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      Understanding delusions

      review-article
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      Industrial Psychiatry Journal
      Medknow Publications
      Delusions, Etiology, Psychopathology, Phenomenology

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          Abstract

          Delusion has always been a central topic for psychiatric research with regard to etiology, pathogenesis, diagnosis, treatment, and forensic relevance. The various theories and explanations for delusion formation are reviewed. The etiology, classification and management of delusions are briefly discussed. Recent advances in the field are reviewed.

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          Most cited references21

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          Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia.

          The clinical hallmark of schizophrenia is psychosis. The objective of this overview is to link the neurobiology (brain), the phenomenological experience (mind), and pharmacological aspects of psychosis-in-schizophrenia into a unitary framework. Current ideas regarding the neurobiology and phenomenology of psychosis and schizophrenia, the role of dopamine, and the mechanism of action of antipsychotic medication were integrated to develop this framework. A central role of dopamine is to mediate the "salience" of environmental events and internal representations. It is proposed that a dysregulated, hyperdopaminergic state, at a "brain" level of description and analysis, leads to an aberrant assignment of salience to the elements of one's experience, at a "mind" level. Delusions are a cognitive effort by the patient to make sense of these aberrantly salient experiences, whereas hallucinations reflect a direct experience of the aberrant salience of internal representations. Antipsychotics "dampen the salience" of these abnormal experiences and by doing so permit the resolution of symptoms. The antipsychotics do not erase the symptoms but provide the platform for a process of psychological resolution. However, if antipsychotic treatment is stopped, the dysregulated neurochemistry returns, the dormant ideas and experiences become reinvested with aberrant salience, and a relapse occurs. The article provides a heuristic framework for linking the psychological and biological in psychosis. Predictions of this hypothesis, particularly regarding the possibility of synergy between psychological and pharmacological therapies, are presented. The author describes how the hypothesis is complementary to other ideas about psychosis and also discusses its limitations.
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            Interacting minds--a biological basis.

            The ability to "mentalize," that is to understand and manipulate other people's behavior in terms of their mental states, is a major ingredient in successful social interactions. A rudimentary form of this ability may be seen in great apes, but in humans it is developed to a high level. Specific impairments of mentalizing in both developmental and acquired disorders suggest that this ability depends on a dedicated and circumscribed brain system. Functional imaging studies implicate medial prefrontal cortex and posterior superior temporal sulcus (STS) as components of this system. Clues to the specific function of these components in mentalizing come from single cell recording studies: STS is concerned with representing the actions of others through the detection of biological motion; medial prefrontal regions are concerned with explicit representation of states of the self. These observations suggest that the ability to mentalize has evolved from a system for representing actions.
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              Delusional thinking and perceptual disorder.

              B A Maher (1974)
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                Author and article information

                Journal
                Ind Psychiatry J
                IPJ
                Industrial Psychiatry Journal
                Medknow Publications (India )
                0972-6748
                0976-2795
                Jan-Jun 2009
                : 18
                : 1
                : 3-18
                Affiliations
                Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Kanke, Ranchi - 834 006, Jharkhand, India
                Author notes
                Address for correspondence: Dr. Suprakash Chaudhury, Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Kanke, Ranchi - 834 006, Jharkhand, India. E-mail: suprakashch@ 123456gmail.com
                Article
                IPJ-18-3
                10.4103/0972-6748.57851
                3016695
                21234155
                e2fc6162-3c17-443d-b1d3-d868cf1b781a
                © Industrial Psychiatry Journal

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Review Article

                Clinical Psychology & Psychiatry
                delusions,etiology,psychopathology,phenomenology
                Clinical Psychology & Psychiatry
                delusions, etiology, psychopathology, phenomenology

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