Psychopathology最新文献

Epidemiological studies have reported associations between creativity and genetic vulnerability for schizophrenia and other severe mental disorders. Alterations of selfhood have been proposed as a possible link between these phenomena. In this explorative study, we examined disturbances of basic selfhood and imagination, as well as general psychopathology, in a non-clinical sample of professional visual artists. Methods Ten visual artists, exhibiting at prestigious galleries, were recruited through professional networks. They underwent a comprehensive interview assessment of psychopathology, including the Present State Examination (PSE), the Examination of Anomalous Self-experience (EASE), the Examination of Anomalous fantasy and Imagination (EAFI), and a qualitative interview exploring the creative working process. Results Four participants described a moderate to high level of self-disorders and/or anomalies of imagination and described an involvement of these experiences in their creative working process. The participants met ICD-10 research criteria for lifetime diagnoses of mood, anxiety and schizophrenia-spectrum disorders. Discussion The findings are exploratory and based on a small sample. Drawing on phenomenological considerations, we tentatively suggest that, for some individuals, alterations of the pre-reflective structure of subjectivity may be related to creativity through subtle alienation from fundamental common-sense categories, an inclination towards preoccupation with the imaginary, and a spatialized mode of experiencing the inner life.

Major depressive disorder (MDD) is one of the most frequent psychiatric diseases worldwide. Growing evidence suggests that cortical gyrification measures may present an early risk marker for depression. Medial views of cortical surface reconstructions provide the basis for a simple, expert-rated measure of cortical gyrification. In this study, we examined left anterior cingulate cortex (ACC) gyrification as a potential marker of MDD. We selected this region of interest based on the limbic-cortical dysregulation model of depression and prior research results. One third of subjects exhibited two antero-posterior gyri in the left hemisphere, whereas the other subjects exhibited one longitudinal gyrus or longitudinal gyrification was interrupted. Subjects with the fewer-gyri left ACC variant more often experienced MDD at some point in their lifetime (p = .048). Moreover, among all subjects with MDD, disorder onset happened earlier in subjects with the fewer-gyri variant (d = -0.30), hinting at early developmental contributions to the phenotypic marker. In addition, subjects with fewer longitudinal gyri scored higher on neuroticism (η2= .02), but not on extraversion. Automatically derived measures of gyrification and cortical surface area were largely consistent with the differences observed using the expert rater-based gyrification measure. Future studies should investigate left ACC gyrification and to what extent it exists in at-risk subjects, further elucidating it with ACC structural and functional connectivity measures.

Background: Phenomenological psychopathology has traditionally focused on individual experience, yet contemporary clinical practice increasingly requires understanding of how collective cultural forces shape psychological life. In an era of advanced globalization, stable social aggregates have given way to fluid "cultural flows" that transcend geographical and social boundaries, necessitating new conceptual frameworks for clinical assessment.

Summary: This paper proposes a critical expansion of phenomenological psychopathology of the individual to explicitly integrate the collective dimension. In order to accurately describe the scenario of collective life, and its relationship with the psychology and psychopathology of individual existences, we propose two moves: (1) a shift of focus from society (which denotes an organized aggregate of individuals) to culture (a transversal symbolic system, capable of extending beyond the boundaries of the original social group) since in the context of advanced globalization the conception of stable social aggregates has been replaced by models of fluid and changing "cultural flows" and (2) to phenomenologically describe these cultural flows that traverse the contemporary world, we introduce the concept of "cultural existentials" (time, space, body, and others) as a priori conditions of experience derived from the analysis of the fundamental structures of individual lifeworlds, as employed in phenomenology. These cultural existentials are integrated into a dialectical experiential matrix (DEM), designed to overcome the reductionism of both structuralism and subjectivist individualism. The DEM frames the patient's experience as a dynamic interplay between individual freedom (the capacity for self-positioning) and cultural influence. An illustrative application analyzing the convergence between "pornographic culture" and the "homo œconomicus" anthropological type is provided to demonstrate how cultural existentials offer a collective model for specific narcissistic vulnerabilities and dysregulations of alterity, providing a crucial diagnostic device for the clinician.

Key messages: The DEM provides clinicians with a diagnostic device for understanding how contemporary cultural configurations shape individual psychopathology. By articulating the dialectical relationship between cultural existentials and individual positioning, this framework enables more accurate phenomenological description of patients whose suffering reflects not merely idiosyncratic biography but participation in collective cultural patterns. This approach addresses the limitations of purely individualistic psychopathology while maintaining phenomenological rigor.

