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Rootes-Murdy K, Goldsmith DR, Turner JA. Clinical and Structural Differences in Delusions Across Diagnoses: A Systematic Review. Front Integr Neurosci 2022; 15:726321. [PMID: 35140591 PMCID: PMC8818879 DOI: 10.3389/fnint.2021.726321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/16/2021] [Indexed: 12/18/2022] Open
Abstract
Delusions are marked, fixed beliefs that are incongruent with reality. Delusions, with comorbid hallucinations, are a hallmark of certain psychotic disorders (e.g., schizophrenia). Delusions can present transdiagnostically, in neurodegenerative (e.g., Alzheimer's disease and fronto-temporal dementia), nervous system disorders (e.g., Parkinson's disease) and across other psychiatric disorders (e.g., bipolar disorder). The burden of delusions is severe and understanding the heterogeneity of delusions may delineate a more valid nosology of not only psychiatric disorders but also neurodegenerative and nervous system disorders. We systematically reviewed structural neuroimaging studies reporting on delusions in four disorder types [schizophrenia (SZ), bipolar disorder (BP), Alzheimer's disease (AD), and Parkinson's disease (PD)] to provide a comprehensive overview of neural changes and clinical presentations associated with delusions. Twenty-eight eligible studies were identified. This review found delusions were most associated with gray matter reductions in the dorsolateral prefrontal cortex (SZ, BP, and AD), left claustrum (SZ and AD), hippocampus (SZ and AD), insula (SZ, BP, and AD), amygdala (SZ and BP), thalamus (SZ and AD), superior temporal gyrus (SZ, BP, and AD), and middle frontal gyrus (SZ, BP, AD, and PD). However, there was a great deal of variability in the findings of each disorder. There is some support for the current dopaminergic hypothesis of psychosis, but we also propose new hypotheses related to the belief formation network and cognitive biases. We also propose a standardization of assessments to aid future transdiagnostic study approaches. Future studies should explore the neural and biological underpinnings of delusions to hopefully, inform future treatment.
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Affiliation(s)
- Kelly Rootes-Murdy
- Department of Psychology, Georgia State University, Atlanta, GA, United States
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- *Correspondence: Kelly Rootes-Murdy
| | - David R. Goldsmith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Jessica A. Turner
- Department of Psychology, Georgia State University, Atlanta, GA, United States
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
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2
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Möller TJ, Georgie YK, Schillaci G, Voss M, Hafner VV, Kaltwasser L. Computational models of the "active self" and its disturbances in schizophrenia. Conscious Cogn 2021; 93:103155. [PMID: 34130210 DOI: 10.1016/j.concog.2021.103155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022]
Abstract
The notion that self-disorders are at the root of the emergence of schizophrenia rather than a symptom of the disease, is getting more traction in the cognitive sciences. This is in line with philosophical approaches that consider an enactive self, constituted through action and interaction with the environment. We thereby analyze different definitions of the self and evaluate various computational theories lending to these ideas. Bayesian and predictive processing are promising approaches for computational modeling of the "active self". We evaluate their implementation and challenges in computational psychiatry and cognitive developmental robotics. We describe how and why embodied robotic systems provide a valuable tool in psychiatry to assess, validate, and simulate mechanisms of self-disorders. Specifically, mechanisms involving sensorimotor learning, prediction, and self-other distinction, can be assessed with artificial agents. This link can provide essential insights to the formation of the self and new avenues in the treatment of psychiatric disorders.
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Affiliation(s)
- Tim Julian Möller
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
| | - Yasmin Kim Georgie
- Department of Computer Science, Humboldt-Universität zu Berlin, Germany.
| | - Guido Schillaci
- The BioRobotics Institute and Dept. of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Martin Voss
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine and St. Hedwig Hospital, Berlin, Germany.
| | | | - Laura Kaltwasser
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
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3
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Yaple ZA, Tolomeo S, Yu R. Abnormal prediction error processing in schizophrenia and depression. Hum Brain Mapp 2021; 42:3547-3560. [PMID: 33955106 PMCID: PMC8249895 DOI: 10.1002/hbm.25453] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/01/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022] Open
Abstract
To make adaptive decisions under uncertainty, individuals need to actively monitor the discrepancy between expected outcomes and actual outcomes, known as prediction errors. Reward‐based learning deficits have been shown in both depression and schizophrenia patients. For this study, we compiled studies that investigated prediction error processing in depression and schizophrenia patients and performed a series of meta‐analyses. In both groups, positive t‐maps of prediction error tend to yield striatum activity across studies. The analysis of negative t‐maps of prediction error revealed two large clusters within the right superior and inferior frontal lobes in schizophrenia and the medial prefrontal cortex and bilateral insula in depression. The concordant posterior cingulate activity was observed in both patient groups, more prominent in the depression group and absent in the healthy control group. These findings suggest a possible role in dopamine‐rich areas associated with the encoding of prediction errors in depression and schizophrenia.
