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Examination of Anomalous Self-Experience in First-Episode Psychosis: Interrater Reliability

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The growing research focus on early detection of schizophrenia has fostered an increasing interest in the nonpsychotic experiential anomalies that may antedate schizophrenia spectrum disorders and assist early differential diagnosis. The Examination of Anomalous Self-Experience (EASE) is a phenomenologically inspired checklist, specifically designed to support the comprehensive assessment of these characteristic subjective experiences. To assess the interrater reliability of the EASE. Twenty-five first-episode psychosis (FEP) patients were interviewed with the EASE. Videotaped interviews were blindly reevaluated. Internal consistency, overall interrater correlation and item interrater agreement (Cohen's kappa) were estimated. The EASE showed good to excellent internal consistency across the two raters (Cronbach's alpha above 0.87) and an overall inter-rater correlation above 0.80 (Spearman's rho, p < 0.001). The average kappa of the EASE was 0.65, ranging from 0.51 to 0.73 over the 5 domains; kappa values at an item level were very good in 9 items, good in 20 items, moderate in 11 items and fair in 4 items. The EASE provides a reliable and internally consistent clinical tool for the assessment of subjective experience in FEP patients, suggesting that this instrument could usefully supplement standard clinical assessments during the onset phase of psychosis.
... Although not developing a specific temporal description for schizophrenia, their work points out that the structural characteristic of schizophrenia is the impairment of the ability to integrate the various subtle, yet most fundamental subjective conscious experiences, as a result of lost ipseity (Møller, Haug, Raballo, Parnas, & Melle, 2011;Parnas, 2011;Parnas & Handest, 2003). ...
... No entanto, Parnas descreve que esses sinais e sintomas são apenas consequências secundárias dos transtornos do eu, que são o núcleo clínico de todos os transtornos do espectro esquizofrênico (Parnas, 2011;Parnas & Handest, 2003;Sass & Parnas, 2003). Embora não desenvolvendo uma descrição temporal específica para a esquizofrenia, seu trabalho aponta que a característica estrutural da esquizofrenia é o comprometimento da capacidade de integrar as várias experiências conscientes subjetivas sutis, mas fundamentais, como resultado da perda de ipseidade (Møller, Haug, Raballo, Parnas, & Melle, 2011;Parnas, 2011;Parnas & Handest, 2003). Na Avaliação das Experiências Anômalas de Si (Examination of Anomalous Self-Experience -EASE), é descrito um atraso ou prejuízo na experiência de propriedade (no sentido de posse) das vivências e uma infinidade de experiências relacionadas ao tempo, que é sentido como congelado, lento ou cronicamente apressado, entre outros (Parnas et al., 2005). ...
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Post-traumatic stress disorder (PTSD) is a severe mental disorder described only by operational criteria, without a proper dialectic essential analysis. In this study, we present a typical PTSD case with psychotic features, describing his living world through the domains of Heideggerian ontological-existential constituents –spatiality, temporality, corporeity and interpersonality (being-with-others). A phenomenological reduction and diagnostic elaboration was then performed. An essence of pervasive fear, that locks all intentionality and taints the entire being-in-the-world is described as the main characteristic of PTSD. The differential diagnosis is then discussed through a temporal perspective, showing essential differences among Bipolar Disorder, Schizophrenia and Persistent Delusional Disorder. We stand for a return to phenomenology, and its use to diagnosis and disorder description as a way to improve diagnostic validity and reliability.
... EASE has very good to excellent internal consistency and inter-rater reliability with k values ranging from 0.62 to 0.94. 39 The interview is semi-structured and should be performed in a highly conversational style. If items are endorsed, the patient is asked to describe in more detail the experiences in question (i.e., a disturbed sense of identity) in his/her own words and to give concrete personal illustrating examples. ...
