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Schizophrenia Bulletin Advance Access published online on October 17, 2007
Schizophrenia Bulletin, doi:10.1093/schbul/sbm116
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© The Author 2007. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

The Dream as a Model for Psychosis: An Experimental Approach Using Bizarreness as a Cognitive Marker

Silvio Scarone1,2,3, Maria Laura Manzone3, Orsola Gambini2,3, Ilde Kantzas2, Ivan Limosani2, Armando D'Agostino2 and J. Allan Hobson4
2 Chair of Psychiatry, Department of Medicine, Surgery and Dentistry, University of Milan Medical School, Via Di Rudiní 8, 20142 Milan, Italy
3 Psychiatric Unit, San Paolo Hospital, Via Di Rudiní 8, 20142 Milan, Italy
4 Department of Psychiatry, Harvard Medical School, 74 Fenwood Road, 401 Park Drive, 2nd Floor East, Boston, MA 02115 USA

1 To whom correspondence should be addressed; tel: +39-028-184-4517, fax: +39-028-184-4517, e-mail: silvio.scarone{at}unimi.it.

Many previous observers have reported some qualitative similarities between the normal mental state of dreaming and the abnormal mental state of psychosis. Recent psychological, tomographic, electrophysiological, and neurochemical data appear to confirm the functional similarities between these 2 states. In this study, the hypothesis of the dreaming brain as a neurobiological model for psychosis was tested by focusing on cognitive bizarreness, a distinctive property of the dreaming mental state defined by discontinuities and incongruities in the dream plot, thoughts, and feelings. Cognitive bizarreness was measured in written reports of dreams and in verbal reports of waking fantasies in 30 schizophrenics and 30 normal controls. Seven pictures of the Thematic Apperception Test (TAT) were administered as a stimulus to elicit waking fantasies, and all participating subjects were asked to record their dreams upon awakening. A total of 420 waking fantasies plus 244 dream reports were collected to quantify the bizarreness features in the dream and waking state of both subject groups.

Two-way analysis of covariance for repeated measures showed that cognitive bizarreness was significantly lower in the TAT stories of normal subjects than in those of schizophrenics and in the dream reports of both groups.

The differences between the 2 groups indicated that, under experimental conditions, the waking cognition of schizophrenic subjects shares a common degree of formal cognitive bizarreness with the dream reports of both normal controls and schizophrenics. Though very preliminary, these results support the hypothesis that the dreaming brain could be a useful experimental model for psychosis.

Keywords: dreaming / schizophrenia / REM sleep


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