Psychological phenomena in the first two weeks of pharmacotherapy of schizophrenic patients in the framework of Shitij Kapur's theory of psychosis as a state of aberrant salience - a preliminary report
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Arch Psych Psych 2008;10(1):67–77
Aim. According to the theory proposed by S. Kapur psychosis is a state of aberrant salience. Dopamine and the mesolimbic system play the key role in the occurrence of psychosis. According to Kapur, dopamine mediates the conversion of neural representations of an external stimulus from a neutral into attractive or aversive. In the psychotic state this physiological role of the dopamine is changed. Dopamine starts to create process of salience acquisition, instead of mediating it, as it is in normal circumstances. According to Kapur delusions are cognitive explanations that the individual imposes on the experience of aberrant salience. Pharmacological agents share the psychological effect - dampening salience. But antipsychotics only provide the state of attenuated salience and symptomatic improvement needs further psychological and cognitive resolution. Subjects and method. Four cases of patients hospitalized because of first or second episode of schizophrenia were observed and the resolution of symptoms was carefully recorded. In addition the PANSS scale and Drug Appraisal Inventory were administered to the patients. Results. Several psychological phenomena were noted like: patients' cognitive efforts to deal with psychosis and the recovery process, the verbal way of describing symptoms resolution, attribution of symptomatic change to factors understandable for patients, rationalization and defence of the content of psychosis, personal assessment of psychosis and the subjective worsening of symptoms in the presence of symptomatic improvement. Conclusions. The theory of psychosis as a state of aberrant salience may provide us with a framework useful in analyzing the subjective experience of patients in the early stages of symptoms resolution at the first week of pharmacotherapy of psychotic patients