Clinical correlates of aberrant salience throughout the course of schizophrennia

Aberrant salience is the unusual or incorrect assignment of salience or significance to innocuous stimuli and has been hypothesized to be a central mechanism in the development of psychosis and for the profiling of vulnerability to psychosis . Although it has been well established that patients with psychotic disorders exhibit a more impairment in salience attribution when compared with non psychotic disorders , the research domain of aberrant salience is much broader and in fact transdiagnostic in nature. The aim of this study was to assess aberrant salience psychopathological differences between schizophrenia patients during the course of illness and patients without a psychotic disorder, in order to elucidate the role of the salience in mental illness. Furthermore, given the high suicide rate among different stages of schizophrenia, we aimed to evaluate the relationship between aberrant salience and suicide risk throughout the course of the illness. Sixteen individuals with a putative prodromal syndrome, 20 patients with first episode of schizophrenia (FES), 26 patients with multi-episode schizophrenia (MES) and 43 patients with general anxiety disorder (GAD) were assessed to examine salience attribution, clinical features and suicide risk. The results revealed no differences between the psychotic groups and the non-psychotic group, that is consistent with the continuum model of psychosis that posits that psychotic symptoms are distributed throughout the population, with diagnosable clinical disorder existing at a certain point along this continuum. Furthermore, we found aberrant salience more strongly correlated with psychopathological dimensions strictly related to the schizophrenia illness only at the early stage of the disease. At the onset of the disease, psychotic symptoms could be interpreted as a top-down cognitive explanation that individuals impose on experiences of aberrant salience, in attempt to make sense of what is perceived. This relationship is lost in chronicity, suggesting the existence of different mechanisms involved in maintenance of psychotic symptoms. Finilly, we found a relationship between more aberrant salience and more suicide ideation severity only in the FES group, suggesting the recommendation to evaluate for and treat aberrant salience in the early stage of schizophrenia in the perspective of suicide prevention.