Deficits in predictive coding underlie hallucinations in schizophrenia

Differing Pattern of Mismatch Negativity Responses in Clinical and Nonclinical Voice Hearers Challenge Predictive Coding Accounts of Psychosis

Background

Among people with schizophrenia (PSZ), reduced mismatch negativity (MMN) is conceptualized as evidence of disrupted prediction error signaling that underlies positive symptoms. However, this conceptualization has been challenged by observations that MMN and positive symptoms are often uncorrelated. In the current study, we tested the hypothesis that reduced MMN is associated with the presence of hallucinations and delusions specifically rather than the presence of a psychiatric illness. A second aim was to determine whether the strength of the association with positive symptoms increases for indices that reflect predictions at higher levels of abstraction.

Methods

Fifty-six PSZ, 34 nonclinical voice hearers, and 48 healthy comparison subjects (HCs) completed 2 MMN paradigms: one with a simple duration deviant type, and one with a higher-level, pattern-violation deviant type. We also measured the repetition positivity, which reflects the formation of auditory memory traces.

Results

We observed that although PSZ exhibited the expected pattern of significantly reduced duration MMN and reduced pattern-violation MMN at the trend level compared with HCs, nonclinical voice hearers exhibited a pattern of duration MMN and pattern-violation MMN amplitude that was statistically similar to that of HCs (ps > .64). Similarly, PSZ exhibited a significantly reduced repetition positivity slope compared with HCs in the duration condition and a trend-level reduction compared with HCs in the pattern-violation condition. Nonclinical voice hearers did not differ from either group in repetition positivity slope in either condition.

Conclusions

These results indicate that the MMN as a prediction error signal does not reflect processes relevant for the manifestation of hallucinations and delusions.

Effect of prior beliefs and cognitive deficits on learning in first-episode schizophrenia patients

Introduction

It is known that cognitive deficits are a core feature of schizophrenia and that in the general population, prior beliefs significantly influence learning and reasoning processes. However, the interaction of prior beliefs with cognitive deficits and their impact on performance in schizophrenia patients is still poorly understood. This study investigates the role of beliefs and cognitive variables (CVs) like working memory, associative learning, and processing speed on learning processes in individuals with schizophrenia. We hypothesize that beliefs will influence the ability to learn correct predictions and that first-episode schizophrenia patients (FEP) will show impaired learning due to cognitive deficits.

Methods

We used a predictive-learning task to examine how FEP (n = 23) and matched controls (n = 23) adjusted their decisional criteria concerning physical properties during the learning process when predicting the sinking behavior of two transparent containers filled with aluminum discs when placed in water.

Results

On accuracy, initial differences by group, trial type, and interaction effects of these variables disappeared when CVs were controlled. The differences by conditions, associated with differential beliefs about why the objects sink slower or faster, were seen in patients and controls, despite controlling the CVs' effect.

Conclusions

Differences between groups were mainly explained by CVs, proving that they play an important role than what is assumed in this type of task. However, beliefs about physical events were not affected by CVs, and beliefs affect in the same way the decisional criteria of the control or FEP patients' groups.

Network Localization of State and Trait of Auditory Verbal Hallucinations in Schizophrenia

BACKGROUND AND HYPOTHESIS

Neuroimaging studies investigating the neural substrates of auditory verbal hallucinations (AVH) in schizophrenia have yielded mixed results, which may be reconciled by network localization. We sought to examine whether AVH-state and AVH-trait brain alterations in schizophrenia localize to common or distinct networks.

STUDY DESIGN

We initially identified AVH-state and AVH-trait brain alterations in schizophrenia reported in 48 previous studies. By integrating these affected brain locations with large-scale discovery and validation resting-state functional magnetic resonance imaging datasets, we then leveraged novel functional connectivity network mapping to construct AVH-state and AVH-trait dysfunctional networks.

STUDY RESULTS

The neuroanatomically heterogeneous AVH-state and AVH-trait brain alterations in schizophrenia localized to distinct and specific networks. The AVH-state dysfunctional network comprised a broadly distributed set of brain regions mainly involving the auditory, salience, basal ganglia, language, and sensorimotor networks. Contrastingly, the AVH-trait dysfunctional network manifested as a pattern of circumscribed brain regions principally implicating the caudate and inferior frontal gyrus. Additionally, the AVH-state dysfunctional network aligned with the neuromodulation targets for effective treatment of AVH, indicating possible clinical relevance.

CONCLUSIONS

Apart from unifying the seemingly irreproducible neuroimaging results across prior AVH studies, our findings suggest different neural mechanisms underlying AVH state and trait in schizophrenia from a network perspective and more broadly may inform future neuromodulation treatment for AVH.

Neuroanatomical correlates and predictors of psychotic symptoms in Alzheimer's disease: A systematic review and meta-analysis

BACKGROUND

Psychotic symptoms (hallucinations and delusions) are a type of neuropsychiatric symptom found during Alzheimer's Disease (AD).

OBJECTIVE

This systematic review aims to comprehensively capture, analyse, and evaluate the body of evidence that has investigated associations between brain regions/networks and psychotic symptoms in AD.

METHODS

The protocol, created according to the PRISMA guidelines, was pre-registered on OSF (https://osf.io/tg8xp/). Searches were performed using PubMed, Web of Science and PsycInfo. A partial coordinate-based meta-analysis (CBMA) was performed based on data availability.

RESULTS

Eighty-two papers were selected: delusions were found to be associated mainly with right fronto-temporal brain regions and the insula; hallucinations mainly with fronto-occipital areas; both were frequently associated with the anterior cingulate cortex. The CBMA, performed on the findings of fourteen papers on delusions, identified a cluster in the frontal lobe, one in the putamen, and a smaller one in the insula.

CONCLUSIONS

The available evidence highlights that key brain regions, predominantly in the right frontal lobe, the anterior cingulate cortex, and temporo-occipital areas, appear to underpin the different manifestations of psychotic symptoms in AD and MCI. The fronto-temporal areas identified in relation to delusions may underpin a failure to assimilate correct information and consider alternative possibilities (which might generate and maintain the delusional belief), and dysfunction within the salience network (anterior cingulate cortex and insula) may suggest a contribution for how internal and external stimuli are identified; the fronto-occipital areas linked to hallucinations may indicate diminished sensory processing and non-optimal predictive processing, that together contribute to misinterpretation of stimuli and misperceptions; the fronto-temporal and occipital areas, as well as the anterior cingulate cortex were linked to the psychotic cluster.

Functional Localization of the Human Auditory and Visual Thalamus Using a Thalamic Localizer Functional Magnetic Resonance Imaging Task

Functional magnetic resonance imaging (fMRI) of the auditory and visual sensory systems of the human brain is an active area of investigation in the study of human health and disease. The medial geniculate nucleus (MGN) and lateral geniculate nucleus (LGN) are key thalamic nuclei involved in the processing and relay of auditory and visual information, respectively, and are the subject of blood-oxygen-level-dependent (BOLD) fMRI studies of neural activation and functional connectivity in human participants. However, localization of BOLD fMRI signal originating from neural activity in MGN and LGN remains a technical challenge, due in part to the poor definition of boundaries of these thalamic nuclei in standard T1-weighted and T2-weighted magnetic resonance imaging sequences. Here, we report the development and evaluation of an auditory and visual sensory thalamic localizer (TL) fMRI task that produces participant-specific functionally-defined regions of interest (fROIs) of both MGN and LGN, using 3 Tesla multiband fMRI and a clustered-sparse temporal acquisition sequence, in less than 16 minutes of scan time. We demonstrate the use of MGN and LGN fROIs obtained from the TL fMRI task in standard resting-state functional connectivity (RSFC) fMRI analyses in the same participants. In RSFC analyses, we validated the specificity of MGN and LGN fROIs for signals obtained from primary auditory and visual cortex, respectively, and benchmark their performance against alternative atlas- and segmentation-based localization methods. The TL fMRI task and analysis code (written in Presentation and MATLAB, respectively) have been made freely available to the wider research community.

