Andrea Raballo

Dr. Raballo is Marie Curie research fellow at the Danish National Research Foundation at the University of Copenhagen in Denmark. ... Faculty Disclosures: The author reports no affiliation with or financial interest in any organization that might pose a conflict of interest.

In its initial formulation, the concept of basic symptoms (BSs) integrated findings on the early symptomatic course of schizophrenia and first in vivo evidence of accompanying brain aberrations. It argued that the subtle subclinical disturbances in mental processes described as BSs were the most direct self-experienced expression of the underlying neurobiological aberrations of the disease. Other characteristic symptoms of psychosis (e.g., delusions and hallucinations) were conceptualized as secondary phenomena, resulting from dysfunctional beliefs and suboptimal coping styles with emerging BSs and/or concomitant stressors. While BSs can occur in many mental disorders, in particular affective disorders, a subset of perceptive and cognitive BSs appear to be specific to psychosis and are currently employed in two alternative risk criteria. However, despite their clinical recognition in the early detection of psychosis, neurobiological research on the aetiopathology of psychosis with n...

Anomalous subjective experiences involving an alteration of the basic sense of self (ie, Self-disorder [SD]) are emerging as a core marker of schizophrenia spectrum disorders with potential impact on current early detection strategies as well. In this study, we wished to field-test the prevalence of SD in a clinical sample of adolescent/young adult help-seekers at putative risk for psychosis attending standard community mental health facilities in Italy. Participants (n = 47), aged between 14 and 25, underwent extensive psychopathological evaluations with current semi-structured tools to assess Clinical High Risk (CHR) state (ie, Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms [SIPS/SOPS], Schizophrenia Proneness Instrument-Adult/Child and Youth [SPI-A/CY]). SD aggregated in CHR subjects as compared to the non-CHR and revealed substantial association with sub-psychotic symptoms (SIPS), subjective experience of cognitive and cognitive-perceptual vulnerability (basic symptoms) and functional level (Global Assessment of functioning). Moreover, a combination of the 2 approaches (ie, CHR plus SD) enabled further "closing-in" on a subgroup of CHR with lower global functioning. The results confirm SD's relevance for the early profiling of youths at potential high risk for psychosis.

Contemporary phenomenological research has considered abnormal bodily phenomena (ABP) to be a phenotypic trait of subjects with schizophrenia in their first psychotic episode. Yet the prevalence of ABP and their clinical significance in subjects at Ultra High Risk (UHR) of psychosis remain unidentified. This study is an exploratory investigation of ABP in UHR subjects and matched healthy controls (HCs) examining their relation to clinical features and basic self-disturbances. A sample of 26 UHR and 14 HC subjects from three prodromal and early intervention clinics in South London, West London and Cambridge was assessed with the Abnormal Bodily Phenomena questionnaire (ABPq), Comprehensive Assessment of At-Risk Mental States (CAARMS), the Positive and Negative Syndrome Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS) and the Examination of Anomalous Self Experiences (EASE) checklist. In our sample ABP occurred in 73.1% of UHR subjects and prominent ABP (proABP) were referred in 53.8% of them. No HC subject reported ABP. The UHR group with proABP had lower CAARMS total score (t=-9.265, p=0.006). There were no differences in PANSS total score (t=-1.235, p=0.277), SOFAS score (H(2) 22.27, p=0.666) and EASE total scores (z=8.565, adjusted p=0.185) in the UHR subjects with prominent ABP versus those that did not. This initial investigation suggests that ABP could be a prevalent phenotypic feature of UHR subjects.

Antipsychotic medication may influence brain structure, but to what extent effects of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) differ is still not clear. Here we aimed to disentangle the effects of FGA and SGA on variation in volumes of subcortical structures in patients with long-term treated schizophrenia. Magnetic resonance images were obtained from 95 patients with schizophrenia and 106 healthy control subjects. Among the patients, 40 received only FGA and 42 received only SGA. FreeSurfer 5.3.0 was used to obtain volumes of 27 subcortical structures as well as total brain volume and estimated intracranial volume. Findings of reduced total brain volume, enlarged ventricular volume and reduced hippocampal volume bilaterally among patients were replicated, largely independent of medication class. In the basal ganglia, FGA users had larger putamen bilaterally and right caudate volume compared to healthy controls, and the right putamen was significantly larger than among SGA users. FGA and SGA users had similar and larger globus pallidus volumes compared to healthy controls. Post hoc analyses revealed that the difference between FGA and SGA could be attributed to smaller volumes in the clozapine users specifically. We therefore conclude that basal ganglia volume enlargements are not specific to FGA.

