Active inference, epistemic value, and uncertainty in conceptual disorganization in first episode schizophrenia

Background and HypothesisActive inference has become an influential concept in psychopathology. We apply active inference to investigate language behaviour in first-episode schizophrenia. We conceptualize speech production as a decision-making process affected by the latent “conceptual organization” during the selection of words. We consider conceptual organization as a special case of uncertainty about the causes of sensory information. Uncertainty is minimized via speech production —in which functions words index conceptual organization in terms of analytic thinking— and tracked by a domain-general salience network. We hypothesize that analytic thinking depends on the conceptual organization state and that this state affects the effective connectivity within the salience network.Study DesignWith one-minute speech samples from a picture description task and resting state fMRI from 30 patients and 30 healthy subjects, we employed dynamic causal and probabilistic graphical models to investigate if the effective connectivity of the salience network underwrites conceptual organization. Study ResultsLow analytic thinking scores index low conceptual organization which affects diagnostic status. The influence of the anterior insula on the anterior cingulate cortex is elevated while the self-inhibition within the anterior cingulate cortex is reduced given low conceptual organization (i.e., conceptual disorganization). ConclusionsConceptual organization, a construct that explains formal thought disorder, can be modeled in an active inference framework and studied in relation to putative neural substrates of disrupted language in schizophrenia. This provides a critical advance to move away from rating scale scores to deeper constructs in the pursuit of the pathophysiology of formal thought disorder.