studies on the self. NeuroImage, 31(1), 440–457. https://doi.org/10.1016/j.neuroimage.2005.12.002.
Peralta, V., & Cuesta, M. J. (1994). Psychometric properties of the positive and negative syndrome scale (PANSS) in schizophrenia. Psychiatry Research, 53(1), 31–40.
Phillips, W. A., & Silverstein, S. M. (2003). Convergence of biological and psychological perspectives on cognitive coordination in schizophrenia. The Behavioral and Brain Sciences, 26(1), 65–82 discussion 82-137.
Repovs, G., Csernansky, J. G., & Barch, D. M. (2011). Brain network connectivity in individuals with schizophrenia and their siblings. Biological Psychiatry, 69(10), 967–973. https://doi.org/10.1016/j.biopsych.2010.11.009.
Rocca, P., Galderisi, S., Rossi, A., Bertolino, A., Rucci, P., Gibertoni, D., et al. (2016). Social cognition in people with schizophrenia: a cluster-analytic approach. Psychological Medicine, 46(13), 2717–2729. https://doi.org/10.1017/S0033291716001100.
Rosen, A., & Reiner, M. (2017). Right frontal gamma and beta band enhancement while solving a spatial puzzle with insight. International Journal of Psychophysiology, 122, 50–55. https://doi.org/10.1016/j.ijpsycho.2016.09.008.
Sandkuhler, S., & Bhattacharya, J. (2008). Deconstructing insight: EEG correlates of insightful problem solving. PLoS One, 3(1), e1459. https://doi.org/10.1371/journal.pone.0001459.
Sapara, A., Ffytche, D. H., Cooke, M. A., Williams, S. C., & Kumari, V. (2015). Is it me? Verbal self-monitoring neural network and clinical insight in schizophrenia. Psychiatry Research, 234(3), 328–335. https://doi.org/10.1016/j.pscychresns.2015.10.007.
Saykin, A. J., Gur, R. C., Gur, R. E., Mozley, P. D., Mozley, L. H., Resnick, S. M., et al. (1991). Neuropsychological function in schizophrenia. Selective impairment in memory and learning. Archives of General Psychiatry, 48(7), 618–624.
Schmitt, A., Hasan, A., Gruber, O., & Falkai, P. (2011). Schizophrenia as a disorder of disconnectivity. European Archives of Psychiatry and Clinical Neuroscience, 261(2), 150.
Sevy, S., Nathanson, K., Visweswaraiah, H., & Amador, X. (2004). The relationship between insight and symptoms in schizophrenia. Comprehensive Psychiatry, 45(1), 16–19. https://doi.org/10.1016/j.comppsych.2003.09.002.
Sheth, B. R., Sandkuhler, S., & Bhattacharya, J. (2009). Posterior Beta and anterior gamma oscillations predict cognitive insight. Journal of Cognitive Neuroscience, 21(7), 1269–1279. https://doi.org/10.1162/jocn.2009.21069.
Silverstein, S. M., Kovacs, I., Corry, R., & Valone, C. (2000). Perceptual organization, the disorganization syndrome, and context processing in chronic schizophrenia. Schizophrenia Research, 43(1), 11–20.
Smith, C. U. (1998). Descartes’ pineal neuropsychology. Brain and Cognition, 36(1), 57–72. https://doi.org/10.1006/brcg.1997.0954.
Smith, R. W., & Kounios, J. (1996). Sudden insight: all-or-none processing revealed by speed-accuracy decomposition. Journal of Experimental Psychology. Learning, Memory, and Cognition, 22(6), 1443–1462.
Smith, T. E., Hull, J. W., & Santos, L. (1998). The relationship between symptoms and insight in schizophrenia: a longitudinal perspective. Schizophrenia Research, 33(1–2), 63–67.
Sommer, I. E., Clos, M., Meijering, A. L., Diederen, K. M., & Eickhoff, S. B. (2012). Resting state functional connectivity in patients with chronic hallucinations. PLoS One, 7(9), e43516. https://doi.org/10.1371/journal.pone.0043516.
Spencer, K. M. (2008). Visual gamma oscillations in schizophrenia: implications for understanding neural circuitry abnormalities. Clinical EEG and Neuroscience, 39(2), 65–68.
Spencer, K. M., Nestor, P. G., Perlmutter, R., Niznikiewicz, M. A., Klump, M. C., Frumin, M., et al. (2004). Neural synchrony indexes disordered perception and cognition in schizophrenia. Proceedings of the National Academy of Sciences of the United States of America, 101(49), 17288–17293. https://doi.org/10.1073/pnas.0406074101.
Sprong, M., Schothorst, P., Vos, E., Hox, J., & van Engeland, H. (2007). Theory of mind in schizophrenia: meta-analysis. The British Journal of Psychiatry, 191, 5–13. https://doi.org/10.1192/bjp.bp.107.035899.
Tononi, G. (2004). An information integration theory of consciousness. BMC Neuroscience, 5, 42. https://doi.org/10.1186/1471-2202-5-42.
