What causes the onset of psychosis?

• Published in: Schizophrenia research Vol. 79; no. 1; pp. 23 - 34
• Main Authors: Broome, Matthew R., Woolley, James B., Tabraham, Paul, Johns, Louise C., Bramon, Elvira, Murray, Graham K., Pariante, Carmine, McGuire, Philip K., Murray, Robin M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier B.V 01.11.2005; Elsevier Science
• Subjects: Adult and adolescent clinical studies; Aetiology/Etiology; Biological and medical sciences; Brain - physiopathology; Culture; Epidemiology; Humans; Imaging; Medical sciences; Prodromal; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychosis; Psychotic Disorders - epidemiology; Psychotic Disorders - etiology; Psychotic Disorders - physiopathology; Schizophrenia; Schizophrenia - epidemiology; Schizophrenia - genetics; Schizophrenia - physiopathology; Social Environment; Substance-Related Disorders - complications; Substance-Related Disorders - epidemiology; Psychosis; Schizophrenia; Epidemiology; Aetiology/Etiology; Imaging; Prodromal; Human; Dopamine; Cognition; Review; Catecholamine; Etiology; Neurotransmitter; Genetics; Social aspect; Public health
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2005.02.007

It has become increasingly clear that the simple neurodevelopmental model fails to explain many aspects of schizophrenia including the timing of the onset, and the nature of the abnormal perceptions. Furthermore, we do not know why some members of the general population have anomalous experiences but remain well, while others enter the prodrome of psychosis, and a minority progress to frank schizophrenia. We suggest that genes or developmental damage result in individuals vulnerable to dopamine deregulation. In contemporary society, this is often compounded by abuse of drugs such as amphetamines and cannabis, which then propel the individual into a state of dopamine-induced misinterpretation of the environment. Certain types of social adversity such as migration and social isolation, as well as affective change can also contribute to this. Thereafter, biased cognitive appraisal processes result in delusional interpretation of the abnormal perceptual experiences. Thus, a plausible model of the onset of psychosis needs to draw not only on neuroscience, but also on the insights of social psychiatry and cognitive psychology.