A replication study of JTC bias, genetic liability for psychosis and delusional ideation

Associations of conservatism and jumping to conclusions biases with aberrant salience and default mode network

AIM

While conservatism bias refers to the human need for more evidence for decision-making than rational thinking expects, the jumping to conclusions (JTC) bias refers to the need for less evidence among individuals with schizophrenia/delusion compared to healthy people. Although the hippocampus-midbrain-striatal aberrant salience system and the salience, default mode (DMN), and frontoparietal networks ("triple networks") are implicated in delusion/schizophrenia pathophysiology, the associations between conservatism/JTC and these systems/networks are unclear.

METHODS

Thirty-seven patients with schizophrenia and 33 healthy controls performed the beads task, with large and small numbers of bead draws to decision (DTD) indicating conservatism and JTC, respectively. We performed independent component analysis (ICA) of resting functional magnetic resonance imaging (fMRI) data. For systems/networks above, we investigated interactions between diagnosis and DTD, and main effects of DTD. We similarly applied ICA to structural and diffusion MRI to explore the associations between DTD and gray/white matter.

RESULTS

We identified a significant main effect of DTD with functional connectivity between the striatum and DMN, which was negatively correlated with delusion severity in patients, indicating that the greater the anti-correlation between these networks, the stronger the JTC and delusion. We further observed the main effects of DTD on a gray matter network resembling the DMN, and a white matter network connecting the functional and gray matter networks (all P < 0.05, family-wise error [FWE] correction). Function and gray/white matter showed no significant interactions.

CONCLUSION

Our results support the novel association of conservatism and JTC biases with aberrant salience and default brain mode.

Examining the relationships between cognition and auditory hallucinations: A systematic review

OBJECTIVE

Auditory hallucinations (hearing voices) have been associated with a range of altered cognitive functions, pertaining to signal detection, source-monitoring, memory, inhibition and language processes. Yet, empirical results are inconsistent. Despite this, several theoretical models of auditory hallucinations persist, alongside increasing emphasis on the utility of a multidimensional framework. Thus, clarification of current evidence across the broad scope of proposed mechanisms is warranted.

METHOD

A systematic search of the Web of Science, PubMed and Scopus databases was conducted. Records were screened to confirm the use of an objective behavioural cognitive task, and valid measurement of hallucinations specific to the auditory modality.

RESULTS

Auditory hallucinations were primarily associated with difficulties in perceptual decision-making (i.e. reduced sensitivity/accuracy for signal-noise discrimination; liberal responding to ambiguity), source-monitoring (i.e. self-other and temporal context confusion), working memory and language function (i.e. reduced verbal fluency). Mixed or limited support was observed for perceptual feature discrimination, imagery vividness/illusion susceptibility, source-monitoring for stimulus form and spatial context, recognition and recall memory, executive functions (e.g. attention, inhibition), emotion processing and language comprehension/hemispheric organisation.

CONCLUSIONS

Findings were considered within predictive coding and self-monitoring frameworks. Of concern was the portion of studies which - despite offering auditory-hallucination-specific aims and inferences - employed modality-general measures, and/or diagnostic-based contrasts with psychologically healthy individuals. This review highlights disparities within the literature between theoretical conceptualisations of auditory hallucinations and the body of rigorous empirical evidence supporting such inferences. Future cognitive investigations, beyond the schizophrenia-spectrum, which explicitly define and measure the timeframe and sensory modality of hallucinations, are recommended.

Tobacco, Alcohol, and Drug Use Among Young Adults with Serious Mental Illness

To inform early intervention, this study describes correlates of substance use among young people with serious mental illness (SMI) enrolled in integrated care in community mental health settings. 227 adults ages 18-35 were assessed for clinical characteristics and substance use. Logistic regressions were used to describe relationships between substance use and participant characteristics. Over a third (38.9%) reported daily cannabis, 15.9% past month other illicit drug, 13.5% frequent/heavy alcohol and 47.4% any of these; 50.2% reported daily tobacco smoking and 23.3% current vaping. Daily cannabis and tobacco were the most common combination. Alcohol, drug, and cannabis with tobacco were associated with higher mental health symptoms but not with emergency room or hospital utilization. Cannabis and other substance use was common and associated with higher symptoms but not with greater hospital utilization, suggesting that early intervention could prevent long-term negative consequences.

Whodunit - A novel video-based task for the measurement of jumping to conclusions in the schizophrenia spectrum

Jumping to conclusions (JTC) is implicated in the formation and maintenance of the positive symptoms of psychosis and over the years has become a prominent treatment target. Yet, measures designed to detect JTC are compromised by a number of limitations. We aimed to address some of these shortcomings with a new video-based "Whodunit task" among participants scoring high and low on the Community Assessment of Psychic Experiences (CAPE). We recruited a large sample (N = 979) from the general population who were divided into subgroups high vs. low on psychotic-like experiences (PLE), matched for depression and background characteristics. In the Whodunit task, participants were asked to rate the likelihood that one out of six suspects was the perpetrator of a crime (deliberately ambiguous with no clear clues until the end). The primary measure was the number of sequences-to-decision (STD). In line with the hypothesis, participants scoring high on the CAPE positive subscale displayed significantly lower STD and a higher rate of JTC. Response confidence in the assessments was elevated in the PLE-High group. The number of overall decisions was also significantly elevated for the PLE-High group. No group differences were found when comparing those scoring high versus low on depression. The STD index correlated significantly with a corresponding index from another JTC task. The study presents a new paradigm for the measurement of data gathering in the schizophrenia spectrum. Speaking to its validity, the Whodunit task was correlated with another JTC measure. Future research should test abbreviated versions of the paradigm, preferably using multiple trials with differing topics/emotional themes.

