Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Opinion
  • Published:

Cognitive neuropsychiatry: towards a scientific psychopathology

Nature Reviews Neuroscience volume 2, pages 209–215 (2001)Cite this article

Abstract

Cognitive neuropsychiatry represents a systematic and theoretically driven approach to explain clinical psychopathologies in terms of deficits to normal cognitive mechanisms. A concern with the neural substrates of impaired cognitive mechanisms links cognitive neuropsychiatry to the basic neurosciences. The emergence of cognitive neuropsychiatry in the 1990s illustrates the growing rapprochement between cognitive neuropsychology, clinical medicine and the neurosciences in addressing common questions about disorders of the mind/brain. In reviewing recent applications, we highlight how this hybrid discipline will make a distinctive contribution to the science of psychopathology.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: A cognitive model of face processing62.
Figure 2: Surface-rendered fMRI images of auditory activation during and after recovering from auditory hallucinations.
Figure 3: Functional MRI study of auditory hallucinations78.

Similar content being viewed by others

References

  1. David, A. S. Cognitive neuropsychiatry? Psychol. Med. 23, 1–5 (1993).

    CAS  PubMed  Google Scholar 

  2. Charlton, B. G. Cognitive neuropsychiatry and the future of diagnosis: a 'PC' model of the mind. Br. J. Psychiat. 167, 149– 153 (1995). PubMed

    CAS  Google Scholar 

  3. David, A. S. The future of diagnosis: commentary on 'Cognitive neuropsychiatry and the future of diagnosis: a 'PC' model of the mind '. Br. J. Psychiat. 167, 155–157 ( 1995).

    Google Scholar 

  4. Bentall, R. P. Brains, biases, deficits and disorders. Br. J. Psychiat. 167, 153–155 (1995).

    Google Scholar 

  5. Marshall, J. G. & Halligan, P. W. Methods in madness. Br. J. Psychiat. 167, 157– 158 (1995).

    Google Scholar 

  6. David, A. S. & Halligan, P. W. Editorial: Cognitive neuropsychiatry . Cogn. Neuropsychiat. 1, 1– 3 (1996).

    CAS  Google Scholar 

  7. Halligan, P. W. & Marshall, J. C. Method of Madness. Case Studies in Cognitive Neuropsychiatry (Psychology Press, Hove, East Sussex, 1996).

    Google Scholar 

  8. David, A. S. & Halligan, P. W. Cognitive neuropsychiatry: potential for progress. J. Neuropsychiat. Clin. Neurosci. 12, 506–510 (2000). Pubmed

    CAS  Google Scholar 

  9. Shallice, T. From Neuropsychology to Mental Structure (Cambridge Univ. Press, Cambridge, 1988).

    Google Scholar 

  10. Lishman, W. A. Organic Psychiatry. The Psychological Consequences of Cerebral Disorder 3rd edn (Blackwell Scientific Publications, Oxford & London, 1998).

    Google Scholar 

  11. James, W. The Varieties of Religious Experience (Collins, Glasgow, 1901).

    Google Scholar 

  12. Saykin, A. J. et al. Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia. Arch. Gen. Psychiat. 51, 124–131 (1994).

    CAS  PubMed  Google Scholar 

  13. McKay, A. P. et al. Semantic memory is impaired in schizophrenia. Biol. Psychiat. 39, 929–937 (1996).

    CAS  PubMed  Google Scholar 

  14. Hodges, J. R. et al. The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: a comparative neuropsychological study. Neuropsychology 13, 31–40 ( 1999).

    CAS  PubMed  Google Scholar 

  15. Rossell, S. L., Shapleske, J. & David, A. S. Direct and indirect semantic priming with neutral and emotional words in schizophrenia: relationship to delusions. Cogn. Neuropsychiat. 5, 271–292 (2000).

