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Self-reported interoception and exteroception are atypical and excessively coupled in psychosis compared to healthy controls

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Abstract

Although psychotic disorders are characterized by an impaired ability to discriminate internal and external worlds, the role of interoceptive and exteroceptive perceptions in determining this alteration is still unclear. This observational study aimed at investigating (a) increases/decreases in interoceptive and exteroceptive perceptions in patients with psychosis (PSY) compared to healthy controls (HC); (b) the association between interoception and exteroception in HC and PSY. Two hundred and ten HC and 72 PSY completed the Multidimensional Assessment of Interoceptive awareness (MAIA, 8 domains) and the Adolescent-Adult Sensory Profile (AASP, 4 domains). MAIA/AASP differences were evaluated with MANOVA, Kruskal–Wallis and Mann–Whitney tests. MAIA and AASP scores were correlated to quantify the interoceptive–exteroceptive coupling as Spearman’s rho coefficients. Subgroup analyses were performed dividing PSY in schizophrenia/schizoaffective versus other psychosis. Compared to HC, PSY showed increased mean scores in four MAIA and two AASP domains (Bonferroni-p < 0.01). The interoceptive–exteroceptive coupling followed two correlation patterns in HC. A first pattern displayed negative correlations between MAIA not-worrying and AASP sensory sensitivity/sensation avoidance, while the second pattern highlighted positive correlations between MAIA scores and AASP sensation seeking. The two correlation patterns between HC and other-PSY subgroup were similar. However, schizophrenia/schizoaffective PSY did not show positive correlations in the second pattern, rather displaying negative correlations between MAIA scores and AASP domains related to passive behavioral responses. Correlation values were more extreme in PSY subgroups, indicating stronger interoceptive–exteroceptive coupling compared to HC. This study demonstrates that interoception and exteroception are atypical and excessively coupled in psychosis compared to the general population.

Clinical Trials Registration: Protocol Number 20210003663 (Pavia, Ethical Committee IRCCS Policlinico San Matteo).

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References

  1. Van Duppen Z (2017) The meaning and relevance of Minkowski’s’ loss of vital contact with reality’. Philos Psychiatry Psychol 24:385–397

    Article  Google Scholar 

  2. Fusar-Poli P, Estradé A, Stanghellini G, Venables J, Onwumere J, Messas G, Gilardi L, Nelson B, Patel V, Bonoldi I (2022) The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. World Psychiatr 21:168–188

    Article  Google Scholar 

  3. Sass LA (2001) Self and world in schizophrenia: three classic approaches. Philos Psychiatry Psychol 8:251–270

    Article  Google Scholar 

  4. Bleuler E (1911) Dementia praecox, oder gruppe der schizophrenien. Deuticke

    Google Scholar 

  5. Damiani S, Donadeo A, Bassetti N, Salazar-de-Pablo G, Guiot C, Politi P, Fusar-Poli P (2022) Understanding source monitoring subtypes and their relation to psychosis: a systematic review and meta-analysis. Psychiatr Clin Neurosci 76:162–171

    Article  CAS  Google Scholar 

  6. Damiani S, Fusar-Poli L, Brondino N, Provenzani U, Baldwin H, Fusar-Poli P, Politi P (2020) World/self ambivalence: a shared mechanism in different subsets of psychotic experiences? Linking symptoms with resting-state fmri. Psychiatry Res 299:111068

    Article  Google Scholar 

  7. American Psychiatric Association D, Association AP (2013) Diagnostic and statistical manual of mental disorders: Dsm-5. American psychiatric association Washington, DC

  8. Parnas J, Handest P (2003) Phenomenology of anomalous self-experience in early schizophrenia. Compr Psychiatry 44:121–134

    Article  PubMed  Google Scholar 

  9. Koreki A, Garfkinel SN, Mula M, Agrawal N, Cope S, Eilon T, Gould Van Praag C, Critchley HD, Edwards M, Yogarajah M (2020) Trait and state interoceptive abnormalities are associated with dissociation and seizure frequency in patients with functional seizures. Epilepsia 61:1156–1165