EEG resting state alpha dynamics predict an individual's vulnerability to auditory hallucinations

Task-free brain activity exhibits spontaneous fluctuations between functional states, characterized by synchronized activation patterns in distributed resting-state (RS) brain networks. The temporal dynamics of the networks' electrophysiological signatures reflect individual variations in brain activity and connectivity linked to mental states and cognitive functions and can predict or monitor vulnerability to develop psychiatric or neurological disorders. In particular, RS alpha fluctuations modulate perceptual sensitivity, attentional shifts, and cognitive control, and could therefore reflect a neural correlate of increased vulnerability to sensory distortions, including the proneness to hallucinatory experiences. We recorded 5 min of RS EEG from 33 non-clinical individuals varying in hallucination proneness (HP) to investigate links between task-free alpha dynamics and vulnerability to hallucinations. To this end, we used a dynamic brain state allocation method to identify five recurrent alpha states together with their spatiotemporal dynamics and most active brain areas through source reconstruction. The dynamical features of a state marked by activation in somatosensory, auditory, and posterior default-mode network areas predicted auditory and auditory-verbal HP, but not general HP, such that individuals with higher vulnerability to auditory hallucinations spent more time in this state. The temporal dynamics of spontaneous alpha activity might reflect individual differences in attention to internally generated sensory events and altered auditory perceptual sensitivity. Altered RS alpha dynamics could therefore instantiate a neural marker of increased vulnerability to auditory hallucinations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-024-10093-1.

Repetition-Dependent Adaptation and Prediction Error Signalling in Schizophrenia Patients With Auditory Hallucinations: A Roving Mismatch Negativity Study

BACKGROUND

Dysregulated prediction error-signalling may explain auditory hallucinations in schizophrenia (SZ-AH). Roving mismatch negativity (rMMN) is an event-related potential (ERP) index where the deviant tone becomes the new standard with repetitions. Longer repetitions of standard stimuli yield a more positive sensory-adaptation response (Repetition Positivity-RP), elicit a stronger deviance-detection when interrupted (deviant negativity-DN), and the difference waveform between them reflects the strength of prediction-error signalling (mismatch negativity-MMN).

METHODS

Twenty-three SZ-AH patients and twenty-three healthy controls (HC) underwent rMMN assessment. Various standard stimuli were repeated in sets of 3, 8 and 33 yielding three components for RP (RP3, RP8, RP33), DN (DN3, DN8, DN33), and MMN (MMN3, MMN8, MMN33). Amplitudes and latencies were compared across groups. Correlation between (a) rMMN amplitudes and latencies, and clinical variables in SZ-AH, and (b) the RP-DN amplitude pair for all three repetition sets (3, 8, 33) were also examined.

RESULTS

All DN and MMN33 amplitudes were significantly suppressed in SZ-AH, while RP amplitudes were not. MMN33 latency was significantly longer in SZ-AH than HC. A few amplitudes and latencies significantly correlated with the frequency of AH. HC showed a significant positive correlation between RP-DN amplitude pairs for sets of 3 and 8 but not for 33; SZ-AH group's correlation profile was opposite to this.

DISCUSSION

The link between repetition-dependent sensory-adaptation and deviance-detection is perturbed in SZ-AH. The unimpaired RP profile in SZ-AH is due to potential interference of AH with auditory information processing, and does not indicate a preserved short-term plasticity of the echoic memory trace.

Prior Context and Individual Alpha Frequency Influence Predictive Processing during Language Comprehension

The extent to which the brain predicts upcoming information during language processing remains controversial. To shed light on this debate, the present study reanalyzed Nieuwland and colleagues' (2018) [Nieuwland, M. S., Politzer-Ahles, S., Heyselaar, E., Segaert, K., Darley, E., Kazanina, N., et al. Large-scale replication study reveals a limit on probabilistic prediction in language comprehension. eLife, 7, e33468, 2018] replication of DeLong and colleagues (2015) [DeLong, K. A., Urbach, T. P., & Kutas, M. Probabilistic word pre-activation during language comprehension inferred from electrical brain activity. Nature Neuroscience, 8, 1117-1121, 2005]. Participants (n = 356) viewed sentences containing articles and nouns of varying predictability, while their EEG was recorded. We measured ERPs preceding the critical words (namely, the semantic prediction potential), in conjunction with postword N400 patterns and individual neural metrics. ERP activity was compared with two measures of word predictability: cloze probability and lexical surprisal. In contrast to prior literature, semantic prediction potential amplitudes did not increase as cloze probability increased, suggesting that the component may not reflect prediction during natural language processing. Initial N400 results at the article provided evidence against phonological prediction in language, in line with Nieuwland and colleagues' findings. Strikingly, however, when the surprisal of the prior words in the sentence was included in the analysis, increases in article surprisal were associated with increased N400 amplitudes, consistent with prediction accounts. This relationship between surprisal and N400 amplitude was not observed when the surprisal of the two prior words was low, suggesting that expectation violations at the article may be overlooked under highly predictable conditions. Individual alpha frequency also modulated the relationship between article surprisal and the N400, emphasizing the importance of individual neural factors for prediction. The present study extends upon existing neurocognitive models of language and prediction more generally, by illuminating the flexible and subject-specific nature of predictive processing.

Entrainment echoes in the cerebellum

Evidence accumulates that the cerebellum's role in the brain is not restricted to motor functions. Rather, cerebellar activity seems to be crucial for a variety of tasks that rely on precise event timing and prediction. Due to its complex structure and importance in communication, human speech requires a particularly precise and predictive coordination of neural processes to be successfully comprehended. Recent studies proposed that the cerebellum is indeed a major contributor to speech processing, but how this contribution is achieved mechanistically remains poorly understood. The current study aimed to reveal a mechanism underlying cortico-cerebellar coordination and demonstrate its speech-specificity. In a reanalysis of magnetoencephalography data, we found that activity in the cerebellum aligned to rhythmic sequences of noise-vocoded speech, irrespective of its intelligibility. We then tested whether these "entrained" responses persist, and how they interact with other brain regions, when a rhythmic stimulus stopped and temporal predictions had to be updated. We found that only intelligible speech produced sustained rhythmic responses in the cerebellum. During this "entrainment echo," but not during rhythmic speech itself, cerebellar activity was coupled with that in the left inferior frontal gyrus, and specifically at rates corresponding to the preceding stimulus rhythm. This finding represents evidence for specific cerebellum-driven temporal predictions in speech processing and their relay to cortical regions.