    Google Scholar 

  16. Spitzer, M. A cognitive neuroscience view of schizophrenic thought disorder. Schizophrenia Bull. 23, 29–50 (1997). PubMed

    CAS  Google Scholar 

  17. Goldberg, T. E. & Weinberger, D. R. Thought disorder in schizophrenia: a reappraisal of older formulations and an overview of some recent studies. Cogn. Neuropsychiat. 5, 1–19 (2000).

    Google Scholar 

  18. Kuperberg, G. R., McGuire, P. K. & David, A. S. Reduced sensitivity to linguistic context in schizophrenic thought disorder: evidence from on-line monitoring for words in linguistically anomalous sentences. J. Abnorm. Psychol. 107, 423–434 (1998).

    CAS  PubMed  Google Scholar 

  19. Kuperberg, G. R., McGuire, P. K. & David, A. S. Sensitivity to linguistic anomalies in spoken sentences: a case study approach to understanding thought disorder in schizophrenia. Psychol. Med. 30, 345–357 (2000).

    CAS  PubMed  Google Scholar 

  20. Rossell, S. L., Rabe-Hesketh, S., Shapleske, J. & David, A. S. Is semantic fluency differentially impaired in schizophrenic patients with delusions? J. Clin. Exp. Neuropsychol. 21, 629–642 (1999).

    CAS  PubMed  Google Scholar 

  21. Joyce, E. M., Collinson, S. L. & Crichton, P. Verbal fluency in schizophrenia: relationship with executive function, semantic memory and clinical alogia. Psychol. Med. 26, 39–49 (1996).

    CAS  PubMed  Google Scholar 

  22. Dolan, R. J., et al. Dorsolateral prefrontal cortex dysfunction in the major psychoses; symptom or disease specificity? J. Neurol. Neurosurg. Psychiat. 56, 1290–1294 ( 1993).

    CAS  PubMed  Google Scholar 

  23. McGuire, P. K. & Frith, C. D. Disordered functional connectivity in schizophrenia. Psychol. Med. 26, 663–667 (1996).

    CAS  PubMed  Google Scholar 

  24. Baron-Cohen, S. Mindblindness: An Essay on Autism and Theory of Mind (MIT Press, Cambridge, Massachusetts, 1997).

    Google Scholar 

  25. Frith, C. Cognitive Neuropsychology of Schizophrenia (Lawrence Erlbaum, Hove, 1992).

    Google Scholar 

  26. Mlakar, J. Jensterle, J. & Frith, C. D. Central monitoring deficiency and schizophrenic symptoms . Psychol. Med. 24, 557– 564 (1994).

    CAS  PubMed  Google Scholar 

  27. Spence, S. A. et al. A PET study of voluntary movement in schizophrenic patients experiencing passivity phenomena (delusions of alien control). Brain 120, 1997–2011 ( 1997).

    PubMed  Google Scholar 

  28. Blakemore, S., Smith, S.-J., Steele, R., Johnstone, E. C. & Frith, C. D. The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring. Psychol. Med. 30 , 1131 (2000).

    CAS  PubMed  Google Scholar 

  29. Rauch, S. L. & Savage, C. R. Neuroimaging and neuropsychology of the striatum. Bridging basic science and clinical practice. Psychiatric Clinics of North America 20, 741– 768 (1997). PubMed

    CAS  PubMed  Google Scholar 

  30. Marchetti, C. & Della Sala, S. Disentagling the alien and anarchic hand Cogn. Neuropsychiat. 3, 191– 208 (1998).

    Google Scholar 

  31. Halligan, P. W., Marshall, J. C. & Wade, D. T. Unilateral somatoparaphrenia after right hemisphere stroke: a case description. Cortex 31, 173 –182 (1995).

    CAS  PubMed  Google Scholar 

  32. Halligan, P. W., Marshall, J. C. & Wade, D. T. Three arms: a case study of supernumerary phantom limb after right hemisphere stroke. J. Neurol. Neurosurg. Psychiat. 56, 159–166 ( 1993).

