Accounting for Emotion in the Psychopathology of Acute Schizophrenia

In this article, we review clinical, theoretical, and empirical grounds for the consideration of a decisive, yet unrecognized, role of emotions in the psychopathology of acute schizophrenia. We describe accordingly the presence of an emotional syndrome named "Psychotic Arousal" and we further explore its clinical characteristics on the grounds of a psychopathological investigation, including its relevance to recent neurobiological advances. Psychotic arousal has been defined as a diffuse affective state, dominated by abnormal experiences that signify disturbed self-processing, as the brain interacts with external or internal objects. This process may eventually result in the experiential alienation of internal and external reality. Evidence supports that the aberrant experiences are of emotional origin and are seen as abnormal experiential feelings. In addition, this article outlines essential characteristics of the abnormal experiences with arguable biological significance. We propose that they are highly eligible to represent a real pathophysiological process, stemming from a hidden physiology related to the formation of core consciousness and reality perception, with severe consequences for cognition. We underline that the recognition of their medical semiology is important and offers us a unique opportunity to unveil aspects of the physiological mechanism behind the development of delusions and the psychopathology of acute schizophrenia. Moreover, we propose a plausible neurobiological path of investigation based on their phenomenological properties. Finally, we call for the field of Psychopathology to recognize and explore the pivotal role of emotions in the emergence of psychosis and the formation of delusions.