Contributions of Basal Ganglia Circuits to Perception, Attention, and Consciousness

Research into ascending sensory pathways and cortical networks has generated detailed models of perception. These same cortical regions are strongly connected to subcortical structures, such as the basal ganglia (BG), which have been conceptualized as playing key roles in reinforcement learning and action selection. However, because the BG amasses experiential evidence from higher and lower levels of cortical hierarchies, as well as higher-order thalamus, it is well positioned to dynamically influence perception. Here, we review anatomical, functional, and clinical evidence to demonstrate how the BG can influence perceptual processing and conscious states. This depends on the integrative relationship between cortex, BG, and thalamus, which allows contributions to sensory gating, predictive processing, selective attention, and representation of the temporal structure of events.

Exploring the use of visual predictions in social scenarios while under anticipatory threat

One of the less recognized effects of anxiety lies in perception alterations caused by how one weighs both sensory evidence and contextual cues. Here, we investigated how anxiety affects our ability to use social cues to anticipate the others' actions. We adapted a paradigm to assess expectations in social scenarios, whereby participants were asked to identify the presence of agents therein, while supported by contextual cues from another agent. Participants (N = 66) underwent this task under safe and threat-of-shock conditions. We extracted both criterion and sensitivity measures as well as gaze data. Our analysis showed that whilst the type of action had the expected effect, threat-of-shock had no effect over criterion and sensitivity. Although showing similar dwell times, gaze exploration of the contextual cue was associated with shorter fixation durations whilst participants were under threat. Our findings suggest that anxiety does not appear to influence the use of expectations in social scenarios.

Is P3 amplitude associated with greater gaze distraction effect in schizotypy?

A recently proposed "Hyperfocusing hypothesis" suggests that schizotypy is associated with a more narrow but more intense way of allocating attention. The current study aims to test a vital prediction of this hypothesis in a social context, that schizotypy may be related to greater difficulty overcoming the distracting effects of gaze. This could cause a longer time to respond to targets that are invalidly cued by gaze. The current study tested this prediction in a modified Posner cueing paradigm by using P3 as an indicator for attentional resources. Seventy-four young healthy individuals with different levels of schizotypy were included, they were asked to detect the location of a target that was cued validly or invalidly by the gaze and head orientation. The results revealed that (a) schizotypy is associated with hyperfocusing on gaze direction, leading to greater difficulty overcoming the distracting effect of gaze. The higher the trait-schizotypy score, the more time needed to respond to targets that were invalidly cued by gaze (b) schizotypy is associated with reduced P3 which is directed by social communicative stimuli. The higher the trait-schizotypy score, the smaller the amplitude of P3 (c) the relationship between schizotypal traits and response times of the gaze-invalid condition is fully intermediated by P3. The findings of the current study suggest the P3 component may be a crucial neural mechanism underlying joint attention deficits in schizophrenia.

More widespread and rigid neuronal representation of reward expectation underlies impulsive choices

Impulsive choices prioritize smaller, more immediate rewards over larger, delayed, or potentially uncertain rewards. Impulsive choices are a critical aspect of substance use disorders and maladaptive decision-making across the lifespan. Here, we sought to understand the neuronal underpinnings of expected reward and risk estimation on a trial-by-trial basis during impulsive choices. To do so, we acquired electrical recordings from the human brain while participants carried out a risky decision-making task designed to measure choice impulsivity. Behaviorally, we found a reward-accuracy tradeoff, whereby more impulsive choosers were more accurate at the task, opting for a more immediate reward while compromising overall task performance. We then examined how neuronal populations across frontal, temporal, and limbic brain regions parametrically encoded reinforcement learning model variables, namely reward and risk expectation and surprise, across trials. We found more widespread representations of reward value expectation and prediction error in more impulsive choosers, whereas less impulsive choosers preferentially represented risk expectation. A regional analysis of reward and risk encoding highlighted the anterior cingulate cortex for value expectation, the anterior insula for risk expectation and surprise, and distinct regional encoding between impulsivity groups. Beyond describing trial-by-trial population neuronal representations of reward and risk variables, these results suggest impaired inhibitory control and model-free learning underpinnings of impulsive choice. These findings shed light on neural processes underlying reinforced learning and decision-making in uncertain environments and how these processes may function in psychiatric disorders.

A novel model of divergent predictive perception

Predictive processing theories state that our subjective experience of reality is shaped by a balance of expectations based on previous knowledge about the world (i.e. priors) and confidence in sensory input from the environment. Divergent experiences (e.g. hallucinations and synaesthesia) are likely to occur when there is an imbalance between one's reliance on priors and sensory input. In a novel theoretical model, inspired by both predictive processing and psychological principles, we propose that predictable divergent experiences are associated with natural or environmentally induced prior/sensory imbalances: inappropriately strong or inflexible (i.e. maladaptive) high-level priors (beliefs) combined with low sensory confidence can result in reality discrimination issues, a characteristic of psychosis; maladaptive low-level priors (sensory expectations) combined with high sensory confidence can result in atypical sensory sensitivities and persistent divergent percepts, a characteristic of synaesthesia. Crucially, we propose that whether different divergent experiences manifest with dominantly sensory (e.g. hallucinations) or nonsensory characteristics (e.g. delusions) depends on mental imagery ability, which is a spectrum from aphantasia (absent or weak imagery) to hyperphantasia (extremely vivid imagery). We theorize that imagery is critically involved in shaping the sensory richness of divergent perceptual experience. In sum, to predict a range of divergent perceptual experiences in both clinical and general populations, three factors must be accounted for: a maladaptive use of priors, individual level of confidence in sensory input, and mental imagery ability. These ideas can be expressed formally using nonparametric regression modeling. We provide evidence for our theory from previous work and deliver predictions for future research.

Flexibility Retained: Unimpaired Updating of Expectations in Schizophrenia

Flexibly and actively updating expectations based on feedback is crucial for navigating daily life. Previous research has shown that people with schizophrenia (PSZ) have difficulty adjusting their expectations. However, there are studies suggesting otherwise. To explore this further, we used a novel trial-based expectation updating paradigm called attribute amnesia. In the task, the participants needed to report the location of a target stimulus among distractors in pre-surprise trials. In the surprise trial, they were unexpectedly asked to report the identity of the target before reporting its location. Afterward, control trials were conducted whereby the participants were asked the same questions as in the surprise trial. Notably, the surprise trial and control trials were nearly identical, except that the participants expected to be asked about identity information in the control trials but not in the surprise trial. Thus, an improvement in identity reporting accuracy in the control trials in comparison with the surprise trial indicated active updating of expectations. In the current study, a total of 63 PSZ and 60 healthy control subjects (HCS) were enrolled. We found that both the PSZ and the HCS were unable to report information that they had fully attended to (i.e., identity) in the surprise trial. However, both groups showed a significant improvement in reporting identity information even in the first control trial. Critically, there was no significant difference in the magnitude of improvement between the two groups. The current findings indicate that PSZ have the ability to update their expectations as quickly and flexibly as HCS, at least in the context of the current task. The possible factors that might contribute to the discrepancy regarding expectation updating are discussed.

