You read my mind: fMRI markers of threatening appraisals in people with persistent psychotic experiences

Raphael Underwood,Jeffrey Dalton,Veena Kumari,Gareth J Barker,Liam Mason,Andrew Simmons,Emmanuelle Peters,Owen O’Daly

doi:10.1038/s41537-021-00173-0

Abstract

Anomalous perceptual experiences are relatively common in the general population. Evidence indicates that the key to distinguishing individuals with persistent psychotic experiences (PEs) with a need for care from those without is how they appraise their anomalous experiences. Here, we aimed to characterise the neural circuits underlying threatening and non-threatening appraisals in people with and without a need for care for PEs, respectively. A total of 48 participants, consisting of patients with psychosis spectrum disorder (clinical group, n = 16), non-need-for-care participants with PEs (non-clinical group, n = 16), and no-PE healthy control participants (n = 16), underwent functional magnetic resonance imaging while completing the Telepath task, designed to induce an anomalous perceptual experience. Appraisals of the anomalous perceptual experiences were examined, as well as functional brain responses during this window, for significant group differences. We also examined whether activation co-varied with the subjective threat appraisals reported in-task by participants. The clinical group reported elevated subjective threat appraisals compared to both the non-clinical and no-PE control groups, with no differences between the two non-clinical groups. This pattern of results was accompanied by reduced activation in the superior and inferior frontal gyri in the clinical group as compared to the non-clinical and control groups. Precuneus activation scaled with threat appraisals reported in-task. Resilience in the context of persistent anomalous experiences may be explained by intact functioning of fronto-parietal regions, and may correspond to the ability to contextualise and flexibly evaluate psychotic experiences.

Highlights

Cognitive models of psychosis propose that appraisals are key to the transition from benign psychotic experiences to clinically relevant symptoms[1,2,3,4,5]
Regression of subjective threat appraisal ratings in the psychotic experiences (PEs) groups. When observing both PE groups together, higher threat appraisal scores were a significant predictor of less activity in the precuneus (Fig. 3; peak: 2[x], −58[y], 32[z], T = 5.78; 20 contiguous voxels; cluster-forming threshold FWE-corrected p = 0.015)
Non-clinical participants reported having had their psychotic experiences for significantly more years than the clinical group, echoing previous findings[23]

Summary

Introduction

Cognitive models of psychosis propose that appraisals are key to the transition from benign psychotic experiences to clinically relevant symptoms[1,2,3,4,5] These models postulate that biological, psychological, and environmental factors give rise to the aberrant assignment of salience to perceptual experiences (perceiving such experiences as more important or personally relevant than they are). Individuals with a ‘need for care’ are more likely to appraise their psychotic experiences as caused by other people[6], and malevolent in intent[7,8] These threatening appraisals contribute to clinically relevant distress[9].

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Conclusion