Article Statistical significance was set at p<0.05. The views expressed here are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Hgele C, created the Aberrant Salience Inventory (ASI) as a valid and reliable measure of aberrant salience in both the clinical and general population [9]. While correlation analyses consistently showed a good correlation between scales assessing the same or similar pathological dimensions, none of them showed a significant correlation with ASI. PubMed 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK, 2Psychiatric Imaging Group, MRC Clinical Sciences Centre, Imperial College London, London, UK. Thus, the observed outcomes could provide interesting perspectives regarding the use of aberrant salience as a clinically useful paradigm, as part of a psychopathological approach evaluating vulnerability to psychosis recurrence. https://doi.org/10.1111/j.1460-9568.2012.07990.x. By extension, when salience is misattributed to internal representations and selfgenerated actions, these phenomena may be interpreted as externally generated3, giving rise to auditory verbal hallucinations and passivity phenomena. This is a cross-sectional, monocentric study, conducted by the psychiatric research team at the Adult Psychiatry Unit of Florence University Hospital, according to Good Clinical Practices (GCP), the Declaration of Helsinki (1964), and further revisions. Reward learning: reinforcement, incentives, and expectations. Early Interv Psychiatry. California Privacy Statement, Current (16.766.02 vs 13.375.76; p=0.001), lifetime (15.746.08 vs 13.165.74; p=0.005) and past (15.756.01 vs 13.335.80; p=0.009) FRS were the main clusters dichotomizing ASI. ASI could be used as a tool to identify psychopathological dimensions, rather than the categorical diagnoses, in the schizophrenic spectrum. The aberrant salience hypothesis proposes that striatal dopamine dysregulation causes misattribution of salience to irrelevant stimuli leading to psychosis. 203 consecutive subjects were asked to enter the study, and 7 of them refused to give their consent. 2016;15:1934. Patients with FRS (current, lifetime, or past) had significantly higher ASI scores. Cookies policy. Further explanations were given by the research team as needed. A dimensional approach evaluating aberrant salience may provide a different framework in the assessment of psychotic diagnoses. Google Scholar. Mol Psychiatry. Furthermore, there is a correlation between mesolimbic signalling abnormalities and both positive and negative symptoms. In fact, at this stage the onset of apprehension and anguish is common for a world that has become uncertain and full of new meanings: This delusional atmosphere has been described by Jaspers as a change which envelops everything with a subtle, pervasive and strangely uncertain light [10]. Jaspers K. General psychopathology. van Os J. 2022 BioMed Central Ltd unless otherwise stated. 1997;9:45263. https://doi.org/10.1016/S0079-7421(00)80022-5.

https://doi.org/10.1093/schbul/sbq031. https://doi.org/10.1093/schbul/sbv190. In this sense, higher values of ASI in patients with current, lifetime, and previous FRS seem to confirm this approach. https://doi.org/10.1176/appi.ajp.160.1.13. Psychol Learn Motiv. These experimental approaches also have vastly different spatial and temporal resolution. Aberrant salience relationship with first rank symptoms, https://doi.org/10.1186/s12991-022-00383-5, https://doi.org/10.1176/appi.ajp.160.1.13, https://doi.org/10.1016/S0079-7421(00)80022-5, https://doi.org/10.1016/j.schres.2005.01.003, https://doi.org/10.1111/j.1460-9568.2012.07990.x, https://doi.org/10.1007/s00213-006-0578-x, https://doi.org/10.1037/0022-006X.51.2.215, https://doi.org/10.1037/1040-3590.9.4.452, https://icd.who.int/browse10/2010/en#!Q77, https://doi.org/10.1017/S0033291708003899, https://doi.org/10.1111/j.1600-0447.2009.01456.x, https://doi.org/10.1192/bjp.bp.108.054254, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, Treatment guidelines/clinical psychopathology. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. BrombergMartin ES, 2009;35:54962.

