Apparent motion perception in patients with paranoid schizophrenia

Schizotypal traits and anomalous perceptual experiences are associated with greater visual temporal acuity

One of the main tasks of the human visual system is to organize the temporal flow of visual events into meaningful patterns. It has been suggested that segregation/integration of continuous visual stimuli relies on temporal windows that are phase-locked to brain oscillations in the alpha frequency range (~10 Hz). From a behavioral point of view, the balance between integration and segregation is reflected in visual temporal acuity: the ability to perceive a small temporal gap between two identical stimuli. Disruption of this balance may lead to impairment of perceptual organization processes. Notably, schizophrenia, a condition characterized by unusual perceptual experiences, has been associated with abnormal temporal processing of sensory stimuli and aberrant oscillations. We asked a large cohort of healthy participants to complete an online version of the two-flash fusion task and two questionnaires for schizotypal personality traits to investigate individual differences in the temporal resolution of perception, particularly its relationship with anomalous perceptual experiences. We found that two-flash discrimination acuity declines with age and that schizotypal traits are associated with better performances. Although this association was strong for perceptual and cognitive subscales, we found that this result could not be attributed to response biases (e.g., hallucination of two flashes). While these results appear to contrast with findings of slower alpha rhythms and sensory processing in schizotypy, we propose that a faster visual rate could be the consequence of an oscillopathy or a disconnection between different sensory modalities and their physiological pacemaker.

A neural model of modified excitation/inhibition and feedback levels in schizophrenia

Introduction

The strength of certain visual illusions, including contrast-contrast and apparent motion, is weakened in individuals with schizophrenia. Such phenomena have been interpreted as the impaired integration of inhibitory and excitatory neural responses, and impaired top-down feedback mechanisms.

Methods

To investigate whether and how these factors influence the perceived contrast-contrast and apparent motion illusions in individuals with schizophrenia, we propose a two-layer network, with top-down feedback from layer 2 to layer 1 that can model visual receptive fields (RFs) and their inhibitory and excitatory subfields.

Results

Our neural model suggests that illusion perception changes in individuals with schizophrenia can be influenced by altered top-down mechanisms and the organization of the on-center off-surround receptive fields. Alteration of the RF inhibitory surround and/or the excitatory center can replicate the difference of illusion precepts between individuals with schizophrenia within certain clinical states and normal controls. The results show that the simulated top-down feedback modulation enlarges the difference of the model illusion representations, replicating the difference between the two groups.

Discussion

We propose that the heterogeneity of visual and in general sensory processing in certain clinical states of schizophrenia can be largely explained by the degree of top-down feedback reduction, emphasizing the critical role of top-down feedback in illusion perception, and to a lesser extent on the imbalance of excitation/inhibition. Our neural model provides a mechanistic explanation for the modulated visual percepts of contrast-contrast and apparent motion in schizophrenia with findings that can explain a broad range of visual perceptual observations in previous studies. The two-layer motif of the current model provides a general framework that can be tailored to investigate subcortico-cortical (such as thalamocortical) and cortico-cortical networks, bridging neurobiological changes in schizophrenia and perceptual processing.

A neural model of modified excitation/inhibition and feedback levels in schizophrenia

The strength of certain visual illusions is weakened in individuals with schizophrenia. Such phenomena have been interpreted as the impaired integration of inhibitory and excitatory neural responses, and impaired top-down feedback mechanisms. To investigate whether and how these factors influence the perceived illusions in individuals with schizophrenia, we propose a two-layer network that can model visual receptive fields (RFs), their inhibitory and excitatory subfields, and the top-down feedback. Our neural model suggests that illusion perception changes in individuals with schizophrenia can be influenced by altered top-down mechanisms and the organization of the on-center off-surround receptive fields. Alteration of the RF inhibitory surround and/or the excitatory center can replicate the difference of illusion precepts between individuals with schizophrenia and normal controls. The results show that the simulated top-down feedback modulation enlarges the difference of the model illusion representations, replicating the difference between the two groups. We propose that the heterogeneity of visual and in general sensory processing in schizophrenia can be largely explained by the degree of top-down feedback reduction, emphasizing the critical role of top-down feedback in illusion perception, and to a lesser extent on the imbalance of excitation/inhibition. Our neural model provides a mechanistic explanation for the modulated visual percepts in schizophrenia with findings that can explain a broad range of visual perceptual observations in previous studies. The two-layer motif of the current model provides a general framework that can be tailored to investigate subcortico-cortical (such as thalamocortical) and cortico-cortical networks, bridging neurobiological changes in schizophrenia and perceptual processing.