    Article  PubMed  PubMed Central  Google Scholar 

  10. Humpston CS, Broome MR (2020) Thinking, believing, and hallucinating self in schizophrenia. Lancet Psychiatry 7:638–646

    Article  PubMed  Google Scholar 

  11. Raballo A, Poletti M, Preti A, Parnas J (2021) The self in the spectrum: a meta-analysis of the evidence linking basic self-disorders and schizophrenia. Schizophr Bull 47:1007–1017

    Article  PubMed  PubMed Central  Google Scholar 

  12. Javitt DC, Freedman R (2015) Sensory processing dysfunction in the personal experience and neuronal machinery of schizophrenia. Am J Psychiatry 172:17–31

    Article  PubMed  Google Scholar 

  13. Craig AD (2002) How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci 3:655–666

    Article  PubMed  CAS  Google Scholar 

  14. Park H-D, Bernasconi F, Salomon R, Tallon-Baudry C, Spinelli L, Seeck M, Schaller K, Blanke O (2018) Neural sources and underlying mechanisms of neural responses to heartbeats, and their role in bodily self-consciousness: an intracranial EEG study. Cereb Cortex 28:2351–2364

    Article  PubMed  Google Scholar 

  15. Ronchi R, Bello-Ruiz J, Lukowska M, Herbelin B, Cabrilo I, Schaller K, Blanke O (2015) Right insular damage decreases heartbeat awareness and alters cardio-visual effects on bodily self-consciousness. Neuropsychologia 70:11–20

    Article  PubMed  Google Scholar 

  16. Seth AK, Friston KJ (2016) Active interoceptive inference and the emotional brain. Philos Trans Royal Soc B 371:20160007

    Article  Google Scholar 

  17. Colman AM (2015) A dictionary of psychology. Oxford quick reference

  18. Randeniya R, Oestreich LK, Garrido MI (2018) Sensory prediction errors in the continuum of psychosis. Schizophr Res 191:109–122

    Article  PubMed  CAS  Google Scholar 

  19. Dijkstra N, Kok P, Fleming SM (2022) Perceptual reality monitoring: Neural mechanisms dissociating imagination from reality. Neurosci Biobehav Rev 135:104557

    Article  PubMed  Google Scholar 

  20. Simons JS, Garrison JR, Johnson MK (2017) Brain mechanisms of reality monitoring. Trends Cogn Sci 21:462–473

    Article  PubMed  Google Scholar 

  21. van den Boogert F, Klein K, Spaan P, Sizoo B, Bouman YH, Hoogendijk WJ, Roza SJ (2022) Sensory processing difficulties in psychiatric disorders: a meta-analysis. J Psychiatric Res. https://doi.org/10.1080/0164212X.2022.2125925

    Article  Google Scholar 

  22. Yao B, Thakkar K (2021) Interoception abnormalities in schizophrenia: a review of preliminary evidence and an integration with bayesian accounts of psychosis. Neurosci Biobehav Rev 132:757–773

    Article  PubMed  Google Scholar 

  23. Madeira L, Pienkos E, Filipe T, Melo M, Queiroz G, Eira J, Costa C, Figueira ML, Sass L (2019) Self and world experience in non-affective first episode of psychosis. Schizophr Res 211:69–78

    Article  PubMed  Google Scholar 

  24. Millière R (2017) Looking for the self: phenomenology, neurophysiology and philosophical significance of drug-induced ego dissolution. Front Hum Neurosci 11:245

    Article  PubMed  PubMed Central  Google Scholar 

  25. Waters F, Woodward T, Allen P, Aleman A, Sommer I (2012) Self-recognition deficits in schizophrenia patients with auditory hallucinations: a meta-analysis of the literature. Schizophr Bull 38:741–750

    Article  PubMed  Google Scholar 

  26. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (strobe) statement: guidelines for reporting observational studies. The Lancet 370:1453–1457

    Article  Google Scholar 

  27. Garson E, Castle DJ, George TP (2023) Substance-induced psychosis: a narrative review. Curr Addict Rep 10:335–340

    Article  Google Scholar 

  28. Benabarre A, Vieta E, Colom F, Martinez-Aran A, Reinares M, Gasto C (2001) Bipolar disorder, schizoaffective disorder and schizophrenia: epidemiologic, clinical and prognostic differences. Eur Psychiatry 16:167–172