Tononi, G., & Edelman, G. M. (1998). Consciousness and complexity. Science, 282(5395), 1846–1851.
Tononi, G., & Edelman, G. M. (2000). Schizophrenia and the mechanisms of conscious integration. Brain Research. Brain Research Reviews, 31(2–3), 391–400.
Uhlhaas, P. J., & Singer, W. (2010). Abnormal neural oscillations and synchrony in schizophrenia. Nature Reviews. Neuroscience, 11(2), 100–113. https://doi.org/10.1038/nrn2774.
Uhlhaas, P. J., & Singer, W. (2011). The development of neural synchrony and large-scale cortical networks during adolescence: relevance for the pathophysiology of schizophrenia and neurodevelopmental hypothesis. Schizophrenia Bulletin, 37(3), 514–523. https://doi.org/10.1093/schbul/sbr034.
Uhlhaas, P. J., & Singer, W. (2015). Oscillations and neuronal dynamics in schizophrenia: the search for basic symptoms and translational opportunities. Biological Psychiatry, 77(12), 1001–1009. https://doi.org/10.1016/j.biopsych.2014.11.019.
Uhlhaas, P. J., Phillips, W. A., Mitchell, G., & Silverstein, S. M. (2006). Perceptual grouping in disorganized schizophrenia. Psychiatry Research, 145(2–3), 105–117. https://doi.org/10.1016/j.psychres.2005.10.016.
Urbach, M., Brunet-Gouet, E., Bazin, N., Hardy-Bayle, M. C., & Passerieux, C. (2013). Correlations of theory of mind deficits with clinical patterns and quality of life in schizophrenia. Frontiers in Psychiatry, 4, 30. https://doi.org/10.3389/fpsyt.2013.00030.
van Buuren, M., Vink, M., & Kahn, R. S. (2012). Default-mode network dysfunction and self-referential processing in healthy siblings of schizophrenia patients. Schizophrenia Research, 142(1–3), 237–243. https://doi.org/10.1016/j.schres.2012.09.017.
van der Meer, L., Costafreda, S., Aleman, A., & David, A. S. (2010). Self-reflection and the brain: a theoretical review and meta-analysis of neuroimaging studies with implications for schizophrenia. Neuroscience and Biobehavioral Reviews, 34(6), 935–946. https://doi.org/10.1016/j.neubiorev.2009.12.004.
van der Meer, L., de Vos, A. E., Stiekema, A. P., Pijnenborg, G. H., van Tol, M. J., Nolen, W. A., et al. (2013). Insight in schizophrenia: involvement of self-reflection networks? Schizophrenia Bulletin, 39(6), 1288–1295. https://doi.org/10.1093/schbul/sbs122.
Van Os, J., Fahy, T., Jones, P., Harvey, I., Sham, P., Lewis, S., et al. (1996). Psychopathological syndromes in the functional psychoses: associations with course and outcome. Psychological medicine, 26(1), 161–176.
Vohs, J. L., George, S., Leonhardt, B. L., & Lysaker, P. H. (2016). An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments. Expert Review of Neurotherapeutics, 16(10), 1193–1204. https://doi.org/10.1080/14737175.2016.1199275.
Wallwork, R. S., Fortgang, R., Hashimoto, R., Weinberger, D. R., & Dickinson, D. (2012). Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Research, 137(1–3), 246–250. https://doi.org/10.1016/j.schres.2012.01.031.
Weiler, M. A., Fleisher, M. H., & McArthur-Campbell, D. (2000). Insight and symptom change in schizophrenia and other disorders. Schizophrenia Research, 45(1–2), 29–36.
Williams, S., & Boksa, P. (2010). Gamma oscillations and schizophrenia. Journal of Psychiatry & Neuroscience, 35(2), 75–77.
Woo, T. U., Spencer, K., & McCarley, R. W. (2010). Gamma oscillation deficits and the onset and early progression of schizophrenia. Harvard Review of Psychiatry, 18(3), 173–189. https://doi.org/10.3109/10673221003747609.
Xavier, R. M., Pan, W., Dungan, J. R., Keefe, R. S. E., & Vorderstrasse, A. (2017). Unraveling interrelationships among psychopathology symptoms, cognitive domains and insight dimensions in chronic schizophrenia. Schizophrenia Research. https://doi.org/10.1016/j.schres.2017.07.002.
Zhou, Y., Rosenheck, R., Mohamed, S., Zhang, J., Chang, Q., Ou, Y., et al. (2015). Insight in inpatients with schizophrenia: relationship to symptoms and neuropsychological functioning. Schizophrenia Research, 161(2–3), 376–381. https://doi.org/10.1016/j.schres.2014.12.009.
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Petraskova Touskova, T. Disorganization and Insight in Schizophrenia. Act Nerv Super 60, 1–7 (2018). https://doi.org/10.1007/s41470-017-0013-0
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DOI: https://doi.org/10.1007/s41470-017-0013-0