The concept of basic self-disturbance offers a renewed, phenomenologically oriented framework to approach both the cross-sectional and longitudinal complexity of schizophrenia spectrum psychopathology. According to this approach, schizophrenia is characterized by instability in the most foundational and irreducible dimension of selfhood, i.e. the basic sense of self. Whereas normal basic self-experience is characterized by being a self-present, single, temporally persistent, bodily and demarcated (bounded) subject of experience and action, vulnerability to schizophrenia is marked by several structural shifts in such a basic selfhood (e.g. unstable first-person perspective, diminished sense of presence, and loss of vital contact with reality). This provides the ground for the emergence of the varied symptoms of schizophrenia, such as positive, negative and disorganization symptoms. Recent empirical research confirms that basic self-disturbance is specific to the schizophrenia spectrum and might be of value in the prospective identification of prodromal patients. The concept has implications for both aetiopathogenetic research and clinical-psychotherapeutic intervention. Furthermore, it may offer an integrative framework across 'levels' of inquiry in schizophrenia research (i.e. across psychopathological, neurocognitive and neurobiological domains).

Dr. Raballo is Marie Curie research fellow at the Danish National Research Foundation at the University of Copenhagen in Denmark. ... Faculty Disclosures: The author reports no affiliation with or financial interest in any organization that might pose a conflict of interest.

This research is an attempt to gain a comprehensive insight into alexithymia in schizophrenia. Previous studies offered clinically-descriptive and phenomenologically oriented suggestions regarding alexithymia putative contribution in shaping schizophrenic psychopathology. However, the factorial structure of the scales used to assess alexithymia had never been applied to a schizophrenic sample as a preliminary step to interpret results, thus assuming the purported dimensions of the alexithymia construct (i.e. difficulties identifying feelings, difficulties describing feelings, and externally oriented thinking) to be transnosographically stable. In order to explore the psychopathologic meaning and interrelations with other schizophrenic symptoms, we evaluated 76 chronic schizophrenic outpatients using the 20-item Toronto Alexithymia Scale, standardized measures of positive, negative, disorganized and depressive symptoms, social and physical anhedonia scales, and the Bonn Scale for the...

Unusual subjective experiences are relatively common in the general population and have been associated with an increased level of vulnerability to psychosis. The current study aimed to a) determine the distribution of hallucination-like experiences (HLEs) in a community sample of young adults, b) investigate their dimensional subtypes, and c) test the association of HLEs with indicators of poor mental health. Four hundred thirty-seven participants (men, 41%) completed a battery of questionnaires including the 16-item Launay-Slade Hallucination Scale (LSHS), the 12-item General Health Questionnaire (GHQ-12) and the 21-item Peters et al. Delusions Inventory (PDI). The LSHS correlated significantly with GHQ-12 and PDI. Individuals with higher levels of psychological distress were found to report higher frequencies of the HLEs compared with those in the reference range. Exploratory factor analysis of LSHS produced a four-factor solution: a) "auditory and visual HLEs," b) "multisensory HLEs," c) "intrusive thoughts," and d) "vivid daydreams." The current results provide further support for the multidimensional nature of hallucination proneness in the general population and indicate that some HLEs (particularly those related to intrusiveness of thought) are associated with a lower level of perceived well-being.

Il fenomeno dell'autocentralità connota la modificazione qualitativa dell'esperienza psicotica. Transitori vissuti di autoriferimento sono riscontrati sistematicamente in soggetti in fase prodromica, all'esordio o nella fase postpsicotica e trovano un preci-so ...

The purpose of this study is to examine the classic psychopathologic notion of depersonalization in the light of the Basic Symptom paradigm. A sample of 57 chronic schizophrenics was cross-sectionally assessed with the Bonn Scale for the Assessment of Basic Symptoms (BSABS) and contextually with specific scales testing positive, negative, depressive and alexithymic dimensions. In order to categorize depersonalized vs.