    Article  PubMed  CAS  Google Scholar 

  29. Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A (2012) The multidimensional assessment of interoceptive awareness (maia). PLoS ONE 7:e48230

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Ventura-Bort C, Wendt J, Weymar M (2021) The role of interoceptive sensibility and emotional conceptualization for the experience of emotions. Front Psychol. https://doi.org/10.3389/fpsyg.2021.712418

    Article  PubMed  PubMed Central  Google Scholar 

  31. Brown C, Dunn W (2002) The adult sensory profile. The Psychological Corporation, San Antonio, TX

    Google Scholar 

  32. Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (panss) for schizophrenia. Schizophr Bull 13:261–276

    Article  PubMed  CAS  Google Scholar 

  33. Gardner DM, Murphy AL, O’Donnell H, Centorrino F, Baldessarini RJ (2014) International consensus study of antipsychotic dosing. Focus 12:235–243

    Article  Google Scholar 

  34. Hayasaka Y, Purgato M, Magni LR, Ogawa Y, Takeshima N, Cipriani A, Barbui C, Leucht S, Furukawa TA (2015) Dose equivalents of antidepressants: evidence-based recommendations from randomized controlled trials. J Affect Disord 180:179–184

    Article  PubMed  CAS  Google Scholar 

  35. Inada T, Inagaki A (2015) Psychotropic dose equivalence in Japan. Psychiatry Clin Neurosci 69:440–447

    Article  PubMed  Google Scholar 

  36. French A, Macedo M, Poulsen J, Waterson T, Yu A (2008) Multivariate analysis of variance (manova)

  37. Massey FJ Jr (1951) The Kolmogorov–Smirnov test for goodness of fit. J Am Stat Assoc 46:68–78

    Article  Google Scholar 

  38. Royston P (1992) Approximating the Shapiro–Wilk W-test for non-normality. Stat Comput 2:117–119

    Article  Google Scholar 

  39. Weisstein EW (2004) Bonferroni correction. https://mathworld.wolfram.com

  40. Zar JH (1972) Significance testing of the spearman rank correlation coefficient. J Am Stat Assoc 67:578–580

    Article  Google Scholar 

  41. McKight PE, Najab J (2010) Kruskal–Wallis test. The Corsini encyclopedia of psychology, 1–1

  42. McKnight PE, Najab J (2010) Mann–Whitney U test. The Corsini encyclopedia of psychology, 1–1

  43. Faul F, Erdfelder E, Buchner A, Lang A-G (2009) Statistical power analyses using g* power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160

    Article  PubMed  Google Scholar 

  44. Rusticus SA, Lovato CY (2019) Impact of sample size and variability on the power and type I error rates of equivalence tests: a simulation study. Pract Assess Res Eval 19:11

    Google Scholar 

  45. Pallant J (2020) SPSS survival manual: a step by step guide to data analysis using IBM SPSS. McGraw-Hill Education (UK), London

  46. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR (2005) What does the panss mean? Schizophr Res 79:231–238

    Article  PubMed  Google Scholar 

  47. Koreki A, Funayama M, Terasawa Y, Onaya M, Mimura M (2021) Aberrant interoceptive accuracy in patients with schizophrenia performing a heartbeat counting task. Schizophrenia Bulletin Open 2:sgaa067

    Article  Google Scholar 

  48. Torregrossa LJ, Amedy A, Roig J, Prada A, Park S (2022) Interoceptive functioning in schizophrenia and schizotypy. Schizophr Res 239:151–159

    Article  PubMed  Google Scholar 

  49. Brown TA, Berner LA, Jones MD, Reilly EE, Cusack A, Anderson LK, Kaye WH, Wierenga CE (2017) Psychometric evaluation and norms for the multidimensional assessment of interoceptive awareness (maia) in a clinical eating disorders sample. Eur Eat Disord Rev 25:411–416

    Article  PubMed  Google Scholar 

  50. Dudley R, Taylor P, Wickham S, Hutton P (2016) Psychosis, delusions and the “jumping to conclusions” reasoning bias: a systematic review and meta-analysis. Schizophr Bull 42:652–665

