Abstract
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.
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10 March 2020
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Acknowledgements
The authors thank T. Maia, S. Haber and K. Schmack for insightful discussions on the ideas presented in this article. The authors acknowledge funding sources: G.H.: R01MH117323, R01MH114965;A.A-D.: R01MH109635.
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Nature Reviews Neuroscience thanks P. Corlett, P. Fletcher and the other, anonymous, reviewer(s), for their contribution to the peer review of this work.
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G.H. researched data for the article, and both authors made substantial contributions to discussion of the content and writing, reviewing and editing the manuscript before submission.
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Glossary
- Schizophrenia
-
A psychiatric illness characterized by a variety of symptoms, including positive symptoms, negative symptoms (for example, apathy and amotivation) and cognitive impairments (for example, memory deficits).
- Psychotic disorders
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A group of disorders, including schizophrenia and other disorders, such as bipolar disorder, with psychotic features, that present with psychotic or positive symptoms.
- Auditory verbal hallucinations
-
(AVH). Percepts of speech or voices without corresponding speech stimuli.
- Positive symptoms
-
Also known as psychotic symptoms or psychosis; symptoms that are added to the repertoire of usual experiences and that represent a loss of contact with reality (that is, subjective experiences that substantially deviate from what most perceive as objective evidence), including hallucinations and delusions.
- Prodromal
-
Related to the psychosis prodrome or prodromal phase, terms that refer to the phase preceding the development of full-blown symptoms of a psychotic disorder; typically defined by the expression of attenuated forms of positive symptoms.
- Marr’s three levels of analysis
-
A framework whereby information-processing systems can be understood at three distinct, complementary levels: computational (the problem that is solved), algorithmic (what representations and processes are used to solve this problem) and implementational (the physical and biological substrates through which the solution is realized).
- Bayesian inference
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A statistical algorithm for probabilistic estimation that relies on the optimal combination of prior knowledge and new data.
- Inner speech
-
A person’s inner dialogue, expressed as a silent conscious stream of thoughts in a coherent linguistic form.
- Gating
-
A process by which the passage of information is actively controlled, thereby facilitating or impeding information flow.
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Horga, G., Abi-Dargham, A. An integrative framework for perceptual disturbances in psychosis. Nat Rev Neurosci 20, 763–778 (2019). https://doi.org/10.1038/s41583-019-0234-1
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DOI: https://doi.org/10.1038/s41583-019-0234-1
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