conrad case study schizophrenia

• First Online: 10 August 2016

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• Clara S. Humpston 3 &
• Matthew R. Broome 4  

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The sense of perplexity is a key feature of delusional mood/atmosphere which plays an important role in the phenomenology of early psychosis. Here we begin this chapter by presenting a clinical scenario of the psychosis prodrome and refer to this case study as our basis of discussion. We provide a detailed picture of psychiatric and philosophical literature to investigate in depth the phenomenon of perplexity drawing from theories such as Conrad’s stage model of beginning schizophrenia before placing the original case study into context and discuss concepts related to a loss of common sense and delusional elaboration in the pathogenesis of the perplexed feelings experienced by many prodromal individuals. We end the chapter with clinical implications and offer potential suggestions for improving the assessment, diagnosis and treatment of early psychosis, in particular the importance of recognising the individual’s suffering and acknowledge his own reality.

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The phenomenology of hypo- and hyperreality in psychopathology.

Double bookkeeping in schizophrenia spectrum disorder: an empirical-phenomenological study

Double bookkeeping and schizophrenia spectrum: divided unified phenomenal consciousness.

Patient name and identifiable factors have been changed to protect anonymity.

Addington, J., Penn, D., Woods, S. W., Addington, D., & Perkins, D. O. (2008). Social functioning in individuals at clinical high risk for psychosis. Schizophrenia Research, 99 (1), 119–124.

Article   PubMed   Google Scholar  

Addington, J., Van Mastrigt, S., Hutchinson, J., & Addington, D. (2002). Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatrica Scandinavica, 106 (5), 358–364.

Article   CAS   PubMed   Google Scholar  

Berner, P. (1991). Delusional atmosphere. British Journal of Psychiatry, 159 , 88–93.

Google Scholar  

Berrios, G. (1991). Delusions as wrong beliefs: A conceptual history. British Journal of Psychiatry, 159 , 6–13.

Bortolotti, L. (2010). Delusions and other irrational beliefs . Oxford: Oxford University Press.

Broome, M. R., Harland, R., Owen, G. S., & Stringaris, A. (Eds.). (2012). The Maudsley reader in phenomenological psychiatry . Cambridge: Cambridge University Press.

Broome, M. R., Woolley, J. B., Johns, L. C., Valmaggia, L. R., Tabraham, P., Gafoor, R., et al. (2005a). Outreach and support in south London (OASIS): Implementation of a clinical service for prodromal psychosis and the at risk mental state. European Psychiatry, 20 (5), 372–378.

Broome, M. R., Woolley, J. B., Tabraham, P., Johns, L. C., Bramon, E., Murray, G. K., et al. (2005b). What causes the onset of psychosis? Schizophrenia Research, 79 (1), 23–34.

Carr, V. J. (2010). Beauty and belief: William James and the aesthetics of delusions in schizophrenia. Cognitive Neuropsychiatry, 15 (1-3), 181–201.

Cermolacce, M., Naudin, J., & Parnas, J. (2007). The “minimal self” in psychopathology: re-examining the self-disorders in the schizophrenia spectrum. Consciousness and Cognition, 16 (3), 703–714.

Cornblatt, B. A., Lencz, T., & Kane, J. M. (2001). Treatment of the schizophrenia prodrome: Is it presently ethical? Schizophrenia Research, 51 (1), 31–38.

Currie, G. (2000). Imagination, delusion and hallucinations. Mind & Language, 15 (1), 168–183.

Article   Google Scholar  

Earnshaw, O. (2011). Losing anchoring in the everyday: The role of trust in commonsense and its breakdown in delusions. PhD Thesis.

Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., et al. (2012). Predicting psychosis: Meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry, 69 (3), 220–229.

Fyfe, S., Williams, C., Mason, O. J., & Pickup, G. J. (2008). Apophenia, theory of mind and schizotypy: Perceiving meaning and intentionality in randomness. Cortex, 44 (10), 1316–1325.

Gerrans, P. (2001). Delusions as performance failures. Cognitive Neuropsychiatry, 6 (3), 161–173.

Hawkes, E. (2012). Making meaning. Schizophrenia Bulletin, 38 (6), 1109–1110.

Article   PubMed   PubMed Central   Google Scholar  

Humpston, C. S., & Broome, M. R. (2015). The spectra of soundless voices and audible thoughts: Towards an integrative model of auditory verbal hallucinations and thought insertion. Review of Philosophy and Psychology , 1–19.

Humpston, C. S., Walsh, E., Oakley, D. A., Mehta, M. A., Bell, V., & Deeley, Q. (2016). The relationship between different types of dissociation and psychosis-like experiences in a non-clinical sample. Consciousness and Cognition, 41 , 83–92.

James, W. (1950). The principles of psychology (Vol. 1). New York: Dover Publications.

Jaspers, K. (1962). General Psychopathology (J. Hoenig & M. W. Hamilton, Trans.). Manchester, UK: Manchester University Press.

Kapur, S. (2003). Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry, 160 (1), 13–23.

Kim, Y., Takemoto, K., Mayahara, K., Sumida, K., & Shiba, S. (1994). An analysis of the subjective experience of schizophrenia. Comprehensive Psychiatry, 35 (6), 430–436.

