An investigation of the experience of control through the sense of agency in people with obsessive-compulsive disorder: a review and meta-analysis.

The construct of sense of agency (SoA) has proven useful for understanding mechanisms underlying obsessive-compulsive disorder (OCD) phenomenology, especially in explaining the apparent dissociation in OCD between actual and perceived control over one's actions. Paradoxically, people with OCD appear to experience both diminished SoA (feeling unable to control their actions) and inflated SoA (having "magical" control over events). The present review investigated the extent to which the SoA is distorted in OCD, in terms of both implicit (ie, inferred from correlates and outcomes of voluntary actions) and explicit (ie, subjective judgment of one's control over an outcome) measures of SoA. Our search resulted in 15 studies that met the criteria for inclusion in a meta-analysis, where we also examined the potential moderating effects of the type of measure (explicit versus implicit) and of the actual control participants had over the outcome. We found that participants with OCD or with high levels of OCD symptoms show lower implicit measures of SoA and at the same time tend to overestimate their control in situations where they do not actually have it. Together, these findings support the hypothesized dissociation in OCD between actual and perceived control over one's actions.

Uncovering the Motor Dynamics of Obsessive-Compulsive Rituals Through Cluster Analysis.

ABSTRACT: Rituals represent a prominent human behavior in different contexts such as daily routines, life cycle stages, and psychopathology, for example, obsessive compulsive disorder (OCD) where they are referred to as compulsions. OCD compulsions differ from habitual behaviors and stereotypies regarding their formal features: acts repetition, the addition of nonfunctional acts, and attentional focus on basic motor units. This study aims to categorize OCD compulsions based on the motor patterns of acts repetition and inclusion of nonfunctional acts. We analyzed 28 video-recorded OCD compulsions; we adopted a cluster analytic model to identify distinct patterns within the data and determine cluster characteristics. Our findings revealed a moderate negative covariance between nonfunctionality and repetitiveness, indicating that as nonfunctionality increased, repetitiveness decreased. Three distinct clusters in OCD rituals were identified according to the motor pattern: "idiosyncratic rituals," characterized by strong incorporation of nonfunctional acts; "iterative rituals" showing high repetitiveness; and "routines," with minimal repetition and limited inclusion of nonfunctional acts. These motor patterns highlight evolutionarily conserved behavioral strategies aimed at coping with conditions of environmental unpredictability. The findings might allow fine-grained discrimination of ritual compulsions and help target personalized interventions.

The Evolution of Symbolic Thought: At the Intersection of Schizophrenia Psychopathology, Ethnoarchaeology, and Neuroscience.

The human capacity for symbolic representation arises, evolutionarily and developmentally, from the exploitation of a widespread sensorimotor network, along a fundamental continuity between embodied and symbolic modes of experience. In this regard, the fine balancing between constrained sensorimotor connections (responsible for self-embodiment processing) and more untethered neural associations (responsible for abstract and symbolic processing) is context dependent and plastically neuromodulated, thus intersubjectively constructed within a specific socio-cultural milieu. Instead, in the schizophrenia spectrum this system falls off catastrophically, due to an unbalance toward too unconstrained sensorimotor connectivity, leading to a profound distortion of self/world relation with a symbolic activity detached from its embodied ground. For this very reason, however, schizophrenia psychopathology may contribute to unveil, in a distorted or magnified way, ubiquitous structural features of human symbolic activity, beneath the various, historically determined cultural systems. In this respect, a comparative approach, linking psychopathology and ethnoarchaeology, allows highlight the following invariant formal characteristics of symbolic processing: (1) Emergence of salient perceptive fragments, which stand out from the perceptual field. (2) Spreading of a multiplicity of new significances with suspension of common-sense meaning. (3) Dynamic and passive character through which meaning proliferation is experienced. This study emphasizes the importance of fine-grained psychopathology to elucidate, within a cross-disciplinary framework, the evolutionarily and developmental pathways that shape the basic structures of human symbolization.

The Role of Shame in Schizophrenia Delusion: The Interplay Between Cognitive-Perceptual and Emotional Traits.