Systematic review of visual illusions in schizophrenia

Visual illusions have long been used as tools to investigate sensory-perceptual deficits in schizophrenia. Recent conflicting accounts have called into question the assumption of abnormal illusion perception in patients and, therefore, the validity of this approach. Here, we present a systematic review of the current evidence regarding visual illusion perception abnormalities in patients with schizophrenia. Relevant publications were identified by a systematic search of PubMed, Literatura LILACS, PsycINFO, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), IBECS, BIOSIS, and Web of Science. Forty-five studies were selected which included illusions classified as 'Motion illusions', 'Geometric-optical illusions', 'Illusory contours', 'Depth inversion illusion', and 'Non-specific'. There is concordant evidence of abnormal processing of illusions in patients for most categories, especially in facial Depth Inversion and Müller-Lyer illusions. There were significant methodological disparities and shortcomings, but risk of bias was overall low for individual studies. The usefulness of visual illusions as tools in clinical settings as well as in basic research may be contingent on significant methodological refinements.

Intact and deficient contextual processing in schizophrenia patients

Schizophrenia patients are known to have deficits in contextual vision. However, results are often very mixed. In some paradigms, patients do not take the context into account and, hence, perform more veridically than healthy controls. In other paradigms, context deteriorates performance much more strongly in patients compared to healthy controls. These mixed results may be explained by differences in the paradigms as well as by small or biased samples, given the large heterogeneity of patients' deficits. Here, we show that mixed results may also come from idiosyncrasies of the stimuli used because in variants of the same visual paradigm, tested with the same participants, we found intact and deficient processing.

Heightened perception of illusory motion is associated with symptom severity in schizophrenia patients

Abnormal perceptual processing in schizophrenia may contribute to the development of positive symptoms such as hallucinations. Experimental findings suggest that such abnormalities result from impaired processing of local signals into complex cortical representations. Because complex processing is needed to generate the perception of illusory motion from local signals, deteriorated perception of illusory motion would be expected in schizophrenia. However, findings are mixed, and the relationship between complex motion processing and symptoms is unclear. Illusions with multiple flow components (e.g. rotation/expansion) are known to strongly engage specialized complex processing mechanisms that may be abnormal in schizophrenia, but have not yet been investigated. We used a recently constructed paradigm based on the Pinna-Brelstaff illusion to manipulate complex-flow illusory perception in a quantitative manner and probe associations with dimensional symptoms. In 102 patients and 90 controls, perceived speed and perceptual variability for the PBF were measured across a range of parameters. Meanwhile, eye movement was recorded and gaze parameters were analysed to examine effects on illusory perception. Our results showed that patients experienced faster illusory rotation than controls, while they made fewer eye fixations. This heightened illusory perception was significantly correlated with positive and general, but not negative, symptom scores. Our results indicate that unusual processing of complex-flow motion in patients may be specifically related to dimensional symptoms, which could provide a promising strategy for parsing heterogeneity in the schizophrenia syndrome. This further highlights the role of motion perception abnormalities in the pathophysiology of schizophrenia, thus encouraging future investigation into visual remediation therapeutics.

Examining motion speed processing in schizophrenia using the flash lag illusion

Research on visual perception in schizophrenia suggests a deficit in motion processing. Specifically, difficulties with discriminating motion speed are commonly reported. However, speed discrimination tasks typically require participants to make judgments about the difference between two stimuli in a two-interval forced choice (2IFC) task. Such tasks not only tap into speed processing mechanisms, but also rely on higher executive functioning including working memory and attention which has been shown to be compromised in schizophrenia. We used the Flash Lag illusion to examine speed processing in patients with schizophrenia. Based on previous research showing a strong dependence between motion speed and the illusion magnitude, we expected a deficit in speed processing to alter this relationship. A motion processing deficit in patients would also predict overall reductions in perceived lag. We found the magnitude and speed dependence of the Flash Lag illusion to be similar in patients and controls. Together, the findings suggest no general abnormality in motion speed processing in schizophrenia.