Objective: Felt presence (FP) is the experience that another entity is present in one's proximal environment, despite no sensory evidence. Occurrence of FP is linked to psychosis risk, but qualities of FP in the context of psychosis are not well understood. We conducted an online, exploratory survey assessing qualities of FP in relation to psychosis risk in the general population.

Methods: Three hundred and seventy-six participants completed an anonymous online survey consisting of validated measures of sensed presence, psychosis risk, loneliness, trauma, resilience and general mental health. They also responded to questions about perceptual qualities of FP. We investigated the role of the presence and its qualities in predicting psychosis risk, and relationships between qualities of FP and psychosis risk. We also examined the relationships between qualities of FP and psychosocial variables with psychosis risk.

Results: FP and anxiety significantly predicted elevated psychosis risk. FP experiences in the high-risk group were more frequent, distressing, vivid, and multisensory than in the low-risk group. Specifically, distress during FP significantly predicted psychosis-risk status over and above demographic and psychiatric covariates (including anxiety). Cumulative trauma was linked with total number of FP experiences as well as increased frequency, distress, vividness, and understandings of FP's identity. Depression, anxiety, and stress were associated with more physiological sensations and increased distress during FP, as well as knowledge of FP's identity. Resilience was associated with more frequent and vivid FPs.

Conclusions: These results demonstrate strong links between FP and psychosis risk in the general population and provide preliminary evidence of qualitative markers that differentiate FP from psychosocial factors in the context of psychosis risk. Assessment and clinical conceptualizations of risk for schizophrenia should consider including experiences of bodily self-disturbance, such as FP.

Background: According to the standard definition, a hallucination is (1) a perceptual experience occurring in the absence of a relevant perceptual object, (2) it has the sense of reality of a veridical perception, and (3) it is unwilled and not under voluntary control of the hallucinator. This definition is supposed to encompass all hallucinations, across mental disorders and experiential modalities.

Summary: In this article, we examine the standard definition's validity by comparing visual hallucinations in delirium and auditory verbal hallucinations (AVHs) in schizophrenia, focusing especially on the definition's second criterion, i.e., the sense of reality criterion. Our analysis reveals stark differences between these two disorders, their concomitant experiential structures, and the experience of hallucinations. While hallucinated objects are experienced as real in both disorders, they are typically not experienced as real in the same sense of the term. In delirium, hallucinatory objects are experienced as real in the way perceptual objects are, and they often are indistinguishable from such objects. In schizophrenia, by contrast, hallucinatory objects are often not experienced as real in the way perceptual objects are, and they often are distinguishable from such objects.

Key message: An appreciation of the different kinds of sense of reality of hallucinations is relevant for developing more precise psychopathological concepts, clinical care, and empirical research. Based on our findings, we offer a revision of the standard definition of hallucination, making it valid for the variety of hallucinations that are found across mental disorders.

Introduction: The present paper identified key components of anxiety and fear based on a large community sample of 387 psychiatrically healthy or depressed participants.

Methods: Subfactors were defined based on a principal component analysis with promax rotation and characterized via correlations with other psychiatric as well as physiological and volumetric indicators collected in this large study.

Results: The key components were labeled "discomfort," "fright," "nervousness," "lack of self-confidence," and "worry." We discuss the components according to their organizational complexity, but also in terms of their affective and motivational content.

Conclusion: The components may be useful for future research, as they are based on three of the most-used psychiatric questionnaires assessing anxiety and fear symptoms.

Introduction: Delusions frequently involve strong beliefs about, or interactions with, illusory social agents. Although such agents have been systematically described in hallucinations, few studies have investigated their nature and identity in delusions.

Methods: We identified 205 electronic mental health records describing the content of delusions from the Clinical Record Interactive Search platform at South London and Maudsley NHS Foundation Trust. Delusional content was classified as non-social, implicitly social, or explicitly social. Descriptions of illusory social agents from explicitly social delusions were extracted and categorized using an upward coding analysis. A hierarchical cluster analysis identified distinct groupings of illusory social agents.

Results: Most delusions (83.4%) contained explicit references to illusory social agents. Across 238 instances, we identified 220 distinct agent identities, with a mean of 1.17 agents per record. The majority were humans (85.1%), most often identified as family members (31.0%), followed by acquaintances (17.2%), religious figures (13.2%), unnamed persons (12.8%), professionals (11.8%), and cultural figures (10.9%). Hierarchical clustering revealed two distinct groups: one including socially proximate agents and the other more socially distant agents. These findings indicate a social gradient in delusions.

Conclusion: Social content predominates in delusions, with patients experiencing delusions about socially closer individuals more frequently. We discuss the extent to which social gradient may not be unique to delusional misidentification syndromes but may instead represent a general feature of delusions. Better characterization of social agents in delusions could inform mechanistic accounts of these symptoms and, in clinical practice, guide family support and risk assessment.

