Temporal disorganization and inner-outer confusion in acute mental illness

Redrawing the Map and Resetting the Time: Phenomenology and the Cognitive Sciences

In recent years there has been some hard-won but still limited agreement that phenomenology can be of central and positive importance to the cognitive sciences. This realization comes in the wake of dismissive gestures made by philosophers of mind who mistakenly associate phenomenological method with untrained psychological introspection (e.g., Dennett 1991). For very different reasons, resistance is also found on the phenomenological side of this issue. There are many thinkers well versed in the Husserlian tradition who are not willing to consider the validity of a naturalistic science of mind. For them cognitive science is too computational or too reductionistic to be seriously considered as capable of explaining experience or consciousness. In some cases, when phenomenologists have seriously engaged the project of the cognitive sciences, rather than pursing a positive rapprochement with this project, they have been satisfied in drawing critical lines that identify its limitations.

On the one hand, such negative attitudes are understandable from the perspective of the Husserlian rejection of naturalism, or from strong emphasis on the transcendental current in phenomenology.

First rank symptoms for schizophrenia

BACKGROUND

Early and accurate diagnosis and treatment of schizophrenia may have long-term advantages for the patient; the longer psychosis goes untreated the more severe the repercussions for relapse and recovery. If the correct diagnosis is not schizophrenia, but another psychotic disorder with some symptoms similar to schizophrenia, appropriate treatment might be delayed, with possible severe repercussions for the person involved and their family. There is widespread uncertainty about the diagnostic accuracy of First Rank Symptoms (FRS); we examined whether they are a useful diagnostic tool to differentiate schizophrenia from other psychotic disorders.

OBJECTIVES

To determine the diagnostic accuracy of one or multiple FRS for diagnosing schizophrenia, verified by clinical history and examination by a qualified professional (e.g. psychiatrists, nurses, social workers), with or without the use of operational criteria and checklists, in people thought to have non-organic psychotic symptoms.

SEARCH METHODS

We conducted searches in MEDLINE, EMBASE, and PsycInfo using OvidSP in April, June, July 2011 and December 2012. We also searched MEDION in December 2013.

SELECTION CRITERIA

We selected studies that consecutively enrolled or randomly selected adults and adolescents with symptoms of psychosis, and assessed the diagnostic accuracy of FRS for schizophrenia compared to history and clinical examination performed by a qualified professional, which may or may not involve the use of symptom checklists or based on operational criteria such as ICD and DSM.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened all references for inclusion. Risk of bias in included studies were assessed using the QUADAS-2 instrument. We recorded the number of true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN) for constructing a 2 x 2 table for each study or derived 2 x 2 data from reported summary statistics such as sensitivity, specificity, and/or likelihood ratios.

MAIN RESULTS

We included 21 studies with a total of 6253 participants (5515 were included in the analysis). Studies were conducted from 1974 to 2011, with 80% of the studies conducted in the 1970's, 1980's or 1990's. Most studies did not report study methods sufficiently and many had high applicability concerns. In 20 studies, FRS differentiated schizophrenia from all other diagnoses with a sensitivity of 57% (50.4% to 63.3%), and a specificity of 81.4% (74% to 87.1%) In seven studies, FRS differentiated schizophrenia from non-psychotic mental health disorders with a sensitivity of 61.8% (51.7% to 71%) and a specificity of 94.1% (88% to 97.2%). In sixteen studies, FRS differentiated schizophrenia from other types of psychosis with a sensitivity of 58% (50.3% to 65.3%) and a specificity of 74.7% (65.2% to 82.3%).

AUTHORS' CONCLUSIONS

The synthesis of old studies of limited quality in this review indicates that FRS correctly identifies people with schizophrenia 75% to 95% of the time. The use of FRS to diagnose schizophrenia in triage will incorrectly diagnose around five to 19 people in every 100 who have FRS as having schizophrenia and specialists will not agree with this diagnosis. These people will still merit specialist assessment and help due to the severity of disturbance in their behaviour and mental state. Again, with a sensitivity of FRS of 60%, reliance on FRS to diagnose schizophrenia in triage will not correctly diagnose around 40% of people that specialists will consider to have schizophrenia. Some of these people may experience a delay in getting appropriate treatment. Others, whom specialists will consider to have schizophrenia, could be prematurely discharged from care, if triage relies on the presence of FRS to diagnose schizophrenia. Empathetic, considerate use of FRS as a diagnostic aid - with known limitations - should avoid a good proportion of these errors.We hope that newer tests - to be included in future Cochrane reviews - will show better results. However, symptoms of first rank can still be helpful where newer tests are not available - a situation which applies to the initial screening of most people with suspected schizophrenia. FRS remain a simple, quick and useful clinical indicator for an illness of enormous clinical variability.

The Concept of Time in Rehabilitation and Psychosocial Adaptation to Chronic Illness and Disability

The first part of this article focused on providing the reader with a general overview of the concept of time with special emphasis on understanding time’s role in the structure of personality theories and their associated therapeutic approaches, as well as linking the discussion to the understanding of time in the context of psychosocial adaptation to chronic illnesses and disabilities (CIDs). In the second part of this article, the author seeks to (a) briefly comment on the association among death, disability, and time; (b) discuss findings from the clinical and empirical literatures regarding time perception/orientation within the context of psychiatric disabilities; (c) review findings on the relationships between time perception/orientation and psychosocial adaptation to CIDs; and (d) highlight those treatment modalities that have been suggested for individuals whose disabilities have resulted in time distortions.

Can the hippocampus tell time? The temporo-septal engram shift model

An essential feature of episodic memory, the type of memory dependent on hippocampus, is that individual memories belong to particular moments in time. Recent PET studies suggest that memory encoding and recall occur at different locations in human hippocampus. Coupled with other attributes of hippocampus, this suggested to us that the septo-temporal hippocampal axis may play an important role in time perception. We propose a temporo-septal engram shift model of hippocampal memory. The model posits that memories gradually move along the hippocampus from a temporal encoding site to ever more septal sites from which they are recalled. We propose that the sense of time is encoded by the location of the engram along the temporo-septal axis.

Cognitive changes during the menstrual cycle

A predominantly non-student group of sixty-five women volunteers, screened for medication use, prospectively completed the Moos Menstrual Distress Questionnaire (MDQ) and the Temporal Disorganization Scale (TDS) weekly for one month along with a daily calendar of menstrual status. Data analysis revealed that TDS, concentration disturbances, negative affect, pain and water retention were rated as higher premenstrually and menstrually. Women dichotomized into groups based on high and low premenstrual TDS scores demonstrated different symptom patterns across the menstrual cycle. For the high premenstrual TDS group, concentration, behavioral change, negative affect and pain were all rated highest premenstrually; for the low premenstrual TDS and group the TDS score was rated highest menstrually. The relevance of these findings to literature reports of associations between psychopathology and menstrual cycle phase are discussed.

Early childhood amnesia: a quantitative study with implications for the study of retrograde amnesia after brain injury

Measurement of retrieval of episodic memories ascribed to the various years of early childhood was made over a three-month period of search by 17 normal young adults. The distribution of episodes ascribed to various ages is described, and it is shown that the recovery of memory from early childhood tends to show features of shrinking retrograde amnesia. Methods which were used to recover very early episodes are described, and implications for the study of shrinking retrograde amnesia in brain-damaged patients are discussed.