    CAS  PubMed  Google Scholar 

  33. Halligan, P. W., & David, A. S. (Eds). Conversion hysteria: towards a cognitive neuropsychological account. Brighton: Psychology Press (2000).

    Google Scholar 

  34. Marshall, J. C., Halligan, P. W., Fink, G. R., Wade, D. T. & Frackowiak, R. S. The functional anatomy of a hysterical paralysis. Cognition 64, B1 –B8 (1997).

    CAS  PubMed  Google Scholar 

  35. Bryant, R. A. & McConkey, K. M. Functional blindness: a construction of cognitive and social influences. Cogn. Neuropsychiat. 4, 227–244 (1999).

    Google Scholar 

  36. Oakley, D. Hypnosis and conversion hysteria: a unifying model. Cogn. Neuropsychiat. 4, 243–266 ( 1999).

    CAS  Google Scholar 

  37. Lloyd, G. G. & Lishman, W. A. Effects of depression on the speed of recall of pleasant and unpleasant experiences. Psychol. Med. 5, 173–180 ( 1975).

    CAS  PubMed  Google Scholar 

  38. Williams, J. M. & Scott, J. Autobiographical memory in depression. Psychol. Med. 18, 689–695 (1988).

    CAS  PubMed  Google Scholar 

  39. Lucchelli. F., Muggia, S. & Spinnler, H. The syndrome of pure retrograde amnesia. Cogn. Neuropsychiat. 3, 91–118 (1998).

    Google Scholar 

  40. Kopelman, M. Focal retrograde amnesia and the attribution of causality: an exceptionally critical review. Cogn. Neuropsychol. 17, 585–662. (2000).

    CAS  PubMed  Google Scholar 

  41. Cutting, J. The Right Cerebral Hemisphere and Psychiatric Disorder (Oxford Univ. Press, Oxford, 1990).

    Google Scholar 

  42. Taylor, G. J. Recent developments in alexithymia theory and research. Can. J. Psychiat. 45, 134–142 ( 2000). PubMed

    CAS  Google Scholar 

  43. Sierra. M. & Berrios, G. E. Depersonalization: neurobiological perspectives. Biol. Psychiat. 44, 898– 908 (1998).

    CAS  PubMed  Google Scholar 

  44. Damasio, H., Grabowski, T., Frank, R., Galaburda, A. M. & Damasio, A. R. The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science. 264, 1102–1105 (1994).

    CAS  PubMed  Google Scholar 

  45. Williams, J. M., Mathews, A. & MacLeod C. The emotional Stroop task and psychopathology. Psychol. Bull. 120, 3–24 (1996).

    CAS  PubMed  Google Scholar 

  46. Leafhead, K. M., Young, A. W. & Szulecka, T. K. Delusions demand attention. Cogn. Neuropsychiat. 1, 5–16 (1996 ).

    CAS  Google Scholar 

  47. Freeman, D., Garety, P. A. & Phillips, M. L. An examination of hypervigilance for external threat in individuals with generalized anxiety disorder and individuals with persecutory delusions using visual scan paths. Q. J. Exp. Psychol. A 53, 549–567 (2000).

    CAS  PubMed  Google Scholar 

  48. Phillips, M. L., Senior, C. & David, A. S. Perception of threat in schizophrenics with persecutory delusions: an investigation using visual scan paths. Psychol. Med. 30, 157–167 ( 2000).

    CAS  PubMed  Google Scholar 

  49. Teasdale, J. D. et al. Functional MRI study of the cognitive generation of affect . Am. J. Psychiat. 156, 209– 215 (1999).

    CAS  PubMed  Google Scholar 

  50. Drevets, W. C. et al. Subgenual prefrontal cortex abnormalities in mood disorders . Nature 386, 824–827 (1997).

    CAS  PubMed  Google Scholar 

  51. Barnes. J. et al. Cortical activity during rotational and linear transformation . Neuropsychologia 38, 1148– 1156 (2000).

