Spurious Autobiographical Memory of Psychosis: A Mechanistic Hypothesis for the Resolution, Persistence, and Recurrence of Positive Symptoms in Psychotic Disorders
Psychotic disorders are complex disorders with multiple etiologies. While increased dopamine synthesis capacity has been proposed to underlie psychotic episodes, dopamine-independent processes are also involved (less responsive to dopamine receptor-blocking medications). The underlying mechanism(s)...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-07-01
|
| Series: | Brain Sciences |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-3425/13/7/1069 |
| _version_ | 1797590014362648576 |
|---|---|
| author | Eric Y. H. Chen Stephanie M. Y. Wong Eric Y. H. Tang Lauren K. S. Lei Yi-nam Suen Christy L. M. Hui |
| author_facet | Eric Y. H. Chen Stephanie M. Y. Wong Eric Y. H. Tang Lauren K. S. Lei Yi-nam Suen Christy L. M. Hui |
| author_sort | Eric Y. H. Chen |
| collection | DOAJ |
| description | Psychotic disorders are complex disorders with multiple etiologies. While increased dopamine synthesis capacity has been proposed to underlie psychotic episodes, dopamine-independent processes are also involved (less responsive to dopamine receptor-blocking medications). The underlying mechanism(s) of the reduction in antipsychotic responsiveness over time, especially after repeated relapses, remain unclear. Despite the consistent evidence of dopamine overactivity and hippocampal volume loss in schizophrenia, few accounts have been provided based on the interactive effect of dopamine on hippocampal synapse plasticity mediating autobiographical memory processes. The present hypothesis builds upon previous works showing the potential effects of dopamine overactivity on hippocampal-mediated neuroplasticity underlying autobiographical memory, alongside known patterns of autobiographical memory dysfunction in psychosis. We propose that spurious autobiographical memory of psychosis (SAMP) produced during active psychosis may be a key mechanism mediating relapses and treatment non-responsiveness. In a hyperdopaminergic state, SAMP is expected to be generated at an increased rate during active psychosis. Similar to other memories, it will undergo assimilation, accommodation, and extinction processes. However, if SAMP fails to integrate with existing memory, a discontinuity in autobiographical memory may result. Inadequate exposure to normalizing experiences and hyposalience due to overmedication or negative symptoms may also impede the resolution of SAMP. Residual SAMP is hypothesized to increase the propensity for relapse and treatment non-responsiveness. Based on recent findings on the role of dopamine in facilitating hippocampal synapse plasticity and autobiographical memory formation, the SAMP hypothesis is consistent with clinical observations of DUP effects, including the repetition of contents in psychotic relapses as well as the emergence of treatment non-responsiveness after repeated relapses. Clinical implications of the hypothesis highlight the importance of minimizing active psychosis, integrating psychosis memory, avoiding over-medication, and fostering normalizing experiences. |
| first_indexed | 2024-03-11T01:14:20Z |
| format | Article |
| id | doaj.art-24b05cbe0d55441cbb46bd61aee89989 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-11T01:14:20Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-24b05cbe0d55441cbb46bd61aee899892023-11-18T18:34:55ZengMDPI AGBrain Sciences2076-34252023-07-01137106910.3390/brainsci13071069Spurious Autobiographical Memory of Psychosis: A Mechanistic Hypothesis for the Resolution, Persistence, and Recurrence of Positive Symptoms in Psychotic DisordersEric Y. H. Chen0Stephanie M. Y. Wong1Eric Y. H. Tang2Lauren K. S. Lei3Yi-nam Suen4Christy L. M. Hui5Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaPsychotic disorders are complex disorders with multiple etiologies. While increased dopamine synthesis capacity has been proposed to underlie psychotic episodes, dopamine-independent processes are also involved (less responsive to dopamine receptor-blocking medications). The underlying mechanism(s) of the reduction in antipsychotic responsiveness over time, especially after repeated relapses, remain unclear. Despite the consistent evidence of dopamine overactivity and hippocampal volume loss in schizophrenia, few