Am J Psychiatry
January 1, 2003
2,813 citations
A framework is proposed in which psychosis in schizophrenia arises from a dysregulated, dopamine-driven process of aberrant salience. Normally, dopamine mediates the attribution of salience—the process by which stimuli and thoughts become noticeable and guide behavior. In schizophrenia, this system becomes dysfunctional, causing patients to experience heightened or inappropriate salience for ordinary events and internal thoughts. This aberrant salience leads to the formation of delusions as cognitive explanations for these strange experiences, and hallucinations as direct perceptual experiences of salience. The framework integrates biological, phenomenological, and pharmacological evidence, explaining how antipsychotics work by dampening salience, and how this model can guide future research and treatment.
Am J Psychiatry
January 1, 2024
31 citations
This critical response addresses misinterpretations and omissions in a commentary by Goodwin and colleagues on psilocybin-assisted therapy, arguing that the commentary misrepresents existing evidence and overlooks key methodological issues. The authors contend that the commentary fails to adequately discuss safety concerns, including adverse events and the potential for psychological distress, and omits important data on long-term outcomes. They emphasize the need for rigorous, balanced evaluation of psilocybin-assisted therapy's risks and benefits, cautioning against overstating positive outcomes while underreporting negative findings. The response calls for more transparent reporting and careful interpretation of clinical trial results.
Am J Psychiatry
January 1, 2024
22 citations
Psychotherapy is a necessary component of psychedelic treatment, providing safety and evidence-based support. The text argues that integrating structured psychological guidance with psychedelic sessions enhances therapeutic benefits and improves mental health outcomes. This combined approach fosters a supportive journey, leading to transformative mental health care and healing potential.
Am J Psychiatry
March 26, 2025
9 citations
The salience hypothesis of psychosis, which links dopamine dysfunction to delusion formation, is critically evaluated against newer evidence. The hypothesis's specific predictions about dopamine dysfunction's neural and behavioral loci in psychosis are found lacking. Advances in tools for measuring and manipulating dopamine circuits inform this critique. Contemporary theories proposing dopamine's role in belief formation, belief updating under uncertainty, and abductive inference are argued to better explain patient behavior and dopamine function. While influential for uniting neurochemistry with clinical phenomenology, the original hypothesis faces challenges, and the authors highlight novel predictions for future research.
Am J Psychiatry
January 1, 2025
9 citations
A comprehensive review argues that psychedelic-assisted psychotherapy research should expand beyond clinical efficacy to include potential harms, diverse patient experiences, and ethical integration. The authors advocate for a balanced approach that examines both therapeutic benefits and risks, emphasizing humility in interpreting findings. They call for broader investigation into how context, patient diversity, and responsible integration shape outcomes, rather than focusing solely on symptom reduction. The review highlights the need to address challenges such as adverse effects, cultural appropriation, and equitable access to ensure the full impact of these treatments is understood.
Am J Psychiatry
January 1, 2025
6 citations
The Veterans Health Administration (VHA) is exploring the integration of psychedelic-assisted therapy as a potential treatment for veterans with mental health conditions, particularly PTSD. The text outlines the need for careful research and implementation strategies within the VHA system, emphasizing safe integration, care pathways, and the development of clinical protocols. It highlights the importance of addressing regulatory, ethical, and logistical challenges to ensure veteran well-being and recovery. The work suggests that psychedelic-assisted therapies could offer innovative treatment options, but rigorous study and structured implementation are necessary before widespread adoption.
Am J Psychiatry
April 22, 2026
In a nationally representative survey of U.S. adults, past-year psilocybin use was reported by a small but notable percentage of respondents. The study describes the characteristics of those who used psilocybin, including demographic and other substance use correlates. The findings suggest that psilocybin use is associated with certain demographic factors and patterns of other drug use, though the analysis is descriptive and does not establish causation.