Delusions and prediction error: re-examining the behavioural evidence for disrupted error signalling in delusion formation

Introduction. There is now significant evidence that prediction error signalling is mediated by dopamine in the midbrain, and that dopamine dysfunction is implicated in people experiencing psychotic symptoms, including delusions. There has also been significant theorizing and experimentation concerning the remaining link in this triad, namely that deviant prediction error signalling produces or maintains psychotic symptoms.

Methods. The research supporting the link between prediction error signalling and delusional symptoms was reviewed. Numerous studies indirectly support this link, but only one set of studies claim to directly test this hypothesis by combining three crucial elements: a patient sample, a manipulation of prediction error and neuroimaging. This particular set of studies were examined in detail.

Results. Important methodological limitations in these studies were observed, and a reinterpretation of their data was offered.

Conclusions. Methodological inconsistencies significantly weaken the claims made by these studies, but their data are consistent with current theorizing and they are instructive for future lines of inquiry in this field.