Brain Advance Access published online on August 9, 2007
Brain, doi:10.1093/brain/awm173
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Disrupted prediction-error signal in psychosis: evidence for an associative account of delusions
1Brain Mapping Unit, Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, 2CAMEO, Cambridgeshire and Peterborough Mental Health Partnership NHS Trust, Cambridge, CB1 5EE, 3Department of Experimental Psychology, University of Cambridge, Downing Street, CB2 3EB, UK and 4Department of Psychology, University College London, Gower Street, London WC1E 6BT, UK
Correspondence to:
Dr Paul C. Fletcher, Box 255, University of Cambridge, Department of Psychiatry, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK E-mail: pcf22{at}cam.ac.uk
Delusions are maladaptive beliefs about the world. Based upon experimental evidence that prediction error—a mismatch between expectancy and outcome—drives belief formation, this study examined the possibility that delusions form because of disrupted prediction-error processing. We used fMRI to determine prediction-error-related brain responses in 12 healthy subjects and 12 individuals (7 males) with delusional beliefs. Frontal cortex responses in the patient group were suggestive of disrupted prediction-error processing. Furthermore, across subjects, the extent of disruption was significantly related to an individual's propensity to delusion formation. Our results support a neurobiological theory of delusion formation that implicates aberrant prediction-error signalling, disrupted attentional allocation and associative learning in the formation of delusional beliefs.
Key Words: prediction error; associative learning; fMRI; delusions; psychosis
Abbreviations: rPFC, right prefrontal cortex
Received February 7, 2007. Accepted July 5, 2007.
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