No evidence for abnormal priors in early vision in schizophrenia

The predictive coding account of psychosis postulates the abnormal formation of prior beliefs in schizophrenia, resulting in psychotic symptoms. One domain in which priors play a crucial role is visual perception. For instance, our perception of brightness, line length, and motion direction are not merely based on a veridical extraction of sensory input but are also determined by expectation (or prior) of the stimulus. Formation of such priors is thought to be governed by the statistical regularities within natural scenes. Recently, the use of such priors has been attributed to a specific set of well-documented visual illusions, supporting the idea that perception is biased toward what is statistically more probable within the environment. The Predictive Coding account of psychosis proposes that patients form abnormal representations of statistical regularities in natural scenes, leading to altered perceptual experiences. Here we use classical vision experiments involving a specific set of visual illusions to directly test this hypothesis. We find that perceptual judgments for both patients and control participants are biased in accordance with reported probability distributions of natural scenes. Thus, despite there being a suggested link between visual abnormalities and psychotic symptoms in schizophrenia, our results provide no support for the notion that altered formation of priors is a general feature of the disorder. These data call for a refinement in the predictions of quantitative models of psychosis.

Is the perception of illusions abnormal in schizophrenia?

There seems to be no common factor for visual perception, i.e., performance in visual tasks correlates only weakly with each other. Similar results were found with visual illusions. One may expect common visual factors for individuals suffering from pathologies that alter brain functioning, such as schizophrenia. For example, patients who are more severely affected by the disease, e.g., stronger positive symptoms, may show increased illusion magnitudes. Here, in the first experiment, we used a battery of seven visual illusions and a mental imagery questionnaire. Illusion magnitudes for the seven illusions did not differ significantly between the patients and controls. In addition, correlations between the different illusions and mental imagery were low. In the second experiment, we tested 59 patients (mostly outpatients) with ten visual illusions. As for the first experiment, patients and controls showed similar susceptibility to all but one visual illusion. Moreover, there were no significant correlations between different illusions, symptoms, or medication type. Thus, it seems that perception of visual illusions is mostly intact in schizophrenia.

Delusions of control in schizophrenia: Resistant to the mind's best trick?

The existence of a free will is fiercely debated in neuroscience and philosophy. The debate has great impact on society and our self-understanding as human beings. Behavioral and electrophysiological data have challenged the intuitive assumption that human behavior is the result of conscious intentions. This notion has important implications for delusions of control in schizophrenia, where patients experience bodily movements as not being controlled by themselves. Current theories explain control delusions as a deficit to perceive certain aspects of motor control, but many findings are inconsistent with this idea. Here, an alternative view is proposed: Control delusions might be triggered by an even more veridical perception of the temporal order of intentions and actions. This hypothesis is supported by evidence that (a) conscious intentions in healthy subjects are often based on retrospective inferences, (b) temporal recalibrations of conscious percepts occur in healthy subjects and are disturbed in schizophrenia and (c) basic perceptual functions of schizophrenic patients are less influenced by expectations and therefore they can sometimes be closer to physical reality than those of healthy subjects.

A Perceptual Inference Mechanism for Hallucinations Linked to Striatal Dopamine

Hallucinations, a cardinal feature of psychotic disorders such as schizophrenia, are known to depend on excessive striatal dopamine. However, an underlying cognitive mechanism linking dopamine dysregulation and the experience of hallucinatory percepts remains elusive. Bayesian models explain perception as an optimal combination of prior expectations and new sensory evidence, where perceptual distortions such as illusions and hallucinations may occur if prior expectations are afforded excessive weight. Such excessive weight of prior expectations, in turn, could stem from a gain-control process controlled by neuromodulators such as dopamine. To test for such a dopamine-dependent gain-control mechanism of hallucinations, we studied unmedicated patients with schizophrenia with varying degrees of hallucination severity and healthy individuals using molecular imaging with a pharmacological manipulation of dopamine, structural imaging, and a novel task designed to measure illusory changes in the perceived duration of auditory stimuli under different levels of uncertainty. Hallucinations correlated with a perceptual bias, reflecting disproportional gain on expectations under uncertainty. This bias could be pharmacologically induced by amphetamine, strongly correlated with striatal dopamine release, and related to cortical volume of the dorsal anterior cingulate, a brain region involved in tracking environmental uncertainty. These findings outline a novel dopamine-dependent mechanism for perceptual modulation in physiological conditions and further suggest that this mechanism may confer vulnerability to hallucinations in hyper-dopaminergic states underlying psychosis.

A review of abnormalities in the perception of visual illusions in schizophrenia

Specific abnormalities of vision in schizophrenia have been observed to affect high-level and some low-level integration mechanisms, suggesting that people with schizophrenia may experience anomalies across different stages in the visual system affecting either early or late processing or both. Here, we review the research into visual illusion perception in schizophrenia and the issues which previous research has faced. One general finding that emerged from the literature is that those with schizophrenia are mostly immune to the effects of high-level illusory displays, but this effect is not consistent across all low-level illusions. The present review suggests that this resistance is due to the weakening of top-down perceptual mechanisms and may be relevant to the understanding of symptoms of visual distortion rather than hallucinations as previously thought.

