Anomalías de la experiencia subjetiva en psicosis: Concepto y validación empírica del modelo de los Síntomas Básicos / Anomalies of subjective experience in psychosis: Concept and empirical validation of the Basic Symptoms model

Introducción Tradicionalmente, en la investigación, el diagnóstico y el tratamiento de los trastornos del espectro psicótico ha imperado un modelo de comprensión objetivista, centrado principalmente en los síntomas positivos y negativos. Aunque es innegable el valor de esta aproximación, implica considerables limitaciones ampliamente conocidas. De forma complementaria, existe una larga y prometedora tradición fenomenológica en la cual la experiencia subjetiva del síntoma del paciente adquiere una importancia fundamental. La aproximación de las anomalías de la experiencia subjetiva o, específicamente, de los Síntomas Básicos ha adquirido mucha fuerza dentro del contexto de detección precoz de psicosis y esquizofrenia. Objetivo Esta revisión expone la aproximación fenomenológica de las anomalías de la experiencia subjetiva y se define detalladamente el modelo de los Síntomas Básicos, así como su proceso de validación empírica en el campo de detección precoz de psicosis. Método Las bases de datos consultadas han sido PubMed Central® y PsycINFO®, así como libros de autores de referencia. Resultados En las dos últimas décadas ha habido un creciente interés científico sobre esta orientación con resultados muy prometedores. Discusión y conclusión El modelo más destacado a nivel empírico es el de los Síntomas Básicos, aunque recientemente también han ganado gran relevancia las alteraciones del flujo de la consciencia o del self. Se ha comprobado que las anomalías de la experiencia subjetiva consiguen delimitar un perfil de riesgo de psicosis más temprano que los síntomas psicóticos atenuados. Por tanto, son un complemento altamente válido en las estrategias de detección e intervención temprana de psicosis.

Introduction Research, diagnosis and treatment of psychotic spectrum disorders have been traditionally dominated by an objectivist approach to their understanding, being primarily focused on positive and negative symptoms. The value of this approach goes without question, but it also involves considerable and widely known limitations. From a complementary perspective, there is a longstanding and promising phenomenological tradition in which the subjective experience of the patient's symptom becomes crucial. The focus on the anomalies of subjective experience, or the Basic Symptom concept specifically, has gained much momentum in the context of early detection of psychosis and schizophrenia. Objective This review presents the phenomenological approach to the anomalies of subjective experience and the Basic Symptoms model and its empirical validation process in the field of early detection of psychosis. Method The scientific literature was collected from PubMed Central® and PsyclNFO® databases and books from authors of reference. Results In the last two decades there has been a growing scientific interest in this approach with very promising results. Discussion and conclusion The most prominent model from an empirical standpoint is the Basic Symptoms approach, although recently the disturbances of the flow of consciousness or self disorders have achieved great relevance as well. It has been found that the anomalies of subjective experience could delimitate a risk profile that precedes that defined by attenuated psychotic symptoms. Therefore, this approach is a highly valuable complement in the early detection and intervention of psychosis strategies.

Phenomenological Psychopathology / 신경정신의학

Phenomenology was founded in the 19th century by Edmund Husserl. Apart from natural sciences and metaphysics, phenomenology is presented as a rigorous scientific discipline, which aims to provide an understanding of the subjective experiences of human beings. After the eras of descriptive and dynamic psychiatry, phenomenological methods were adopted by psychiatry, and phenomenological psychopathology suggested a new perspective for understanding the pathological experiences of psychiatric patients. However, after the development of psychopharmacology and the operational diagnostic system, the center of phenomenology in psychopathology was moved from comprehensive understanding to simple description. Thus, phenomenological psychopathology in its original meaning did not get remarkable repercussions, especially in the English-speaking world. In this article, some major concepts of phenomenology will be briefly presented and then phenomenological psychopathology in its original meaning will be introduced. Secondly, as an example of its application, symptoms of schizophrenia will be interpreted in terms of phenomenological psychopathology. Finally, the authors will present a neurobiological interpretation of the phenomenological psychopathology of schizophrenia and suggest a possible role of phenomenological psychopathology in mitigating the impasse in psychiatric genetics research.