The new PMC design is here! AB, MT, MS, VR: designed the study. Eventually, delusions become a possible explanation to make sense of these experiences. PubMed Central Learn more 2005;79:5968. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. https://doi.org/10.1002/wps.20370. will also be available for a limited time. government site. One of the research team members was addressed to give any further explanation to patients and to collect socio-demographic and anamnestic data. Although the aberrant salience account of delusional atmosphere is appealing, it is less intuitive how anomalous experiences lead to positive psychotic symptoms. https://doi.org/10.1192/bjp.bp.108.054254. To date there has been no direct demonstration of aberrant phasic dopaminergic activity in patients with schizophrenia, because of inherent methodological challenges. An official website of the United States government. The ASI is a self-reported questionnaire including 29 Yes/No questions (Yes: one point; No: zero points), based on the phenomenological descriptions of the prodromal phase of psychosis [9]. Lenzenweger MF, Bennett ME, Lilenfeld LR. Hikosaka O. Egerton A, n.d. Jensen J, Kapur S. Salience and psychosis: moving from theory to practise. More than half of the patients (51.2%) had experienced at least one FRS during their life. Berridge KC. This outcome seemed reasonable, hypothesizing that ASI can vary depending on the current or lifetime presence of psychotic experiences. https://doi.org/10.1111/j.1600-0447.2009.01456.x. Schizophr Bull. From this perspective, sensory information is salient when it violates the brain's predictive model of the world, represented in cortical regions. 1983;51:21525. 2009;39:1978. ASI may be used in screening and prevention programs to identify subjects for which a deeper and more careful psychopathological assessment is warranted. Midbrain dopamine neurons, however, are not homogeneous: whilst a proportion encode motivational value for positive outcomes such as food, engendering seeking behaviour and value learning4, others respond to salient but nonrewarding (e.g., aversive) stimuli, encoding a motivational salience signal that triggers orienting and exploration behaviour5. Hamilton M. The assessment of anxiety states by rating. https://doi.org/10.1093/schbul/13.2.261. Functional dimensions of the Manual for the Assessment and Documentation of Psychopathology (AMDP) [19]; Positive and Negative Syndrome Scale (PANSS) [20]; MontgomeryAsberg Depression Rating Scale (MADRS) [21]; The presence of Schneiders FRS was assessed according to the following items in the Manual for the AMDP [24]: We have collected the presence of any FRS only, and analyzed it accordingly; AMDP items were not analyzed. Bethesda, MD 20894, Web Policies Moreover, aberrant salience attribution is higher in individuals at ultrahigh risk of psychosis compared with healthy volunteers, and both aberrant salience attribution and ventral striatal fMRI responses to irrelevant stimuli are correlated with severity of delusionlike symptoms14. The present study showed that ASI values were higher in patients with FRS, but they did not differ in patients with any specific psychiatric diagnosis. Rapp M et al. A preliminary cluster analysis (Chi-square automatic interaction detection, CHAID) was conducted to investigate which of the collected variables dichotomized ASI at a statistically significant level; a step-by-step approach was used. Variables identified as discriminative were excluded from the next steps. Acute psychotic episode (according to clinical evaluation); Cognitive impairment due to psychiatric or medical conditions; All diagnoses were assessed by expert psychiatrists (authors AB and VR). Subsequent electrophysiological studies in animals established a role in reward processing and motivation4. The authors have been funded by a Medical Research Council (UK) grant (MCA6565QD30), a Maudsley Charity Grant (no. Google Scholar. Ultimately, studies directly modulating the dopamine system and measuring associated changes in psychological appraisal will provide the final proof that the aberrant salience hypothesis bridges the explanatory gap from neurobiology to symptoms of psychosis. Furthermore, PANSS scores (average PANSS total 58.0821.61; PANSS general 33.9312.53), together with the use of any antipsychotic in 92 subjects (54.2%), confirmed