    CAS  PubMed  Google Scholar 

  52. ffytche, D. H. et al. The anatomy of conscious vision: an fMRI study of visual hallucinations . Nature Neurosci. 1, 738– 742 (1998).

    CAS  PubMed  Google Scholar 

  53. Adolphs, R., Tranel, D., Damasio, H. & Damasio, A. Impaired recognition of emotion in facial expressions following bilateral damage to the human amygdala . Nature 372, 669–672 (1994).

    CAS  Google Scholar 

  54. Rauch, S. L. et al. A symptom provocation study of post traumatic stress disorder using positron emission tomography and script-driven imagery. Arch. Gen. Psychiat. 53, 380–387 (1996).

    CAS  PubMed  Google Scholar 

  55. Phillips, M. L. et al. A specific neural substrate for perceiving facial expressions of disgust. Nature 389, 495– 498 (1997).

    CAS  PubMed  Google Scholar 

  56. Phillips, M. L. et al. A differential neural response in obsessive-compulsive patients with washing compared with checking symptoms to disgust. Psychol. Med. 30, 1037–1050 ( 2000).

    CAS  PubMed  Google Scholar 

  57. Blair, R. J., Morris, J. S., Frith, C. D., Perrett, D. I. & Dolan, R. J. Dissociable neural responses to facial expressions of sadness and anger. Brain 122, 883–893 (1999).

    PubMed  Google Scholar 

  58. Phillips, M. L. et al. A differential neural response to threatening and non-threatening negative facial expressions in paranoid and non-paranoid schizophrenics. Psychiatr. Res. Neuroimaging 92, 11– 31 (1999).

    CAS  Google Scholar 

  59. Fine, C. & Blair, R. J. R. The cognitive and emotional effects of amygdala damage. Neurocase 6, 435–450 (2000).

    Google Scholar 

  60. Ellis, H. D. Cognitive neuropsychiatry and delusional misidentification syndromes: an exemplary vindication of the new disciplines. Cogn. Neuropsychiat. 3, 81–90 (1998).

    CAS  Google Scholar 

  61. Ellis, H. D. & Young, A. W. Accounting for delusional misidentifications . Br. J. Psychiatry. 157, 239– 248 (1990).

    CAS  PubMed  Google Scholar 

  62. Signer, S. F. Localization and lateralization in the delusion of substitution. Capgras symptom and its variants. Psychopathology 27, 168 –176 (1994).

    CAS  PubMed  Google Scholar 

  63. Bruce, V. & Young, A. Understanding face recognition. Br. J. Psychol. 77, 305–327 (1986).

    PubMed  Google Scholar 

  64. Breen, N., Caine, D. & Coltheart, M. Models of face recognition and delusional misidentification: a critical review. Cogn. Neuropsychol. 17, 55–72 (2000).

    CAS  PubMed  Google Scholar 

  65. Bauer, R. M. Autonomic recognition of names and faces in prosopagnosia: a neuropsychological application of the Guilty Knowledge Test Neuropsychologia 22, 457–469 (1984).

    CAS  PubMed  Google Scholar 

  66. Tranel, D. & Damasio, A. R. Knowledge without awareness: an autonomic index of facial recognition by prosopagnosics. Science 228, 1453–1454 ( 1985).

    CAS  PubMed  Google Scholar 

  67. Ellis, H. D. et al. Reduced autonomic responses to faces in Capgras delusion. Proc. R. Soc. Lond. B 264, 1085–1092 (1997).

    CAS  Google Scholar 

  68. Hirstein, W. & Ramachandran, V. S. Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons. Proc. R. Soc. Lond. B 264, 437 –444 (1997).

    CAS  Google Scholar 

  69. Tranel, D., Damasio, A. R. & Damasio, H. Double dissociation between overt and covert recognition . J. Cogn. Neurosci. 7, 425– 432 (1995).