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Affiliation(s)
| | - Serenella Tolomeo
- Department of Psychology, National University of Singapore, Singapore
| | - Rongjun Yu
- Department of Management, Hong Kong Baptist University, Hong Kong, China.,Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China.,Department of Physics, Hong Kong Baptist University, Hong Kong, China
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4
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Smigielski L, Wotruba D, Treyer V, Rössler J, Papiol S, Falkai P, Grünblatt E, Walitza S, Rössler W. The Interplay Between Postsynaptic Striatal D2/3 Receptor Availability, Adversity Exposure and Odd Beliefs: A [11C]-Raclopride PET Study. Schizophr Bull 2021; 47:1495-1508. [PMID: 33876249 PMCID: PMC8379534 DOI: 10.1093/schbul/sbab034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Between unaffected mental health and diagnosable psychiatric disorders, there is a vast continuum of functioning. The hypothesized link between striatal dopamine signaling and psychosis has guided a prolific body of research. However, it has been understudied in the context of multiple interacting factors, subclinical phenotypes, and pre-postsynaptic dynamics. METHOD This work investigated psychotic-like experiences and D2/3 dopamine postsynaptic receptor availability in the dorsal striatum, quantified by in vivo [11C]-raclopride positron emission tomography, in a sample of 24 healthy male individuals. Additional mediation and moderation effects with childhood trauma and key dopamine-regulating genes were examined. RESULTS An inverse relationship between nondisplaceable binding potential and subclinical symptoms was identified. D2/3 receptor availability in the left putamen fully mediated the association between traumatic childhood experiences and odd beliefs, that is, inclinations to see meaning in randomness and unfounded interpretations. Moreover, the effect of early adversity was moderated by a DRD2 functional variant (rs1076560). The results link environmental and neurobiological influences in the striatum to the origination of psychosis spectrum symptomology, consistent with the social defeat and diathesis-stress models. CONCLUSIONS Adversity exposure may affect the dopamine system as in association with biases in probabilistic reasoning, attributional style, and salience processing. The inverse relationship between D2/3 availability and symptomology may be explained by endogenous dopamine occupying the receptor, postsynaptic compensatory mechanisms, and/or altered receptor sensitivity. This may also reflect a cognitively stabilizing mechanism in non-help-seeking individuals. Future research should comprehensively characterize molecular parameters of dopamine neurotransmission along the psychosis spectrum and according to subtype profiling.
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Affiliation(s)
- Lukasz Smigielski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland,To whom correspondence should be addressed; Psychiatric University Hospital Zurich, Militärstrasse 8, 8004 Zurich, Switzerland; tel: +044-296-73-94, fax: +044-296-74-69, e-mail:
| | - Diana Wotruba
- Collegium Helveticum, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland,Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Julian Rössler
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University, Munich, Germany,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland,Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland,Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland,Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, Berlin, Germany,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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5
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Connors MH, Halligan PW. Delusions and theories of belief. Conscious Cogn 2020; 81:102935. [DOI: 10.1016/j.concog.2020.102935] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 03/28/2020] [Accepted: 04/08/2020] [Indexed: 02/01/2023]
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Abstract
Introduction: In this paper we present and defend a hybrid theory of the development of delusions that incorporates the central ideas of two influential (yet sometimes bitterly opposing) theoretical approaches to delusions-the two-factor theory and the prediction error theory. Method: After introducing the central ideas of the two-factor theory and the prediction error theory, we describe the motivations for our conciliatory project, explain the theoretical details of the hybrid theory we propose, and answer potential objections to our proposal. Results: According to the hybrid theory we advance, the first factor of a delusion is physically grounded in an abnormal prediction error, and the second factor is physically grounded in the overestimation of the precision of the abnormal prediction error. Against anticipated objections, we argue that the hybrid theory is internally coherent, and that it constitutes a genuine hybrid between the two-factor theory and the prediction error theory. Conclusion: A rapprochement between the two-factor theory and the prediction error theory is both possible and desirable. In particular, our hybrid theory provides a parsimonious and unified account of delusions, whether monothematic or polythematic, across a wide variety of medical conditions.