ABSTRACT: Through a strictly dimensional approach, the present study aimed at evaluating the interplay between cognitive-perceptual disturbances and emotional dispositions, particularly shame proneness, in schizophrenia delusion. One hundred one outpatients with schizophrenia were administered the Peters et al. Delusions Inventory, the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS), the Perceptual Aberration Scale (PAS), the Positive and Negative Affect Schedule and the Experiences of Shame Scale (ESS). The severity of delusional ideation was positively related to all the cognitive-perceptual scales (REF, MIS, and PAS) and to shame proneness (ESS). Referential thinking (REF) emerged as the strongest predictor of delusion severity. The experience of shame played a mediation role in the relationship between cognitive-perceptual traits and delusional severity. These data suggest that severity delusion in schizophrenia depends, at least in part, on a complex interplay between cognitive-perceptual disturbances and experiences of shame.

The motor profile of obsessive-compulsive rituals: psychopathological and evolutionary implications.

BACKGROUND: Studies investigating obsessive-compulsive disorder from an ethological approach have highlighted a specific motor pattern of compulsive rituals with respect to corresponding ordinary behaviors. Particularly, compulsive motor profile is built through the repetition of acts, with prevalence of nonfunctional ones and redirection of attention to its basic structural units. These formal features would characterize ritual behavior throughout evolution, from nonhuman animals to human cultures. However, no study to date has investigated a possible relationship between such motor profile and underlying psychopathology. Therefore, the first objective of the study was to confirm previous findings on a larger sample size of obsessive patients; the second objective was to elucidate whether motor profile might be associated with obsessive-compulsive psychopathology and/or prepsychotic symptoms of schizophrenia. METHODS: Twenty-one obsessive-compulsive outpatients provided a videotape of their rituals. An equal number of healthy controls, matched for sex and age, were registered for corresponding ordinary acts. Obsessive patients were administered the Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Hamilton Rating Scale for Depression, and the Frankfurt Complaint Questionnaire. RESULTS: The results of the present study confirm that ritual compulsions present a specific motor structure characterized by repetition of both functional and nonfunctional acts and their longer duration. Such a motor pattern is independent from obsessive-compulsive psychopathology, whereas it results specifically associated with prepsychotic symptoms of schizophrenia. CONCLUSIONS: We argue that this association may reflect the adaptive significance of ritual behavior across evolution, that is, its homeostatic function in conditions of unpredictability.

A clinical investigation of psychotic vulnerability in early-onset Obsessive-Compulsive Disorder through Cognitive-Perceptive basic symptoms.

Childhood-onset Obsessive-Compulsive Disorder (OCD) shows distinct comorbidity patterns and developmental pathways, as well as an increased risk of psychosis with respect to adult-onset forms. Nevertheless, little is known about the prodromal symptoms of psychosis in children and adolescents with a primary diagnosis of OCD. The present study was aimed at evaluating the occurrence of Cognitive-Perceptual basic symptoms (COPER) and high- risk criterion Cognitive Disturbances (COGDIS) in pediatric and adults OCD patients, verifying if they might vary according to the age of onset of OCD. The study included 90 outpatients with a primary diagnosis of obsessive-compulsive disorder. The study sample was collapsed into three groups according to the age at onset: 1) very early onset group (< 10 years); 2) early onset group (11-18 years); 3) adult-onset group (> 18 years). All patients were administered the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), the Schizophrenia Proneness Instrument-Adult (SPIA) and its Child and Adolescent version (SPI-CY) and the Social and Occupational Functioning Assessment Scale (SOFAS). COPER and COGDIS symptoms were positively associated with OCD severity and detectable, respectively, in 28.9 and 26.7% of our study sample. The very early onset group significantly had higher COPER and COGDIS symptoms than the adult-onset group. Our data suggest that COPER and COGDIS symptoms are frequent in obsessive patients, in particular in those with earlier onset; therefore, their detection in childhood-onset OCD may represent an early and specific indicator of psychotic vulnerability.

Conversational metrics, psychopathological dimensions and self-disturbances in patients with schizophrenia.