Hallucination-Proneness is Associated With a Decrease in Robust Averaging of Perceptual Evidence

BACKGROUND AND HYPOTHESIS

Hallucinations are characterized by disturbances in perceptual decision-making about environmental stimuli. When integrating across multiple stimuli to form a perceptual decision, typical observers engage in "robust averaging" by down-weighting extreme perceptual evidence, akin to a statistician excluding outlying data. Furthermore, observers adapt to contexts with more unreliable evidence by increasing this down-weighting strategy. Here, we test the hypothesis that hallucination-prone individuals (n = 38 high vs n = 91 low) would show a decrease in this robust averaging and diminished sensitivity to changes in evidence variance.

STUDY DESIGN

We used a multielement perceptual averaging task to elicit dichotomous judgments about the "average color" (red/blue) of an array of stimuli in trials with varied strength (mean) and reliability (variance) of decision-relevant perceptual evidence. We fitted computational models to task behavior, with a focus on a log-posterior-ratio (LPR) model which integrates evidence as a function of the log odds of each perceptual option and produces a robust averaging effect.

STUDY RESULTS

Hallucination-prone individuals demonstrated less robust averaging, seeming to weigh inlying and outlying extreme or untrustworthy evidence more equally. Furthermore, the model that integrated evidence as a function of the LPR of the two perceptual options and produced robust averaging showed poorer fit for the group prone to hallucinations. Finally, the weighting strategy in hallucination-prone individuals remained insensitive to evidence variance.

CONCLUSIONS

Our findings provide empirical support for theoretical proposals regarding evidence integration aberrations in psychosis and alterations in the perceptual systems that track statistical regularities in environmental stimuli.

Biomarkers of Auditory-Verbal Hallucinations

Auditory-verbal hallucinations (AVH) are debilitating symptoms experienced by those diagnosed with psychosis as well as many other neurological and psychiatric disorders. Critical to supporting individuals with AVH is identifying biomarkers that serve to track changes in brain states that put individuals at risk for developing or worsening of symptoms. There has been substantial literature identifying neural areas to track over time that may prove to be effective clinical tools. The efficacy of these tools has been bolstered when considering them under mechanistic accounts of AVH. In this chapter, we explore the literature that connects mechanistic theories and structurally based models of AVH and the potential biomarkers derived from this research.

Pavlovian conditioning-induced hallucinations reduce MMN amplitudes for duration but not frequency deviants

The mismatch negativity (MMN) is an evoked potential that indexes auditory regularity violations. Since the 90's, a reduced amplitude of this brain activity in patients with schizophrenia has been consistently reported. Recently, this alteration has been related to the presence of auditory hallucinations (AHs) rather than the schizophrenia diagnostic per se. However, making this attribution is rather problematic due to the high heterogeneity of symptoms in schizophrenia. In an attempt to isolate the AHs influence on the MMN amplitude from other cofounding variables, we artificially induced AHs in a non-clinical population by Pavlovian conditioning. Before and after conditioning, volunteers (N = 31) participated in an oddball paradigm that elicited an MMN. Two different types of deviants were presented: a frequency and a duration deviant, as the MMN alteration seems to be especially present in schizophrenia with the latter type of deviant. Hence, this pre-post design allowed us to compare whether experiencing conditioning-induced AHs exert any influence on MMN amplitudes. Our results show that duration-deviant related MMN reductions significantly correlate with the number of AHs experienced. Moreover, we found a significant correlation between AHs proneness (measured with the Launay-Slade Hallucination Extended Scale) and the number of AHs experienced during the paradigm. In sum, our study shows that AHs can be conditioned and exert similar effects on MMN modulation in healthy participants as has been reported for patients with schizophrenia. Thus, conditioning paradigms offer the possibility to study the association between hallucinations and MMN reductions without the confounding variables present in schizophrenia patients.

Pedunculopontine-induced cortical decoupling as the neurophysiological locus of dissociation

Mounting evidence suggests an association between aberrant sleep phenomena and dissociative experiences. However, no wake-sleep boundary theory provides a compelling explanation of dissociation or specifies its physiological substrates. We present a theoretical account of dissociation that integrates theories and empirical results from multiple lines of research concerning the domain of dissociation and the regulation of rapid eye movement (REM) sleep. This theory posits that individual differences in the circuitry governing the REM sleep promoting Pedunculopontine Nucleus and Laterodorsal Tegmental Nucleus determine the degree of similarity in the cortical connectivity profiles of wakefulness and REM sleep. We propose that a latent trait characterized by elevated dissociative experiences emerges from the decoupling of frontal executive regions due to a REM sleep-like aminergic/cholinergic balance. The Pedunculopontine-Induced Cortical Decoupling Account of Dissociation (PICDAD) suggests multiple fruitful lines of inquiry and provides novel insights. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A neural mechanism underlying predictive visual motion processing in patients with schizophrenia

Psychotic symptoms may be traced back to sensory sensitivity. Thereby, visual motion (VM) processing particularly has been suggested to be impaired in schizophrenia (SCZ). In healthy brains, VM underlies predictive processing within hierarchically structured systems. However, less is known about predictive VM processing in SCZ. Therefore, we performed fMRI during a VM paradigm with three conditions of varying predictability, i.e., Predictable-, Random-, and Arbitrary motion. The study sample comprised 17 SCZ patients and 23 healthy controls. We calculated general linear model (GLM) analysis to assess group differences in VM processing across motion conditions. Here, we identified significantly lower activity in right temporoparietal junction (TPJ) for SCZ patients. Therefore, right TPJ was set as seed for connectivity analyses. For patients, across conditions we identified increased connections to higher regions, namely medial prefrontal cortex, or paracingulate gyrus. Healthy subjects activated sensory regions as area V5, or superior parietal lobule. Reduced TPJ activity may reflect both a failure in the bottom-up flow of visual information and a decrease of signal processing as consequence of increased top-down input from frontal areas. In sum, these altered neural patterns provide a framework for future studies focusing on predictive VM processing to identify potential biomarkers of psychosis.

A quantitative model reveals a frequency ordering of prediction and prediction-error signals in the human brain

The human brain is proposed to harbor a hierarchical predictive coding neuronal network underlying perception, cognition, and action. In support of this theory, feedforward signals for prediction error have been reported. However, the identification of feedback prediction signals has been elusive due to their causal entanglement with prediction-error signals. Here, we use a quantitative model to decompose these signals in electroencephalography during an auditory task, and identify their spatio-spectral-temporal signatures across two functional hierarchies. Two prediction signals are identified in the period prior to the sensory input: a low-level signal representing the tone-to-tone transition in the high beta frequency band, and a high-level signal for the multi-tone sequence structure in the low beta band. Subsequently, prediction-error signals dependent on the prior predictions are found in the gamma band. Our findings reveal a frequency ordering of prediction signals and their hierarchical interactions with prediction-error signals supporting predictive coding theory.

A link between age, affect, and predictions?

The prevalence of depressive symptoms decreases from late adolescence to middle age adulthood. Furthermore, despite significant losses in motor and cognitive functioning, overall emotional well-being tends to increase with age, and a bias to positive information has been observed multiple times. Several causes have been discussed for this age-related development, such as improvement in emotion regulation, less regret, and higher socioeconomic status. Here, we explore a further explanation. Our minds host mental models that generate predictions about forthcoming events to successfully interact with our physical and social environment. To keep these models faithful, the difference between the predicted and the actual event, that is, the prediction error, is computed. We argue that prediction errors are attenuated in the middle age and older mind, which, in turn, may translate to less negative affect, lower susceptibility to affective disorders, and possibly, to a bias to positive information. Our proposal is primarily linked to perceptual inferences, but may hold as well for higher-level, cognitive, and emotional forms of error processing.

Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis

Psychotic experiences can occur in autism spectrum disorders (ASD). Some of the ASD individuals with these experiences may fulfil Clinical High-Risk for Psychosis (CHR-P) criteria. A systematic literature search was performed to review the information on ASD and CHR-P. A meta-analysis of the proportion of CHR-P in ASD was conducted. The systematic review included 13 studies. The mean age of ASD individuals across the included studies was 11.09 years. The Attenuated Psychosis Syndrome subgroup was the most frequently reported. Four studies were meta-analysed, showing that 11.6% of CHR-P individuals have an ASD diagnosis. Symptoms of prodromal psychosis may be present in individuals with ASD. The transition from CHR-P to psychosis is not affected by ASD.

Hallucinations: A Functional Network Model of How Sensory Representations Become Selected for Conscious Awareness in Schizophrenia

Hallucinations are conscious perception-like experiences that are a common symptom of schizophrenia spectrum disorders (SSD). Current neuroscience evidence suggests several brain areas are involved in the generation of hallucinations including the sensory cortex, insula, putamen, and hippocampus. But how does activity in these regions give rise to aberrant conscious perceptions that seemingly invade ongoing conscious experience? Most existing models assume that sensory representations are sometimes spontaneously activated in the brain, and that these spontaneous activations somehow play a causal role in the generation of hallucinations. Yet, it remains unclear how these representations become selected for conscious processing. No existing theory of hallucinations has specified such a “selection mechanism.” Global Workspace (GW) theorists argue that the brain’s interconnected processors select relevant piece(s) of information for broadcasting to other brain processors, rendering the information accessible to consciousness; this process known as “ignition” is associated with synchronized activity across distributed cortical and subcortical brain regions. Yet, it remains unclear how certain information and representations become selected for conscious processing. While GW theorists maintain that attention plays an important role, they have not delineated a formal “selection mechanism.” This paper specifies a selection mechanism based upon two central hypotheses: (1) a functional network called the “salience network” plays a critical role in selecting sensory representations for conscious broadcast to the GW in normal (healthy) perception; (2) sensory representations become abnormally selected for conscious broadcast to the GW (instead of being filtered out of consciousness) in individuals with SSD that experience hallucinations.

A review of functional and structural neuroimaging studies to investigate the inner speech model of auditory verbal hallucinations in schizophrenia

Although the pathophysiology of auditory verbal hallucinations remains uncertain, the inner speech model remains a prominent theory. A systematic review and meta-analyses of both functional and structural neuroimaging studies were performed to investigate the inner speech model. Of the 417 papers retrieved, 26 met the inclusion criteria. Meta-analyses found the left insula to be significantly active during auditory verbal hallucinations and to have a significantly reduced grey matter volume in hallucinators. Dysfunction of the left insula may contribute to the misattribution of inner speech due to its suggested roles in both inner speech production and the salience network. No significant activity was found at Broca's area or Heschl's gyrus during auditory verbal hallucinations. Furthermore, no structural abnormalities were found at these sites or in the arcuate fasciculi. Overall, evidence was found to both support and oppose the inner speech model. Further research should particularly include a systematic review of task-based trait studies with a focus on inner speech production and self-referential processing, and analyses of additional language-related white matter tracts.

Perceived and mentally rotated contents are differentially represented in cortical depth of V1

Primary visual cortex (V1) in humans is known to represent both veridically perceived external input and internally-generated contents underlying imagery and mental rotation. However, it is unknown how the brain keeps these contents separate thus avoiding a mixture of the perceived and the imagined which could lead to potentially detrimental consequences. Inspired by neuroanatomical studies showing that feedforward and feedback connections in V1 terminate in different cortical layers, we hypothesized that this anatomical compartmentalization underlies functional segregation of external and internally-generated visual contents, respectively. We used high-resolution layer-specific fMRI to test this hypothesis in a mental rotation task. We found that rotated contents were predominant at outer cortical depth bins (i.e. superficial and deep). At the same time perceived contents were represented stronger at the middle cortical bin. These results identify how through cortical depth compartmentalization V1 functionally segregates rather than confuses external from internally-generated visual contents. These results indicate that feedforward and feedback manifest in distinct subdivisions of the early visual cortex, thereby reflecting a general strategy for implementing multiple cognitive functions within a single brain region.

External speech processing and auditory verbal hallucinations: A systematic review of functional neuroimaging studies

It has been documented that individuals who hear auditory verbal hallucinations (AVH) exhibit diminished capabilities in processing external speech. While functional neuroimaging studies have attempted to characterise the cortical regions and networks facilitating these deficits in a bid to understand AVH, considerable methodological heterogeneity has prevented a consensus being reached. The current systematic review investigated the neurobiological underpinnings of external speech processing deficits in voice-hearers in 38 studies published between January 1990 to June 2020. AVH-specific deviations in the activity and lateralisation of the temporal auditory regions were apparent when processing speech sounds, words and sentences. During active or affective listening tasks, functional connectivity changes arose within the language, limbic and default mode networks. However, poor study quality and lack of replicable results plague the field. A detailed list of recommendations has been provided to improve the quality of future research on this topic.

Disentangling predictive processing in the brain: a meta-analytic study in favour of a predictive network

According to the predictive coding (PC) theory, the brain is constantly engaged in predicting its upcoming states and refining these predictions through error signals. Despite extensive research investigating the neural bases of this theory, to date no previous study has systematically attempted to define the neural mechanisms of predictive coding across studies and sensory channels, focussing on functional connectivity. In this study, we employ a coordinate-based meta-analytical approach to address this issue. We first use the Activation Likelihood Estimation (ALE) algorithm to detect spatial convergence across studies, related to prediction error and encoding. Overall, our ALE results suggest the ultimate role of the left inferior frontal gyrus and left insula in both processes. Moreover, we employ a meta-analytic connectivity method (Seed-Voxel Correlations Consensus). This technique reveals a large, bilateral predictive network, which resembles large-scale networks involved in task-driven attention and execution. In sum, we find that: (i) predictive processing seems to occur more in certain brain regions than others, when considering different sensory modalities at a time; (ii) there is no evidence, at the network level, for a distinction between error and prediction processing.