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Affiliation(s)
- Kengo Miyazono
- Graduate School of Integrated Arts and Sciences, Hiroshima University , Higashi-Hiroshima City , Japan
| | - Ryan McKay
- Department of Psychology, Royal Holloway, University of London , Egham , UK
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7
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Corlett PR. Factor one, familiarity and frontal cortex: a challenge to the two-factor theory of delusions. Cogn Neuropsychiatry 2019; 24:165-177. [PMID: 31010382 PMCID: PMC6686846 DOI: 10.1080/13546805.2019.1606706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Two-factor theory suggests delusions require two neuropsychological impairments, one in perception (which furnishes content), and a second in belief evaluation (that augers formation and maintenance). Capgras delusion; the belief that one's loved one has been replaced by an imposter, then entails two independent processes; first a lack of skin conductance response to familiar faces so the loved one feels different. This has been demonstrated in four patients with damage to the ventromedial prefrontal cortex (vmPFC) but who do not have delusions. Thus two-factor theorists demand a second factor: a change in belief evaluation, which is associated with damage to the right dorsolateral prefrontal cortex (rDLPFC). METHODS Literature review of foundational and related papers on the cognitive neuropsychology of delusions, perception and belief. RESULTS The four vmPFC patients appear together in another publication, uncited by two-factor theorists, in which the full extent of their damage is documented. These four cases not only lack skin responses to familiar faces, but lack responses to salient psychological stimuli more generally, which challenges factor one. They also have damage outside vmPFC, including damage to rDLPFC, which challenges factor two. CONCLUSION Two-factor theory is found lacking and should be reappraised.
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Affiliation(s)
- Philip R. Corlett
- Department of Psychiatry, Yale University, School of Medicine. New Haven, CT, USA,Corresponding author.
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8
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Watson P, Pearson D, Wiers RW, Le Pelley ME. Prioritizing pleasure and pain: attentional capture by reward-related and punishment-related stimuli. Curr Opin Behav Sci 2019. [DOI: 10.1016/j.cobeha.2018.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Abnormal reward prediction-error signalling in antipsychotic naive individuals with first-episode psychosis or clinical risk for psychosis. Neuropsychopharmacology 2018; 43:1691-1699. [PMID: 29748629 PMCID: PMC6006166 DOI: 10.1038/s41386-018-0056-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/20/2022]
Abstract
Ongoing research suggests preliminary, though not entirely consistent, evidence of neural abnormalities in signalling prediction errors in schizophrenia. Supporting theories suggest mechanistic links between the disruption of these processes and the generation of psychotic symptoms. However, it is unknown at what stage in the pathogenesis of psychosis these impairments in prediction-error signalling develop. One major confound in prior studies is the use of medicated patients with strongly varying disease durations. Our study aims to investigate the involvement of the meso-cortico-striatal circuitry during reward prediction-error signalling in earliest stages of psychosis. We studied patients with first-episode psychosis (FEP) and help-seeking individuals at-risk for psychosis due to sub-threshold prodromal psychotic symptoms. Patients with either FEP (n = 14), or at-risk for developing psychosis (n = 30), and healthy volunteers (n = 39) performed a reinforcement learning task during fMRI scanning. ANOVA revealed significant (p < 0.05 family-wise error corrected) prediction-error signalling differences between groups in the dopaminergic midbrain and right middle frontal gyrus (dorsolateral prefrontal cortex, DLPFC). FEP patients showed disrupted reward prediction-error signalling compared to controls in both regions. At-risk patients showed intermediate activation in the midbrain that significantly differed from controls and from FEP patients, but DLPFC activation that did not differ from controls. Our study confirms that FEP patients have abnormal meso-cortical signalling of reward-prediction errors, whereas reward-prediction-error dysfunction in the at-risk patients appears to show a more nuanced pattern of activation with a degree of midbrain impairment but preserved cortical function.
