A study led by Stanford Medicine has shed light on the brain mechanisms that underlie psychosis. The study focused on two key systems in the brain that are dysfunctional in people with psychosis: a “filter” that directs attention toward important external events and internal thoughts, and a “predictor” composed of pathways that anticipate rewards. Dysfunction in these systems can lead to difficulties in distinguishing what’s real, resulting in hallucinations and delusions that are characteristic of psychosis.
The findings of the study, published in Molecular Psychiatry, were based on brain scan data from children, teens, and young adults with psychosis. The study confirmed an existing theory of how breaks with reality occur in individuals with psychosis. The results are significant as they advance scientists’ understanding of the underlying brain mechanisms and theoretical frameworks related to psychosis. Psychosis is a hallmark symptom of serious mental illnesses such as bipolar disorder and schizophrenia, characterized by hallucinations, delusional beliefs, social withdrawal, disorganized thinking, and a reduction in energy and motivation.
To gain insight into how schizophrenia begins in the brain, the research team studied young people with 22q11.2 deletion syndrome, a genetic condition with a 30% risk for psychosis or schizophrenia. They found that brain function in individuals with 22q11.2 deletion syndrome who have psychosis is similar to those with psychosis of unknown origin. The study used machine learning algorithms to analyze patterns of brain function in individuals with the syndrome compared to healthy subjects. These patterns supported theoretical models of how cognitive control systems malfunction in psychosis, leading to intrusive thoughts dominating the brain’s normal functioning.
The study identified the brain’s salience network and the ventral striatum as key regions involved in predicting psychosis. These brain regions play a crucial role in directing attention to important internal thoughts and external events and predicting rewarding or important outcomes. The findings of the study suggest that functional interactions among brain regions within the same systems are abnormal early on, even before the onset of psychosis symptoms. This suggests that targeting these brain regions with treatments such as transcranial magnetic stimulation or focused ultrasound could potentially prevent or delay the onset of psychosis or lessen symptoms.
The research team’s goal is to understand the underlying brain mechanisms of psychosis to develop targeted treatments aimed at preventing or delaying the onset of schizophrenia. By monitoring brain activity in key centers using functional MRI, scientists may be able to investigate how existing antipsychotic medications are working. The study underscores the importance of approaching individuals with psychosis with compassion and empathy, emphasizing the need for greater understanding and support for those living with the condition. The findings of the study have implications for improving the treatment and management of psychosis and inspiring a cultural shift toward empathy and solidarity for those experiencing psychosis.
