The development of delusion revisited: a transdiagnostic framework

Area of Science:

• Neuroscience
• Psychiatry
• Cognitive Psychology

Background:

• Delusions are a core symptom in various psychiatric (e.g., schizophrenia, bipolar disorder) and neurological disorders (e.g., stroke, neurodegenerative diseases).
• Existing research often focuses on specific disorders, limiting a unified understanding of delusion formation.
• A transdiagnostic approach is needed to identify common underlying mechanisms.

Purpose of the Study:

• To propose a transdiagnostic framework for delusion development.
• To identify a common core of neural and cognitive alterations associated with delusions across diverse clinical conditions.
• To extend existing models of delusion formation by integrating neural and cognitive factors.

Main Methods:

• Review of empirical evidence on neural and cognitive alterations in disorders characterized by delusions.
• Analysis of functional changes in ventromedial prefrontal cortex (vmPFC) networks.
• Examination of neuropsychological dysfunctions in affective value generation, internal world modeling, and self/other reflection.

Main Results:

• Delusions are associated with neural changes in ventromedial prefrontal cortex (vmPFC) networks.
• Neuropsychological deficits include impaired affective salience attribution, distorted internal world models, and reduced cognitive control.
• The concurrent dysfunction of these processes is critical for the transition to a delusional state.

Conclusions:

• A transdiagnostic framework for delusions integrates neural and cognitive factors.
• Delusions manifest when stimuli gain aberrant affective salience, are explained by distorted models, and are not inhibited by cognitive control.
• Common neural mechanisms underlie delusions in both psychiatric and neurological disorders, supporting a unified etiological perspective.