Evidence for Reduced Sensory Precision and Increased Reliance on Priors in Hallucination-Prone Individuals in a General Population Sample

A Computational Account of the Development and Evolution of Psychotic Symptoms

The mechanisms of psychotic symptoms such as hallucinations and delusions are often investigated in fully formed illness, well after symptoms emerge. These investigations have yielded key insights but are not well positioned to reveal the dynamic forces underlying symptom formation itself. Understanding symptom development over time would allow us to identify steps in the pathophysiological process leading to psychosis, shifting the focus of psychiatric intervention from symptom alleviation to prevention. We propose a model for understanding the emergence of psychotic symptoms within the context of an adaptive, developing neural system. We make the case for a pathophysiological process that begins with cortical hyperexcitability and bottom-up noise transmission, which engenders inappropriate belief formation via aberrant prediction error signaling. We argue that this bottom-up noise drives learning about the (im)precision of new incoming sensory information because of diminished signal-to-noise ratio, causing a compensatory relative overreliance on prior beliefs. This overreliance on priors predisposes to hallucinations and covaries with hallucination severity. An overreliance on priors may also lead to increased conviction in the beliefs generated by bottom-up noise and drive movement toward conversion to psychosis. We identify predictions of our model at each stage, examine evidence to support or refute those predictions, and propose experiments that could falsify or help select between alternative elements of the overall model. Nesting computational abnormalities within longitudinal development allows us to account for hidden dynamics among the mechanisms driving symptom formation and to view established symptoms as a point of equilibrium among competing biological forces.

Multisensory perceptual and causal inference is largely preserved in medicated post-acute individuals with schizophrenia

Hallucinations and perceptual abnormalities in psychosis are thought to arise from imbalanced integration of prior information and sensory inputs. We combined psychophysics, Bayesian modeling, and electroencephalography (EEG) to investigate potential changes in perceptual and causal inference in response to audiovisual flash-beep sequences in medicated individuals with schizophrenia who exhibited limited psychotic symptoms. Seventeen participants with schizophrenia and 23 healthy controls reported either the number of flashes or the number of beeps of audiovisual sequences that varied in their audiovisual numeric disparity across trials. Both groups balanced sensory integration and segregation in line with Bayesian causal inference rather than resorting to simpler heuristics. Both also showed comparable weighting of prior information regarding the signals' causal structure, although the schizophrenia group slightly overweighted prior information about the number of flashes or beeps. At the neural level, both groups computed Bayesian causal inference through dynamic encoding of independent estimates of the flash and beep counts, followed by estimates that flexibly combine audiovisual inputs. Our results demonstrate that the core neurocomputational mechanisms for audiovisual perceptual and causal inference in number estimation tasks are largely preserved in our limited sample of medicated post-acute individuals with schizophrenia. Future research should explore whether these findings generalize to unmedicated patients with acute psychotic symptoms.

A computational account of the development and evolution of psychotic symptoms

The mechanisms of psychotic symptoms like hallucinations and delusions are often investigated in fully-formed illness, well after symptoms emerge. These investigations have yielded key insights, but are not well-positioned to reveal the dynamic forces underlying symptom formation itself. Understanding symptom development over time would allow us to identify steps in the pathophysiological process leading to psychosis, shifting the focus of psychiatric intervention from symptom alleviation to prevention. We propose a model for understanding the emergence of psychotic symptoms within the context of an adaptive, developing neural system. We will make the case for a pathophysiological process that begins with cortical hyperexcitability and bottom-up noise transmission, which engenders inappropriate belief formation via aberrant prediction error signaling. We will argue that this bottom-up noise drives learning about the (im)precision of new incoming sensory information because of diminished signal-to-noise ratio, causing an adaptive relative over-reliance on prior beliefs. This over-reliance on priors predisposes to hallucinations and covaries with hallucination severity. An over-reliance on priors may also lead to increased conviction in the beliefs generated by bottom-up noise and drive movement toward conversion to psychosis. We will identify predictions of our model at each stage, examine evidence to support or refute those predictions, and propose experiments that could falsify or help select between alternative elements of the overall model. Nesting computational abnormalities within longitudinal development allows us to account for hidden dynamics among the mechanisms driving symptom formation and to view established symptomatology as a point of equilibrium among competing biological forces.

The mechanisms underlying conditioning of phantom percepts differ between those with hallucinations and synesthesia

There are many different kinds of 'phantom' percepts but it is unknown whether they are united by common mechanisms. For example, synaesthesia (e.g., numbers evoking colour) and hallucinations appear conceptually and phenomenologically similar: both result in a percept that does not have an environmental correlate. Here, people with synaesthesia (n = 66) performed a conditioned hallucinations paradigm known to be sensitive to hallucination susceptibility, and we asked whether synaesthetes would show the same behavioural profile as hallucinators in this task. Repeated pairing of checkerboards with tones, and gratings with colours encourages the participant to draw on prior knowledge when asked to report on the presence of the difficult-to-detect target stimulus. Synaesthetes show increased modelled expectancies for the stimulus association across the board, resulting in a higher number of detections at all stimulus intensities. This is in contrast to the pattern observed in hallucinators, who weigh their prior beliefs more strongly than controls, giving rise to more conditioned hallucinations. Results indicate that fundamentally different perceptual processes may be at the core of these seemingly similar experiences.