Basic Symptoms in Schizophrenic Patients / 신경정신의학

OBJECTIVES: This study is to explore the frequency of basic symptoms and their relationship with current clinical variables in patients with schizophrenia. METHODS: Eighty-eight schizophrenic patients diagnosed with SCID were interviewed with the Bonn Scale for the Assessment of Basic Symptom (BSABS) and Positive and Negative Syndrome Scale (PANSS). RESULTS: Most frequent basic symptoms were related to abnormalities in perception, cognition and stress reactivity. After controlling age effect, number of admission was correlated negatively with cluster 3 (impaired tolerance to normal stress). Onset age was correlated positively with cluster 3 and cluster 4 (disorders of emotion and affect) and total score. Scores of cluster 1 (thought, language, perception, motor disturbances), and cluster 2 (impaired bodily sensations), and total score of BSABS were significantly lower in paranoid type than residual type of schizophrenia. Scores of cluster 1, cluster 2, and total score of BSABS were correlated positively with subscales for positive and negative symptoms and general psychopathology and total score of PANSS. Cluster 3 was correlated positively only with general psychopathology score and cluster 4 with both positive symptoms and general psychopathology score. CONCLUSION: These findings suggest that certain basic symptoms aggregate significantly in schizophrenia, especially in paranoid type schizophrenia and that systemic evaluation of basic symptoms can be used for the prediction of onset and progress of schizophrenia.

Basic Symptoms in Schizophrenic Patients / 신경정신의학

OBJECTIVES: This study is to explore the frequency of basic symptoms and their relationship with current clinical variables in patients with schizophrenia. METHODS: Eighty-eight schizophrenic patients diagnosed with SCID were interviewed with the Bonn Scale for the Assessment of Basic Symptom (BSABS) and Positive and Negative Syndrome Scale (PANSS). RESULTS: Most frequent basic symptoms were related to abnormalities in perception, cognition and stress reactivity. After controlling age effect, number of admission was correlated negatively with cluster 3 (impaired tolerance to normal stress). Onset age was correlated positively with cluster 3 and cluster 4 (disorders of emotion and affect) and total score. Scores of cluster 1 (thought, language, perception, motor disturbances), and cluster 2 (impaired bodily sensations), and total score of BSABS were significantly lower in paranoid type than residual type of schizophrenia. Scores of cluster 1, cluster 2, and total score of BSABS were correlated positively with subscales for positive and negative symptoms and general psychopathology and total score of PANSS. Cluster 3 was correlated positively only with general psychopathology score and cluster 4 with both positive symptoms and general psychopathology score. CONCLUSION: These findings suggest that certain basic symptoms aggregate significantly in schizophrenia, especially in paranoid type schizophrenia and that systemic evaluation of basic symptoms can be used for the prediction of onset and progress of schizophrenia.

Relationships between Subjective Symptoms and Objective Psychopathology in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Kyung Hee-Frankfurter Beschwerde-Fragebogen(K-FBF) is a representative subjective symptom measuring tool of schizophrenic patients. We performed psychopathology measurements using K-FBF, Positive and Negative Syndrome Scale(PANSS) and Symptom Checklist-90-Revised(SCL-90-R) in patients with schizophrenia and then compared the results of these three examinations one another, in order to examine which psychopathologic aspects K-FBF might reflect and to measure the possibility whether this instrument reflect the negative symptoms or cognitive impairments, which are difficult to measure by conventional objective instruments measuring psychopathology. METHODS: All 66 patients satisfying DSM-IV criteria for schizophrenia, were approached. Their education level was more than high school and they were not in the acute stage of schizophrenia. They performed K-FBF and SCL-90-R, and at the same day, they were interviewed by one of both psychiatirsts using PANSS. We examined the patterns of K-FBF response and performed facor analysis about 10 subscales. We examined the correlation between K-FBF and age, sex and insight. Also, we performed correlation analysis among the K-FBF, PANSS and SCL-90-R. RESULTS: As for K-FBF, with increasing age, the number of positive response items and the symptom severity were decreased. Even when controlling prevalence period as control variable, the correlation remained unchanged. Performing factor analysis to the K-FBF subscales, we created 2 factors, ie summation subscales. We named those recognized distress(RD) and perceptual alteration(PA) each. Using K-FBF standardized total scores as controlling variable, we performed partial correlation between PA and PANSS negative symptom scale. The result was PA and PANSS have statistically significant correlation. This correspons with the view that Huber's basic symptoms are reflecting subjective approach of negative symptoms of schizophrenia. While K-FBF standardized total scores and PANSS total scores had statistically strong correlations, SCL-90-R total scores and PANSS total scores had statistically significant, but very mild correlations. So, we had the judgement that the correlations among the psychopathology measurement tools are more influenced by the rater than the contents of tools. CONCLUSION: We concluded that Huber's basic symptoms, measured by K-FBF, reflect more negative symptoms of schizophrenia than other symptoms. And K-FBF has more correlation with the PANSS, objective psychopathology measuring tool, than the SCL-90-R, self-report quetionnaire. But, more studies using patients with another disease stages and another demographic variables are needed in order to generalize the results of this study.