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10
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Abraham A. The imaginative mind. Hum Brain Mapp 2018; 37:4197-4211. [PMID: 27453527 DOI: 10.1002/hbm.23300] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/31/2016] [Accepted: 06/20/2016] [Indexed: 01/04/2023] Open
Abstract
The astounding capacity for the human imagination to be engaged across a wide range of contexts is limitless and fundamental to our day-to-day experiences. Although processes of imagination are central to human psychological function, they rarely occupy center stage in academic discourse or empirical study within psychological and neuroscientific realms. The aim of this paper is to tackle this imbalance by drawing together the multitudinous facets of imagination within a common framework. The processes fall into one of five categories depending on whether they are characterized as involving perceptual/motor related mental imagery, intentionality or recollective processing, novel combinatorial or generative processing, exceptional phenomenology in the aesthetic response, or altered psychological states which range from commonplace to dysfunctional. These proposed categories are defined on the basis of theoretical ideas from philosophy as well as empirical evidence from neuroscience. By synthesizing the findings across these domains of imagination, this novel five-part or quinquepartite classification of the human imagination aids in systematizing, and thereby abets, our understanding of the workings and neural foundations of the human imagination. It would serve as a blueprint to direct further advances in the field of imagination while also promoting crosstalk with reference to stimulus-oriented facets of information processing. A biologically and ecologically valid psychology is one that seeks to explain fundamental aspects of human nature. Given the ubiquitous nature of the imaginative operations in our daily lives, there can be little doubt that these quintessential aspects of the mind should be central to the discussion. Hum Brain Mapp 37:4197-4211, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Anna Abraham
- School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, United Kingdom.
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11
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Humpston CS, Evans LH, Teufel C, Ihssen N, Linden DE. Evidence of absence: no relationship between behaviourally measured prediction error response and schizotypy. Cogn Neuropsychiatry 2017; 22:373-390. [PMID: 28697644 PMCID: PMC5646181 DOI: 10.1080/13546805.2017.1348289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The predictive processing framework has attracted much interest in the field of schizophrenia research in recent years, with an increasing number of studies also carried out in healthy individuals with nonclinical psychosis-like experiences. The current research adopted a continuum approach to psychosis and aimed to investigate different types of prediction error responses in relation to psychometrically defined schizotypy. METHODS One hundred and two healthy volunteers underwent a battery of behavioural tasks including (a) a force-matching task, (b) a Kamin blocking task, and (c) a reversal learning task together with three questionnaires measuring domains of schizotypy from different approaches. RESULTS Neither frequentist nor Bayesian statistical methods supported the notion that alterations in prediction error responses were related to schizotypal traits in any of the three tasks. CONCLUSIONS These null results suggest that deficits in predictive processing associated with clinical states of psychosis are not always present in healthy individuals with schizotypal traits.
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Affiliation(s)
- Clara S. Humpston
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK, Clara S. Humpston
| | - Lisa H. Evans
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK
| | | | - Niklas Ihssen
- Department of Psychology, Durham University, Durham, UK
| | - David E. J. Linden
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK,School of Medicine, Cardiff University, Cardiff, UK
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Abstract
BACKGROUND The symptom "delusions" is a central psychopathological symptom in psychiatric diseases. Since the beginning of psychiatry various disciplines have attempted to explain and understand delusions but even now no generally accepted definition of this phenomenon exists. AIM A comprehensive review of current psychopathological and neurobiological theories of delusions is given. MATERIAL AND METHODS PubMed and Google scholar searches were performed using the keywords "delusion", "psychodynamic" and "neurobiology", both in English and German. Relevant German textbooks of psychiatry were also included. DISCUSSION A differentiated perspective of the phenomenon of delusions appears to be necessary to approach this complex and fascinating symptom. A one-dimensional approach does not do justice to the complexity of delusions. The various explanatory approaches can increasingly be linked to each other and are no longer considered to be mutually exclusive.
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Affiliation(s)
- R Knorr
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychiatrie Reichenau, Feursteinstraße 55, 78479, Reichenau, Deutschland.
