Vass Agota, Csukly Gabor, Farkas Kinga
Pszichiátriai és Pszichoterápiás Klinika, Semmelweis Egyetem, Budapest.
Neuropsychopharmacol Hung. 2024 Dec;26(4):218-226.
Autism spectrum disorder and schizophrenia are traditionally viewed as distinct diagnostic categories. However, evidence increasingly suggests overlapping pathological functioning at various levels, starting from brain circuitry to behaviour. Notably, both disorders are characterized by anomalous minimal self-experience (altered body ownership and agency), which is a trait-like, phenomenological distortion. We propose a conceptual framework that unites multiple levels, from neural mechanisms to cognitive and phenomenological correlates, for understanding minimal self-disturbance across diagnostic boundaries.
A comprehensive review of existing literature was conducted, examining phenomenological, neurocognitive, and neural correlates of minimal self-disturbance in both schizophrenia and autism spectrum disorder. Assessment tools and scales such as the Examination of Anomalous Self-Experience Scale, as well as experimental neurocognitive paradigms like the Rubber-Hand Illusion and self-relevant stimuli tasks, were examined for their relevance in evaluating self-experience in both conditions.
Minimal self-disturbances were found to be a prominent feature of both schizophrenia and autism, albeit with different manifestations. Patients with schizophrenia showed heightened susceptibility to body ownership alterations, while individuals with autism exhibited decreased susceptibility. Neural markers, particularly within the default mode network and thalamocortical connectivity, were implicated in self-disturbance in both disorders, suggesting a shared neurobiological basis.
The minimal self- disturbance appears to be a transdiagnostic feature of both schizophrenia and autism spectrum disorder, indicating that these conditions may represent points along a shared psychopathological continuum. The proposed model integrates neurobiological, cognitive, and phenomenological aspects of self-disturbance, offering a comprehensive framework for understanding and assessing disruptions in self-experience across these conditions. This approach promotes a shift away from rigid diagnostic classifications towards approaches that highlight the importance of atypical self-experience. (Neuropsychopharmacol Hung 2024; 26(4): 218-226)
传统上，自闭症谱系障碍和精神分裂症被视为不同的诊断类别。然而，越来越多的证据表明，从脑回路到行为，这两种疾病在各个层面都存在重叠的病理功能。值得注意的是，这两种疾病都具有异常的最小自我体验（身体所有权和能动性改变）的特征，这是一种类似特质的现象学扭曲。我们提出了一个概念框架，将从神经机制到认知和现象学关联的多个层面统一起来，以理解跨越诊断界限的最小自我干扰。
对现有文献进行了全面综述，研究了精神分裂症和自闭症谱系障碍中最小自我干扰的现象学､神经认知和神经关联。考察了诸如异常自我体验量表等评估工具和量表，以及诸如橡皮手错觉和自我相关刺激任务等实验性神经认知范式在评估这两种情况下自我体验方面的相关性。
发现最小自我干扰是精神分裂症和自闭症两者的一个突出特征，尽管表现形式不同。精神分裂症患者对身体所有权改变的易感性增强，而自闭症患者的易感性降低。神经标志物，特别是在默认模式网络和丘脑皮质连接内的标志物，与这两种疾病的自我干扰有关，表明存在共同的神经生物学基础。
最小自我干扰似乎是精神分裂症和自闭症谱系障碍的一个跨诊断特征，表明这些疾病可能代表了一个共同精神病理连续体上的不同点。所提出的模型整合了自我干扰的神经生物学､认知和现象学方面，为理解和评估这些情况下自我体验的破坏提供了一个全面的框架。这种方法促进了从严格的诊断分类向强调非典型自我体验重要性的方法的转变。（《匈牙利神经精神药理学》2024年；26(4): 218 - 226）
