There is a broad body of research on schizophrenia spectrum issues. Some of the research is focused on the neurobiological aspects of the illness using magnetic resonance imaging (MRIs) and other methods of exploration. Other examinations into schizophrenia have focused on the prodromal aspects of the illness and the clinical assessment.
In a recent study conducted by Dusan Hirjak of the Department of General Psychiatry and the Center of Psychosocial Medicine at the University of Heidelberg in Germany, subjective first rank symptoms (FRS) were looked at as a way to perhaps bridge the gap between clinical and neurobiological assessments. For the study, Hirjak sought to determine the origin of two specific FRS, volitional acts and made impulses.
Made impulses refer to disturbances of intention that are often experienced in prodromal schizophrenia. Similarly, made volition is an extension of those impulses and subjectively, can result in maladaptive lived experiences that manifest as delusions or hallucinations. Hirjak and others believe that these FRS can lead to acute schizophrenia and psychosis, and this relationship underscores the need for early identification of FRS. After examining existing research, Hirjak discovered that both made volition and made impulses are directly associated with agency and intention. Although these symptoms are exhibited differently, they share a phenomenological architecture.
Both FRS are linked to self-awareness and disruptions in this awareness. Self-awareness has been previously shown to be at the core of many schizophrenia spectrum issues. But this study is the first to clearly evidence that nonpsychotic FRS can erode agency and lay the way for disembodiment and externalization, which can ultimately lead to full psychosis. Because clinicians are charged with the task of identifying and diagnosing schizophrenia, understanding the FRS and how they are related to lived-experiences can help in clinical assessments.
Further, this identification of FRS and psychotic manifestations can help link clinical symptoms to neurobiological impairments, thus making diagnosis more accurate. This awareness of FRS can also help clinicians distinguish between individuals with schizophrenia and those with other psychotic and mood issues such as depression or bipolar. In conclusion, these results provide insight into where these FRS originate. Hirjak said, “We propose that the subjective experience of schizophrenia patients with body-affecting FRS is rooted in the disturbance of intentionality and diminished sense of agency.” These results open new windows of opportunity for further research in this area.
Hirjak, D., Breyer, T., Thomann, P.A., Fuchs, T. (2013). Disturbance of intentionality: A phenomenological study of body-affecting first-rank symptoms in schizophrenia. PLoS ONE 8(9): e73662. doi:10.1371/journal.pone.0073662
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