| | - K Hoffmann
- Klinik für Forensische Psychiatrie und Psychotherapie, Zentrum für Psychiatrie Reichenau, Feursteinstraße 55, 78479, Reichenau, Deutschland
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13
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Experimental evidence for circular inference in schizophrenia. Nat Commun 2017; 8:14218. [PMID: 28139642 PMCID: PMC5290312 DOI: 10.1038/ncomms14218] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 12/07/2016] [Indexed: 01/05/2023] Open
Abstract
Schizophrenia (SCZ) is a complex mental disorder that may result in some combination of hallucinations, delusions and disorganized thinking. Here SCZ patients and healthy controls (CTLs) report their level of confidence on a forced-choice task that manipulated the strength of sensory evidence and prior information. Neither group's responses can be explained by simple Bayesian inference. Rather, individual responses are best captured by a model with different degrees of circular inference. Circular inference refers to a corruption of sensory data by prior information and vice versa, leading us to ‘see what we expect' (through descending loops), to ‘expect what we see' (through ascending loops) or both. Ascending loops are stronger for SCZ than CTLs and correlate with the severity of positive symptoms. Descending loops correlate with the severity of negative symptoms. Both loops correlate with disorganized symptoms. The findings suggest that circular inference might mediate the clinical manifestations of SCZ. Schizophrenia is a mental disorder characterized by hallucinations and delusions. Here the authors report a novel probabilistic inference task in which compared to healthy subjects, schizophrenia patients show greater degree of circular inference that matches the severity of their clinical symptoms.
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Abstract
In 2007, we proposed an explanation of delusion formation as aberrant prediction error-driven associative learning. Further, we argued that the NMDA receptor antagonist ketamine provided a good model for this process. Subsequently, we validated the model in patients with psychosis, relating aberrant prediction error signals to delusion severity. During the ensuing period, we have developed these ideas, drawing on the simple principle that brains build a model of the world and refine it by minimising prediction errors, as well as using it to guide perceptual inferences. While previously we focused on the prediction error signal per se, an updated view takes into account its precision, as well as the precision of prior expectations. With this expanded perspective, we see several possible routes to psychotic symptoms - which may explain the heterogeneity of psychotic illness, as well as the fact that other drugs, with different pharmacological actions, can produce psychotomimetic effects. In this article, we review the basic principles of this model and highlight specific ways in which prediction errors can be perturbed, in particular considering the reliability and uncertainty of predictions. The expanded model explains hallucinations as perturbations of the uncertainty mediated balance between expectation and prediction error. Here, expectations dominate and create perceptions by suppressing or ignoring actual inputs. Negative symptoms may arise due to poor reliability of predictions in service of action. By mapping from biology to belief and perception, the account proffers new explanations of psychosis. However, challenges remain. We attempt to address some of these concerns and suggest future directions, incorporating other symptoms into the model, building towards better understanding of psychosis.
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Affiliation(s)
| | | | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, UK .,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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15
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Manza P, Hu S, Ide JS, Farr OM, Zhang S, Leung HC, Li CSR. The effects of methylphenidate on cerebral responses to conflict anticipation and unsigned prediction error in a stop-signal task. J Psychopharmacol 2016; 30:283-93. [PMID: 26755547 PMCID: PMC4837899 DOI: 10.1177/0269881115625102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To adapt flexibly to a rapidly changing environment, humans must anticipate conflict and respond to surprising, unexpected events. To this end, the brain estimates upcoming conflict on the basis of prior experience and computes unsigned prediction error (UPE). Although much work implicates catecholamines in cognitive control, little is known about how pharmacological manipulation of catecholamines affects the neural processes underlying conflict anticipation and UPE computation. We addressed this issue by imaging 24 healthy young adults who received a 45 mg oral dose of methylphenidate (MPH) and 62 matched controls who did not receive MPH prior to performing the stop-signal task. We used a Bayesian Dynamic Belief Model to make trial-by-trial estimates of conflict and UPE during task performance. Replicating previous research, the control group showed anticipation-related activation in the presupplementary motor area and deactivation in the ventromedial prefrontal cortex and parahippocampal gyrus, as well as UPE-related activations in the dorsal anterior cingulate, insula, and inferior parietal lobule. In group comparison, MPH increased anticipation activity in the bilateral caudate head and decreased UPE activity in each of the aforementioned regions. These findings highlight distinct effects of catecholamines on the neural mechanisms underlying conflict anticipation and UPE, signals critical to learning and adaptive behavior.
