Hypothetical Construct: An Integrative Neurocognitive Deficit

I am proposing that individuals with both positive and negative symptoms have some neurocognitive deficit, which is expressed when the individuals are under stress. The usual types of stressors, such as interpersonal problems, threaten to produce overstimulation, which is stressful and leads the individual to cope with this stressor in some way. The usual strategy is withdrawal, which is manifested in the negative symptoms. Thus, we get the paradigm of the threat of overstimulation (which may be manifest in increased delusions and hallucinations) or just overall physiological stress. In any event, the negative symptoms serve as a protection against further stimulation, which may produce disorganization and is also part of a resource conservation program. The individual perceives an inadequate supply of resources and thus, resorts to support sparing when stress threatens to soak up the resources. Paul Meehl first described this hypothetical construct in terms of a deficit in neurocognitive integrative processes. Work in the 1990s indicated an impact of the “stress hormone,” cortisol, on the memory system. It seems to me that a broad view of the reaction of the individuals would be a hypersensitivity to stressful conditions. Thus, while it is true that these individuals have a greater than average incidence of negative events during development, it seems highly unlikely that these events in themselves are sufficient to cause a predisposition to psychosis. It is more likely that these individuals have the above described neurocognitive deficit, which leads to their overreaction to situations. This overreaction sets the stage later for subsequent flooding of the brain with dopamine when a final stressor occurs in adolescence or later. The proposed sequence that would be: neurocognitive integrative deficit (probably due to genetic mutations) —> overreaction to traumatic events (perhaps accompanied by catastrophizing) —> triggering of the resource conservation system manifested by some social withdrawal-> precipitating factors in adolescence —> hyperexcitation of the brain and a compensatory conservation of resources, manifested by the negative symptoms.

Note: These individuals tend to overreact even to minor challenges, such as the administration of the neurocognitive tests. These tests are evidentially perceived as stressors and thus, activate resource sparing, which is manifested in these individuals’ avoidance response and a detriment to respond to the challenge. The challenge, incidentally, is similar to that involved in the 1990’s studies on the impact of cortisol on memory (Newcomer, Selke, Melson, Hershey, Craft, Richards, & Alderson, 1999; Lupien, Gaudreau, Tchiteya, Maheu, Sharma, Nair, Hauger, McEwen, & Meaney, 1997). I have previously written about neurocognitive insufficiency analogizing this to cardiac insufficiency. This notion does fit in with the idea described above: the hypothetical construct, namely the deficit in the integrative activity imposes a limitation on the available resources. In other words, there is a perceived deficit in resources, which then accounts for the conservation of the energy program.