The Radically Embodied Conscious Cybernetic Bayesian Brain: From Free Energy to Free Will and Back Again

Drawing from both enactivist and cognitivist perspectives on mind, I propose that explaining teleological phenomena may require reappraising both "Cartesian theaters" and mental homunculi in terms of embodied self-models (ESMs), understood as body maps with agentic properties, functioning as predictive-memory systems and cybernetic controllers. Quasi-homuncular ESMs are suggested to constitute a major organizing principle for neural architectures due to their initial and ongoing significance for solutions to inference problems in cognitive (and affective) development. Embodied experiences provide foundational lessons in learning curriculums in which agents explore increasingly challenging problem spaces, so answering an unresolved question in Bayesian cognitive science: what are biologically plausible mechanisms for equipping learners with sufficiently powerful inductive biases to adequately constrain inference spaces? Drawing on models from neurophysiology, psychology, and developmental robotics, I describe how embodiment provides fundamental sources of empirical priors (as reliably learnable posterior expectations). If ESMs play this kind of foundational role in cognitive development, then bidirectional linkages will be found between all sensory modalities and frontal-parietal control hierarchies, so infusing all senses with somatic-motoric properties, thereby structuring all perception by relevant affordances, so solving frame problems for embodied agents. Drawing upon the Free Energy Principle and Active Inference framework, I describe a particular mechanism for intentional action selection via consciously imagined (and explicitly represented) goal realization, where contrasts between desired and present states influence ongoing policy selection via predictive coding mechanisms and backward-chained imaginings (as self-realizing predictions). This embodied developmental legacy suggests a mechanism by which imaginings can be intentionally shaped by (internalized) partially-expressed motor acts, so providing means of agentic control for attention, working memory, imagination, and behavior. I further describe the nature(s) of mental causation and self-control, and also provide an account of readiness potentials in Libet paradigms wherein conscious intentions shape causal streams leading to enaction. Finally, I provide neurophenomenological handlings of prototypical qualia including pleasure, pain, and desire in terms of self-annihilating free energy gradients via quasi-synesthetic interoceptive active inference. In brief, this manuscript is intended to illustrate how radically embodied minds may create foundations for intelligence (as capacity for learning and inference), consciousness (as somatically-grounded self-world modeling), and will (as deployment of predictive models for enacting valued goals).

Adjudicating Between Local and Global Architectures of Predictive Processing in the Subcortical Auditory Pathway

Predictive processing, a leading theoretical framework for sensory processing, suggests that the brain constantly generates predictions on the sensory world and that perception emerges from the comparison between these predictions and the actual sensory input. This requires two distinct neural elements: generative units, which encode the model of the sensory world; and prediction error units, which compare these predictions against the sensory input. Although predictive processing is generally portrayed as a theory of cerebral cortex function, animal and human studies over the last decade have robustly shown the ubiquitous presence of prediction error responses in several nuclei of the auditory, somatosensory, and visual subcortical pathways. In the auditory modality, prediction error is typically elicited using so-called oddball paradigms, where sequences of repeated pure tones with the same pitch are at unpredictable intervals substituted by a tone of deviant frequency. Repeated sounds become predictable promptly and elicit decreasing prediction error; deviant tones break these predictions and elicit large prediction errors. The simplicity of the rules inducing predictability make oddball paradigms agnostic about the origin of the predictions. Here, we introduce two possible models of the organizational topology of the predictive processing auditory network: (1) the global view, that assumes that predictions on the sensory input are generated at high-order levels of the cerebral cortex and transmitted in a cascade of generative models to the subcortical sensory pathways; and (2) the local view, that assumes that independent local models, computed using local information, are used to perform predictions at each processing stage. In the global view information encoding is optimized globally but biases sensory representations along the entire brain according to the subjective views of the observer. The local view results in a diminished coding efficiency, but guarantees in return a robust encoding of the features of sensory input at each processing stage. Although most experimental results to-date are ambiguous in this respect, recent evidence favors the global model.

Language Dysfunction in Schizophrenia: Assessing Neural Tracking to Characterize the Underlying Disorder(s)?

Deficits in language production and comprehension are characteristic of schizophrenia. To date, it remains unclear whether these deficits arise from dysfunctional linguistic knowledge, or dysfunctional predictions derived from the linguistic context. Alternatively, the deficits could be a result of dysfunctional neural tracking of auditory information resulting in decreased auditory information fidelity and even distorted information. Here, we discuss possible ways for clinical neuroscientists to employ neural tracking methodology to independently characterize deficiencies on the auditory-sensory and abstract linguistic levels. This might lead to a mechanistic understanding of the deficits underlying language related disorder(s) in schizophrenia. We propose to combine naturalistic stimulation, measures of speech-brain synchronization, and computational modeling of abstract linguistic knowledge and predictions. These independent but likely interacting assessments may be exploited for an objective and differential diagnosis of schizophrenia, as well as a better understanding of the disorder on the functional level-illustrating the potential of neural tracking methodology as translational tool in a range of psychotic populations.

Local versus long-range connectivity patterns of auditory disturbance in schizophrenia

Auditory hallucinations are a debilitating symptom of schizophrenia. Effective treatment is limited because the underlying neural mechanisms remain unknown. Our study investigates how local and long-range functional connectivity is associated with auditory perceptual disturbances (APD) in schizophrenia. APD was assessed using the Auditory Perceptual Trait and State Scale. Resting state fMRI data were collected for N=99 patients with schizophrenia. Local functional connectivity was estimated using regional homogeneity (ReHo) analysis; long-range connectivity was estimated using resting state functional connectivity (rsFC) analysis. Mediation analyses tested whether local (ReHo) connectivity significantly mediated associations between long-distance rsFC and APD. Severity of APD was significantly associated with reduced ReHo in left and right putamen, left temporoparietal junction (TPJ), and right hippocampus-pallidum. Higher APD was also associated with reduced rsFC between the right putamen and the contralateral putamen and auditory cortex. Local and long-distance connectivity measures together explained 40.3% of variance in APD (P < 0.001), with the strongest predictor being the left TPJ ReHo (P < 0.001). Additionally, TPJ ReHo significantly mediated the relationship between right putamen - left putamen rsFC and APD (Sobel test, P = 0.001). Our findings suggest that both local and long-range functional connectivity deficits contribute to APD, emphasizing the role of striatum and auditory cortex. Considering the translational impact of these circuit-based findings within the context of prior clinical trials to treat auditory hallucinations, we propose a model in which correction of both local and long-distance functional connectivity deficits may be necessary to treat auditory hallucinations.

Reconciling competing mechanisms posited to underlie auditory verbal hallucinations

Perception is not the passive registration of incoming sensory data. Rather, it involves some analysis by synthesis, based on past experiences and context. One adaptive consequence of this arrangement is imagination-the ability to richly simulate sensory experiences, interrogate and manipulate those simulations, in service of action and decision making. In this paper, we will discuss one possible cost of this adaptation, namely hallucinations-perceptions without sensory stimulation, which characterize serious mental illnesses like schizophrenia, but which also occur in neurological illnesses, and-crucially for the present piece-are common also in the non-treatment-seeking population. We will draw upon a framework for imagination that distinguishes voluntary from non-voluntary experiences and explore the extent to which the varieties and features of hallucinations map onto this distinction, with a focus on auditory-verbal hallucinations (AVHs)-colloquially, hearing voices. We will propose that sense of agency for the act of imagining is key to meaningfully dissecting different forms and features of AVHs, and we will outline the neural, cognitive and phenomenological sequelae of this sense. We will conclude that a compelling unifying framework for action, perception and belief-predictive processing-can incorporate observations regarding sense of agency, imagination and hallucination. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

The role of expectancies and emotional load in false auditory perceptions among patients with schizophrenia spectrum disorders

Cognitive models suggest that top-down and emotional processes increase false perceptions in schizophrenia spectrum disorders (SSD). However, little is still known about the interaction of these processes in false auditory perceptions. The present study aimed at investigating the specific as well as joint impacts of expectancies and emotional load on false auditory perceptions in SSD. Thirty-three patients with SSD and 33 matched healthy controls were assessed with a false perception task. Participants were asked to detect a target stimulus (a word) in a white noise background (the word was present in 60% of the cases and absent in 40%). Conditions varied in terms of the level of expectancy (1. no cue prior to the stimulus, 2. semantic priming, 3. semantic priming accompanied by a video of a man's mouth spelling out the word). The words used were neutral or emotionally negative. Symptom severity was assessed with the Positive and Negative Syndrome Scale. Higher expectancy significantly increased the likelihood of false auditory perceptions only among the patients with SSD (the group x expectancy condition interaction was significant), which was unrelated to general cognitive performance. Emotional load had no impact on false auditory perceptions in either group. Patients made more false auditory perceptions with high confidence than controls did. False auditory perceptions were significantly correlated with the severity of positive symptoms and disorganization, but not with other dimensions. Perception in SSD seems to be susceptible to top-down processes, increasing the likelihood of high-confidence false auditory perceptions.

