The subcortical confinement hypothesis: A neurological model for schizotypal hallucinations

Golembiewski, Jan A. (2013) The subcortical confinement hypothesis: A neurological model for schizotypal hallucinations. Cureus, 5(5), e118.

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Different types of hallucinations are symptomatic of different conditions. Schizotypal hallucinations are unique in that they follow existing delusional narrative patterns: they are often bizarre, they are generally multimodal, and they are particularly vivid (the experience of a newsreader abusing you personally over the TV is both visual and aural. Patients who feel and hear silicone chips under their skin suffer from haptic hallucinations as well as aural ones, etc.) Although there are a number of hypotheses for hallucinations, few cogently grapple the sheer bizarreness of the ones experienced in schizotypal psychosis.


A review-based hypothesis, traversing theory from the molecular level to phenomenological expression as a distinct and recognizable symptomatology.


Hallucinations appear to be caused by a two-fold dysfunction in the mesofrontal dopamine pathway, which is considered here to mediate attention of different types: in the anterior medial frontal lobe, the receptors (largely D1 type) mediate declarative awareness, whereas the receptors in the striatum (largely D2 type) mediate latent awareness of known schemata. In healthy perception, most of the perceptual load is performed by the latter: by the top-down predictive and mimetic engine, with the bottom-up mechanism being used as a secondary tool to bring conscious deliberation to stimuli that fails to match up against expectations. In schizophrenia, the predictive mode is over-stimulated, while the bottom-up feedback mechanism atrophies.

The dysfunctional distribution pattern effectively confines dopamine activity to the striatum, thereby stimulating the structural components of thought and behaviour: well-learned routines, narrative structures, lexica, grammar, schemata, archetypes, and other procedural resources. Meanwhile, the loss of activity in the frontal complex reduces the capacity for declarative awareness and for processing anything that fails to meet expectations.

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ID Code: 84772
Item Type: Journal Article
Refereed: Yes
Keywords: schizophrenia, hallucinations, delusions, cytoarchitecture, dopamine, glutamate, attention, perception, striatum, prefrontal cortex
DOI: 10.7759/cureus.118
ISSN: 2168-8184
Subjects: Australian and New Zealand Standard Research Classification > PSYCHOLOGY AND COGNITIVE SCIENCES (170000) > PSYCHOLOGY (170100)
Divisions: Current > Schools > School of Design
Current > QUT Faculties and Divisions > Creative Industries Faculty
Copyright Owner: Copyright 2013 Golembiewski.
Copyright Statement: This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Deposited On: 15 Jun 2015 00:41
Last Modified: 15 Jun 2015 23:39

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