Difficulties in interpersonal communication, including conversational skill impairments, are core features of schizophrenia. However, very few studies have performed conversation analyses in a clinical population of schizophrenia patients. Here we investigate the conversational patterns of dialogues in schizophrenia patients to assess possible associations with symptom dimensions, subjective self-disturbances and social functioning. Thirty-five schizophrenia patients were administered the Positive and Negative Syndrome Scale (PANSS), the Clinical Language Disorder Rating Scale (CLANG), the Scale for the Assessment of Thought, Language and Communication (TLC), the Examination of Anomalous Self-Experience Scale (EASE), and the Social and Occupational Functioning Assessment Scale (SOFAS). Moreover, participants underwent a recorded semi-structured interview, to extract conversational variables. Conversational data were associated with negative symptoms and social functioning, but not with positive or disorganization symptoms. A significant positive correlation was found between "pause duration" and the EASE item "Spatialization of thought". The present study suggests an association between conversational patterns and negative symptom dimension of schizophrenia. Moreover, our findings evoke a relationship between the natural fluidity of conversation and of the natural unraveling of thoughts.

The Affective Core of Delusional Disorder.

The aim of the present study is to investigate the relationship between personality, trait affectivity, and severity of delusions in patients with delusional disorder (DD). Thirty-two outpatients affected by DD were administered the Structured Interview for DSM-IV-TR Personality Disorders (SIDP-IV), the Pathological Narcissism Inventory (PNI), the Positive and Negative Affect Schedule (PANAS), and the Psychotic Symptom Rating Scale (PSYRATS). We analyzed the prevalence of personality disorder in our sample of patients with DD and studied the correlations between the severity of delusions and the different affective variables. Finally, we obtained a multivariate explanatory model of the severity of the delusions. The severity of delusions was directly associated with "grandiose fantasy" item of narcissistic personality and inversely related with the feelings of shame, fear, and guilt. In the multivariate model, the feeling of shame was the only independent variable capable of accounting for the severity of delusions that, in DD patients, would lie on an affective core of shame.

The "Obsessive Paradox": The Complex Relationship Between Cognitive and Obsessive Dimensions in Schizophrenia.

The objective of the study was to investigate the relationship between cognitive functions and obsessive-compulsive dimension in schizophrenia and a possible moderating effect of schizophrenia symptom dimensions on this association. Sixty-one schizophrenia patients were administered the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and the Matrics Consensus Cognitive Battery. A U-shaped curve described a gradual transition from an inverse association to a positive relationship between YBOCS and processing speed scores, along a severity gradient of obsessive dimension. This effect ("the obsessive paradox") was not moderated by other symptom dimensions. The present study suggests that severe obsessive-compulsive symptoms may participate to counterbalance processing speed impairment independently from other symptom dimensions. These results highlight the complexity of the relationship between cognitive and obsessive dimensions in schizophrenia.

Temperament and Depression After a First Acute Coronary Syndrome.

Few studies assess the role of personality styles in predicting the onset of depression among cardiac patients. This study evaluates whether temperament and character can represent a risk factor for the development of incident first-ever depressive episodes in patients at their first acute coronary syndrome (ACS). Two hundred sixty-seven (72.1%) subjects (male) completed the Temperament and Character Inventory (TCI) a few days after the cardiac event. At baseline and after 1, 2, 4, 6, 9, 12, and 24 months of follow-up, the participants completed the Primary Care Evaluation of Mental Disorder (PRIME-MD) and the Hospital Anxiety and Depression Scale to establish the presence of a depressive episode and its severity. During the follow-up, 61 (22.8%) participants developed a depressive episode. Temperamental risk factors for incident depression were scored high on novelty seeking and harm avoidance at the TCI. Given the detrimental effect of depression on cardiac prognosis, clinicians should take temperament variables into account when determining the treatment plans of their patients with ACS.

Delusional disorder: The role of personality and emotions on delusional ideation.

