Castiello Santiago, Rossi-Goldthorpe Rosa, Fan Siyan, Kenney Joshua, Waltz James A, Erickson Molly, Bansal Sonia, Gold James M, Corlett Philip R
Wu Tsai Institute, Yale University, New Haven, Connecticut.
School of Medicine, University of Maryland, Baltimore, Maryland.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2024 Dec 20. doi: 10.1016/j.bpsc.2024.12.006.
Phenomenological psychopathologists have recently highlighted how people with delusions experience multiple realities (delusional and nondelusional) and have suggested that this double bookkeeping cannot be explained via predictive processing. Here, we present data from Kamin blocking and extinction learning that show how predictive processing might, in principle, explain a pervasive sense of dual reality.
This cross-sectional study involved 3 participant groups: patients with schizophrenia (SZ) (n = 42), healthy participants with elevated esoteric beliefs (EEBs) (clairaudient psychics) (n = 31), and healthy control participants (HCs) with neither illness nor significant delusional ideation (n = 62). We examined belief formation using a Kamin blocking causal learning task with extinction and delusions with the 40-item Peters Delusion Inventory, specifically the unreality item "Do things around you ever feel unreal, as though it was all part of an experiment?" as a proxy for unreality experiences and beliefs. A clinician also assessed symptoms with a structured clinical interview.
Some people with SZ did not report a sense of unreality, and some people with elevated esoteric beliefs (but no psychotic illness) reported unreality experiences. No HCs reported them (despite reporting other delusion-like beliefs). Unreality experiences in clinical delusions and nonclinical delusion-like beliefs were associated with different types of aberrant prediction error processing.
These data suggest how predictive processing may explain the sense of unreality. They indicate that different prediction error dysfunctions are associated with delusions with different contents. In this case, we have used predictive processing to address a salient issue raised by our phenomenological colleagues, namely the impact of psychosis on experiences of and beliefs about reality.
现象学精神病理学家最近强调了妄想症患者如何体验多种现实（妄想性和非妄想性），并指出这种双重记录无法通过预测性加工来解释。在此，我们展示了来自卡明阻断和消退学习的数据，这些数据表明预测性加工原则上可能如何解释普遍存在的双重现实感。
这项横断面研究涉及3个参与者组：精神分裂症（SZ）患者（n = 42）、具有超自然信仰（EEB）（有幻听的灵媒）的健康参与者（n = 31）以及既无疾病也无明显妄想观念的健康对照参与者（HC）（n = 62）。我们使用带有消退的卡明阻断因果学习任务来检查信念形成，并使用40项彼得斯妄想量表来检查妄想，特别是将“你周围的事情是否曾感觉不真实，就好像这一切都是一个实验的一部分？”这一非现实项目作为非现实体验和信念的替代指标。一名临床医生还通过结构化临床访谈评估症状。
一些SZ患者未报告非现实感，一些具有超自然信仰（但无精神疾病）的人报告了非现实体验。没有HC报告这些（尽管他们报告了其他类似妄想的信念）。临床妄想和非临床类似妄想信念中的非现实体验与不同类型的异常预测误差加工相关。
这些数据表明预测性加工可能如何解释非现实感。它们表明不同的预测误差功能障碍与不同内容的妄想相关。在这种情况下，我们使用预测性加工来解决现象学同事提出的一个突出问题，即精神病对现实体验和信念的影响。
