World psychiatry : official journal of the World Psychiatric Association (WPA)
June 1, 2022
Paolo Fusar-Poli, Andrés Estradé, Giovanni Stanghellini et al.
225 citations
Psychosis unfolds through distinct stages, each with its own core existential experiences. Early phases (premorbid and prodromal) involve loss of common sense, perplexity, lack of immersion in the world, heightened salience, a feeling that something important is about to happen, perturbation of the sense of self, and a need to hide inner turmoil. The first episode brings transitory relief from delusions, intense self-referentiality, permeated self-world boundaries, internal noise, and dissolution of self with social withdrawal. Later stages (relapsing and chronic) involve grieving losses, feeling split, and struggling to accept inner chaos, a new self, diagnosis, and uncertain future. Treatment experiences include both positive and negative aspects, with recovery understood as reconstructing personhood and re-establishing bonds toward meaningful goals.
World psychiatry : official journal of the World Psychiatric Association (WPA)
June 1, 2015
Louis Sass, Greg Byrom
94 citations
Phenomenological accounts of delusions, especially in schizophrenia, emphasize disturbances in minimal self-experience (ipseity) and hyperreflexivity, while neurocognitive models stress salience dysregulation and prediction error. This paper reviews major phenomenological perspectives from Jaspers, Matussek, and Conrad, noting consistencies with neurocognitive approaches but also reservations about homogenizing tendencies that treat all delusions as mistaken beliefs about objective facts. The authors suggest that current neurocognitive models emphasizing hypersalience—where banal stimuli feel strange—may be complemented by considering hyposalience, where strange experiences feel banal, possibly linked to default mode network activation. Hyposalience could foster a derealized 'anything goes' attitude conducive to delusion formation, differing from the hypersalience focus in existing theories.
World psychiatry : official journal of the World Psychiatric Association (WPA)
February 1, 2025
Chris R Brewin, Lukoye Atwoli, Jonathan I Bisson et al.
73 citations
The diagnosis of post-traumatic stress disorder (PTSD) has shaped understanding of trauma responses. Early diagnostic criteria and epidemiological findings, including sociocultural differences, are reviewed. Evidence shows post-traumatic reactions occur in contexts not previously defined as traumatic. Recent developments such as the DSM-5 dissociative subtype and ICD-11 complex PTSD indicate several distinct PTSD phenotypes. Psychological foundations involve disturbances to memory and identity, with a broader focus on identity accommodating group and communal influences. Biological foundations include genetic and neuroimaging studies. While prevention progress has been disappointing, psychological treatments like trauma-focused cognitive behavior therapy, EMDR, and non-trauma-focused therapies are effective. Emerging identity-based approaches and MDMA-assisted psychotherapy show promise. Adapting interventions in resource-limited settings and community-based approaches are priorities.
World psychiatry : official journal of the World Psychiatric Association (WPA)
June 1, 2024
Dan J Stein, Kris Nielsen, Anna Hartford et al.
70 citations
Psychiatric understanding and treatment benefit from integrating both objective facts and subjective values, moving beyond strict scientism toward a softer naturalism. A pluralist approach—embracing ontological, explanatory, and value pluralism—acknowledges the multi-level causal interactions underlying psychopathology and highlights the importance of lived experience and diverse difference-makers in research and practice. Embodied, embedded, and enactive views of the brain-mind offer a conceptual framework for the mind-body problem that clinically integrates cognitive-affective neuroscience with phenomenological psychopathology.