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ORIGINAL RESEARCH article

Front. Psychiatry
Sec. Schizophrenia
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1441585

Altered Sense of Agency in Schizophrenia: The Aberrant Effect of Cardiac Interoceptive Signals

Provisionally accepted
Akihiro Koreki Akihiro Koreki 1*Yuri Terasawa Yuri Terasawa 2Atsuo Nuruki Atsuo Nuruki 3Hiroki Oi Hiroki Oi 4Hugo Critchley Hugo Critchley 5Mahinda Yogarajah Mahinda Yogarajah 6Mitsumoto Onaya Mitsumoto Onaya 1
  • 1 National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
  • 2 Keio University, Minato, Tōkyō, Japan
  • 3 Kagoshima University, Kagoshima, Kagoshima, Japan
  • 4 School of Medicine, Keio University, Tokyo, Japan
  • 5 University of Sussex, Brighton, West Sussex, United Kingdom
  • 6 University College London, London, England, United Kingdom

The final, formatted version of the article will be published soon.

    Background: Schizophrenia (SZ) is characterized by abnormalities in self-representation, including a disturbed sense of agency (SoA). The continuous processing of sensory information concerning the internal state of the body (interoception) is argued to be fundamental to neural representations of the self. We, therefore, tested if aberrant interoception underpins disturbances in SoA in SZ, focusing on cardiac interoceptive signaling.Methods: Forty-two SZ and 29 non-clinical participants (healthy controls; HC) performed an intentional binding task to measure SoA during concurrent heartbeat recording. The effect of cardiac interoceptive signals on SoA was measured by the difference in intentional binding effect during systole and diastole. This measure was standardised based on the overall intentional binding effect to control for non-cardiac factors, and then compared between SZ and HC.Results: Our study revealed a significant difference between SZ and HC groups, with opposite effects of cardiac systole on SoA. Specifically, cardiac systole disrupted SoA in SZ, contrasting with the enhanced SoA in HC. Across the SZ group, the extent to which SoA was disrupted by cardiac systole correlated significantly with a clinical proxy for symptom instability, namely the number of hospital admissions for hallucinations and delusions. Furthermore, the disruption was particularly observed in patients with severe hallucinations.This study revealed a disturbance in the impact of cardiac interoceptive signals on an implicit index of SoA in schizophrenia. This supports the notion that pathophysiological disruption of the central integration of interoceptive information increases vulnerability to disturbances in self-representation and the associated expression of schizophrenic symptoms.

    Keywords: Brain, interoception, Heart, Schizophrenia, sense of agency, self

    Received: 31 May 2024; Accepted: 30 Aug 2024.

    Copyright: © 2024 Koreki, Terasawa, Nuruki, Oi, Critchley, Yogarajah and Onaya. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Akihiro Koreki, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan

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