Abnormal Body Phenomena in Persons with Major Depressive Disorder.

BACKGROUND: Depressive disorders, despite being classified as mood or affective disorders, are known to include disturbances in the experience of body, space, time, and intersubjectivity. However, current diagnostic manuals largely ignore these aspects of depressive experience. In this article, we use phenomenological accounts of embodiment as a theoretical foundation for a qualitative study of abnormal body phenomena (ABP) in depressive disorders. METHODS: 550 patients affected by schizophrenic and affective disorders were interviewed in a clinical setting. Interviews sought to uncover the qualitative features of experiences through self-descriptions. Clinical files were subsequently digitized and re-examined using consensual qualitative research. RESULTS: Ninety-nine out of 100 patients with MDD reported at least one ABP. From cross-analysis of the MDD sample, we obtained 4 general categories of ABP, 3 of which had additional subcategories. The 4 categories include slowed embodied temporality (N = 90), anomalous vital rhythms (N = 82), worries about one's body (N = 22), and body deformation (N = 47). CONCLUSIONS: The results provide empirical evidence in support of theoretical discussions of embodiment in MDD found in the work of classical and contemporary phenomenologists. The findings also provide nuanced insight into the experience of persons living with MDD. Some categories of ABP, like slowed embodied temporality, can help to finely characterize psychomotor retardation or the so-called "medically unexplained symptoms" (MUS). This fine-tuned characterization can help to connect MUS to neuropsychological and neurobiological (e.g., alterations of interoceptive processes linked to anomalies of the brain resting-state hypothesis) and inflammatory (e.g., studies linking environmental stressors, inflammation mediators, and neurovegetative and affective symptoms) models of MDD. Our results can also support a pathogenic model of MDD, which posits, on the phenomenal level, ABP as the point of departure for the development of secondary symptoms including cognitive elaborations of these, namely, delusions about the body. Moreover, some of the categories, when contrasted with phenomenological qualitative studies of other disorders, provide conceptual resources of differential diagnosis and of identifying a "depressive core syndrome." For example, findings within category 4, deformation of the body, provide resources for using ABP to distinguish between MDD and schizophrenia.

Abnormal Space Experiences in Persons With Schizophrenia: An Empirical Qualitative Study.

Abnormal space experience (ASE) is a common feature of schizophrenia, despite its absence from current diagnostic manuals. Phenomenological psychopathologists have investigated this experiential disturbance, but these studies were typically based on anecdotal evidence from limited clinical interactions. To better understand the nature of ASE in schizophrenia and attempt to validate previous phenomenological accounts, we conducted a qualitative study of 301 people with schizophrenia. Clinical files were analyzed by means of Consensual Qualitative Research, an inductive method for analyzing descriptions of lived experience. Our main findings can be summed up as follows: (1) ASEs are a relevant feature in schizophrenia (70.1% of patients reported at least 1 ASE). (2) ASE in schizophrenia are characterized by 5 main categories of phenomena (listed from more represented to less represented): (a) experiences of strangeness and unfamiliarity (eg "Everything appeared weird. Face distorted, world looks terrible, nasty"); (b) experiences of centrality/invasion of peripersonal space (eg "Handkerchief on scaffolding: message telling him something"); (c) alteration of the quality of things (eg "Buildings leaning down"); (d) alteration of the quality of the environment (eg "Person sitting six feet away seemed to be at an infinite distance"); and (e) itemization and perceptive salience (eg "All patients [in ward] have bright eyes"). (3) ASEs are much more frequent in acute (91.9%) than in chronic (28.15%) schizophrenia patients. Moreover, our findings further empirical support for phenomenological accounts of schizophrenia, including those developed by Jaspers, Binswanger, Minkowski, and Conrad, among others and provide the background for translational research.

A meta-analysis of the core essence of psychopathological entities: an historical exercise in phenomenological psychiatry.

