Schizophrenie und Psychose: Der gestaltpsychologische Ansatz


Conrad K. (1958). Die beginnende Schizophrenie. Stuttgart: Thieme.

Andreasen NC, Paradiso S, O'Leary DS. (1998) "Cognitive dysmetria" as an integrative theory of schizophrenia: a dysfunction in cortical-subcortical-cerebellar circuitry? Schizophrenia Bulletin, 24(2): 203-218.
Abstract: Earlier efforts to localize the symptoms of schizophrenia in a single brain region have been replaced by models that postulate a disruption in parallel distributed or dynamic circuits. Based on empirical data derived from both magnetic resonance and positron emission tomography, we have developed a model that implicates connectivity among nodes located in prefrontal regions, the thalamic nuclei, and the cerebellum. A disruption in this circuitry produces "cognitive dysmetria," difficulty in prioritizing, processing, coordinating, and responding to information. This "poor mental coordination" is a fundamental cognitive deficit in schizophrenia and can account for its broad diversity of symptoms.

Phillips WA & Silverstein SM (2003). Convergence of Biological and Psychological Perspectives on Cognitive Coordination in Schizophrenia. Behavioral and Brain Sciences, 26, 65-138

Friston KJ (1998). The disconnection hypothesis. Schizophrenia Research, 30, 115-125

Silverstein SM, Kovacs I, Corry R, & Valone C (2000). Perceptual organization, the disorganization syndrome, and context processing in chronic schizophrenia. Schizophrenia Research, 43, 11-20.

Parnas, J, Vianin, P, Saebye, D, Jansson, L, Volmer-Larsen, A, Bovet, P (1992). Visual binding abilities in the initial and advanced stages of schizophrenia. Acta Psychiatrica Scandinavica, 103, 171-180.

Uhlhaas PJ & Silverstein SM (2003). The continuing relevance of Gestalt psychology for an understanding of schizophrenia. Gestalt Theory, 25, 215-240.
(dieser Artikel sowie die darauffolgend in "Gestalt Theory" publizierten Kommentare)

Tschacher W, Dubouloz P, Meier R, & Junghan U (2008). Altered Perception of Apparent Motion in Schizophrenia Spectrum Disorder. Psychiatry Research, 159, 290-299.
Abstract: Apparent motion (AM), the gestalt perception of motion in the absence of physical motion, was used to study perceptual organization and neurocognitive binding in schizophrenia. Associations between AM perception and psychopathology as well as meaningful subgroups were sought. Circular and stroboscopic AM stimuli were presented to 68 schizophrenia spectrum patients and healthy participants. Psychopathology was measured using the Positive and Negative Syndrome Scale PANSS. Psychopathology was related to AM perception differentially: Positive and disorganization symptoms were linked to reduced gestalt stability; negative symptoms, excitement and depression had opposite regression weights. Dimensions of psychopathology thus have opposing effects on Gestalt perception. It was generally found that AM perception was closely associated with psychopathology. No difference existed between patients and controls but two latent classes were found. Class A members who had low levels of AM stability comprised the majority of inpatients and control subjects; such participants were generally young, male, with short reaction times. Class B typically contained outpatients and some control subjects; participants in class B were older and showed longer reaction times. Hence AM perception dysfunctions are not specific for schizophrenia, yet AM may be a promising stage marker.

Tschacher W, Schuler D, & Junghan U (2006). Reduced Perception of the Motion-Induced Blindness Illusion in Schizophrenia. Schizophrenia Research, 81, 261-267.
Abstract: Motion-induced blindness (MIB) occurs when target stimuli are presented together with a moving distractor pattern. Most observers experience the targets disappearing and reappearing repeatedly for periods of up to several seconds. MIB can be viewed as a striking marker for the organization of cognitive functioning. In the present study, MIB rates and durations were assessed in 34 schizophrenia-spectrum disorder patients and matched controls. The results showed that positive symptoms and excitement enhanced MIB, whereas depression and negative symptoms attenuated the illusion. MIB was more frequently found in normal subjects. The results remained consistent after adjusting for reaction time and error rates. Hence, MIB may provide a valid and reliable measure of cognitive organization in schizophrenia.

Tschacher W & Kupper Z (2006). Perception of Causality in Schizophrenia Spectrum Disorder. Schizophrenia Bulletin, 32, S106-S112.
Abstract: Patients with schizophrenia spectrum disorders often maintain deviating views on cause-effect relationships, especially when positive and disorganization symptoms are manifest. Altered perceived causality is prominent in delusional ideation, in ideas of reference, and in the mentalizing ability or 'Theory of mind' (ToM) of patients. In the present study, perception of causality was investigated as a pre-attentional capability similar to gestalt-like perceptual organization. 31 patients (24 men and 7 women with  with mean age 27.7 y) and the same number of healthy control subjects matched to patients with respect to age and sex were tested. A visual paradigm was used in which two identical discs move, from opposite sides of a monitor, steadily toward and then past one another. Their coincidence generates an ambiguous, bistable percept (discs either 'stream through' or to 'bounce off' one another). The bouncing perception, i.e. perceived causality, is enhanced when auditory stimuli are presented at the time of coincidence. Psychopathology was measured using the Positive and Negative Syndrome Scale (PANSS). It was found that positive symptoms were associated with increased perceived causality, disorganization with attenuated perceived causality. Patients were not significantly different from controls, and timing of the auditory stimulus had similar influences on causality perception in the patients group. Perceived causality may be interpreted as a basic pre-attentional process that underlies ToM deficiencies. Conclusions for cognitive remediation therapy were drawn based on the results.

Tschacher W & Bergomi C (2011). Cognitive binding in Schizophrenia: Weakened integration of temporal intersensory information. Schizophrenia Bulletin, 37, S13–S22.
Abstract: Cognitive functioning is based on binding processes, by which different features and elements of neurocognition are integrated and coordinated. Binding is an essential ingredient of, for instance, Gestalt perception. We have implemented a paradigm of causality perception based on the work of Albert Michotte, in which two identical discs move, from opposite sides of a monitor, steadily toward and then past one another. Their coincidence generates an ambiguous percept of either 'streaming' or 'bouncing', which the subjects (34 schizophrenia-spectrum patients and 34 controls with mean age 27.9 y) were instructed to report. The latter perception is a marker of the binding processes underlying perceived causality (type I binding). In addition to this visual task, acoustic stimuli were presented at different times during the task (150 ms before and after visual coincidence), which can modulate perceived causality. This modulation by intersensory and temporally delayed stimuli is viewed as a different type of binding (type II). We show here, using a mixed-effects hierarchical analysis, that type II binding distinguishes schizophrenia-spectrum patients from healthy controls, whereas type I binding does not. Type I binding may even be excessive in some patients, especially those with positive symptoms; Type II binding, however, was generally attenuated in patients. The present findings point to ways in which the disconnection (or Gestalt) hypothesis of schizophrenia can be refined, suggesting more specific markers of neurocognitive functioning and potential targets of treatment.

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