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Hierarchical temporal processing deficit model of reality distortion and psychoses

Molecular Psychiatry volume 16, pages 129–144 (2011)Cite this article

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A Corrigendum to this article was published on 26 March 2012

Abstract

We posit in this article that hierarchical temporal processing deficit is the underlying basis of reality distortion and psychoses. Schizophrenia is a prototypical reality distortion disorder in which the patient manifests with auditory hallucinations, delusions, disorganized speech and thinking, cognitive impairment, avolition and social and occupational dysfunction. Reality distortion can be present in many other disorders including bipolar disorder, major depression and even dementia. Conceptually, schizophrenia is a heterogeneous entity likely to be because of numerous causes similar to dementia. Although no single symptom or set of symptoms is pathognomonic, a cardinal feature in all patients with schizophrenia is chronic distortion of reality. The model that we have proposed accounts for the varied manifestations of reality distortion including hallucinations and delusions. In this paper we consider the implications of this model for the underlying biology of psychoses and also for the neurobiology of schizophrenia and suggest potential targets to consider for the etiology and pathophysiology of reality distortion, especially in the context of schizophrenia.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA

    R R Krishnan

  2. Program in Neuroscience and Neurobehavioral Disorders, Duke-NUS Graduate Medical School Singapore, Singapore, Singapore

    M Fivaz

  3. Medical Psychology, Duke University Medical Center, Durham, NC, USA

    M S Kraus & R S E Keefe

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  1. R R Krishnan
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  2. M Fivaz
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  3. M S Kraus
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  4. R S E Keefe
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Correspondence to R R Krishnan.

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Krishnan, R., Fivaz, M., Kraus, M. et al. Hierarchical temporal processing deficit model of reality distortion and psychoses. Mol Psychiatry 16, 129–144 (2011). https://doi.org/10.1038/mp.2010.63

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