Stéphane Raffard

Remembering the Past and Imagining the Future in Schizophrenia

It has been suggested that patients with schizophrenia experience a distorted sense of continuity of self across time. However, temporal aspects of self-processing have received little empirical attention in schizophrenia. In this study, the authors investigated schizophrenic patients ability to generate specific mental images of their personal past and future. Results showed that patients recalled fewer specific past events than did healthy controls and were even more impaired in generating specific future events. These deficits were associated with positive symptoms but were not associated with negative symptoms or with performances on verbal fluency tasks. It is suggested that schizophrenic patients failures to project themselves into specific past and future episodes might be related to difficulties in retrieving contextual details from memory, as well as disturbance of the sense of subjective time.

Narrative identity in schizophrenia

This study examined narrative identity in a group of 81 patients with schizophrenia and 50 healthy controls through the recall of self-defining memories. The results indicated that patients narratives were less coherent and elaborate than those of controls. Schizophrenia patients were severely impaired in the ability to make connections with the self and extract meaning from their memories, which significantly correlated with illness duration. In agreement with earlier research, patients exhibited an early reminiscence bump. Moreover, the period of the reminiscence bump, which is highly relevant for identity development, was characterized by fewer achievements and more life-threatening event experiences, compared with controls. A negative correlation was found between negative symptoms, number of self-event connections and specificity of narratives. Our results suggest that schizophrenia patients have difficulties to organize and extract meaning from their past experiences in order to create coherent personal narratives.

Exploring self-defining memories in schizophrenia.

Previous studies have shown that patients with schizophrenia are impaired in recalling specific events from their personal past. However, the relationship between autobiographical memory impairments and disturbance of the sense of identity in schizophrenia has not been investigated in detail. In this study the authors investigated schizophrenic patients’ ability to recall self-defining memories; that is, memories that play an important role in building and maintaining the self-concept. Results showed that patients recalled as many specific self-defining memories as healthy participants. However, patients with schizophrenia exhibited an abnormal reminiscence bump and reported different types of thematic content (i.e., they recalled less memories about past achievements and more memories regarding hospitalisation and stigmatisation of illness). Furthermore, the findings suggest that impairments in extracting meaning from personal memories could represent a core disturbance of autobiographical memory in patients with schizophrenia.

The Beck Cognitive Insight Scale in Outpatients With Psychotic Disorders: Further Evidence From a French-Speaking Sample

Objective: The Beck Cognitive Insight Scale (BCIS) evaluates patients self-report of their ability to detect and correct misinterpretation. Our study aims to confirm the factor structure and the convergent validity of the original scale in a French-speaking environment. Method: Outpatients (n = 158) suffering from schizophrenia or schizoaffective disorders fulfilled the BCIS. The 51 patients in Montpellier were equally assessed with the Positive and Negative Syndrome Scale (PANSS) by a psychiatrist who was blind of the BCIS scores. Results: The fit indices of the confirmatory factor analysis validated the 2-factor solution reported by the developers of the scale with inpatients, and in another study with middle-aged and older outpatients. The BCIS composite index was significantly negatively correlated with the clinical insight item of the PANSS. Conclusions: The French translation of the BCIS appears to have acceptable psychometric proprieties and gives additional support to the scale, as well as cross-cultural validity for its use with outpatients suffering from schizophrenia or schizoaffective disorders. The correlation between clinical and composite index of cognitive insight underlines the multidimensional nature of clinical insight. Cognitive insight does not recover clinical insight but is a potential target for developing psychological treatments that will improve clinical insight.

Do facets of self-reported impulsivity predict decision-making under ambiguity and risk? Evidence from a community sample.

We investigated the links among decision-making assessed by the Iowa Gambling Task (IGT) and the Game of Dice Task (GDT), and the four facets of impulsivity (urgency, lack of premeditation, lack of perseverance, and sensation seeking, UPPS) proposed by Whiteside and Lynam (2001) in a sample of 107 healthy volunteers. Hierarchical regressions controlling for age and gender indicated that sensation seeking and urgency were linked to disadvantageous decisions on the GDT while no association was found between IGT performance and the UPPS. Sensation seeking and urgency facets of impulsivity are related in healthy individuals, to decision-making processes where potential consequences of different options and their subsequent probabilities rely on explicit information. In healthy controls, there is little overlap between decision-making influenced by both implicit and explicit information and impulsivity as measured by the UPPS. These findings add evidence to the notion that self-reported trait impulsivity is associated with the decision making process. Decisions made under risk seemed to be differentially associated with specific facets of impulsivity.

Impaired ability to imagine future pleasant events is associated with apathy in schizophrenia

Recent research has established that schizophrenia patients have difficulties envisioning the future. Although mental simulations have a clear adaptive value, little is known about the function of simulating future episodes, particularly emotional events. The aim of this study was to explore the relationships between apathy and future projection in schizophrenia. Twenty-five schizophrenia patients and 25 healthy controls were asked to imagine pleasant and unpleasant episodes that might happen to them in the future. Verbal descriptions were scored for specificity, and participants also completed the Memory Characteristics Questionnaire, which assesses phenomenal characteristics of imagined future events. Apathy was assessed with the Lille Apathy Rating Scale and the apathetic/social withdrawal item of the Positive and Negative Syndrome Scale. Results showed that schizophrenia patients pleasant and unpleasant imagined future events were less specific and contained fewer phenomenal characteristics (e.g., amount of sensory details) than those of controls. In the schizophrenia group, difficulties imagining future pleasant events, and particularly poor self-referential information for future pleasant events, were specifically associated with apathy, even after controlling for working memory. These results suggest that episodic future thinking impairments, especially for future events of pleasure, may partly underlie the motivational deficits characteristic of schizophrenia.

A further evaluation of decision-making under risk and under ambiguity in schizophrenia.

Abnormal decision-making has been described as a key-concept to understand some behavioral disturbances in schizophrenia. However, whether schizophrenia patients display impairments in profitable decision-making on experimental designs is still controversial (1) to assess performance on decision-making paradigms under ambiguity and under risk conditions in a large sample of schizophrenia patients and (2) to study the impact of clinical variables on decision-making performance in schizophrenia. The Iowa gambling task (IGT) and the game of dice task (GDT) were administered to assess, respectively, decision-making under ambiguity and under risk in 63 schizophrenia patients and 67 healthy controls. In addition, clinical variables (e.g., schizophrenic symptoms, self-reported depression, and impulsivity) were evaluated using appropriate questionnaires the same day. Pharmacological treatments were reported. Schizophrenia patients had impaired performances on both IGT and GDT tasks. No correlation between the decision-making tasks performance and clinical variables was found. Lower gains on the GDT were associated with executive dysfunctioning in schizophrenia. These findings give evidence that schizophrenia patients display impairments in both decision-making under ambiguity and under risk.

Scene construction in schizophrenia

OBJECTIVEnRecent research has revealed that schizophrenia patients are impaired in remembering the past and imagining the future. In this study, we examined patients ability to engage in scene construction (i.e., the process of mentally generating and maintaining a complex and coherent scene), which is a key part of retrieving past experiences and episodic future thinking.nnnMETHODn24 participants with schizophrenia and 25 healthy controls were asked to imagine new fictitious experiences and described their mental representations of the scenes in as much detail as possible. Descriptions were scored according to various dimensions (e.g., sensory details, spatial reference), and participants also provided ratings of their subjective experience when imagining the scenes (e.g., their sense of presence, the perceived similarity of imagined events to past experiences).nnnRESULTSnImagined scenes contained less phenomenological details (d = 1.11) and were more fragmented (d = 2.81) in schizophrenia patients compared to controls. Furthermore, positive symptoms were positively correlated to the sense of presence (r = .43) and the perceived similarity of imagined events to past episodes (r = .47), whereas negative symptoms were negatively related to the overall richness of the imagined scenes (r = -.43).nnnCONCLUSIONSnThe results suggest that schizophrenic patients impairments in remembering the past and imagining the future are, at least in part, due to deficits in the process of scene construction. The relationships between the characteristics of imagined scenes and positive and negative symptoms could be related to reality monitoring deficits and difficulties in strategic retrieval processes, respectively.

Competence to consent and insight in schizophrenia: Is there an association? A pilot study

OBJECTIVEnThe capacity to consent to treatment or research of patients with severe mental disorders is the focus of important ethical and clinical debate. Many studies evaluate the links between clinical symptoms and the capacity to consent. The aim of this study was to explore the correlations existing between the competence to consent to treatment and the level of awareness of the disease (insight) in patients suffering from schizophrenia in a cross-sectional study.nnnMETHODnParticipants included 60 outpatients meeting the criteria for a DSM-IV diagnosis of schizophrenia. Measures included the MacArthur Competence Assessment tool for Treatment (MacCAT-T), the Scale to Assess Unawareness of Mental Disorder (SUMD) and psychopathology rating scales including the Positive and Negative Syndrome Scale (PANSS).nnnRESULTSnThe MacCAT-T dimension Understanding was found to be negatively correlated with negative and total PANSS scores but was not found to be correlated with any of the SUMD dimensions. However a systematic negative correlation was observed between the MacCAT-T Appreciation and Reasoning dimensions and the five SUMD dimensions. Finally, the MacCAT-T Expressing a choice dimension was found to be negatively correlated with two SUMD dimensions: Having a mental disorder and consequences of the mental disorder.nnnCONCLUSIONSnThese findings suggest an important correlation between the competence to consent to treatment and insight, a clinical variable currently assessed by clinicians. We hypothesized that this link could be mediated by cognitive impairments in schizophrenia. Emphasis should be placed on developing prospective studies comparing the courses of insight, cognitive disorders and capacity to consent in schizophrenia.

Face recognition in schizophrenia disorder: A comprehensive review of behavioral, neuroimaging and neurophysiological studies.

Facial emotion processing has been extensively studied in schizophrenia patients while general face processing has received less attention. The already published reviews do not address the current scientific literature in a complete manner. Therefore, here we tried to answer some questions that remain to be clarified, particularly: are the non-emotional aspects of facial processing in fact impaired in schizophrenia patients? At the behavioral level, our key conclusions are that visual perception deficit in schizophrenia patients: are not specific to faces; are most often present when the cognitive (e.g. attention) and perceptual demands of the tasks are important; and seems to worsen with the illness chronification. Although, currently evidence suggests impaired second order configural processing, more studies are necessary to determine whether or not holistic processing is impaired in schizophrenia patients. Neural and neurophysiological evidence suggests impaired earlier levels of visual processing, which might involve the deficits in interaction of the magnocellular and parvocellular pathways impacting on further processing. These deficits seem to be present even before the disorder out-set. Although evidence suggests that this deficit may be not specific to faces, further evidence on this question is necessary, in particularly more ecological studies including context and body processing.