Deficits in Prediction Ability Trigger Asymmetries in Behavior and Internal Representation

Predictive coding is an emerging theoretical framework for explaining human perception and behavior. The proposed underlying mechanism is that signals encoding sensory information are integrated with signals representing the brain's prior prediction. Imbalance or aberrant precision of the two signals has been suggested as a potential cause for developmental disorders. Computational models may help to understand how such aberrant tendencies in prediction affect development and behavior. In this study, we used a computational approach to test the hypothesis that parametric modifications of prediction ability generate a spectrum of network representations that might reflect the spectrum from typical development to potential disorders. Specifically, we trained recurrent neural networks to draw simple figure trajectories, and found that altering reliance on sensory and prior signals during learning affected the networks' performance and the emergent internal representation. Specifically, both overly strong or weak reliance on predictions impaired network representations, but drawing performance did not always reflect this impairment. Thus, aberrant predictive coding causes asymmetries in behavioral output and internal representations. We discuss the findings in the context of autism spectrum disorder, where we hypothesize that too weak or too strong a reliance on predictions may be the cause of the large diversity of symptoms associated with this disorder.

Expected TMS excites the motor system less effectively than unexpected stimulation

The brain's response to sensory input is modulated by prediction. For example, sounds that are produced by one's own actions, or those that are strongly predicted by environmental cues, elicit an attenuated N1 component in the auditory evoked potential. It has been suggested that this form of sensory attenuation to stimulation produced by one's own actions is the reason we are unable to tickle ourselves. Here we examined whether the neural response to direct stimulation of the brain is attenuated by prediction in a similar manner. Transcranial magnetic stimulation (TMS) applied over primary motor cortex can be used to gauge the excitability of the motor system. Motor-evoked potentials (MEPs), elicited by TMS and measured in peripheral muscles, are larger when actions are being prepared and smaller when actions are voluntarily suppressed. We tested whether the amplitude of MEPs was attenuated under circumstances where the TMS pulse can be reliably predicted, even though control of the relevant motor effector was never required. Self-initiation of the TMS pulse and reliable cuing of the TMS pulse both produced attenuated MEP amplitudes, compared to those generated programmatically in an unpredictable manner. These results suggest that predictive coding may be governed by domain-general mechanisms responsible for all forms predictive learning. The findings also have important methodological implications for designing TMS experiments that control for the predictability of TMS pulses.

Aberrant Salience, Information Processing, and Dopaminergic Signaling in People at Clinical High Risk for Psychosis

The aberrant salience hypothesis proposes that striatal dopamine dysregulation causes misattribution of salience to irrelevant stimuli leading to psychosis. Recently, new lines of preclinical evidence on information coding by subcortical dopamine coupled with computational models of the brain's ability to predict and make inferences about the world (predictive processing) provide a new perspective on this hypothesis. We review these and summarize the evidence for dopamine dysfunction, reward processing, and salience abnormalities in people at clinical high risk of psychosis (CHR) relative to findings in patients with psychosis. This review identifies consistent evidence for dysregulated subcortical dopamine function in people at CHR, but also indicates a number of areas where neurobiological processes are different in CHR subjects relative to patients with psychosis, particularly in reward processing. We then consider how predictive processing models may explain psychotic symptoms in terms of alterations in prediction error and precision signaling using Bayesian approaches. We also review the potential role of environmental risk factors, particularly early adverse life experiences, in influencing the prior expectations that individuals have about their world in terms of computational models of the progression from being at CHR to frank psychosis. We identify a number of key outstanding questions, including the relative roles of prediction error or precision signaling in the development of symptoms and the mechanism underlying dopamine dysfunction. Finally, we discuss how the integration of computational psychiatry with biological investigation may inform the treatment for people at CHR of psychosis.

Voluntary control of auditory hallucinations: phenomenology to therapeutic implications

Auditory verbal hallucinations (AVH) have traditionally been thought to be outside the influence of conscious control. However, recent work with voice hearers makes clear that both treatment-seeking and non-treatment-seeking voice hearers may exert varying degrees of control over their voices. Evidence suggests that this ability may be a key factor in determining health status, but little systematic examination of control in AVH has been carried out. This review provides an overview of the research examining control over AVH in both treatment-seeking and non-treatment-seeking populations. We first examine the relationship between control over AVH and health status as well as the psychosocial factors that may influence control and functioning. We then link control to various cognitive constructs that appear to be important for voice hearing. Finally, we reconcile the possibility of control with the field’s current understanding of the proposed cognitive, computational, and neural underpinnings of hallucinations and perception more broadly. Established relationships between control, health status, and functioning suggest that the development of control over AVH could increase functioning and reduce distress. A more detailed understanding of the discrete types of control, their development, and their neural underpinnings is essential for translating this knowledge into new therapeutic approaches.

Associations of mismatch negativity with psychotic symptoms and functioning transdiagnostically across psychotic disorders

Mismatch negativity (MMN) amplitude has been widely shown to be diminished in schizophrenia and, more recently, in other psychotic disorders. Although there is considerable evidence linking MMN reduction to cognitive and functional deficits in schizophrenia, there is little evidence of associations with specific psychotic symptoms. Further, it is unclear if MMN reductions relate to specific symptoms, cognitive, and functional deficits transdiagnostically across different psychotic disorders. The present study examines MMN amplitude in a large cohort of cases diagnosed with psychotic disorders including schizophrenia and schizoaffective disorder (N = 116); bipolar disorder and major depressive disorder (N = 75); and other psychotic disorders (N = 25), as well as individuals with no psychotic disorder diagnoses (N = 248). Furthermore, we examined the association of MMN with symptoms, cognitive functioning, and real-world functioning to determine whether these relationships differ by diagnosis. Results showed that MMN amplitude was reduced in cases overall compared to never-psychotic individuals, with no differences between psychotic disorders. Furthermore, there were transdiagnostic associations of reduced duration MMN (MMN-D) with worse auditory hallucinations (r = .14) and disorganization (r = .14), frequency MMN (MMN-F) with real-word functioning (r = .20) and episodic memory (r = -.22), and both components with executive functioning (MMN-D: r = -.17; MMN-F: r = -.15). Our findings relating MMN reductions with cognitive and real-world functioning replicate earlier research in schizophrenia and extend these relationships to other psychotic disorders. Furthermore, our correlations with MMN-D are consistent with computational modeling research and theoretical proposals that view MMN reduction, cognitive dysfunction, and psychotic symptoms as reflecting underlying predictive coding deficits. However, differences in relationships with MMN-F suggest that additional work is warranted on this topic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Changes in motor preparation affect the sensory consequences of voice production in voice hearers

BACKGROUND

Auditory verbal hallucinations (AVH) are a cardinal symptom of psychosis but are also present in 6-13% of the general population. Alterations in sensory feedback processing are a likely cause of AVH, indicative of changes in the forward model. However, it is unknown whether such alterations are related to anomalies in forming an efference copy during action preparation, selective for voices, and similar along the psychosis continuum. By directly comparing psychotic and nonclinical voice hearers (NCVH), the current study specifies whether and how AVH proneness modulates both the efference copy (Readiness Potential) and sensory feedback processing for voices and tones (N1, P2) with event-related brain potentials (ERPs).