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Affiliation(s)
- Peter Manza
- Integrative Neuroscience Program, Department of Psychology, Stony Brook University, Stony Brook, NY, USA Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Sien Hu
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Jaime S Ide
- Department of Psychiatry, Yale University, New Haven, CT, USA Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Olivia M Farr
- Department of Psychiatry, Yale University, New Haven, CT, USA Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Sheng Zhang
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Hoi-Chung Leung
- Integrative Neuroscience Program, Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Chiang-shan R Li
- Department of Psychiatry, Yale University, New Haven, CT, USA Department of Neuroscience, Yale University, New Haven, CT, USA Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA
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Griffiths O, Le Pelley ME, Langdon R. The bridge between neuroscience and cognition must be tethered at both ends. Cogn Neuropsychiatry 2015; 20:106-8. [PMID: 25559738 DOI: 10.1080/13546805.2014.993464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Oren Griffiths
- a School of Psychology , UNSW Australia , Sydney , NSW , Australia
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17
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Badcock JC. A Neuropsychological Approach to Auditory Verbal Hallucinations and Thought Insertion - Grounded in Normal Voice Perception. ACTA ACUST UNITED AC 2015; 7:631-652. [PMID: 27617046 PMCID: PMC4995233 DOI: 10.1007/s13164-015-0270-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A neuropsychological perspective on auditory verbal hallucinations (AVH) links key phenomenological features of the experience, such as voice location and identity, to functionally separable pathways in normal human audition. Although this auditory processing stream (APS) framework has proven valuable for integrating research on phenomenology with cognitive and neural accounts of hallucinatory experiences, it has not yet been applied to other symptoms presumed to be closely related to AVH – such as thought insertion (TI). In this paper, I propose that an APS framework offers a useful way of thinking about the experience of TI as well as AVH, providing a common conceptual framework for both. I argue that previous self-monitoring theories struggle to account for both the differences and similarities in the characteristic features of AVH and TI, which can be readily accommodated within an APS framework. Furthermore, the APS framework can be integrated with predictive processing accounts of psychotic symptoms; makes predictions about potential sites of prediction error signals; and may offer a template for understanding a range of other symptoms beyond AVH and TI.
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Affiliation(s)
- Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, 6009 Western Australia
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Miyazono K. Delusions as harmful malfunctioning beliefs. Conscious Cogn 2015; 33:561-73. [DOI: 10.1016/j.concog.2014.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/24/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
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Abstract
Griffiths and colleagues provided a clear and thoughtful review of the prediction error model of delusion formation [Cognitive Neuropsychiatry, 2014 April 4 (Epub ahead of print)]. As well as reviewing the central ideas and concluding that the existing evidence base is broadly supportive of the model, they provide a detailed critique of some of the experiments that we have performed to study it. Though they conclude that the shortcomings that they identify in these experiments do not fundamentally challenge the prediction error model, we nevertheless respond to these criticisms. We begin by providing a more detailed outline of the model itself as there are certain important aspects of it that were not covered in their review. We then respond to their specific criticisms of the empirical evidence. We defend the neuroimaging contrasts that we used to explore this model of psychosis arguing that, while any single contrast entails some ambiguity, our assumptions have been justified by our extensive background work before and since.
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Affiliation(s)
- Philip Robert Corlett
- Department of Psychiatry, Ribicoff Research Facility, Yale University, 34 Park Street, New Haven, CT, USA,Corresponding author.
| | - Paul Charles Fletcher
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, CambridgeCB2 0SP, UK,Department of Psychiatry, Cambridgeshire and Peterborough Mental Health Partnership NHS Trust, CambridgeCB1 5EE, UK
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Connors MH, Halligan PW. A cognitive account of belief: a tentative road map. Front Psychol 2015; 5:1588. [PMID: 25741291 PMCID: PMC4327528 DOI: 10.3389/fpsyg.2014.01588] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/24/2014] [Indexed: 11/25/2022] Open
Abstract
Over the past decades, delusions have become the subject of growing and productive research spanning clinical and cognitive neurosciences. Despite this, the nature of belief, which underpins the construct of delusions, has received little formal investigation. No account of delusions, however, would be complete without a cognitive level analysis of belief per se. One reason for this neglect is the assumption that, unlike more established and accessible modular psychological process (e.g., vision, audition, face-recognition, language-processing, and motor-control systems), beliefs comprise more distributed and therefore less accessible central cognitive processes. In this paper, we suggest some defining characteristics and functions of beliefs. Working back from cognitive accounts of delusions, we consider potential candidate cognitive processes that may be involved in normal belief formation. Finally, we advance a multistage account of the belief process that could provide the basis for a more comprehensive model of belief.
