An updated preprint on the hypothesis that psychosis may be a state of aberrant assignment of salience (importance) to different items by the brain.
# 20 years of aberrant salience in psychosis: What have we learned?
Abstract:
Twenty years ago Shitij Kapur’s “Psychosis as a state of aberrant salience” captured the attention of clinicians, cognitive, and behavioral neuroscientists. It has become the de facto way of talking about delusion formation in labs and clinics. Here, we critically evaluate the original theory considering evolving data since its publication. We examine its specific predictions, regarding the neural and behavioral loci of dopamine dysfunction in psychosis and find them lacking. Furthermore, we explore our ever-expanding knowledge of the dopamine system and its impacts on behavior following the explosion of new tools and probes for precise measurement and manipulation of dopaminergic circuits. We pay particular attention to theories that have developed since Kapur, which suggest a role for dopamine in belief formation, belief updating under uncertainty, and abductive inference to the best explanation for some set of circumstances – all of which we believe fit better with the work in patients with delusions and hallucinations, how they behave and what we know about their dopamine function. We admire the scope and vision of the original work, and we continue to follow its example by trying to unite neurochemical dysfunction to clinical phenomenology through computational cognitive neuroscience.
