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Received: February 25, 2002
Accepted: January 9, 2003
Abstract
Thought insertion and other experiences of alien control have been explained as a source monitoring deficit, that results from a disconnection between a cognitive system for willed actions and a different system that monitors them. The case we present is a schizophrenic patient that in order to consciously avoid feeling his thoughts as not belonging to himself performs them as a motor act of speech. We suggest an interpretation for this conscious compensation following C. Frith's neuropsychological model of schizophrenia.
Keywords
Thought insertion [middot] Hallucination [middot] Schizophrenia [middot] Forward model [middot] Source monitoring
Copyright (C) 2003 S. Karger AG, Basel
Introduction
Source monitoring deficits have been described in schizophrenic patients especially in those suffering from first rank symptoms, including thought insertion and passivity experiences [1]. Frith and Done [2] proposed to account for the phenomena through a disconnection mechanism between a cognitive system for willed actions and a system that monitors them. Recently, Frith et al. [3] compared delusions of control with alien hand sign, emphasizing differences in insight.
The case we present is that of a patient diagnosed with schizophrenia who in order to consciously avoid experiencing his thoughts as not belonging to himself, initially performs them as a motor act of speech. We suggest an interpretation for this conscious compensation in the light of neuropsychological theories on schizophrenia [1-5].
Case Report
The patient was a 25-year-old man with a 1-year history of poor concentration and depressive mood. Apart from an unconfirmed history of fetal distress and epileptic seizures in his childhood, his past medical and psychiatric history, as well as his family history, were unremarkable.
A year before our first interview he started complaining of sadness, poor concentration and 'tension in his head', 'as if it were to explode'. He started to lose confidence, feeling that he was to able to complete his work. By that time he noticed increasing difficulty in thinking, and was suffering from occasional thought blocking and thought withdrawal.
After a few months he started to experience his thoughts 'as if they belong to another person'. Interestingly, he tried to consciously avoid this sensation by speaking aloud and formulating his inner speech as a dialogue of questions and...