METHODS

Controls with low AVH proneness (n = 15), NCVH (n = 16) and first-episode psychotic patients with AVH (n = 16) engaged in a button-press task with two types of stimuli: self-initiated and externally generated self-voices or tones during EEG recordings.

RESULTS

Groups differed in sensory feedback processing of expected and actual feedback: NCVH displayed an atypically enhanced N1 to self-initiated voices, while N1 suppression was reduced in psychotic patients. P2 suppression for voices and tones was strongest in NCVH, but absent for voices in patients. Motor activity preceding the button press was reduced in NCVH and patients, specifically for sensory feedback to self-voice in NCVH.

CONCLUSIONS

These findings suggest that selective changes in sensory feedback to voice are core to AVH. These changes already show in preparatory motor activity, potentially reflecting changes in forming an efference copy. The results provide partial support for continuum models of psychosis.

Terminology and assessment tools of psychosis: A systematic narrative review

AIM

Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'.

METHODS

EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded.

RESULTS

A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization.

DISCUSSION

A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.

An integrative framework for perceptual disturbances in psychosis

Perceptual disturbances in psychosis, such as auditory verbal hallucinations, are associated with increased baseline activity in the associative auditory cortex and increased dopamine transmission in the associative striatum. Perceptual disturbances are also associated with perceptual biases that suggest increased reliance on prior expectations. We review theoretical models of perceptual inference and key supporting physiological evidence, as well as the anatomy of associative cortico-striatal loops that may be relevant to auditory perceptual inference. Integrating recent findings, we outline a working framework that bridges neurobiology and the phenomenology of perceptual disturbances via theoretical models of perceptual inference.

Auditory Mismatch Negativity Under Predictive Coding Framework and Its Role in Psychotic Disorders

Traditional neuroscience sees sensory perception as a simple feedforward process. This view is challenged by the predictive coding model in recent years due to the robust evidence researchers had found on how our prediction could influence perception. In the first half of this article, we reviewed the concept of predictive brain and some empirical evidence of sensory prediction in visual and auditory processing. The predictive function along the auditory pathway was mainly studied by mismatch negativity (MMN)-a brain response to an unexpected disruption of regularity. We summarized a range of MMN paradigms and discussed how they could contribute to the theoretical development of the predictive coding neural network by the mechanism of adaptation and deviance detection. Such methodological and conceptual evolution sharpen MMN as a tool to better understand the structural and functional brain abnormality for neuropsychiatric disorder such as schizophrenia.

Modality-general and modality-specific processes in hallucinations

There is a growing recognition in psychosis research of the importance of hallucinations in modalities other than the auditory. This has focused attention on cognitive and neural processes that might be shared by, and which might contribute distinctly to, hallucinations in different modalities. In this article, I address some issues around the modality-generality of cognitive and neural processes in hallucinations, including the role of perceptual and reality-monitoring systems, top-down and bottom-up processes in relation to the psychological and neural substrates of hallucinations, and the phenomenon of simultaneous multimodal hallucinations of the same entity. I suggest that a functional systems approach, inspired by some neglected aspects of the writings of A. R. Luria, can help us to understand patterns of hallucinatory experience across modalities and across clinical and non-clinical groups. Understanding the interplay between modality-general and modality-specific processes may bear fruit for improved diagnosis and therapeutic approaches to dealing with distressing hallucinations.

Why context matters? Divisive normalization and canonical microcircuits in psychiatric disorders

Neural activity on cellular, regional, and behavioral levels shows context-dependence. Here we suggest the processing of input-output relationships in terms divisive normalization (DN), including (i) summing/averaging inputs and (ii) normalizing output against input stages, as a computational mechanism to underlie context-dependence. Input summation and output normalization are mediated by input-output relationships in canonical microcircuits (CM). DN/CM are altered in psychiatric disorders like schizophrenia or depression whose various symptoms can be characterized by abnormal context-dependence.

Towards a Unifying Cognitive, Neurophysiological, and Computational Neuroscience Account of Schizophrenia

Psychotic experiences may be understood as altered information processing due to aberrant neural computations. A prominent example of such neural computations is the computation of prediction errors (PEs), which signal the difference between expected and experienced events. Among other areas showing PE coding, hippocampal-prefrontal-striatal neurocircuits play a prominent role in information processing. Dysregulation of dopaminergic signaling, often secondary to psychosocial stress, is thought to interfere with the processing of biologically important events (such as reward prediction errors) and result in the aberrant attribution of salience to irrelevant sensory stimuli and internal representations. Bayesian hierarchical predictive coding offers a promising framework for the identification of dysfunctional neurocomputational processes and the development of a mechanistic understanding of psychotic experience. According to this framework, mismatches between prior beliefs encoded at higher levels of the cortical hierarchy and lower-level (sensory) information can also be thought of as PEs, with important consequences for belief updating. Low levels of precision in the representation of prior beliefs relative to sensory data, as well as dysfunctional interactions between prior beliefs and sensory data in an ever-changing environment, have been suggested as a general mechanism underlying psychotic experiences. Translating the promise of the Bayesian hierarchical predictive coding into patient benefit will come from integrating this framework with existing knowledge of the etiology and pathophysiology of psychosis, especially regarding hippocampal-prefrontal-striatal network function and neural mechanisms of information processing and belief updating.

Significant repetition probability effects in schizophrenia

BACKGROUND

A growing body of evidence suggests that the comparison of expected and incoming sensory stimuli (the prediction-error (ε) processing) is impaired in schizophrenia patients (SZ). For example, in studies of mismatch negativity, an ERP component that signals ε, SZ patients show deficits in the auditory and visual modalities. To test the role of impaired ε processing further in SZ, using neuroimaging methods, we applied a repetition-suppression (RS) paradigm.

METHODS

Patients diagnosed with SZ (n = 17) as well as age- and sex- matched healthy control subjects (HC, n = 17) were presented with pairs of faces, which could either repeat or alternate. Additionally, the likelihood of repetition/alternation trials was modulated in individual blocks of fMRI recordings, testing the effects of repetition probability (P(rep)) on RS.

RESULTS

We found a significant RS in the fusiform and occipital face areas as well as in the lateral occipital cortex that was similar in healthy controls and SZ patients SZ. More importantly, we observed similar P(rep) effects (larger RS in blocks with high frequency of repetitions than in blocks with low repetition likelihood) in both the control and the patient group.

CONCLUSION

Our findings suggest that repetition_probability modulations affect the neural responses in schizophrenia patients and healthy participants similarly. This suggests that the neural mechanisms determining perceptual inferences based on stimulus probabilities remain unimpaired 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.