Self‐experience in the early phases of schizophrenia: 5‐year follow‐up of the Copenhagen Prodromal Study

Abstract

Despite the avalanche of empirical data on prodromal/"at risk" conditions, the essential aspects of the vulnerability to the schizophrenia spectrum remain largely unaddressed. We report here the results of the Copenhagen Schizophrenia Prodromal Study, a prospective, observational study of first admission patients in putative state of beginning psychosis (N=151) with a follow-up length of 60 months. At follow-up, the rate of conversion to schizophrenia spectrum diagnosis was 37%, whereas the conversion rate from schizotypal disorder to schizophrenia was 25%. High levels of perplexity and self-disorders baseline scores yielded the best prediction of the subsequent development of schizophrenia spectrum disorders. Escalating transitions within the spectrum (i.e., from schizotypal disorder to schizophrenia) were not associated to any candidate psychopathological predictor.

Premorbid self‐disorders and lifetime diagnosis in the schizophrenia spectrum: a prospective high‐risk study

“…16 SDs predict psychosis in clinically at-risk prodromal populations 17 as well as new cases of schizophreniaspectrum disorders in a follow up of non-spectrum psychiatric patients 5 years after first admission. 18 SDs affect the 'core' or 'minimal' experiential self, [19][20][21] that is, a structure that must be in place in order for the experience to be subjective, that is, to be someone's experience. The core self refers to a first-personal articulation of experience, typically called 'mineness', 'myness', 'for-me-ness' or ipseity (ipse = self, itself ).…”

“…The EASE exhibits high internal consistency (Cronbach's alpha above 0.80 11,14 ) and a monofactorial structure. 11,27 Although all studies seem to support the notion of SDs as a spectrum-specific manifestation of vulnerability, and follow-up studies of help-seeking, prodromal and first-admission patients have shown the utility of SDs for predicting later spectrum disturbance, 17,18 there have been as yet no attempts to identify SDs and gauge their predictive value in a premorbid, not-help-seeking population at high risk for schizophrenia.…”

Clinical Manifestations of Self-disorders in Schizophrenia Spectrum Conditions

“… Self-disorders hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders [39][40][41][42][43]  There is no statistical difference in the level of selfdisorders among patients with schizophrenia and patients with the schizotypal disorder [41,43]  Self-disorders differentiate between first-admitted cases with bipolar psychosis and schizophrenia [42] and self-disorders occur more frequently in residual schizophrenia than in remitted bipolar psychosis [44]  Self-disorders occur in genetically high-risk individuals [45]  Self-disorders are detectable in community samples of adolescent diagnosed as suffering from "at-risk mental state" [46] and in clinical samples of young adults at Clinical High Risk for psychosis [47]  Prospective studies indicate that self-disorders predict transition to psychosis in an Ultra-High Risk for psychosis sample [48] and that high baseline scores of self-disorders predict later transition to a schizophrenia spectrum diagnosis [49,50]  Positive correlations have been found between self-disorders and positive symptoms, negative symptoms, formal thought disorders, and perceptual disturbances, respectively [43]  Correlations have been found between selfdisorders and social dysfunction [51] and suicidality [52,53], respectively  No correlations have been found between selfdisorders and IQ or neurocognitive measures [43,54,55], except for impaired verbal memory [54]  Self-disorders have been found to be temporarily stable over a 5-year period [56] …”

A Case of Schizotypal Personality Disorder

“…They tend not to improve over time, and some evidence indicates that some will go on to develop the more severe characteristics of schizophrenia. 3 …”