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The phenomenology and neurobiology of delusion formation during psychosis onset: Jaspers, Truman symptoms, and aberrant salience.

ABSTRACT: Following the publication of Karl Jaspers' General Psychopathology (1913), delusions have been characterized as being nonunderstandable in terms of the person's biography, motivations, and historical-cultural context. According to Jaspers, this loss of understandability is due to an underlying neurobiological process, which has interrupted the normal development of the individual's personality. Inheriting the 19th-century division between the natural- and human-historical sciences, Jaspers emphasizes the psychological understanding of mental disorders as narrative-based, holistic, and contextual. By doing so, he embraces cultural, ethnic, and individual differences and anticipates a person-centered medicine. However, he also affirms the value of explanatory neurobiological approaches, especially in the research and diagnosis of delusions. The phenomenological approach leads to neurobiological hypotheses, which can be tested experimentally. The present article addresses these issues by illustrating Jaspers' fundamental contribution to current neurobiological research concerning the formation of delusions during early phases of psychosis. Specifically, we present delusional mood and Truman symptoms as core phenomenological features at the origin of psychosis onset, and we discuss their neurobiological substrate with the aberrant salience and dopamine dysregulation models. Jaspers and his successors' phenomenological approach suggests that delusion is formed through loss of context in its experiential-perceptual origins. This is consistent with the more recent neurobiological models.

SUBMITTER: Mishara AL

PROVIDER: S-EPMC3576172 | biostudies-literature | 2013 Mar

REPOSITORIES: biostudies-literature

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The phenomenology and neurobiology of delusion formation during psychosis onset: Jaspers, Truman symptoms, and aberrant salience.

Mishara Aaron L AL Fusar-Poli Paolo P

Schizophrenia bulletin 20130125 2

Following the publication of Karl Jaspers' General Psychopathology (1913), delusions have been characterized as being nonunderstandable in terms of the person's biography, motivations, and historical-cultural context. According to Jaspers, this loss of understandability is due to an underlying neurobiological process, which has interrupted the normal development of the individual's personality. Inheriting the 19th-century division between the natural- and human-historical sciences, Jaspers empha ...[more]

PMID: 23354468

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Project description:Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies, however, have compared disease-related rates of psychosis prevalence in a large autopsy-based cohort, and it remains unclear how diseases differ with respect to the nature or content of the psychosis. We conducted a retrospective chart review of 372 patients with autopsy-confirmed neurodegenerative pathology: 111 with Alzheimer's disease, 59 with Lewy body disease and concomitant Alzheimer's disease, 133 with frontotemporal lobar degeneration (FTLD) with tau inclusions (including progressive supranuclear palsy, corticobasal degeneration or Pick's disease), and 69 with FTLD and TDP inclusions (FTLD-TDP, including types A-C). Psychosis content was classified by subtype, and the frequency of each subtype was compared among pathological diagnoses using logistic regression. A total of 111 of 372 patients had psychosis. Compared to other groups, patients with Lewy body disease/Alzheimer's disease pathology were significantly more likely to have hallucinations and were more likely to have more than one subtype of hallucination. Patients with Braak Parkinson stage 5-6 Lewy body disease were significantly more likely than those with no Lewy body disease to have visual hallucinations of misperception, peripheral hallucinations, hallucinations that moved, hallucinations of people/animals/objects, as well as delusions regarding a place and delusions of misidentification. The feeling of a presence occurred significantly more frequently in patients with Lewy body disease/Alzheimer's disease than all other pathologies. Patients with FTLD-TDP were significantly more likely to have delusions, and for the delusions to occur in the first 3 years of the disease, when compared to patients with Alzheimer's disease and FTLD-tau, though rates were not significantly greater than patients with Lewy body disease/Alzheimer's disease. Paranoia occurred more frequently in the FTLD-TDP and Lewy body disease/Alzheimer's disease categories compared to patients with Alzheimer's disease or FTLD-tau. Patients with FTLD-TDP pathology had delusions of misidentification as frequently as patients with Lewy body disease/Alzheimer's disease, and were significantly more likely to have self-elevating delusions such as grandiosity and erotomania compared to patients with other pathologies including FTLD-tau. These data show that the nature and content of psychosis can provide meaningful information about the underlying neurodegenerative pathology, emphasizing the importance of characterizing patients' psychoses for prediction of the neuropathological diagnosis, regardless of a patient's clinical syndrome.

Project description:BackgroundA dysfunctional differentiation between self-relevant and irrelevant information may affect the perception of environmental stimuli as abnormally salient. The aberrant salience hypothesis assumes that positive symptoms arise from an attribution of salience to irrelevant stimuli accompanied by the feeling of self-relevance. Self-referential processing relies on the activation of cortical midline structures which was demonstrated to be impaired in psychosis. We investigated the neural correlates of self-referential processing, aberrant salience attribution, and the relationship between these 2 measures across the psychosis continuum.MethodsTwenty-nine schizophrenia patients, 24 healthy individuals with subclinical delusional ideation, and 50 healthy individuals participated in this study. Aberrant salience was assessed behaviorally in terms of reaction times to task irrelevant cues. Participants performed a self-reference task during fMRI in which they had to apply neutral trait words to them or to a public figure. The correlation between self-referential processing and aberrant salience attribution was tested.ResultsSchizophrenia patients displayed increased aberrant salience attribution compared with healthy controls and individuals with subclinical delusional ideation, while the latter exhibited intermediate aberrant salience scores. In the self-reference task, schizophrenia patients showed reduced activation in the ventromedial prefrontal cortex (vmPFC), but individuals with subclinical delusional ideation did not differ from healthy controls. In schizophrenia patients, vmPFC activation correlated negatively with implicit aberrant salience attribution.ConclusionsHigher aberrant salience attribution in schizophrenia patients is related to reduced vmPFC activation during self-referential judgments suggesting that aberrant relevance coding is reflected in decreased neural self-referential processing as well as in aberrant salience attribution.

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The phenomenology and neurobiology of delusion formation during psychosis onset: Jaspers, Truman symptoms, and aberrant salience.

Publications

The phenomenology and neurobiology of delusion formation during psychosis onset: Jaspers, Truman symptoms, and aberrant salience.

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