the high frequency of psychotic symptoms in this population (Table 2). Patients experiencing paranoid delusions tend to exhibit a pessimistic and externalizing thinking style, which may develop after exposure to social adversity and childhood trauma11 (see also Peters et al12 in this issue of the journal). Only the main diagnosis was included in the database. Considering both Kapurs hypothesis concerning dopaminergic dysregulation underpinning salience alteration, and Howes theorization on altered dopaminergic release as the neurobiological basis of prodromal phases of psychosis [31], we suggest that ASI may be used as a tool to identify prodromal stages of psychosis. Schizophr Res. The cluster analyses also showed that depression diagnosis was the first-step discriminant for MADRS (24.9810.74 vs 18.8013.53; p=0.004) and HAMA (14.437.51 vs 11.258.23; p=0.018), the diagnosis of schizophrenia for PANSS negative symptoms (18.159.78 vs 12.787.06; p<0.001), while current FRS was the main discriminator for MRS (6.134.60 vs 2.983.41; p<0.001), PANSS positive symptoms (13.586.15 vs 7.951.90; p<0.001), PANSS general (38.4014.12 vs 31.7511.12; p=0.001) and PANSS total (69.5324.45 vs 52.5117.69; p=0.000). Aberrant salience is a trans-nosographic trait of psychotic and pre-psychotic symptoms which is not commonly used in clinical practice. This was a retrospective study that did not need ethical approval. Reininghaus U, Kempton MJ, Valmaggia L, Craig TKJ, Garety P, Onyejiaka A, et al. The authors thank the patients for giving their consent to participate in this study and the non-medical personnel for their invaluable support in the management of patients. J Pers Disord. We review these and summarize the evidence for dopamine dysfunction, reward processing, and salience abnormalities in people at clinical high risk of psychosis (CHR) relative to findings in patients with psychosis. ICD-10 Version:2010 n.d. https://icd.who.int/browse10/2010/en#!Q77. https://doi.org/10.1016/j.schres.2005.01.003. The use of the Aberrant Salience Inventory may constitute a valuable instrument for the early detection of psychosis. In humans, the most commonly used tool for investigating the neuronal correlates of aberrant salience attribution is fMRI, which neither directly measures neuronal activity nor dopamine release, but rather regional changes in the blood oxygen level on a timescale of seconds. 666), and the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. Recently, new lines of preclinical evidence on information coding by subcortical dopamine coupled with computational models of the brains ability to predict and make inferences about the world (predictive processing) provide a new perspective on this hypothesis. volume21, Articlenumber:8 (2022) Article DSM-5 Task Force. If it can be shown that aberrant salience attribution, caused by dopaminergic dysfunction, is the final component in the causal pathway leading to psychosis, then the most effective therapeutic approach is likely to involve medication targeting the presynaptic dopaminergic dysfunction to dampen aberrant salience attribution, followed by a programme of psychotherapy to help the patient reappraise his/her model of the world, and reinterpret his/her place within it. MT, MS, PM, CA, CB, LM, TT, FP, GD: collected patients data. This activity has been construed as a marker of incentive salience, underpinning motivated action selection4. Careers. 168 adult outpatients with a current psychiatric diagnosis were consecutively enrolled. As the average ASI score in patients with a main diagnosis of schizophrenia did not significantly differ from the one observed in other psychiatric patients (p=0.107), possibly due to the small sample size, it is possible to hypothesize that salience alteration, underpinned by a dysregulated dopaminergic firing, can be linked with a dimensional and trans-nosographic feature (highlighted by the correlation with FRS), rather than strictly fit into a diagnostic categorization. 2007;191:391431. Early articulations of the aberrant salience hypothesis of schizophrenia proposed that disordered mesostriatal dopamine release results in an overattribution of meaning and motivational value (incentive salience) to irrelevant environmental events2. Variables dichotomizing the total ASI score are shown in Table 4. AR performed the statistical analyses and drafted the article.