The underlying structures of clinical caseness and need of care in prodromal (i.e., at-risk) and early phases of schizophrenia remain poorly characterized in their essential psycho-behavioral coherence. To identify the schizophrenia proneness-related subtypes within a population of young help-seekers referred to a dedicated, community-based early detection program (Programma 2000). A sample of consecutive referrals (n = 168) for suspected psychosis or first-episode schizophrenia spectrum psychosis received a detailed clinical assessment, including the early recognition inventory for the retrospective assessment of the onset of schizophrenia checklist. We used exploratory factor analysis (EFA) to determine the underlying dimensional structure and latent class analysis (LCA) to identify putative vulnerability subtypes. EFA identified four factors: dysphoria (irritability tension), paranoid autocentrism, introversive withdrawal, and disturbed subjective experience. LCA distinguished three classes, interpretable as carrying different degrees of "proneness to schizophrenia psychosis," which best captured the underlying continuum of clinical severity. The validity of the three classes was supported by distinct patterns of association with major clinical variables (i.e., diagnostic staging at referral). Vulnerability to schizophrenia psychosis in young help-seekers may manifest in three major clinical prototypes, presenting common levels of dysphoria and social withdrawal but different degrees of paranoid autocentrism and disturbed subjective experience. Overall, the results provide the empirical background to dissect shared features of clinical caseness from more schizophrenia-specific vulnerability components. This is of value for the refinement of the clinical staging model as well as for the pragmatic implementation of multiple-gate screening programs.

The phenomenon of self-centrality denotes a qualitative modification of the psychotic experience. Transitory experiences of self-reference have regularly been found in subjects in the prodromic phase and at the beginning of psychosis or in the post psychotic phase, and are specifically identified in the semeiotics of Basic Symptoms. However, self-centrality, in addition to being a morphological organizer in the psychotic crisis, also manifests itself in schizotypal personality disorders and in first-degree relatives of schizophrenics (where it is correlated to the degree of schizotypal traits). In these subjects, manifestations of self-centrality of a lesser intensity could be an indication of a latent vulnerability trait, which could modulate personal and psychopathological expressions of the schizotaxic diathesis.

An increasing amount of empirical studies demonstrates that anomalies of self-experience (self-disorders) are characteristic of schizophrenia and related spectrum conditions, indicating that self-disorders (SDs) are likely to constitute important vulnerability phenotypes. On a clinical level, SDs are non-psychotic alterations of subjective experience that include disturbances of self-awareness (e.g., fading first-person perspective, waning sense of basic identity, depersonalization and hyperreflectivity), autopsychic disorders (e.g., thought pressure or block, perceptualization of mental stream and spatialization of thoughts), loss of common sense (e.g., perplexity), and existential alterations (e.g., solipsistic grandiosity). Such experiences, define essential aspects of the clinical expressions of schizophrenia lending psychopathological coherence to its spectrum manifestations. Furthermore the experiential nature of SDs makes them amenable to the patient's introspection which...

A consistent amount of empirical research suggests that depression, besides interfering with quality of life and social functioning, may influence other symptom dimensions in schizophrenia, thus constituting an important domain for treatment strategies, outcome, and prognosis. This study investigated the factorial structure of the Calgary depression scale for schizophrenia (CDSS) in a sample of schizophrenic patients and explored the relationships between such factors, major symptom dimensions and subjective experiences. One hundred and sixty-one subjects were examined to assess the severity of schizophrenic symptoms (scored according to the five-dimensional model of Toomey et al. [28]), the distress due to the subjective experience of negative symptoms, and the degree of subjectively-felt cognitive-affective vulnerability (i.e. basic symptoms). Principal component analysis revealed CDSS to include three main factors, namely: "depression-hopelessness" (factor I), "guilty idea of reference-pathological guilt" (factor II) and "early wakening" (factor III). Whereas the last factor did not correlate with any of the other psychopathological domains, the first two factors revealed multiple correlations with both diagnostic symptoms and subjective experiences. The results confirm the threefold factorial structure of the CDSS previously reported by the authors of the scale and could shed further light on the psychopathological nature of the components of depression in schizophrenia. The specific correlation patterns with diagnostic and subjective psychopatholgy substantiate the clinical distinction between a general depression factor ("depression-hopelessness") and a cognitive-guilt factor ("guilty idea of reference-pathological guilt").

Abnormal neuropsychological and cognitive functions in nonpsychotic relatives of schizophrenics are currently the subject of intense interest, mainly because of attention being focused again on the theoretical construct of schizotaxia. Contextually, in recent years the issues of subjective experiences have once again become central and respectable topics in psychopathological research. Among self-experiential disturbances, basic symptoms (BS), stemming from Jaspersian phenomenological psychopathology, are considered the first, protopathic, subjective reverberation of the neurobiological deficit of schizophrenia. Thus BS are expected to be detectable in nonpsychotic relatives of schizophrenia patients. The aim of the present study was to compare the degrees of such anomalous subjective experiences, assessed in siblings of schizophrenic patients, schizophrenia spectrum patients (schizotypals and schizophrenics) and nonclinical controls. Different profiles of BS were obtained in the samples. An increasing gradient of BS ranging from nonclinical to clinical samples, with unaffected siblings in the intermediate position, occurred for some of the BS clusters (i.e. 'thought, language, perception and motor disturbances' and 'impaired bodily sensations'). Other BS clusters (i.e. 'disorders of emotion and affect' and 'increased emotional reactivity') turned out to be typical of the clinical subgroups, whereas an enhanced tolerance to normal stress significantly distinguished the sibling specimen from the other ones. The heterogeneity of these patterns suggests that BS constellations may be underpinned by different psychopathological processes and that cognitive and bodily BS may be clinical target phenotypes for schizotropic liability screening.

The study's aim was to empirically derive the psychopathological constellation associated with self-centrality (i.e. non-delusional self-referential attitude) by seeking an interpretation in the light of the 'Basic Symptoms Model' of schizophrenic psychopathology. Eighty-four patients with an established schizophrenic illness receiving maintenance treatment at the Psychiatry Section of the Parma University Neuroscience Department were examined. The Scales for the Assessment of Positive and Negative Symptoms, the Calgary Depression Scale and the Toronto Alexithymia Scale were administered to all subjects to determine levels of positive, disorganized, negative and depressive symptoms, as well as alexithymia. Subjective experiences, including non-delusional self-centrality, were explored by means of the Bonn Scale for the Assessment of Basic Symptoms. Logistic regression detected three different psychopathological domains (delusional, alexithymic, and basic body symptoms) strongly associated with self-centrality. Among these the most influential independent variable was basic body symptoms. These results suggest that impaired lived body experience (i.e. protopathic body disattunement) is a psychopathologic condition concomitant with the emergence of autocentric polarization of experience (i.e. self-centrality).

The principal concern of this paper lies in the exploration of the possible role of the subjective experience of language impairment in shaping schizophrenic symptomatology. A previous model embracing the basic symptom theory and the vulnerability paradigm hypothesized that (self-perceived) impairment of receptive and expressive language and alexithymia may play a relevant role in facilitating the development of a nonparanoid prototype of schizophrenia. The experimental protocol which led to this model [emphasizing the comprehensive notion of 'language capacity' as pathoplastic modulator of overt schizophrenic syndromes (i.e. pathoplastic model)] was replicated on a wider schizophrenic sample, assessing contextually with diagnostic symptoms, depressive symptoms, alexithymia, subjective experience of negative symptoms and hedonic capacity. Since schizophrenics with self-experienced language capacity impairment did not differ from other schizophrenics, as regards positive, negative and disorganized symptoms, but just in negative symptom-related distress, an alternative interpretation of the possible role of the subjective experience of language impairment in schizophrenic psychopathology is proposed (i.e. idioplastic hypothesis).

Contemporary psychopathological research has shown that some qualitative anomalies of the first-person experiential givenness qualify the subjective experience of schizophrenia. Such essential clinical features of schizophrenia have recently been condensed into 7 phenomenologically coherent clusters derived from the Bonn Scale for the Assessment of Basic Symptoms (BSABS). The experimental intent of this study was to test whether subapophanic self-centrality (i.e. a protopathic nondelusional form of intersubjective spatial disattunement) empowers the discriminant capacity of such a set of subjective experiential disturbances among different diagnostic groups. Three comparably sized samples of outpatients with schizophrenia, obsessive-compulsive or mood disorders were examined with the BSABS. Logistic regression analysis was performed with diagnosis as the outcome variable. Elevated scores in self-perceived cognitive disorders and abnormal self-centrality were associated with DSM-IV diagnosis of schizophrenia. Self-centrality increased the discriminant capacity of the 7 designed a priori dimensions. These findings confirm the previously reported aggregation of some subtle qualitative alterations of subjective experience in schizophrenia, and suggest that a careful consideration of autocentric disturbances of intersubjectivity might enrich current heuristics on schizophrenic experiential vulnerability.