Unrecognized schizophrenia spectrum and other mental disorders in youth disconnected from education and work-life.

Background: Schizophrenia spectrum disorders typically emerge during adolescence or early adulthood. Often the symptomatology is vague initially, while a marked functional decline and social withdrawal can be seen. A group of young people with such social and functional impairments is the so-called "Not in Education, Employment or Training" (NEET), i.e., a youth population that is socially disconnected from education and work-life. Despite the NEET group's disconnection from important parts of social life and a rising concern of an intersection with mental health problems, a psychopathological perspective on the problems experienced by this group remains underexplored. Aim: To examine a NEET sample for psychopathology and if relevant allocate psychiatric diagnoses. Methods: We performed an interview study comprising 40 participants from youth job-counseling services. All underwent a comprehensive psychiatric evaluation. Inclusion criteria were 18-29 years of age and a welfare benefit history of minimum 6 months. Results: Diagnostic criteria of any mental disorder were fulfilled by 95% of the sample; half of whom were diagnosed with a schizophrenia spectrum disorder. The participants with schizophrenia spectrum disorders had lower global functioning, were more often in contact with the mental health services and had higher PANSS and Examination of Anomalous Self-Experiences (EASE) scores compared to those with non-schizophrenia spectrum disorders. The participants fulfilling the criteria for schizophrenia spectrum disorders had lower EASE and PANSS scores than usually reported in the literature, suggesting more "symptom-poor" presentations. Conclusion: Psychiatric illness and particularly schizophrenia spectrum disorders affecting social interaction and the ability to take part in educational and work-life were grossly overrepresented in the NEET sample. Our findings suggest that pronounced social disconnection in youth in and of itself should lead to suspect the presence of a severe mental disorder.

Disordered Selfhood in Schizophrenia and the Examination of Anomalous Self-Experience: Accumulated Evidence and Experience.

Disordered selfhood in schizophrenia was rediscovered at the turn of the millennium. In 2005, Psychopathology published the psychometric instrument, the Examination of Anomalous Self-Experience (EASE). In this article, we summarize the historical background of the creation of the EASE, explicate the notion of the disorder of basic or minimal self with the help of phenomenological philosophy, and provide a brief description of clinical manifestations targeted by the EASE. We also present our personal experience using and teaching the EASE and summarize the empirical evidence obtained so far. We conclude that the basic self-disorder represents a crucial phenotype of schizophrenia spectrum disorders and that this phenotype offers a potential avenue to empirical pathogenetic research and psychotherapeutic treatment.

The Paradox of Help-Seeking Behaviour in Psychosis.

Little is known about which factors actually motivate individuals with psychosis to seek help or how psychosis may complicate the help-seeking process. The aim of this article is to examine the steps of this process and how psychopathological experiences might affect and interfere with it. In this qualitative study we interviewed nine patients with a first episode of psychosis. The interviews were transcribed and analysed according to the principles of thematic analysis using inductive as well as deductive methods. The crucial step in help-seeking behaviour seemed to be for the patients to identify the kind of problem they were facing. None of them clearly recognized their psychotic or otherwise anomalous experiences as symptoms of a mental disorder, and most of them did not seriously question the reality status of these experiences. For most of the patients it was an untenable social situation that caused them to seek help. When they did seek help the majority did not initially contact the psychiatric services. It seems paradoxical to expect patients who experience symptoms of psychosis for the first time to be able to unambiguously identify them as being exactly that and accordingly seek out psychiatric help, as diminished insight into illness is an inherent feature of psychosis. However, the phenomenon of 'double bookkeeping' seemed to provide an opening for seeking help from psychiatry in spite of compromised insight. This observation should be included in everyday clinical work and in future information campaigns.

Social Life in the Schizophrenia Spectrum: A Phenomenological Study of Five Patients.

BACKGROUND: Social difficulties are a hallmark of schizophrenia spectrum conditions, yet their background and exact nature remain contested. Previous pivotal studies on chronically ill patients have suggested that a position of "positive withdrawal" is associated with a decreased tendency to rehospitalization. This concept designates an essentially withdrawn but not negatively experienced position balanced by elements relating the individual to the social world. OBJECTIVES: To explore a less ill subgroup of schizophrenia spectrum patients' ways of navigating the social world and examine potential links to anomalous self-experiences by applying key insights from phenomenology and anthropology. METHOD: The present study was part of a 5-year follow-up on a group of first-admission schizophrenia spectrum patients. From this sample of 48 patients, 5 were selected for qualitative evaluation following the principles of thematic analysis. RESULTS: A "positively withdrawn" position characterizes a wider group of patients than originally reported. Further, we identified a preference for partaking in social activities in particular circumstances with clearly circumscribed goals or social roles and rules. This alleviated social discomfort and helped patients stay embedded in a social milieu. All patients experienced high levels of self-disorders. CONCLUSIONS: We suggest that certain aspects of social impairment may, in fact, reflect meaningful compensatory mechanisms, and argue that this conceptualization of social difficulties is relevant to various psychotherapeutic interventions.

Self-disorders in schizophrenia-spectrum disorders: a 5-year follow-up study.

Self-disorders have been hypothesized to be an underlying and trait-like core feature of schizophrenia-spectrum disorders and a certain degree of temporal stability of self-disorders would therefore be expected. The aim of the study was to examine the persistence of self-disorders measured by the Examination of Anomalous Self Experiences over a time span of 5 years. 48 patients with schizophrenia-spectrum disorders were thoroughly assessed for psychopathology at baseline and 5 years later. Self-disorders were assessed by the Examination of Anomalous Self Experiences. The level of self-disorders was same at the two occasions for the full Examination of Anomalous Self Disorders and for four out of the five domains. For one domain, the level of self-disorders increased slightly from baseline to follow-up. The correlations between baseline and follow-up were moderate. 9 out of the 13 most-frequently rated items at baseline showed equal frequencies at follow-up. The baseline level of self-disorders predicted global symptomatic, but not functional outcome. Self-disorders measured by the Examination of Anomalous Self Experiences show a high level of temporal persistence over 5 years and predict symptomatic outcome.

Intersubjectivity and Psychopathology in the Schizophrenia Spectrum: Complicated We, Compensatory Strategies, and Self-Disorders.

Recent studies in phenomenological psychopathology emphasize the importance of intersubjectivity for our understanding of schizophrenia. Yet, the central role of the "we" in social experience and engagement is largely absent from this literature. Our study explores the relation between psychopathology and intersubjectivity in the schizophrenia spectrum through the prism of the "we." First, we explore the role of intersubjectivity in the current schizophrenia spectrum definitions and discuss the main contemporary research trends. Second, we recollect some of the classical accounts of schizophrenia, which offer a different perspective on the pervasive and often persistent intersubjective difficulties in these conditions. Third, capitalizing on recent advances in collective intentionality studies, we present and discuss a conceptual framework of the "we" and of how the "we" may be disrupted in schizophrenia. Through this framework and with the use of clinical vignettes, we elicit 3 compensatory strategies, which, we suggest, reflect a fragile sense of "we" in the schizophrenia spectrum, i.e. (i) positive withdrawal, (ii) imposing a goal-oriented, spatiotemporal structure on intersubjective engagement, and (iii) preferring social activities with a clear attribution of social roles and rules. Finally, we discuss the relation between anomalous self-experiences (i.e. self-disorders) and the complicated "we."