Phenomenological aspects of self-awareness disorders in the clinical picture of manifest forms of paranoid schizophrenia and schizoaffective disorder

Phenomenological aspects of self-awareness disorders in the clinical picture of manifest forms of paranoid schizophrenia and schizoaffective disorder

 

Authors

 

S.A. Lobkov

Federal State Budgetary Educational Institution of Higher Education “Irkutsk State Medical University” of the Ministry of Health of the Russian Federation, Irkutsk, Russian Federation;
Clinics of Federal State Budgetary Educational Institution of Higher Education “Irkutsk State Medical University” of the Ministry of Health of the Russian Federation,Irkutsk, Russian Federation

 

https://doi.org/10.26617/1810-3111-2026-1(130)-96-106

 

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2026; 1 (130):  96-106.

 

Abstract

Objective: to conduct a comparative analysis of the phenomenological and structural-typological features of self-awareness disorders (depersonalization and derealization – DP-DR) across different stages of episodic (paroxysmal) paranoid schizophrenia and schizoaffective disorder to clarify their diagnostic and prognostic significance. Material. The study was conducted between 2022 and 2025 at the Psychiatric Unit of the Irkutsk State Medical University Clinics and the general psychiatric units of the Irkutsk Regional Psychoneurological Dispensary. Methods: clinical-anamnestic, clinical-follow-up, clinical-psychopathological, psychometric, and statistical methods were employed. The study analysed DP-DR features in 117 patients presenting with their first psychotic episode of paranoid schizophrenia (n=52) or schizoaffective disorder (n=65). Results. Based on the Cambridge Depersonalization Scale, a DP-DR taxonomy was proposed, distinguishing ideational, affective and somatic phenomenological domains. In paranoid schizophrenia, ideational domain experiences predominated (65.4% versus 27.7% in schizoaffective disorder; p<0.001), characterized by disturbances in thought processes and loss of thoughts ownership. In schizoaffective disorder, the affective domain was dominant (70.8% versus 34.6% in paranoid schizophrenia; p<0.001) featuring predominantly hypopathic experiences. The somatic domain occurred with comparable frequency (46-48%), however, in paranoid schizophrenia it was characterized by impaired agency of movement, whereas in schizoaffective disorder it manifested through psychosensory disturbances. At the manifest stage, ideational phenomena in paranoid schizophrenia significantly more often transformed into mental automatisms (76.9% versus 32.3%; p<0.001). A transition pattern was identified from metaphorical descriptions (“as if”) to categorical statements with delusional interpretation.

 

Keywords: disorders of self-awareness, depersonalization, derealization, schizophrenia spectrum disorders, premanifest stage, schizoaffective disorder, paranoid schizophrenia.

 

Article (pdf)

 

Contacts

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Materials  

For citation: Lobkov S.A. Phenomenological aspects of self-awareness disorders in the clinical picture of manifest forms of paranoid schizophrenia and schizoaffective disorder. Siberian Herald of Psychiatry and Addiction Psychiatry.2026, 1 (130): 96-106. https://doi.org/10.26617/1810-3111-2026-1(130)-96-106

 

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