    CAS  PubMed  Google Scholar 

  70. Stone, T. & Young, A. W. Delusions and brain injury; the philosophy and psychology of belief. Mind and Language 12, 327–364, 1997.

    Google Scholar 

  71. Kemp, R., Chua, S., McKenna, P. & David, A. Reasoning in delusions: an empirical study. Br. J. Psychiat. 170, 398–405 (1997). PubMed

    CAS  Google Scholar 

  72. Garety, P. A. & Freeman, D. Cognitive approaches to delusions: a critical review of theories and evidence. Br. J. Clin. Psychol. 38, 113–154 ( 2000). PubMed

    Google Scholar 

  73. Ellis, H. D., Young, A. W., Quayle, A. H. & de Pauw K. W. Response to “Misidentification syndromes and cognitive neuropsychiatry” . Trends Cogn. Sci. 1, 158 ( 1997).

    CAS  PubMed  Google Scholar 

  74. Slade, P. & Bentall, R. Sensory Deception: A Scientific Analysis of Hallucination (London, Croom Helmm, 1988 ).

    Google Scholar 

  75. Dierks, T. et al. Activation of Heschl's gyrus during auditory hallucinations . Neuron 22, 615–621 (1999).

    CAS  PubMed  Google Scholar 

  76. David, A. S. et al. Auditory hallucinations inhibit exogenous activation of auditory association cortex. Neuroreport 7, 932– 936 (1996).

    CAS  PubMed  Google Scholar 

  77. Woodruff, P. W. R. et al. Auditory hallucinations and the temporal cortical response to speech in schizophrenia: a functional magnetic resonance imaging study. Am. J. Psychiat. 154, 1676– 1682 (1997).

    CAS  PubMed  Google Scholar 

  78. Shergill. S. S., Brammer, M. J., Williams, S. C., Murray, R. M. & McGuire, P. K. Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging. Arch. Gen. Psychiat. 57, 1033–1038 (2000).

    CAS  PubMed  Google Scholar 

  79. Evans, C. L., McGuire, P. K. & David, A. S. Is auditory imagery defective in patients with auditory hallucinations? Psychol. Med. 30, 137– 148 (2000).

    CAS  PubMed  Google Scholar 

  80. David, A. S. & Lucas, P. A. Auditory–verbal hallucinations and the phonological loop: a cognitive neuropsychological study. Br. J. Clin. Psychol. 32, 431–441 (1993).

    PubMed  Google Scholar 

  81. David, A. S. in The Neuropsychology of Schizophrenia (eds David, A. S. & Cutting, J. C.) (Lawrence Erlbaum, Hove, 1994).

    Google Scholar 

  82. Brébion, G. et al. Positive symptomatology and source-monitoring failure in schizophrenia — an analysis of symptom-specific effects. Psychiat. Res. 95, 119–131 ( 2000). PubMed

    Google Scholar 

  83. Goldberg, T. E., Gold, J. M., Coppola, R. & Weinberger, D. R. Unnatural practices, unspeakable actions: a study of delayed auditory feedback in schizophrenia . Am. J. Psychiat. 154, 858– 860 (1997).

    CAS  PubMed  Google Scholar 

  84. McGuire, P. K. et al. Abnormal monitoring of inner speech: a physiological basis for auditory hallucinations. Lancet 346 , 596–600 (1995).

    CAS  PubMed  Google Scholar 

  85. Shergill, S. S., Bullmore, E., Simmons, A., Murray, R. & McGuire, P. Functional anatomy of auditory verbal imagery in schizophrenic patients with auditory hallucinations. Am. J. Psychiat. 157, 1691–1693 (2000).

    CAS  PubMed  Google Scholar 

  86. Amador, X. F. & David, A. S. (eds) Insight and psychosis (Oxford Univ. Press, New York, 1998).

    Google Scholar 

  87. Hoffman, R. E. Language processing and hallucinated “voices”: insights from transcranial magnetic stimulation. Cogn. Neuropsychiat. 6, 1–6 (2001).