    Article  PubMed  Google Scholar 

  51. Sanchis-Asensi A, Triviño-Juárez JM, Sanchis-Almiñana H, Romero-Ayuso D (2022) Relationship between sensory profile and self-perceived quality of life in people with schizophrenia: An exploratory study. Occup Therapy Mental Health. 39:1–19

    Google Scholar 

  52. Zhou H-y, Yang H-x, Cui X-l, Shi L-j, Gong J-b, Lui SS, Cheung EF, Watanabe K, Chan RC (2020) Self-reported sensory responsiveness patterns in typically-developing and early-onset schizophrenia adolescents: its relationship with schizotypal and autistic traits. J Psychiatr Res 131:255–262

    Article  PubMed  Google Scholar 

  53. Allen M, Levy A, Parr T, Friston KJ (2022) In the body’s eye: the computational anatomy of interoceptive inference. PLoS Comput Biol 18:e1010490

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  54. Allen M, Tsakiris M (2018) The body as first prior: interoceptive predictive processing and the primacy. The Interoceptive mind: from homeostasis to awareness

  55. Tsakiris M, De Preester H (2018) The interoceptive mind: from homeostasis to awareness. Oxford University Press, Oxford

    Book  Google Scholar 

  56. Bansal S, Ford JM, Spering M (2018) The function and failure of sensory predictions. Ann NY Acad Sci 1426:199–220

    Article  Google Scholar 

  57. Damiani S (2023) Introducing oloudenia: a novel psychopathological framework for ambivalence in psychosis. Psychol Psychother 7:1–2

    Google Scholar 

  58. Teufel C, Subramaniam N, Dobler V, Perez J, Finnemann J, Mehta PR, Goodyer IM, Fletcher PC (2015) Shift toward prior knowledge confers a perceptual advantage in early psychosis and psychosis-prone healthy individuals. Proc Natl Acad Sci 112:13401–13406

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Kaliuzhna M, Stein T, Rusch T, Sekutowicz M, Sterzer P, Seymour KJ (2019) No evidence for abnormal priors in early vision in schizophrenia. Schizophr Res 210:245–254

    Article  PubMed  Google Scholar 

  60. Valton V, Karvelis P, Richards KL, Seitz AR, Lawrie SM, Seriès P (2019) Acquisition of visual priors and induced hallucinations in chronic schizophrenia. Brain 142:2523–2537

    Article  PubMed  PubMed Central  Google Scholar 

  61. Griffin JD, Fletcher PC (2017) Predictive processing, source monitoring, and psychosis. Annu Rev Clin Psychol 13:265

    Article  PubMed  PubMed Central  Google Scholar 

  62. Stanghellini G, Rossi R (2014) Pheno-phenotypes: a holistic approach to the psychopathology of schizophrenia. Curr Opin Psychiatry 27:236–241

    Article  PubMed  Google Scholar 

  63. Forkmann T, Scherer A, Meessen J, Michal M, Schächinger H, Vögele C, Schulz A (2016) Making sense of what you sense: disentangling interoceptive awareness, sensibility and accuracy. Int J Psychophysiol 109:71–80

    Article  PubMed  Google Scholar 

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Acknowledgements

Thanks to Alice Mandrini, Serena Chiara Civardi, Valentina Grecuzzo, Irma Bergamaschini, Erika de Francesco, Francesco Sommi, Silvia Gazzoli, and Emma Facchinetti.

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Authors and Affiliations

  1. Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, Pavia, Italy

    Stefano Damiani, Marie Emilie Giovannelli, Matteo Rocchetti, Pierluigi Politi & Paolo Fusar-Poli

  2. Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy

    Andrea Silva, Alberto Donadeo, Fabrizio Pavone, Elena Farinella & Pierluigi Politi

  3. Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

    Paolo Fusar-Poli

  4. OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK

    Paolo Fusar-Poli

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  1. Stefano Damiani
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Damiani, S., Silva, A., Donadeo, A. et al. Self-reported interoception and exteroception are atypical and excessively coupled in psychosis compared to healthy controls. Eur Arch Psychiatry Clin Neurosci (2023). https://doi.org/10.1007/s00406-023-01728-1

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