Schizophrenia Research Trends

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10Reiko Koide and Akira TamaokaObjective of the StudyA wide variety of studies has appeared on body image aberration in schizophrenia;however, the problem inherent in schizophrenic body image aberration remains elusive.Earlier, the body image problems in schizophrenia were regarded as something related topsychotic symptoms, particularly with delusion and hallucination. Our perceptions of theschizophrenia have changed dramatically, particularly over the past two decades. During1980s, the predominant view of the phenomenology of schizophrenia broadened beyond anarrow focus on psychotic symptoms to include negative symptoms, proprioceptive deficits,and self-injury representing body image problems. In the 1990s, another fundamental changein our perception of the disorder occurred. With this change, we have expanded thephenomenology of schizophrenia even further, beyond symptoms altogether, to include astrong emphasis on neurocognitive aspects of schizophrenia (Green & Neuchterlein, 1999).Schizophrenia has consequently been investigated using “neuropsychological”procedures in order to uncover evidence of discrete neurological damage or dysfunction thatmay account for the great impairments in judgment, attention, concentration, planning abilityand anticipation. In the late 1970s, a new era of neuropsychological study of schizophreniabegan with three different review articles in which the low performance onneuropsychological test in functional patients was compared to organic patients (Goldstein,1978; Heaton et al., 1978; Malec, 1978), and with the initial publication of in vivo evidenceof ventricular enlargement in schizophrenia, as revealed by computerized tomography (CT)(Johonstone et al., 1976; Weinberger et al., 1979).Focus has been on clarifying the relationships between neurocognitive deficits andpsychotic symptoms (Cornblatt et al., 1985; Green & Walker, 1985; Neuchterlein et al.,1986; Green et al., 1992) and negative symptoms (Neuchterlein et al., 1986; Censits et al.,1997; Buchanan et al., 1997), between neurocognitive deficits and functional outcome(Green, 1996), between neurocognitive deficits and insight (Silverstein & Zerwic, 1985;Young et al., 1993; Lysaker & Bell, 1994; Cuesta & Peralta, 1994) and social cognition(Schneider et al., 1995; Bryson et al., 1997). In a current overview, Green and Nuechterlein(1999) searched for meaningful psychopharmacological and cognitive/behavioralinterventions for neurocognitive deficits in schiziophrenia. Conventional antipsychotic agentsare generally effective for psychotic symptoms, but their effects on neurocognition arerelatively weak (Cassens et al., 1990; Strauss, 1993). Novel antipsychotic medications aremore encouraging (Hagger et al., 1993; Green et al., 1997; Jeste et al., 1998; Keefe et al.,1999; Kern et al., 1999; Meltzer & McGurk, 1999). Conventional antipsychotic medicationsinvolve much coadministration of anticholinergic medications (e.g., benoztropine mesylate)that are known to have a negative effect on neurocognition (Spohn & Strauss, 1989).To consider body image aberration in the above context, which deficit of body imagecomes from symptoms and which from medication should be clarified first. The questions are(1) Is body image aberration a result of symptoms seen in attenuated schizophrenic illness?(2) Is body image aberration an effect of medications? (3) What is the schizophrenics’ bodyimage’s inherently aberrational part? Is there any intact part? (4) Is it remediable bybehavioral/cognitive or psychopharmacological intervention? A full investigation of these
Body Image Deviation in Chronic Schizophrenia: New Research 11basic questions is now required. Each section in this chapter is the attempt to clarify thesebasic problems.PART II. STUDIES USING BODYIMAGE QUESTIONNAIRE (BIQ)Study 1. Body Image Aberration and Clinical CharacteristicsIntroductionIn the era of pre-antipsychotics, disturbance of body experiences in schizophrenia hadbeen documented as pathological experiences, especially in relation to hallucinatory anddelusional disturbances. Since the 1970s, several concepts about the course of schizophreniaand recovery from it have been developed in the search for new perspectives (Strauss 1989;Harding et al., 1992). Because there is a growing interest in the recovery phase ofschizophrenia, their body image characteristics should be refocused as multi-phased deviationfrom the normal experiences. In this context, the body image should be redefined rathercomprehensively as persistent attitudes and feelings toward one’s own body, which wouldpreserve deleterious as well as ameliorative effects in the illness-environment interaction ofdisorder and recovery. In addition, with the availability of neuroleptics since mid. 1950s,undesirable physical reactions caused by drugs may also contribute to negative body image.The aim of the study in this section was to reexamine the body image distortionperceived by schizophrenics, using the Body Image Questionnaire, BIQ, (Koide,1982/1985).Special inquiries were made concerning