The relationship between personality and Delusional Disorder in still debated. The present study aimed to evaluate the role of personality features and emotional dispositions on the proneness to delusional beliefs, through the lens of a dimensional approach. 91 outpatients were administered the Structured Interview for DSM-IV Personality Disorders, the Pathological Narcissism Inventory, the Positive and Negative Affect Schedule and the Peters et al. Delusions Inventory. Delusion proneness was positively related to the "Hiding the Self" domain of narcissistic vulnerability and to paranoid traits and negatively related to "Positive Affect". Paranoid traits and "Hiding the Self" significantly interacted in influencing delusion ideation. These data suggest that proneness to delusion depends, at least in part, on a complex interplay between specific emotional and paranoid dispositions within personality.

Obsessive-compulsive symptom severity in schizophrenia: a Janus Bifrons effect on functioning.

The impact of obsessive-compulsive symptoms on functioning in schizophrenia is still debated. This study investigated the relationship between OC symptoms and functioning along a severity gradient of obsessive-compulsive dimension. Sixty patients affected by schizophrenia completed the SCID-IV, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale and the Social and Occupational Functioning Assessment Scale. The relationship between functioning and obsessive-compulsive dimension was described by a reverse U-shaped curve; functioning was positively related to the presence of mild obsessive-compulsive symptoms and inversely related to moderate and severe symptoms, after controlling for the severity of positive, negative, disorganization and general psychopathological symptoms. The role of obsessive-compulsive symptoms on social functioning in schizophrenia occurs along a severity continuum with a gradual transition from a positive correlation (from absent to mild symptoms) to an inverse correlation (for symptoms ranging from moderate to severe) and independently from schizophrenia symptom dimensions.

The role of alexithymia in predicting incident depression in patients at first acute coronary syndrome.

OBJECTIVE: Alexithymia has been considered both to predispose to depression and to worsen cardiac prognosis after an acute coronary syndrome. Nonetheless, no studies have evaluated its role as a risk factor for incident depression, in patients with acute coronary syndrome. METHODS: In 251 consecutive patients, the presence of a first-ever depressive episode was evaluated with the Primary Care Evaluation of Mental Disorders at baseline and 1, 2, 4, 6, 9, 12 and 24 months after their first acute coronary syndrome. At baseline, patients completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale. RESULTS: Out of 251 subjects (80.9% males), a first-ever depressive episode was diagnosed in 66 patients. Depressed and never-depressed patients differed in female gender, living status, alexithymic scores at TAS-20 and depressive symptoms. Nonetheless, nor the TAS-20 factors nor its total score were predictive of developing a depressive episode in a Cox regression. Moreover, baseline differences in TAS-20 scores between the two groups, disappeared after controlling for anhedonic symptoms. CONCLUSION: Our results do not support the hypothesis that alexithymia at TAS-20 is a risk factor for incident depression after acute coronary syndrome.

Anhedonia in schizophrenia: The role of subjective experiences.

BACKGROUND: High levels of anhedonia have been found in patients with schizophrenia; specifically they report higher levels of social anhedonia rather than physical anhedonia, and further, in the anticipatory rather than consummatory facets of pleasure. Nonetheless, contrasting results emerged regarding the underlying mechanisms of this deficit. Basic Symptoms (BS) disturb subjective experiences present for most of the illness' course; this impacts patients' daily lives leading to a loss of the ability to organize the experience of the self and the world in a fluid and automatic way. Considering the role played by negative emotions in the subjective evaluation of anhedonia, the aim of the study is to clarify the role of BS in the assessment of anhedonia in a sample of patients with schizophrenia (n=53) compared with healthy controls (n=46). METHODS: Participants completed a self-administered trait questionnaire evaluating social anhedonia (Revised-Social Anhedonia Scale), physical anhedonia (Physical Anhedonia Scale), and the consummatory and anticipatory pleasure experiences (Temporal Experience of Pleasure Scale). BS were evaluated with the Frankfurter Beschwerde-Frageboden (FBF) whereas psychopathology was assessed with the Positive and Negative Syndromes Scale. RESULTS: Patients scored higher than healthy controls in social, physical and anticipatory anhedonia, but not in consummatory anhedonia and these relationships were mediated by the FBF. Basic Symptoms of Memory, Overstimulation and Lack of Automatism were related to some facets of anhedonia, independently from depressive symptoms. CONCLUSIONS: We hypothesize that a subjective cognitive deficit and a reduced ability in information processing, could prevent patients from retaining a positive experience from past pleasant activities. Therefore the lack of pleasure would be, at least in part, related to an avoidance of potentially stressful new scenarios.