Local versus global and retinotopic versus non-retinotopic motion processing in schizophrenia patients

Schizophrenia impairs cognitive functions as much as perception. For example, patients perceive global motion in random dot kinematograms less strongly, because, as it is argued, the integration of the dots into a single Gestalt is complex and therefore deteriorated. Similarly, the perception of apparent motion is impaired, because filling-in of the illusory trajectory requires complex processing. Here, we investigated very complex motion processing using the Ternus-Pikler display. First, we tested whether the perception of global apparent motion is impaired in schizophrenia patients compared to healthy controls. The task requires both the grouping of multiple elements into a coherent Gestalt and the filling-in of its illusory motion trajectory. Second, we tested the perception of rotation in the same stimulus, which in addition requires the computation of non-retinotopic motion. Contrary to earlier studies, patients were not impaired in either task and even tended to perform better than controls. The results suggest that complex visual processing itself is not impaired in schizophrenia patients.

Perceptual instability in schizophrenia: Probing predictive coding accounts of delusions with ambiguous stimuli

Background

Delusions, a core symptom of schizophrenia, are thought to arise from an alteration in predictive coding mechanisms that underlie perceptual inference. Here, we aimed to empirically test the hypothesized link between delusions and perceptual inference.

Method

28 patients with schizophrenia and 32 healthy controls matched for age and gender took part in a behavioral experiment that assessed the influence of stabilizing predictions on perception of an ambiguous visual stimulus.

Results

Participants with schizophrenia exhibited a weaker tendency towards percept stabilization during intermittent viewing of the ambiguous stimulus compared to healthy controls. The tendency towards percept stabilization in participants with schizophrenia correlated negatively with delusional ideation as measured with a validated questionnaire.

Conclusion

Our results indicate an association between a weakened effect of sensory predictions in perceptual inference and delusions in schizophrenia. We suggest that attenuated predictive signaling during perceptual inference in schizophrenia may yield the experience of aberrant salience, thereby providing the starting point for the formation of delusions.

What visual illusions teach us about schizophrenia

Illusion, namely a mismatch between the objective and perceived properties of an object present in the environment, is a common feature of visual perception, both in normal and pathological conditions. This makes illusion a valuable tool with which to explore normal perception and its impairments. Although still debated, the hypothesis of a modified, and typically diminished, susceptibility to illusions in schizophrenia patients is supported by a growing number of studies. The current paper aimed to review how illusions have been used to explore and reveal the core features of visual perception in schizophrenia from a psychophysical, neurophysiological and functional point of view. We propose an integration of these findings into a common hierarchical Bayesian inference framework. The Bayesian formalism considers perception as the optimal combination between sensory evidence and prior knowledge, thereby highlighting the interweaving of perceptions and beliefs. Notably, it offers a holistic and convincing explanation for the perceptual changes observed in schizophrenia that might be ideally tested using illusory paradigms, as well as potential paths to explore neural mechanisms. Implications for psychopathology (in terms of positive symptoms, subjective experience or behavior disruptions) are critically discussed.

Delusions and the role of beliefs in perceptual inference

Delusions are unfounded yet tenacious beliefs and a symptom of psychotic disorder. Varying degrees of delusional ideation are also found in the healthy population. Here, we empirically validated a neurocognitive model that explains both the formation and the persistence of delusional beliefs in terms of altered perceptual inference. In a combined behavioral and functional neuroimaging study in healthy participants, we used ambiguous visual stimulation to probe the relationship between delusion-proneness and the effect of learned predictions on perception. Delusional ideation was associated with less perceptual stability, but a stronger belief-induced bias on perception, paralleled by enhanced functional connectivity between frontal areas that encoded beliefs and sensory areas that encoded perception. These findings suggest that weakened lower-level predictions that result in perceptual instability are implicated in the emergence of delusional beliefs. In contrast, stronger higher-level predictions that sculpt perception into conformity with beliefs might contribute to the tenacious persistence of delusional beliefs.

Subjective criteria and illusions in visual testing: some methodological limitations

It is argued that illusions cannot generally be investigated with criterion-independent methods. This limits the value of the data obtained from them. This is particularly important when the results are compared between groups of subjects, for example, between dyslexic readers and controls, since it is possible that the differences between the groups reflect differences with regard to criteria rather than real perceptual differences.