the influence of the clinical variables such aspositive and negative symptoms, insight and neuroleptic dosage on body image aberration.The questions addressed in this sections are (1) What are the components of body images? (2)Which phases of body image are aberrant in schizophrenia? (3) Which aberrant body imagesare related to symptoms? (4) Which aberrant body images are associated with favorable signsof remission? (5) Is body image aberration related to neuroleptic dosage?MethodAssessment of Body Image DeviationBody image was assessed using the BIQ, a seven-step self-rating scale (scored as 1 to 7)with three hypothetical components, anatomical, functional and psychological. (SeeAppendix 1.)Assessment of Clinical CharacteristicsPositive symptoms were assessed using the Scale for Assessment of Positive Symptoms,SAPS, (Andreasen, 1983). Negative symptoms were assessed using the Scale for Assessmentof Negative Symptoms, SANS, (Andreasen, 1981). Insight was assessed through Schedule forAssessing Insight, SAI, which comprises three main component scores that includeacceptance, recognition of illness, and relabeling of pathological experiences, and one
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Page 9 and 10: PREFACESchizophrenia is a chronic,
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Page 68 and 69: 56Guy SandnerSubsets of the Disease
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60Guy Sandnerlinked to the ongoing
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62Guy Sandnercorrelated with its pr
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64Guy Sandner(general thought disor
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66Guy Sandneramnesic patients. Thes
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68Guy Sandneras soon as their early
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70Guy Sandnerrole games [106, 142].
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72Guy Sandnerand the cause of the d
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74Guy SandnerA third explanation pl
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76Guy Sandner2. Rats with neonatal
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78Guy SandnerBOX 1DiagnosisPositive
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80Guy SandnerBOX 2Cognitive Science
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82Guy SandnerREFERENCES[1] Alberts
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84Guy Sandner[36] Corcoran R, Merce
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86Guy Sandner[71] Frank N, Farrer C
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88Guy Sandner[103] Jeon YW, Polich
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90Guy Sandner[136] McGurk SR, Muese
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92Guy Sandner[168] Sato Y, Yabe H,
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In: Schizophrenia Research Trends I
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NMDA Receptor Hypofunction in Schiz
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Evolution and Schizophrenia 117In 1
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Evolution and Schizophrenia 119Over
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Evolution and Schizophrenia 121psyc
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Evolution and Schizophrenia 123deri
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Evolution and Schizophrenia 125indi
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Evolution and Schizophrenia 127pred
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Evolution and Schizophrenia 129one
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Evolution and Schizophrenia 131REFE
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Evolution and Schizophrenia 133[41]
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Evolution and Schizophrenia 135[80]
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Latent Inhibition and Learned Irrel
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164M. Nieznański, A. Chojnowska, W
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184Special Book Bibliography on Sch
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INDEXAabdomen, 38abnormal, 132abuse
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Index 251BMA, 216body, vii, viii, 1
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Index 253CRR, 90CTA, 139, 140, 143,
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Index 255eyes, 6, 24, 25, 50, 52, 6
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Index 257inhibition, ix, x, 60, 64,
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Index 259metabolism, 97, 103, 105,
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Index 261personal accounts, 123pers
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Index 263risk, 23, 26, 30, 39, 48,
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Index 265Ttactile stimuli, 85Taiwan
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Schizophrenia Research Trends

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