Abstract
Social functioning can be severely impaired in non-affective psychotic disorder (NAPD). Current models of psychosis pathogenesis do not tend to focus on social dysfunction and pharmacological treatment fails to ameliorate it. In this article, we propose that mentalization theory provides a valuable contribution to the understanding and treatment of NAPD. Impaired mentalizing may contribute to both positive and negatives symptoms as well as social dysfunction observed in NAPD. Furthermore, impaired mentalizing may help explain the relation between childhood abuse, insecure attachment and psychosis. Mentalization based treatment may contribute to the functional recovery of NAPD patients as it targets the social cognitive processes underlying social interaction. The article includes a description of the principles of MBT in general, specific characteristics of using MBT with patients with NAPD and a clinical vignette to illustrate these principles.
Highlights
A recent, dominant model of psychosis pathogenesis (Howes and Murray 2014) suggests that many factors contribute to the etiology of psychosis, such as variant genes, stress, neuroinflammation, dysregulated activity in the hypothalamic–pituitary–adrenal axis, and developmental insults
It is held that the assignment of aberrant salience to mundane stimuli due to a sensitized mesolimbic dopamine system is the final common pathway through which these variables increase psychosis risk
Non-affective psychotic disorders (NAPD1) like schizophrenia, brief psychotic disorder and schizoaffective disorder, involve negative symptoms such as lack of initiative or flattened affective expression and social dysfunction (Green et al 2019), which are less prominently featured in most current etiological models of psychosis
Summary
A recent, dominant model of psychosis pathogenesis (Howes and Murray 2014) suggests that many factors contribute to the etiology of psychosis, such as variant genes, stress, neuroinflammation, dysregulated activity in the hypothalamic–pituitary–adrenal axis, and developmental insults (e.g., pre- and perinatal complications). Patients with NAPD tend to have an impaired ability to infer the mental states of others (for overviews see Harrington et al 2005; Sprong et al 2007) and understand others’ emotional expressions (O’Driscoll et al 2014) They tend to have trouble recognizing their own internal sensory-affective experience (Brunelin et al 2007) and show difficulty verbalizing such experience (Trémeau 2006). Children who repeatedly experience that their internal states are met with distorted or inaccurate caregiver responses, may develop a chronic mistrust regarding others’ messages Both insecure attachment styles and NAPD diagnoses are related to aspects of epistemic hypervigilance such
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