Two fundamentally different approaches among phenomenological psychopathologists can be discerned. One is what we call fixed essentialism, where the pathognomonic element of, say, schizophrenia is conceived of as a single, enduring and intrinsically morbid way of grasping all entities in the world, including self and body. The other, which we call dialectical essentialism, accounts for the same manifestations of, say, schizophrenia, but through a process which is not life-enduring, and, most critically vis-à-vis the former formulation, is not in itself a single morbid defect: a morbid pattern of world, self and body is achieved by an imbalance between two or more otherwise healthy constituents of the 'normal' human being, whose imbalance and attempts to resolve this - the dialectic - induce the 'morbidity'.

Abnormal Time Experiences in Major Depression: An Empirical Qualitative Study.

BACKGROUND: Phenomenological psychopathology, through theoretical and idiographic studies, conceptualizes major depressive disorder (MDD) as a disorder of time experience. Investigations on abnormal time experience (ATE) in MDD adopting methodologies requested by the standards of empirical sciences are still lacking. Our study aimed to provide a qualitative analysis, on an empirical ground and on a large scale, of narratives of temporal experiences of persons affected by MDD. METHODS: We interviewed 550 consecutive patients affected by affective and schizophrenic disorders. Clinical files were analysed by means of consensual qualitative research. RESULTS: Out of 100 MDD patients, 96 reported at least 1 ATE. The principal categories of ATE are vital retardation - the experience of a stagnation of endogenous vital processes (37 patients), the experience of present and future dominated by the past (29 patients), and the experience of the slackening of the flow oftime (25 patients). A comparison with ATE in schizophrenia patients showed that in MDD, unlike in schizophrenia, there is no disarticulation of time experience (disorder of temporal synthesis) but rather a disorder of conation or inhibition of becoming. LIMITATIONS: The interview style was not meant to make a quantitative assessment ("false negatives" cannot be excluded). CONCLUSIONS: Our findings confirm the relevance of distinctive features of ATE in MDD, support the hypothesis of an intrinsic disordered temporal structure in depressive symptoms, and may have direct implications in clinical practice, especially in relation to differential diagnosis, setting the boundaries between "true" and milder forms of depression, and neurobiological research.

Max Scheler's influence on Kurt Schneider.

Kurt Schneider (1887-1967) met Max Scheler (1874-1928) in 1919 when he enrolled in the latter's philosophy seminars at the University of Cologne. Kurt Schneider was then a junior psychiatrist and Max Scheler a renowned philosophy professor and co-founder of the phenomenological movement in philosophy. We uncover the facts about their intellectual and personal relationship, summarize the main articles and books that they wrote and consider whether Max Scheler did influence the young Kurt Schneider. We conclude that Scheler's philosophy of emotion impressed Schneider, and that the latter's notion of 'vital depression' as the core element in melancholia was essentially applied Schelerian philosophy. Schneider's more celebrated contributions to psychiatry - his notion of first rank symptoms of schizophrenia - owed nothing to Scheler or any other philosopher.

Psychopathology of Lived Time: Abnormal Time Experience in Persons With Schizophrenia.

Abnormal time experience (ATE) in schizophrenia is a long-standing theme of phenomenological psychopathology. This is because temporality constitutes the bedrock of any experience and its integrity is fundamental for the sense of coherence and continuity of selfhood and personal identity. To characterize ATE in schizophrenia patients as compared to major depressives we interviewed, in a clinical setting over a period of 15 years, 550 consecutive patients affected by schizophrenic and affective disorders. Clinical files were analyzed by means of Consensual Qualitative Research (CQR), an inductive method suited to research that requires rich descriptions of inner experiences. Of the whole sample, 109 persons affected by schizophrenic (n = 95 acute, n = 14 chronic) and 37 by major depression reported at least 1 ATE. ATE are more represented in acute (N = 109 out of 198; 55%) than in chronic schizophrenic patients (N = 14 out of 103; 13%). The main feature of ATE in people with schizophrenia is the fragmentation of time experience (71 out of 109 patients), an impairment of the automatic and prereflexive synthesis of primal impression-retention-protention. This includes 4 subcategories: disruption of time flowing, déjà vu/vecu, premonitions about oneself and the external world. We contrasted ATE in schizophrenia and in major depression, finding relevant differences: in major depressives there is no disarticulation of time experience, rather timelessness because time lacks duration, not articulation. These core features of the schizophrenic pheno-phenotype may be related to self-disorders and to the manifold of characteristic schizophrenic symptoms, including so called bizarre delusions and verbal-acoustic hallucinations.

