Revisiting the Basic Symptom Concept: Toward Translating Risk Symptoms for Psychosis into Neurobiological Targets

Abstract

In its initial formulation, the concept of basic symptoms (BSs) integrated findings on the early symptomatic course of schizophrenia and first in vivo evidence of accompanying brain aberrations. It argued that the subtle subclinical disturbances in mental processes described as BSs were the most direct self-experienced expression of the underlying neurobiological aberrations of the disease. Other characteristic symptoms of psychosis (e.g., delusions and hallucinations) were conceptualized as secondary phenomena, resulting from dysfunctional beliefs and suboptimal coping styles with emerging BSs and/or concomitant stressors. While BSs can occur in many mental disorders, in particular affective disorders, a subset of perceptive and cognitive BSs appear to be specific to psychosis and are currently employed in two alternative risk criteria. However, despite their clinical recognition in the early detection of psychosis, neurobiological research on the aetiopathology of psychosis with neuroimaging methods has only just begun to consider the neural correlate of BSs. This perspective paper reviews the emerging evidence of an association between BSs and aberrant brain activation, connectivity patterns, and metabolism, and outlines promising routes for the use of BSs in aetiopathological research on psychosis.

Cenesthopathy and Subjective Cognitive Complaints: An Exploratory Study in Schizophrenia

“…atypical patterns of neural activation, which are likely to involve a variety of cortical regions and networks [53].…”

Estados clínicos de alto riesgo para esquizofrenia y otras formas de psicosis: una breve revisión.

“…Los síntomas básicos (SB) fueron propuestos por el equipo de Gerd Huber en Bonn, Alemania (46,47). Pueden definirse como alteraciones finas, subclínicas y autopercibidas del ímpetu, la tolerancia al estrés, el afecto, los procesos de pensamiento y lenguaje, de la percepción y la actividad motora, y que son además fenomenológicamente diferenciables de los síntomas psicóticos.…”

“…En los últimos años se han empezado a desarrollar nuevas investigaciones con el fin de encontrar hallazgos neurobiológicos que expliquen las alteraciones clínicas observadas en los pacientes con SB (47). Diversos estudios han encontrado hallazgos típicos en esta población, de relevancia es, por ejemplo, la presencia de conectividad sináptica aumentada entre la corteza ventral premotora y la corteza cingulada posterior, asociada a la severidad de SB en pacientes con un primer episodio de esquizofrenia (48).…”

“…El otro modelo teórico en cuestión fue concebido en Europa central, específicamente a partir de los trabajos de Gerd Huber y Gisela Gross en Alemania (46,47). La importancia del trabajo de Huber es que propuso la noción de los síntomas básicos (SB), concepto que parte Tabla 1.…”

Mentalization-Based Treatment in Clinical High-Risk for Psychosis: A Rationale and Clinical Illustration

“…The two main contemporary approaches to CHR include the "basic symptoms" approach, which can be used in general population and helpseeking samples , and the "ultra-high risk" approach (Nelson et al 2013) which is most often employed help-seeking samples. Basic symptoms are diagnosed on the basis of subjectively reported alterations in stress tolerance, affect, drive, thinking, speech, perception, motor action and central-vegetative functions (Schultze-Lutter et al 2016). Basic symptoms can be distinguished from ultra-high risk because they seek to identify the earliest subtle disturbances predicting psychosis , whereas ultra-high risk criteria targets imminent risk characterized by sub-clinical syndromes (attenuated psychotic symptoms (APS); brief limited intermittent psychotic symptoms (BLIPS)) encompassing unusual thought content, grandiose ideas, suspiciousness, perceptual abnormalities and disorganized communication (McGlashan et al 2010).…”