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Affiliation(s)
- Michael H. Connors
- ARC Centre of Excellence in Cognition and its DisordersSydney, NSW, Australia
- Department of Cognitive Science, Macquarie UniversitySydney, NSW Australia
- Dementia Collaborative Research Centre, School of Psychiatry, University of New South WalesSydney, NSW, Australia
- Sydney Medical School, University of SydneySydney, NSW, Australia
| | - Peter W. Halligan
- ARC Centre of Excellence in Cognition and its DisordersSydney, NSW, Australia
- School of Psychology, Cardiff UniversityCardiff, UK
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Patru MC, Reser DH. A New Perspective on Delusional States - Evidence for Claustrum Involvement. Front Psychiatry 2015; 6:158. [PMID: 26617532 PMCID: PMC4639708 DOI: 10.3389/fpsyt.2015.00158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/26/2015] [Indexed: 12/21/2022] Open
Abstract
Delusions are a hallmark positive symptom of schizophrenia, although they are also associated with a wide variety of other psychiatric and neurological disorders. The heterogeneity of clinical presentation and underlying disease, along with a lack of experimental animal models, make delusions exceptionally difficult to study in isolation, either in schizophrenia or other diseases. To date, no detailed studies have focused specifically on the neural mechanisms of delusion, although some studies have reported characteristic activation of specific brain areas or networks associated with them. Here, we present a novel hypothesis and extant supporting evidence implicating the claustrum, a relatively poorly understood forebrain nucleus, as a potential common center for delusional states.
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Affiliation(s)
- Maria Cristina Patru
- Department of Psychiatry, Hôpitaux Universitaires de Genève , Geneve , Switzerland
| | - David H Reser
- Department of Physiology, Monash University , Melbourne , Australia
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Fiacconi CM, Barkley V, Finger EC, Carson N, Duke D, Rosenbaum RS, Gilboa A, Köhler S. Nature and extent of person recognition impairments associated with Capgras syndrome in Lewy body dementia. Front Hum Neurosci 2014; 8:726. [PMID: 25309399 PMCID: PMC4173644 DOI: 10.3389/fnhum.2014.00726] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/28/2014] [Indexed: 12/30/2022] Open
Abstract
Patients with Capgras syndrome (CS) adopt the delusional belief that persons well-known to them have been replaced by an imposter. Several current theoretical models of CS attribute such misidentification problems to deficits in covert recognition processes related to the generation of appropriate affective autonomic signals. These models assume intact overt recognition processes for the imposter and, more broadly, for other individuals. As such, it has been suggested that CS could reflect the "mirror-image" of prosopagnosia. The purpose of the current study was to determine whether overt person recognition abilities are indeed always spared in CS. Furthermore, we examined whether CS might be associated with any impairments in overt affective judgments of facial expressions. We pursued these goals by studying a patient with Dementia with Lewy bodies (DLB) who showed clear signs of CS, and by comparing him to another patient with DLB who did not experience CS, as well as to a group of healthy control participants. Clinical magnetic resonance imaging scans revealed medial prefrontal cortex (mPFC) atrophy that appeared to be uniquely associated with the presence CS. We assessed overt person recognition with three fame recognition tasks, using faces, voices, and names as cues. We also included measures of confidence and probed pertinent semantic knowledge. In addition, participants rated the intensity of fearful facial expressions. We found that CS was associated with overt person recognition deficits when probed with faces and voices, but not with names. Critically, these deficits were not present in the DLB patient without CS. In addition, CS was associated with impairments in overt judgments of affect intensity. Taken together, our findings cast doubt on the traditional view that CS is the mirror-image of prosopagnosia and that it spares overt recognition abilities. These findings can still be accommodated by models of CS that emphasize deficits in autonomic responding, to the extent that the potential role of interoceptive awareness in overt judgments is taken into account.
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Affiliation(s)
- Chris M Fiacconi
- Department of Psychology, The Brain and Mind Institute, University of Western Ontario London, ON, Canada
| | | | - Elizabeth C Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London ON, Canada
| | - Nicole Carson
- Department of Psychology, York University Toronto, ON, Canada
| | - Devin Duke
- Department of Psychology, The Brain and Mind Institute, University of Western Ontario London, ON, Canada
| | - R Shayna Rosenbaum
- Department of Psychology, York University Toronto, ON, Canada ; Rotman Research Institute, Baycrest Toronto, ON, Canada
| | - Asaf Gilboa
- Rotman Research Institute, Baycrest Toronto, ON, Canada ; Department of Psychology, University of Toronto Toronto, ON, Canada
| | - Stefan Köhler
- Department of Psychology, The Brain and Mind Institute, University of Western Ontario London, ON, Canada ; Department of Psychology, York University Toronto, ON, Canada
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