Jumping to Conclusions and Its Associations With Psychotic Experiences in Preadolescent Children at Familial High Risk of Schizophrenia or Bipolar Disorder-The Danish High Risk and Resilience Study, VIA 11

BACKGROUND

The jumping to conclusions (JTC) bias, ie, making decisions based on inadequate evidence, is associated with psychosis in adults and is believed to underlie the formation of delusions. Knowledge on the early manifestations of JTC and its associations with psychotic experiences (PE) in children and adolescents is lacking.

DESIGN

Preadolescent children (mean age 11.9 y, SD 0.2) at familial high risk of schizophrenia (FHR-SZ, n = 169) or bipolar disorder (FHR-BP, n = 101), and controls (n = 173) were assessed with the Beads Task to examine JTC. The number of beads drawn before making a decision, "draws to decision" (DTD) was used as a primary outcome. PE were ascertained in face-to-face interviews. General intelligence was measured with Reynolds Intellectual Screening Test.

RESULTS

Children at FHR-SZ took fewer DTD than controls (4.9 vs 5.9, Cohen's d = 0.31, P = .004). Differences were attenuated when adjusting for IQ (Cohen's d = 0.24, P = .02). Higher IQ was associated with a higher number of DTD (B = 0.073, P < .001). Current subclinical delusions compared with no PE were associated with fewer DTD in children at FHR-SZ (P = .04) and controls (P < .05). Associations between delusions and DTD were nullified when accounting for IQ.

CONCLUSIONS

JTC marks familial risk of psychosis in preadolescence, not reducible to general intelligence. JTC is associated with subclinical delusions, but this may be an expression of intellectual impairment. Future studies should establish temporality between JTC and delusion formation and examine JTC as a target for early intervention.

Neural Circuitry of Salience and Reward Processing in Psychosis

The processing of salient and rewarding stimuli is integral to engaging our attention, stimulating anticipation for future events, and driving goal-directed behaviors. Widespread impairments in these processes are observed in psychosis, which may be associated with worse functional outcomes or mechanistically linked to the development of symptoms. Here, we summarize the current knowledge of behavioral and functional neuroimaging in salience, prediction error, and reward. Although each is a specific process, they are situated in multiple feedback and feedforward systems integral to decision making and cognition more generally. We argue that the origin of salience and reward processing dysfunctions may be centered in the subcortex during the earliest stages of psychosis, with cortical abnormalities being initially more spared but becoming more prominent in established psychotic illness/schizophrenia. The neural circuits underpinning salience and reward processing may provide targets for delaying or preventing progressive behavioral and neurobiological decline.

Predictive waves in the autism-schizophrenia continuum: A novel biobehavioral model

The brain is a predictive machine. Converging data suggests a diametric predictive strategy from autism spectrum disorders (ASD) to schizophrenic spectrum disorders (SSD). Whereas perceptual inference in ASD is rigidly shaped by incoming sensory information, the SSD population is prone to overestimate the precision of their priors' models. Growing evidence considers brain oscillations pivotal biomarkers to understand how top-down predictions integrate bottom-up input. Starting from the conceptualization of ASD and SSD as oscillopathies, we introduce an integrated perspective that ascribes the maladjustments of the predictive mechanism to dysregulation of neural synchronization. According to this proposal, disturbances in the oscillatory profile do not allow the appropriate trade-off between descending predictive signal, overweighted in SSD, and ascending prediction errors, overweighted in ASD. These opposing imbalances both result in an ill-adapted reaction to external challenges. This approach offers a neuro-computational model capable of linking predictive coding theories with electrophysiological findings, aiming to increase knowledge on the neuronal foundations of the two spectra features and stimulate hypothesis-driven rehabilitation/research perspectives.

Innovations in the psychopathology of schizophrenia: a primer for busy clinicians

Significant developments in schizophrenia psychopathology are ready to be incorporated into clinical practice. These advances allow a way forward through the well-described challenges experienced with current diagnostic and psychopathological frameworks. This article discusses approaches that will enable clinicians to access a wider and richer spectrum of patient experience; describes process-based models of schizophrenia in the domains of both the brain and the mind; and considers how different levels of analysis might be linked via the predictive processing framework. Multiple levels of analysis provide different targets for varying modalities of treatment – dopamine blockade at the molecular level, psychological therapy at the level of the mind, and social interventions at the personal level. Psychiatry needs to align itself closer to neuroscientific research. It should move from a symptom-based understanding to a model based on process. That is – after having asked about a patient's symptoms and experience clinicians need to introduce steps involving a consideration of what might be the brain and mind processes underlying the experience.