The bodily self: a qualitative study of abnormal bodily phenomena in persons with schizophrenia.

Subtle anomalies of bodily experience have for long been described as relevant features of schizophrenia spectrum disorders, however such disturbing and alienating experiences are usually neglected in routine clinical examination. The overarching aim of this qualitative study is to offer an experience-close mapping of abnormal bodily phenomena (ABP) in patients with schizophrenia that might assist clinical examination and inform the development of dedicated assessment tools. We followed a stepwise methodology: first, data from n=550 clinical interviews were analyzed adopting consensual qualitative research (CQR) inductive method in order to identify relevant clusters of ABP. Then, ABP profiled in schizophrenia patients (n=301) were contrasted with ABP identified in patients affected by major depression (n=56). 70% of the interviewees in the schizophrenia sample reported anomalies of lived corporeality, that could be condensed in the following categories: Dynamization, Morbid objectivation, Dysmorphic-like phenomena and Pain-like phenomena. Those appeared to be reducible to two core features that were not paralleled in the affective disorder sample: dynamization (e.g. ongoing bodily feelings of disintegration/violation) and thingness/mechanization (e.g. one's body experienced as a object-like mechanism). We suggest that dynamization and thingness/mechanization might be considered schizophrenia-specific experiential phenotypes that can contribute to early differential diagnosis of somatic complaints in mental health help-seekers.

Ernst Cassirer's Philosophy of Symbolic Forms and its impact on the theory of psychopathology.

The philosopher Ernst Cassirer (1874-1945) wrote in 1929: 'For what it [the philosophy of symbolic forms] is seeking is not so much common factors in being as common factors in meaning. Hence we must strive to bring the teachings of pathology, which cannot be ignored, into the more universal context of the philosophy of culture' (Cassirer, 1955: 275). This statement summarizes his approach in shifting the focus on psychopathological theory from the brain and its localizations to the living interaction between the self and his/her social environment. The present article looks at the impact of symbol theory on psychopathology - pre- and post-Cassirer's main oeuvre Philosophie der symbolischen Formen - and whether his concept still has a role to play in an ontology of psychopathology.

Abnormal bodily experiences may be a marker of early schizophrenia?

The purpose of this study is to answer the following question: What are the typical features of abnormal bodily experiences (ABEs) in persons affected by acute first-episode schizophrenia? Our overall objective is to contribute to enhance early diagnosis of schizophrenia, and providing supplementary diagnostic criteria especially for ultra-high risk patients. In a group of 39 patients with first-episode schizophrenia selected from a sample of 393 psychotic patients, 30 (76.9 %) reported ABEs. By means of a phenomenologically-based qualitative method of inquiry, we recognized four subtypes of ABEs whose main characteristics are dynamization of bodily boundaries and construction, morbid objectivization/devitalization, dysmorphic experiences and pain-like experiences. These four typologies of ABEs are documented through the patients' first-person self-descriptions, and then operationally defined. Two main properties emerge as tentative eidetic (defining) cores of ABEs in early schizophrenia: dynamization of bodily boundaries and construction, and morbid objectivization/devitalization. Sharpening the diagnostic sensibility for typically schizophrenic ABEs can help improve differential diagnosis between schizophrenia and other disorders entailing other types of anomalies of lived corporeality. Also, studying possible transitions from schizophrenic cenesthopathies to bodily delusions in persons with schizophrenia may refine the concept of bizarre delusions by improving its validity. Furthermore, our knowledge about the pathogenesis of schizophrenia may profit from an in-depth assessment of ABEs and their relationship with an abnormal sense of selfhood, especially in early schizophrenia.

Are people with schizophrenia more logical than healthy volunteers?

We tested a phenomenological hypothesis about theoretical and practical rationality in people with schizophrenia. This hypothesis states that in schizophrenia there is an enhancement of theoretical rationality. Our case-control experiment supported this hypothesis. Philosophical models of rationality that prioritise theoretical over practical rationality may thereby apply more in schizophrenic than in healthy states. The study is an example of how experimental psychopathology can illuminate areas of philosophical dispute that are difficult to settle by thought alone.

Auditory verbal hallucinations--breaking the silence of inner dialogue.

Auditory verbal hallucinations (AVHs) are usually defined as perceptions of speech that occur in the absence of any appropriate external stimulus. This definition, we argue, is false. We maintain that AVHs are disorders of self-consciousness that are best understood as the becoming conscious of inner dialogue. Normally, subconscious interior conversations are experienced as a sense of partnership between distinct parts: we feel these parts as distinct, but also integrated and collaborating with each other in decision-making and in self-representation. AVHs attest to a breakdown in this process of interior conversation: the feeling of unity in duality falls apart, and the dialectic partnership on which self-representation is grounded shatters into a mere dichotomy. There is a fracture in self-consciousness. If ipseity (i.e. the prereflective modality of self-awareness, the self-feeling of one's own self in which the one who feels and what is felt is but one thing) is lacking, the sense of unity weakens, and the sense of duality increases. This crisis of ipseity is accompanied by an increase of reflexivity (i.e. the process through which I take a part of myself as a focal object of awareness). Hyperreflexivity contributes to the objectification of the sense of duality and to the loss of the sense of 'myness' of inner speech. In schizophrenics, inner dialogue becomes anomalously manifest. Whereas in normal conditions, inner dialogue is the medium for self-representation, AVHs arise through its morbid objectification: inner speech comes to the foreground in the concrete fashion of alien 'voices'.

Encuesta sobre parasitismo intestinal en una localidad del este de Panamá en las cercanías de la Carretera Panamericana / A survey of intestinal parasitism in a community on the Pan American Highway route on eastern Panama

La construcción de la Carretera Panamericana en la zona este de Panamá ejerce una acción notable por lo que toca a cambios en el medio. Para efectuar las futuras evaluaciones acerca del impacto que estos cambios tendrán sobre la salud de esa región se necesitará recurrir a datos básicos sobre las condiciones de salud ya existentes. Este artículo da cuenta de los resultados de una encuesta sobre parasitismo intestinal en una comunidad a la que aún no ha llegado la Carretera (AU)

A survey of intestinal parasitism in a community on the Pan American Highway route in eastern Panama

A survey of intestinal parasitism was conducted at Yaviza, a town in eastern Panama's Province of Darien. Single stool specimens from 202 persons, representing 11 percent of the town's total population, were examined. In all, 181 (90 per cent) of the specimens examined were found positive for one or more potentially pathogenic parasites. The most common parasite found was Trichuris trichiura, which was observed in 80 per cent of the samples. Others were Ascaris lumbricoides, in 62 per cent of the samples; hookworm, in 41 per cent; Entamoeba histolytica, in 16 per cent; Stronhyloides stercoralis, in 7 per cent; Giardia lamblia, in 5 per cent; and Hymenolepis diminuta, in 0.5 per cent. The aim of the survey was to gather baseline data on parasite prevalence before the Pan American Highway passes through this area. Construction of the highway is producing marked environmental change. in eastern Panama, and it is anticipated that the date from the survey will prove useful in later efforts to assess the health impact of that change (Au)

Encuesta sobre parasitismo intestinal en una localidad del este de Panamá en las cercanías de la Carretera Panamericana / A survey of intestinal parasitism in a community on the Pan American Highway route on eastern Panama

La construcción de la Carretera Panamericana en la zona este de Panamá ejerce una acción notable por lo que toca a cambios en el medio. Para efectuar las futuras evaluaciones acerca del impacto que estos cambios tendrán sobre la salud de esa región se necesitará recurrir a datos básicos sobre las condiciones de salud ya existentes. Este artículo da cuenta de los resultados de una encuesta sobre parasitismo intestinal en una comunidad a la que aún no ha llegado la Carretera (AU)