Introduction: In biomedicine, entity experiences are conceptualised as compound hallucinations featuring living beings. The term "experience" suggests that these have an objective basis in reality, as those perceiving them may maintain. So-called jinn encounters, typically described by Muslims with and without a psychiatric diagnosis, involve the multimodal perception of a spirit that, as described in the Qur'an, was created by Allah.

Methods: We conducted a phenomenological investigation among Muslim patients residing at Parnassia Psychiatric Institute, The Hague, mostly diagnosed with a schizophrenia spectrum disorder. To enquire specifically into multimodal hallucinations featuring jinn or related entities, we used the Hallucination Attribution List, a tailor-made, semi-structured questionnaire.

Results: Of the 42 interviewees, 35 described multimodal hallucinations, of which 22 fulfilled the criteria of entity experiences involving 2 to 6 sensory modalities simultaneously. Twelve participants (54.5%) were fully convinced they were dealing with jinn; the others left some room for doubt. Although we did not quantitatively assess the levels of jinn-associated distress, all participants characterised their experiences as impressive and impactful.

Conclusion: Multimodal hallucinations may involve full-blown entity experiences, which in Muslim patients typically take the form of jinn encounters. The way in which these entity experiences are mediated is as yet uncertain. However, since visual, auditory, and tactile hallucinations in our sample were described substantially more frequently than somatic, olfactory, and gustatory ones, we hypothesise that the processes underlying the hallucinations may be driven by a stochastic mechanism in that the first three sensory modalities need to have been engaged before the latter three can be recruited. We highlight several biological models of potential underlying mechanisms as well as two overarching models that may help place the mechanisms in the wider context of personal, social, cultural, religious, philosophical, and evolutionary factors that, conceivably, all play a role in their mediation.

Background: The phenomenon of love is an important task for the psychopathologist since love experience is the site in which the Self is formed and potentially dismantled. This paper explores "one-way love" - an autotelic form of love that persists independently of return. It may serve as a way for the person to sustain a sense of autonomy finding fulfilment in the act of loving itself - a paradoxical affirmation of identity, existence, and autonomy.

Summary: The analysis unfolds three central functions of one-way love: (1) it frees the person from dependency on the Other's love; (2) it preserves the integrity of the lover's own desire protecting it from the confrontation with the Other's desire; (3) it offers the lover a heroic and noble self-image rooted in fidelity to feeling. One-way lovers may appear as dependent on a beloved who does not reciprocate, but they are firmly convinced that they are performing a radical act of freedom: loving not to be loved in return, but to assert their own existence as a person fully capable of loving.

Key message: One-way love is a strategy in which desire and fear intersect, sustaining the beloved at a distance and affirming the lover's capacity to love without dependence. Yet, this autonomy carries a cost: it prevents genuine intimacy with the Other. By avoiding the vulnerability required to share private aspects of the Self, one-way lovers evade the very encounter with otherness that is essential to the ongoing development and transformation of the Self.

Introduction: Severe anger and overt aggression are common phenomena in borderline personality disorder (BPD) which have serious negative consequences for those affected and their environment. New developments in psychotherapy for personality disorders aim to target etiological mechanisms involved in psychopathology. Since affect dysregulation is a prominent biobehavioral mechanism underlying overt aggressive behavior in BPD, we aimed to clarify whether a psychotherapy that has been shown to decrease aggression in BPD does indeed modulate this mechanism.

Methods: Accordingly, the neural effects of a novel mechanism-based anti-aggression psychotherapy (MAAP) were compared to those of a nonspecific supportive psychotherapy (NSSP). Twenty-seven highly overt aggressive patients with BPD and 29 healthy controls were included in this functional magnetic resonance imaging (fMRI) study.

Results: The BPD patients treated with MAAP showed an increase in neural activation in clusters comprising the left anterior insula, the right dorsomedial prefrontal cortex (PFC) and the bilateral anterior caudate being related to a reduction in overt aggression. In contrast, the BPD group that had received NSSP exhibited a decrease in activity in the aforementioned clusters, each associated with a rise in overt aggressive behavior. Furthermore, MAAP showed an increase and NSSP a decrease in context-dependent functional connectivity between the caudate seed cluster mentioned above and the left dorsolateral PFC. Likewise, this interaction effect was negatively related to the change in overt aggression with an OAS-M reduction for the MAAP and a rise for the NSSP group.

Conclusion: The data may suggest that the aggression-reducing effect of MAAP is mediated through increasing cognitive control over dysregulated feelings of anger.