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Background Language impairments are key features of schizophrenia spectrum disorders, and have also been suggested to signal enhanced psychosis risk. Incoherence, derailment, and monotonous speaking are however closely related to psychosis onset, and thus not very early markers. Recent phenomenologic-psychiatric studies claim that basic self-disturbance (BSD) may represent more useful early markers. Methods We searched for distinctive irregular linguistics of 30 CHR outpatient adolescents, aged 12–18 years. Standard instruments established psychosis risk and BSD. Participants chose three personal and well manifested BSD phenomena. Ninety verbatim statements were analyzed and grouped into higher order clusters of linguistic irregularities. Findings We identified five clusters of irregular language features: distinctive words, describing an atmosphere of unreality; irregular use of prepositions, indicating experiential detachment; shifts of personal pronouns, indicating identity confusion; near-literal use of metaphors and conjunctions indicating existential insecurity, and idiosyncratic use of adjectives indicating perceptual transcendence. Interpretation The adolescents provided naturalistic descriptions of experiences that were markedly twisted and almost ineffable. This unique irregular “BSD -language” was highly meaningful in its proper context, expressing informative characteristics of first-personal experiential alterations, essential for early detection. The features may additionally represent precursors of psychosis transition, useful for clinical decision-making. Funding Foundation Dam, Oslo, Norway (Grant Number 2017/FO143368)
... However, we do not recommend the implementation of current assessment tools. Despite the high interrater reliability of the EASE and BSABS 12,42 , they are lengthy and resource intensive assessments 7,43 . This creates a difficult conundrum in clinical practice, where the volume of first-hand personal data gathered must be balanced with the limited time clinicians have to perform assessments. ...
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Self-disorders have been proposed as the “clinical core” of the schizophrenia spectrum. This has been explored in recent studies using self-disorder assessment tools. However, there are few systematic discussions of their quality and utility. Therefore, a literature search was performed on Medline, Embase, PsychINFO, PubMed and the Web of Science. Studies using these assessment tools to explore self-disorders within schizophrenia spectrum disorders (SSDs) were included. A meta-analysis was performed on the outcomes of total self-disturbance score and odds ratios of self-disorders, using Comprehensive Meta-Analysis software. Weighted pooled effect sizes in Hedge’s g were calculated using a random-effects model. 16 studies were included, giving a sample of 845 participants on the schizophrenia spectrum. Self-disorders showed a greater aggregation within schizophrenia spectrum groups compared to non-schizophrenia spectrum groups, as measured with the Bonn Scale for the Assessment of Basic Symptoms (Hedge’s g = 0.774, p <0.01) and Examination of Anomalous Self-Experiences (Hedge’s g = 1.604, p <0.01). Also, self-disorders had a greater likelihood of occurring within SSDs (Odds Ratio = 5.435, p <0.01). These findings help validate self-disorders as a core clinical feature of the broad schizophrenia spectrum.
... The EASE is a checklist for a semi-structured interview and consists of 57 items divided into five domains: Consciousness, presence, corporality, demarcation and solipsism (see Supplementary Table 2, for an overview of the domains and items). The EASE has demonstrated high internal consistency and inter-rater reliability (23,24). ARR was trained and certified as EASE-rater by Dr. Julie Nordgaard, an official instructor and director of the EASE-courses. ...
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Background Anomalies of imagination encompass disturbances of the basic experiential structure of fantasies and imagery that can be explored in a semi-structured way with the Examination of Anomalous Fantasy and Imagination (EAFI). We aimed (1) to examine the distribution of anomalies of imagination among different diagnostic groups and a group of healthy controls, and (2) to examine their relation with disorders of basic self, perceptual disturbances and canonical state psychopathology of the schizophrenia-spectrum (positive, negative and general symptoms). Methods The 81 participants included patients with schizophrenia or other non-affective psychosis ( N = 32), schizotypal personality disorder ( N = 15) or other mental illness ( N = 16) and healthy controls ( N = 18). The assessment encompassed EAFI, Examination of Anomalous Self-Experience (EASE), parts of Bonn Scale for the Assessment of Basic Symptoms (BSABS) and Positive and Negative Syndrome Scale (PANSS). For network analysis, the associations of EAFI with the other psychopathological variables were tested by Pearson's correlation coefficient and graphically represented using multidimensional clustering. Comparisons between correlations in the network were tested with Steiger's test. Results Anomalies of imagination aggregated significantly in schizophrenia-spectrum disorders compared to other mental illness and healthy controls with no difference between schizophrenia and schizotypal disorder. In the network analysis, anomalies of imagination were closely inter-connected with self-disorders. Although, the anomalies of imagination correlated moderately with perceptual disturbance and positive, negative and general state symptomatology, these dimensions aggregated separately and relatively distant in the network. Conclusions The results support that anomalies of imagination are highly characteristic of schizophrenia-spectrum disorders and closely related to self-disorders.
... All EASE items were scored on a 0-4 severity Likert scale, but following other similar studies [24,39,54] we subsequently converted these scores into dichotomous 0-1 scores, indicating that the symptom had been absent or questionably present (0), or definitively present (1). The EASE has been found to have good to excellent internal consistency and inter-rater reliability [33,37,41,55]. SIPS and EASE interviews were videotaped at baseline and follow-up. ...
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Basic self-disturbance (BSD) has been proposed as a driver of symptom development in schizophrenia spectrum disorders (SSDs). In a one-year follow-up of 32 patients (15–30 years) at putative risk for psychosis, we investigated trajectories of BSD levels from baseline to follow-up, and associations between clinical characteristics at baseline and follow-up, including follow-up levels of BSD (assessed with the EASE). Clinical high risk (CHR) for psychosis status and symptom severity were assessed with the SIPS/SOPS scales and also according to the cognitive basic symptoms high-risk criteria (COGDIS). DSM-IV diagnoses, functioning and other clinical characteristics were assessed with standard clinical instruments. Higher severity of negative symptoms and meeting COGDIS criteria at baseline were associated with higher BSD levels at follow-up. All measured at follow-up, higher BSD levels correlated with higher severity of positive, negative, disorganization and general symptoms, and with a lower level of global functioning. We found higher BSD levels at follow-up in subjects with schizotypal personality disorder (SPD) at baseline ( n = 5) and in SSDs at follow-up ( n = 12, including nine with SPD). Mean BSD levels decreased significantly from baseline to follow-up, but individual trajectories varied considerably. Increased BSD levels were associated with higher baseline BSD levels, non-remission of positive symptoms and functional decline. Overall, the current study indicates that subgroups in the CHR population with a higher risk of non-remission or deterioration may be identified by supplementing CHR criteria with assessment of BSD and negative symptoms.
... Nelson et al (2012) 73,74,76,[78][79][80][81]122,123 Although several studies have used EASE ratings by interviewers who were properly reliability trained, some studies do not report data on inter-rater reliability; some report inter-rater reliability data and provide κ values, but between EASE raters who are not reliability trained; and some studies state that inter-rater reliability has been established through joint discussions and consensus agreement, but again between EASE raters who are not reliability trained. These method issues concerning diagnostic and psychopathological assessment, including the assess ment of self-disorders, should be kept in mind when assessing the results from the different studies. ...
Article
In foundational texts on schizophrenia, the mental disorder was constitutively linked to a specific disintegration of subjectivity (often termed a self-disorder). Apart from Scharfetter's work on ego-pathology, research on self-disorders generally faded into oblivion, and self-disorders were only rediscovered as notable psychopathological features of the schizophrenia spectrum nearly two decades ago. Subsequently, the Examination of Anomalous Self-Experience (EASE) scale was constructed to allow systematic assessment of non-psychotic self-disorders. This Review is the first systematic review of empirical studies on self-disorders based on the EASE or other related scales. The results consistently show that self-disorders hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders; that self-disorders are found in individuals at a clinical risk of developing psychosis; that self-disorders show a high degree of temporal stability; that self-disorders predict the later development of schizophrenia spectrum disorders; and that self-disorders correlate with the canonical dimensions of the psychopathology of schizophrenia, impaired social functioning, and suicidality. Issues with the methods of the reviewed literature are critically discussed and the role of self-disorders in clinical psychiatry and future research is outlined.
... The EASE was published with a scoring system from 0 to 5, but most of the studies have used a 3-point scale with "0 = absent," "1 = questionably present," and "2 = present" with data analyses using dichotomous ratings with questionably present items recoded as absent. The interrater reliability of the EASE has been shown to be good to excellent [30][31][32], and internal consistency has been reported to be 0.85 [33] and 0.9 [34]. Factor analysis, using varimax rotation in principal component analysis, yielded a 1-factor solution, accounting for 60% of the total variance [34]. ...
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