Deficits in Agency in Schizophrenia, and Additional Deficits in Body Image, Body Schema, and Internal Timing, in Passivity Symptoms

Abstract

Individuals with schizophrenia, particularly those with passivity symptoms, may not feel in control of their actions, believing them to be controlled by external agents. Cognitive operations that contribute to these symptoms may include abnormal processing in agency as well as body representations that deal with body schema and body image. However, these operations in schizophrenia are not fully understood, and the questions of general versus specific deficits in individuals with different symptom profiles remain unanswered. Using the projected-hand illusion (a digital video version of the rubber-hand illusion) with synchronous and asynchronous stroking (500 ms delay), and a hand laterality judgment task, we assessed sense of agency, body image, and body schema in 53 people with clinically stable schizophrenia (with a current, past, and no history of passivity symptoms) and 48 healthy controls. The results revealed a stable trait in schizophrenia with no difference between clinical subgroups (sense of agency) and some quantitative (specific) differences depending on the passivity symptom profile (body image and body schema). Specifically, a reduced sense of self-agency was a common feature of all clinical subgroups. However, subgroup comparisons showed that individuals with passivity symptoms (both current and past) had significantly greater deficits on tasks assessing body image and body schema, relative to the other groups. In addition, patients with current passivity symptoms failed to demonstrate the normal reduction in body illusion typically seen with a 500 ms delay in visual feedback (asynchronous condition), suggesting internal timing problems. Altogether, the results underscore self-abnormalities in schizophrenia, provide evidence for both trait abnormalities and state changes specific to passivity symptoms, and point to a role for internal timing deficits as a mechanistic explanation for external cues becoming a possible source of self-body input.

Cenesthopathy and Subjective Cognitive Complaints: An Exploratory Study in Schizophrenia

“…The observed coexistence of cenesthopathy and subjective cognitive complaints in the self-agency of thoughts supports previous findings about deficits in agency and self-disorders or ipseity in schizophrenia [19,43,44]. It is coherent too with Janet's classic concept of psychasthenia [45], which has been generally applied to the actual concept of obsessive-compulsive disorder, although it was also present for the genesis of the schizophrenia concept [46].…”

On the functions, mechanisms, and malfunctions of intracortical contextual modulation

“…as in thought insertion, arises from decontextualization, either via an impaired sense of ownership of one's own thoughts (Martin and Pacherie, 2013) or directly (Fletcher and Frith, 2009;Seeger, 2013). These altered states of conscious experience include distortions in body representations and a reduction in the coordinated representation of body parts and somatosensory signals (Graham et al, 2014). Thus psychotic experiences provide clear support for the hypothesis that contextual modulation plays a central role in the phenomenology of mental life.…”

When one’s sense of agency goes wrong: Absent modulation of time perception by voluntary actions and reduction of perceived length of intervals in passivity symptoms in schizophrenia

“…Individuals with passivity symptoms display a particularly severe form of this characteristic feature and report a lack of normal sense of ownership for thoughts and actions, alongside the subjective experience that one's will is replaced or influenced by some external agent. Despite strong phenomenological evidence (Wing et al, 1990), epidemiological and symptom cluster analyses (Carpenter, Strauss, & Muleh, 1973;Jablensky et al, 1992;Kimhy, Goetz, Yale, Corcoran, & Malaspina, 2005;McGorry, Bell, Dudgeon, & Jackson, 1998), functional brain imaging evidence (Franck, O'Leary, Flaum, Hichwa, & Andreasen, 2002;Shergill et al, 2014;Spence et al, 1997), heritability evidence (Cardno, Sham, Farmer, Murray, & McGuffin, 2002) and neurocognitive theoretical frameworks (Graham, Martin-Iverson, Holmes, Jablensky, & Waters, 2014;Maruff, Wilson, & Currie, 2003;Waters & Badcock, 2010) that indicate passivity symptoms are distinct from other positive symptoms, research into these symptoms remains relatively sparse.…”