accounts have been provided based on the interactive effect of dopamine on hippocampal synapse plasticity mediating autobiographical memory processes. The present hypothesis builds upon previous works showing the potential effects of dopamine overactivity on hippocampal-mediated neuroplasticity underlying autobiographical memory, alongside known patterns of autobiographical memory dysfunction in psychosis. We propose that spurious autobiographical memory of psychosis (SAMP) produced during active psychosis may be a key mechanism mediating relapses and treatment non-responsiveness. In a hyperdopaminergic state, SAMP is expected to be generated at an increased rate during active psychosis. Similar to other memories, it will undergo assimilation, accommodation, and extinction processes. However, if SAMP fails to integrate with existing memory, a discontinuity in autobiographical memory may result. Inadequate exposure to normalizing experiences and hyposalience due to overmedication or negative symptoms may also impede the resolution of SAMP. Residual SAMP is hypothesized to increase the propensity for relapse and treatment non-responsiveness. Based on recent findings on the role of dopamine in facilitating hippocampal synapse plasticity and autobiographical memory formation, the SAMP hypothesis is consistent with clinical observations of DUP effects, including the repetition of contents in psychotic relapses as well as the emergence of treatment non-responsiveness after repeated relapses. Clinical implications of the hypothesis highlight the importance of minimizing active psychosis, integrating psychosis memory, avoiding over-medication, and fostering normalizing experiences.https://www.mdpi.com/2076-3425/13/7/1069psychotic disordersrelapsetreatment responsesaliencememorydopamine |
| spellingShingle | Eric Y. H. Chen Stephanie M. Y. Wong Eric Y. H. Tang Lauren K. S. Lei Yi-nam Suen Christy L. M. Hui Spurious Autobiographical Memory of Psychosis: A Mechanistic Hypothesis for the Resolution, Persistence, and Recurrence of Positive Symptoms in Psychotic Disorders Brain Sciences psychotic disorders relapse treatment response salience memory dopamine |
| title | Spurious Autobiographical Memory of Psychosis: A Mechanistic Hypothesis for the Resolution, Persistence, and Recurrence of Positive Symptoms in Psychotic Disorders |
| title_full | Spurious Autobiographical Memory of Psychosis: A Mechanistic Hypothesis for the Resolution, Persistence, and Recurrence of Positive Symptoms in Psychotic Disorders |
| title_fullStr | Spurious Autobiographical Memory of Psychosis: A Mechanistic Hypothesis for the Resolution, Persistence, and Recurrence of Positive Symptoms in Psychotic Disorders |
| title_full_unstemmed | Spurious Autobiographical Memory of Psychosis: A Mechanistic Hypothesis for the Resolution, Persistence, and Recurrence of Positive Symptoms in Psychotic Disorders |
| title_short | Spurious Autobiographical Memory of Psychosis: A Mechanistic Hypothesis for the Resolution, Persistence, and Recurrence of Positive Symptoms in Psychotic Disorders |
| title_sort | spurious autobiographical memory of psychosis a mechanistic hypothesis for the resolution persistence and recurrence of positive symptoms in psychotic disorders |
| topic | psychotic disorders relapse treatment response salience memory dopamine |
| url | https://www.mdpi.com/2076-3425/13/7/1069 |
| work_keys_str_mv | AT ericyhchen spuriousautobiographicalmemoryofpsychosisamechanistichypothesisfortheresolutionpersistenceandrecurrenceofpositivesymptomsinpsychoticdisorders AT stephaniemywong spuriousautobiographicalmemoryofpsychosisamechanistichypothesisfortheresolutionpersistenceandrecurrenceofpositivesymptomsinpsychoticdisorders AT ericyhtang spuriousautobiographicalmemoryofpsychosisamechanistichypothesisfortheresolutionpersistenceandrecurrenceofpositivesymptomsinpsychoticdisorders AT laurenkslei spuriousautobiographicalmemoryofpsychosisamechanistichypothesisfortheresolutionpersistenceandrecurrenceofpositivesymptomsinpsychoticdisorders AT yinamsuen spuriousautobiographicalmemoryofpsychosisamechanistichypothesisfortheresolutionpersistenceandrecurrenceofpositivesymptomsinpsychoticdisorders AT christylmhui spuriousautobiographicalmemoryofpsychosisamechanistichypothesisfortheresolutionpersistenceandrecurrenceofpositivesymptomsinpsychoticdisorders |