Levin, R., Sirof, B., Simeon, D., & Guralnick, O. (2004). Role of fantasy proneness, imaginative involvement, and psychological absorption in depersonalisation disorder. The Journal of Nervous and Mental Disease, 192 (1), 69–71.

Maj, M. (2013). Karl Jaspers and the genesis of delusions in schizophrenia. Schizophrenia Bulletin, 39 (2), 242–243.

Mishara, A. L. (2010). Klaus Conrad (1905–1961): Delusional mood, psychosis, and beginning schizophrenia. Schizophrenia Bulletin, 36 (1), 9–13.

Mishara, A. L., & Fusar-Poli, P. (2013). The phenomenology and neurobiology of delusion formation during psychosis onset: Jaspers, Truman symptoms, and aberrant salience. Schizophrenia Bulletin, 39 (2), 278–286.

Nelson, B., Fornito, A., Harrison, B. J., Yücel, M., Sass, L. A., Yung, A. R., et al. (2009). A disturbed sense of self in the psychosis prodrome: Linking phenomenology and neurobiology. Neuroscience and Biobehavioural Reviews, 33 (6), 807–817.

Article   CAS   Google Scholar  

Nelson, B., Thompson, A., & Yung, A. R. (2012). Basic self-disturbance predicts psychosis onset in the ultra high risk for psychosis “prodromal” population. Schizophrenia Bulletin, 38 (6), 1277–1287.

Nelson, B., Yung, A. R., Bechdolf, A., & McGorry, P. D. (2008). The phenomenological critique and self-disturbance: Implications for ultra-high risk (“prodrome”) research. Schizophrenia Bulletin, 34 (2), 381–392.

Niendam, T. A., Bearden, C. E., Zinberg, J., Johnson, J. K., O'Brien, M., & Cannon, T. D. (2007). The course of neurocognition and social functioning in individuals at ultra high risk for psychosis. Schizophrenia Bulletin, 33 (3), 772–781.

Owen, G. S., Cutting, J., & David, A. S. (2007). Are people with schizophrenia more logical than healthy volunteers? The British Journal of Psychiatry, 191 (5), 453–454.

Parnas, J., Bovet, P., & Zahavi, D. (2002). Schizophrenic autism: clinical phenomenology and pathogenetic implications. World Psychiatry, 1 (3), 131.

PubMed   PubMed Central   Google Scholar  

Parnas, J., Møller, P., Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., & Zahavi, D. (2005). EASE: Examination of anomalous self-experience. Psychopathology, 38 (5), 236–258.

Parnas, J., Raballo, A., Handest, P., Jansson, L., Vollmer-Larsen, A., & Saebye, D. (2011). Self‐experience in the early phases of schizophrenia: 5‐year follow‐up of the Copenhagen Prodromal Study. World Psychiatry, 10 (3), 200–204.

Parnas, J., & Sass, L. A. (2001). Self, solipsism, and schizophrenic delusions. Philosophy, Psychiatry, and Psychology, 8 (2), 101–120.

Perona-Garcelán, S., Cuevas-Yust, C., García-Montes, J. M., Pérez-Álvarez, M., Ductor-Recuerda, M. J., Salas-Azcona, R., et al. (2008). Relationship between self-focused attention and dissociation in patients with and without auditory hallucinations. The Journal of Nervous and Mental Disease, 196 (3), 190–197.

Rasmussen, A. R., & Parnas, J. (2015). Pathologies of imagination in schizophrenia spectrum disorders. Acta Psychiatrica Scandinavica, 131 (3), 157–161.

Rietdijk, J., Hogerzeil, S. J., van Hemert, A. M., Cuijpers, P., Linszen, D. H., & van der Gaag, M. (2011). Pathways to psychosis: Help-seeking behavior in the prodromal phase. Schizophrenia Research, 132 (2), 213–219.

Sass, L. A., & Parnas, J. (2003). Schizophrenia, consciousness, and the self. Schizophrenia Bulletin, 29 (3), 427–444.

Stanghellini, G. (2000). Vulnerability to schizophrenia and lack of common sense. Schizophrenia Bulletin, 26 (4), 775–787.

Uhlhaas, P. J., & Mishara, A. L. (2007). Perceptual anomalies in schizophrenia: Integrating phenomenology and cognitive neuroscience. Schizophrenia Bulletin, 33 (1), 142–156.

Wing, J. K., Babor, T., Brugha, T., Burke, J., Cooper, J. E., Giel, R., et al. (1990). SCAN: Schedules for clinical assessment in neuropsychiatry. Archives of General Psychiatry, 47 (6), 589–593.

Yung, A. R., & McGorry, P. D. (1996). The prodromal phase of first-episode psychosis: Past and current conceptualizations. Schizophrenia Bulletin, 22 (2), 353–370.

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School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK

Clara S. Humpston

Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK

Matthew R. Broome

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Department of Psycho,Humanis.&Terr. Sci, Uni"D.Portales",Chile,&Uni“G.D’Annunzio”, Chieti, Italy

Giovanni Stanghellini

Sapienza Univ&Crossing Dialogues Assoc., Rome, Italy

Massimiliano Aragona

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Humpston, C.S., Broome, M.R. (2016). Perplexity. In: Stanghellini, G., Aragona, M. (eds) An Experiential Approach to Psychopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-29945-7_13

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DOI : https://doi.org/10.1007/978-3-319-29945-7_13

Published : 10 August 2016

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