Title

Inefficient neural system stabilization: A theory of spontaneous resolutions and recurrent relapses in psychosis

Document Type

Article

Publication Date

11-1-2019

Journal

Journal of Psychiatry and Neuroscience

Volume

44

Issue

6

First Page

367

Last Page

383

URL with Digital Object Identifier

10.1503/jpn.180038

Abstract

A striking feature of psychosis is its heterogeneity. Presentations of psychosis vary from transient symptoms with no functional consequence in the general population to a tenacious illness at the other extreme, with a wide range of variable trajectories in between. Even among patients with schizophrenia, who are diagnosed on the basis of persistent deterioration, marked variation is seen in response to treatment, frequency of relapses and degree of eventual recovery. Existing theoretical accounts of psychosis focus almost exclusively on how symptoms are initially formed, with much less emphasis on explaining their variable course. In this review, I present an account that links several existing notions of the biology of psychosis with the variant clinical trajectories. My aim is to incorporate perspectives of systems neuroscience in a staging framework to explain the individual variations in illness course that follow the onset of psychosis.

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