Decrease of functioning in remitted and non-remitted patients 16 years after a first-episode schizophrenia.

In schizophrenia, a better level of functioning has been generally associated with symptomatic remission. However, this association has been supported by cross-sectional studies or by studies with a short follow-up period. Forty-eight patients with schizophrenia were evaluated by the Positive and Negative Symptoms Scale and the Social and Occupational Functioning Assessment Scale (SOFAS) at the first episode and after a mean period of 16 years. At follow-up, patients were defined as remitters (R) or non-remitters (NR) according to the Remission Schizophrenia Working Group criteria. R (n = 18; 37.5%) compared to NR showed at the first episode a lower illness severity and a better level of functioning. A functional decline was found in both groups at follow-up, even though NR showed a more than twofold reduction than R. Better SOFAS scores at follow-up were predicted by baseline SOFAS score and less severe negative symptoms at follow-up. Schizophrenia implies a functional decline over time, regardless of the symptomatic remission status with negative symptoms playing a major role.

Mirroring the self: testing neurophysiological correlates of disturbed self-experience in schizophrenia spectrum.

BACKGROUND: Self-disorders (SDs) have been described as a core schizophrenia spectrum vulnerability phenotype, both in classic and contemporary psychopathological literature. However, such a core phenotype has not yet been investigated adopting a trans-domain approach that combines the phenomenological and the neurophysiological levels of analysis. The aim of this study is to investigate the relation between SDs and subtle, schizophrenia-specific impairments of emotional resonance that are supposed to reflect abnormalities in the mirror neurons mechanism. Specifically, we tested whether electromyographic response to emotional stimuli (i.e. a proxy for subtle changes in facial mimicry and related motor resonance mechanisms) would predict the occurrence of anomalous subjective experiences (i.e. SDs). SAMPLING AND METHODS: Eighteen schizophrenia spectrum (SzSp) patients underwent a comprehensive psychopathological examination and were contextually tested with a multimodal paradigm, recording facial electromyographic activity of muscles in response to positive and negative emotional stimuli. Experiential anomalies were explored with the Bonn Scale for the Assessment of Basic Symptoms (BSABS) and then condensed into rational subscales mapping SzSp anomalous self-experiences. RESULTS: SzSp patients showed an imbalance in emotional motor resonance with a selective bias toward negative stimuli, as well as a multisensory integration impairment. Multiple regression analysis showed that electromyographic facial reactions in response to negative stimuli presented in auditory modality specifically and strongly correlated with SD subscore. CONCLUSIONS: The study confirms the potential of SDs as target phenotype for neurobiological research and encourages research into disturbed motor/emotional resonance as possible body-level correlate of disturbed subjective experiences in SzSp.

DS14 is more likely to measure depression rather than a personality disposition in patients with acute coronary syndrome.

It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three-hundred-and-four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re-evaluated at 1, 2, 4, 6, 9 and 12-month follow-ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS-D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co-vary with HADS-D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition.

Late-onset obsessive-compulsive disorder associated with left cerebellar lesion.

The onset of obsessive-compulsive disorder (OCD) after age 50 is rare and generally related to an organic etiology. An involvement of fronto-striatal circuits has been strongly suggested, whereas cerebellum remains so far scarcely explored. We present here the description of a "pure" late-onset OCD associated with a cerebellar lesion, neither comorbid with other mental disorders nor with neurological syndromes. To our knowledge, this condition was not previously described in literature. The patient is a 62-year-old woman who developed a late-onset OCD associated with a left cerebellar lesion due to an arachnoid cyst in the left posterior fossa. We debate the possible role of the cerebellar lesion in favoring a transition from a predisposing liability (namely an obsessive-compulsive personality disorder and a depressive status) to the onset of OCD in this woman.

The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders.

BACKGROUND: This study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression. METHODS: Thirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D). RESULTS: The differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels. CONCLUSIONS: Our data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself.