Clinical, exteroceptive and interoceptive changes in patients experiencing a psychotic episode: an explorative analysis comparing post-acute and recovery phase.

A coordinated multisensory unit is required in order to achieve a whole and solid sense of Self, obtained from the integration between interoception, proprioception, processing of the peri-personal space and exteroception. In psychotic patients an alteration between the sensory pathways and the connections between the internal and external worlds is found, generating multisensory experiences both incoherent and paradoxical. Intero-exteroceptive anomalies appear alongside Self-disorders and positive and negative symptoms connected to the general psychopathology. AIM OF THE STUDY: This pilot study aims to explore whether we do have relations between these domains, and how they have evolved between the post-acute phase (t1) and the recovery phase (t2) of the disease. As a secondary aim we have studied the correlations between the interoceptive and exteroceptive profiles, analyzing whether some factors tend to emerge more than others and what could be the clinical significance of this phenomenon. MATERIALS AND METHODS: this pilot study has been performed on a set of 17 patients diagnosed with psychotic symptoms, coming from the SPDC of the “IRCCS San Matteo hospital” in Pavia, Italy. These patients have been evaluated upon discharge from the hospital (t1) and upon recovery (t2). The tests used in the study are: the Positive and Negative Syndrome Scale (PANSS) to evaluate the clinical status, the Adolescent/Adult Sensory Profile (AASP) for the exteroception appraisal and the Multidimensional Assessment of Interoceptive Awareness (MAIA) for the interoception. RESULTS: The overall PANSS score (PANSS_TOT) shows a significant decrease (p = 0.034) between the post-acute phase (t1) and the recovery phase (t2) (PANSS_TOT t1 = 52.000; PANSS_TOT t2 = 41.000), the AASP ones instead hinted at a diminishing trend (p = 0.100); MAIA values show no significant change (p = 0.359). Correlations between AASP and MAIA values at t2 were relatively stronger then t1: MAIA_emotional awareness increases in t2, and MAIA_not-worring and Sensation Seeking (SP-SK) show high correlations with the rest of the scale components. CONCLUSIONS: Psychotic subjects in post-acute phases of illness have opposite associations between AASP and MAIA with respect to the healthy population, and this trend is preserved even during the recovery phase, seemingly indicating that these sensory profiles could be a constitutional trait typical of patients vulnerable to psychotic episodes, rather than features associated to the phase of illness. Moreover, we found that similar patterns of AASP/MAIA correlations are present between sub-acute and recovery phase, indicating a global decreased response to external sensory stimulation, which could be the expression of a possible shift inward of the awareness as a self-defence mechanism, but also an increased emotional and bodily awareness, indicating that psychotic patients in remission tend to be more acutely aware of any negative feeling, suggesting a possible higher degree of anxiety concerning their global health, but they also developed an improved mind-body integration, by better recognizing that certain physical sensations reflect closely the sensory aspect of emotions. KEY WORDS: psychosis, interoception, exteroception, Self-disorders.