The cognitive neuropsychiatry of delusions: from psychopathology to neuropsychology and back again

Background. The nature of delusions remains unclear despite their interest to researchers and importance in psychopathology. Here we present a review of the contributions from various disciplines, principally cognitive neuroscience, towards a new understanding. Method. Narrative review of published research. Results. The main areas of activity revolve around reasoning biases, attributional and attentional biases, theory of mind, and the role of emotion, with each area beginning to be explored using functional neuroimaging techniques. Of heuristic interest are neurological models, which include confabulation and delusional misidentification and the one- versus two-stage (perceptual versus reasoning plus perceptual) accounts of the latter. Conclusions. These different approaches are shown to each highlight mechanisms which are suggested to cause, contribute to, or modulate the genesis and form of delusions. Such contributions coupled with traditional phenomenological methods should provide the foundations for a cognitive neuropsychiatry of delusions.