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

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.

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Abstract

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