Vulnerable Self, Poor Understanding of Others' Minds, Threat Anticipation and Cognitive Biases as Triggers for Delusional Experience in Schizophrenia: A Theoretical Model

Abstract

It remains unclear what processes lead to the establishment of persecutory delusions in acute phases of schizophrenia. Recently, it has been argued that persecutory delusions arise from an interaction among a range of emotional, cognitive and social factors. In this work, we explored this possibility by first discussing the relevant aspects of recent theoretical models of the causes of persecutory delusions. Then, we offered an analysis of the literature, illustrated with clinical observations suggesting that persecutory delusions are triggered during stressful intersubjective transactions by the interactions of (a) an alteration in empathetic perspective taking and in pragmatic understanding of others' minds; (b) a perception/representation of the self as vulnerable or subordinate and of the other as dominant and threatening; and (c) a hyperfunctioning of the threat/self-protection system when faced with perceived danger. Implications for future research and treatment of people suffering from this symptom are discussed.

Neural responses during social reflection in relatives of schizophrenia patients: Relationship to subclinical delusions

“…Models of delusions in schizophrenia suggest impaired SR may play a role in the formation of delusional beliefs (Bentall et al, 2001; Salvatore et al, 2012b). Supporting this hypothesis, fMRI studies have demonstrated links between dysfunction of brain areas mediating SR, including the MPFC (Menon et al, 2011; Modinos et al, 2011), PCC (Holt et al, 2011b), and the STG (Backasch et al, 2013) and delusions in schizophrenia or schizotypy.…”

Isn’t it ironic? Neural Correlates of Irony Comprehension in Schizophrenia

“…The cognitive model for delusions by Salvatore et al [27], [79] assumes that ambiguous intersubjective interactions, such as ironic remarks, are relevant for the development of positive symptoms in schizophrenia and may be caused by mirror neuron dysfunction. The brain regions typically associated with mirror neurons are the ventral premotor cortex and the inferior parietal lobule [80], and these regions did not show the most prominent differences between patients and controls in our study, although they are known to be involved in irony comprehension in healthy subjects [19], [20].…”

“…Another functional system that might relate to defective irony comprehension in schizophrenia is the mirror neuron system. It has been proposed that mirror neuron dysfunction may underlie the social cognition deficits in patients with schizophrenia [25], [26], [27]. Moreover, this system has been reported to be involved in the comprehension of irony (see [19]).…”

“…The cognitive model proposed by Salvatore et al [27] assumes misinterpretation of “ambigous and hard-to-interpret communicative signals” such as “ironic comments” in co-occurence with the factors above may induce delusions. Thus, investigating the (mis)understanding of ironic remarks in schizophrenia will provide insights into an important aspect of schizophrenic psychopathology.…”

Irony and Proverb Comprehension in Schizophrenia: Do Female Patients “Dislike” Ironic Remarks?

“…This relationship to the perceived “meanness” by patients with schizophrenia seems particularly interesting, because judging the intention of others as “mean” or “hostile” may relate to the origin of delusions in these patients [48, 49]. Indeed, it has been suggested (e.g., by [21, 50]) that misinterpretation of “ambiguous and hard-to-interpret communicative signals” such as “ironic comments” in combination with the above-mentioned factors may contribute to delusion formation in schizophrenia. Ironic comments are often intended to be funny [8, 11, 16].…”