I appreciate Dr. Henry A. Nasrallah’s refreshing, mind-bending thoughts about delusions in, “Are some nonpsychotic psychiatric disorders actually psychotic?” (From the Editor, Current Psychiatry, November 2010, p. 16-19). I am moved to contemplate delusions in a new way and to try an antipsychotic in select cases. If delusional thinking were like a closed circuit with its associated neurotransmitter pathway and no access to cortical modification, it would make sense to use a “circuit breaker” (such as dopamine inhibitors and anxiolytics) to open up a pathway to cortical modification. Cognitive-behavioral therapy would help with the transition to cortical control.
Justine Forbes, MD
Los Gatos, CA