    CAS  Google Scholar 

  88. Ellis, H. D. & Lewis, M. B. Capgras delusion: a window on face recognition. Trends Cogn. Sci. (in the press).

Download references

Acknowledgements

PWH acknowledges the support of The Medical Research Council. We thank Sukhi Shergill for permission to use Figure 3.

Author information

Authors and Affiliations

  1. the School of Psychology, University of Cardiff, Cardiff, CF10 3YG

    Peter W Halligan

  2. the Institute of Psychiatry & GKT School of Medicine, King's College, London, SE5 8AF, UK

    Anthony S David

Authors
  1. Peter W Halligan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony S David
    View author publications

    You can also search for this author in PubMed Google Scholar

Related links

Related links

FURTHER INFORMATION

Cognitive Neuropsychiatry

ENCYCLOPEDIA OF LIFE SCIENCES

Schizophrenia

Glossary

ALIEN AND ANARCHIC HAND SYNDROMES

Neurological conditions in which the patient denies ownership or is not always in control of his/her own hand.

CONDITIONAL REASONING

A form of inferential reasoning that consists of two elements: 1) a conditional clause stating a relationship between two things and 2) some evidence pertaining to the conditional clause. The task is to determine whether the evidence supports, refutes, or is irrelevant to the stated relationship

COTARD'S SYNDROME

A severe type of depression with nihilistic delusions of death.

DSM-IV

Diagnostic and statistical manual of mental disorders, fourth edition.

EPISODIC MEMORY

The recollection of events in an autobiographical context.

ICD-10

The International Statistical Classification of Diseases and Related Health Problems, tenth revision.

NEGATIVE-SYNDROME SCHIZOPHRENIA

Schizophrenia characterized by the absence of normal behaviours such as communicative speech and emotional reactivity.

NOSOLOGY

Branch of medicine that deals with classification of diseases.

PHONOLOGICAL FLUENCY TASK

In this task, people are required to generate or identify words that begin with a specific letter, independent of their meaning.

PROSOPAGNOSIA

Inability to visually recognise faces that were previously familiar.

PSYCHOGENIC FUGUE

Condition in which the patient often assumes a new identity, and suddenly and unexpectedly travels away from his/her usual environment. It is commonly accompanied by an inability to recall the past.

SEMANTIC FLUENCY TASK

In this task, people are required to generate or identify words that belong to a specific category.

SEMANTIC MEMORY

The recollection of factual information independent of the specific episodes in which that information was acquired.

SEMANTIC PRIMING

A quickening in reaction time for responding to words that are preceded by a semantically related 'priming stimulus'.

SOMATOPARAPHRENIA

Syndrome in which patients hold delusional beliefs about parts of their body.

STROOP COLOUR–WORD INTERFERENCE TEST

The test takes advantage of our ability to read words faster than we can name colours. If a word is printed or displayed in a colour different from the colour it actually names, the time it takes to read the word will be shorter than the time needed to name its colour. For example, if the word 'green' is written in blue ink, we will say the word 'green' faster than 'blue'.

SYLLOGISTIC REASONING

A form of inferential reasoning based on a self-evident and irrefutable truth that ends in a necessarily true and therefore irrefutable conclusion.

TOURETTE'S SYNDROME

Neurological disorder characterized by intermittent, brief involuntary movements or sounds that are called tics. It is thought to be caused by abnormalities of the basal ganglia.

TRANSCRANIAL MAGNETIC STIMULATION

A technique use to induced a transient interrruption of normal brain activity in a relatively restricted area of the brain. It is based on the generation of a strong magnetic field near the area of interest which, if changed rapidly enough, it will induce an electric field sufficient to stimulate neurons.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Halligan, P., David, A. Cognitive neuropsychiatry: towards a scientific psychopathology. Nat Rev Neurosci 2, 209–215 (2001). https://doi.org/10.1038/35058586

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/35058586

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing