Dept. of Medicine and Surgery, Unit of Neuroscience, University of Parma, Italy; Italian Academy for Advanced Studies in America, Columbia University, New York, USA.
Dept. of Medicine and Surgery, Unit of Neuroscience, University of Parma, Italy.
Schizophr Res. 2024 Jul;269:152-162. doi: 10.1016/j.schres.2024.05.014. Epub 2024 May 29.
Despite the historically consolidated psychopathological perspective, on the one hand, contemporary organicistic psychiatry often highlights abnormalities in neurotransmitter systems like dysregulation of dopamine transmission, neural circuitry, and genetic factors as key contributors to schizophrenia. Neuroscience, on the other, has so far almost entirely neglected the first-person experiential dimension of this syndrome, mainly focusing on high-order cognitive functions, such as executive function, working memory, theory of mind, and the like. An alternative view posits that schizophrenia is a self-disorder characterized by anomalous self-experience and awareness. This view may not only shed new light on the psychopathological features of psychosis but also inspire empirical research targeting the bodily and neurobiological changes underpinning this disorder. Cognitive neuroscience can today address classic topics of phenomenological psychopathology by adding a new level of description, finally enabling the correlation between the first-person experiential aspects of psychiatric diseases and their neurobiological roots. Recent empirical evidence on the neurobiological basis of a minimal notion of the self, the bodily self, is presented. The relationship between the body, its motor potentialities and the notion of minimal self is illustrated. Evidence on the neural mechanisms underpinning the bodily self, its plasticity, and the blurring of self-other distinction in schizophrenic patients is introduced and discussed. It is concluded that brain-body function anomalies of multisensory integration, differential processing of self- and other-related bodily information mediating self-experience, might be at the basis of the disruption of the self disorders characterizing schizophrenia.
尽管从历史上看，精神病理学观点已经得到了巩固，但当代的有机精神病学观点常常强调神经递质系统的异常，如多巴胺传递的失调、神经回路和遗传因素，这些都是精神分裂症的主要致病因素。另一方面，神经科学迄今为止几乎完全忽略了这种综合征的第一人称体验维度，主要关注高阶认知功能，如执行功能、工作记忆、心理理论等。另一种观点认为，精神分裂症是一种以异常的自我体验和意识为特征的自我障碍。这种观点不仅可以为精神病的精神病理学特征提供新的视角，还可以激发针对这种障碍的身体和神经生物学变化的实证研究。认知神经科学今天可以通过增加一个新的描述层面来解决现象学精神病理学的经典主题，最终使精神病学疾病的第一人称体验方面与其神经生物学根源之间产生关联。本文呈现了关于最小自我概念、身体自我的神经生物学基础的最新实证证据。本文还说明了身体、其运动潜能与最小自我概念之间的关系。本文介绍并讨论了支持身体自我的神经机制、其可塑性以及精神分裂症患者自我与他人区分的模糊性。本文得出的结论是，多感觉整合的大脑-身体功能异常、自我和他人相关身体信息的差异处理，可能是精神分裂症特征性自我障碍的基础。
