Modern perspectives on psychoses: dissociation, automatism, and temporality across exogenous and endogenous dimensions

Substance use and the emergence of Novel Psychoactive Substances (NPS) present a significant public health challenge and diagnostic dilemma, particularly in the context of psychosis. The increasing availability of psychoactive substances among youth has led to a rise in Substance Use Disorders (SUDs...

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Main Authors: Valerio Ricci, Maria Celeste Ciavarella, Carlotta Marrangone, Guilherme Messas, Giuseppe Maina, Giovanni Martinotti
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-03-01
Series:Frontiers in Psychiatry
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Online Access:https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1543673/full
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author Valerio Ricci
Maria Celeste Ciavarella
Carlotta Marrangone
Guilherme Messas
Guilherme Messas
Giuseppe Maina
Giuseppe Maina
Giovanni Martinotti
author_facet Valerio Ricci
Maria Celeste Ciavarella
Carlotta Marrangone
Guilherme Messas
Guilherme Messas
Giuseppe Maina
Giuseppe Maina
Giovanni Martinotti
author_sort Valerio Ricci
collection DOAJ
description Substance use and the emergence of Novel Psychoactive Substances (NPS) present a significant public health challenge and diagnostic dilemma, particularly in the context of psychosis. The increasing availability of psychoactive substances among youth has led to a rise in Substance Use Disorders (SUDs), with profound implications for mental health. This paper explores the psychopathological distinctions between substance-induced psychoses (SIPs) and endogenous psychoses, such as schizophrenia, from a phenomenological perspective. We emphasize three key aspects: dissociation, mental automatism, and temporality, to elucidate the underlying mechanisms of these conditions. Dissociation, as a psychopathological organizer, is central to exogenous psychoses, particularly those triggered by NPS. This phenomenon leads to a fragmentation of consciousness, detachment from reality, and disintegration of identity, distinct from the spaltung observed in endogenous psychoses. The concept of mental automatism, as theorized by De Clerambault, is also explored, highlighting its role in the early stages of exogenous psychoses, where cognitive disruptions precede delusions and hallucinations. Furthermore, the temporal experience in SIPs is characterized by a disconnection from past and future, trapping individuals in an “eternal present.” This contrasts with the fragmented temporality observed in schizophrenia, where patients struggle to maintain a coherent narrative of their lives. The phenomenological approach provides critical insights into the clinical differentiation between SIPs and Primary Psychotic Disorders (PPDs), emphasizing the need for targeted interventions that address the specific temporal and cognitive disruptions in substance-induced conditions. In conclusion, this paper underscores the importance of integrating phenomenological psychopathology into clinical practice, particularly in the face of the evolving landscape of substance use and psychosis. Understanding the distinct psychopathological mechanisms underlying SIPs can inform more accurate diagnoses and effective treatments, ultimately improving patient outcomes in the context of this growing public health issue.
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spelling doaj-art-45b763cd1a424a399d099c70d0523fa22025-08-20T02:51:43ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-03-011610.3389/fpsyt.2025.15436731543673Modern perspectives on psychoses: dissociation, automatism, and temporality across exogenous and endogenous dimensionsValerio Ricci0Maria Celeste Ciavarella1Carlotta Marrangone2Guilherme Messas3Guilherme Messas4Giuseppe Maina5Giuseppe Maina6Giovanni Martinotti7San Luigi Gonzaga Hospital, University of Turin, Orbassano, ItalyDepartment of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio Chieti-Pescara, Chieti, ItalyDepartment of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio Chieti-Pescara, Chieti, ItalyDepartment of Mental Health, Santa Casa de São Paulo School of Medical Sciences, Sao Paulo, BrazilCollaborating Centre for Values-based Practice in Health and Social Care, St Catherine’s College, Oxford, United KingdomSan Luigi Gonzaga Hospital, University of Turin, Orbassano, ItalyDepartment of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, ItalyDepartment of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio Chieti-Pescara, Chieti, ItalySubstance use and the emergence of Novel Psychoactive Substances (NPS) present a significant public health challenge and diagnostic dilemma, particularly in the context of psychosis. The increasing availability of psychoactive substances among youth has led to a rise in Substance Use Disorders (SUDs), with profound implications for mental health. This paper explores the psychopathological distinctions between substance-induced psychoses (SIPs) and endogenous psychoses, such as schizophrenia, from a phenomenological perspective. We emphasize three key aspects: dissociation, mental automatism, and temporality, to elucidate the underlying mechanisms of these conditions. Dissociation, as a psychopathological organizer, is central to exogenous psychoses, particularly those triggered by NPS. This phenomenon leads to a fragmentation of consciousness, detachment from reality, and disintegration of identity, distinct from the spaltung observed in endogenous psychoses. The concept of mental automatism, as theorized by De Clerambault, is also explored, highlighting its role in the early stages of exogenous psychoses, where cognitive disruptions precede delusions and hallucinations. Furthermore, the temporal experience in SIPs is characterized by a disconnection from past and future, trapping individuals in an “eternal present.” This contrasts with the fragmented temporality observed in schizophrenia, where patients struggle to maintain a coherent narrative of their lives. The phenomenological approach provides critical insights into the clinical differentiation between SIPs and Primary Psychotic Disorders (PPDs), emphasizing the need for targeted interventions that address the specific temporal and cognitive disruptions in substance-induced conditions. In conclusion, this paper underscores the importance of integrating phenomenological psychopathology into clinical practice, particularly in the face of the evolving landscape of substance use and psychosis. Understanding the distinct psychopathological mechanisms underlying SIPs can inform more accurate diagnoses and effective treatments, ultimately improving patient outcomes in the context of this growing public health issue.https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1543673/fullschizophrenianovel psychoactive substancescannabispsychosismental automatismdissociation
spellingShingle Valerio Ricci
Maria Celeste Ciavarella
Carlotta Marrangone
Guilherme Messas
Guilherme Messas
Giuseppe Maina
Giuseppe Maina
Giovanni Martinotti
Modern perspectives on psychoses: dissociation, automatism, and temporality across exogenous and endogenous dimensions
Frontiers in Psychiatry
schizophrenia
novel psychoactive substances
cannabis
psychosis
mental automatism
dissociation
title Modern perspectives on psychoses: dissociation, automatism, and temporality across exogenous and endogenous dimensions
title_full Modern perspectives on psychoses: dissociation, automatism, and temporality across exogenous and endogenous dimensions
title_fullStr Modern perspectives on psychoses: dissociation, automatism, and temporality across exogenous and endogenous dimensions
title_full_unstemmed Modern perspectives on psychoses: dissociation, automatism, and temporality across exogenous and endogenous dimensions
title_short Modern perspectives on psychoses: dissociation, automatism, and temporality across exogenous and endogenous dimensions
title_sort modern perspectives on psychoses dissociation automatism and temporality across exogenous and endogenous dimensions
topic schizophrenia
novel psychoactive substances
cannabis
psychosis
mental automatism
dissociation
url https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1543673/full
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