Computational Mechanism for the Effect of Psychosis Community Treatment: A Conceptual Review from Neurobiology to Social Interaction

TL;DR

This paper explores how computational models of psychosis can inform social and community-based treatments by linking neurobiological mechanisms to clinical interventions, aiming to improve understanding and therapeutic strategies.

Contribution

It applies computational models of maladaptive priors to social interventions in psychosis, proposing a mechanistic understanding of treatment effects and patient responses.

Findings

Models explain symptom reduction through increased sensory precision

Interventions provide structure that counters low sensory information precision

Predictions about patient responses to treatment modifications are generated

Abstract

The computational underpinnings of positive psychotic symptoms have recently received significant attention. Candidate mechanisms include some combination of maladaptive priors and reduced updating of these priors during perception. A potential benefit of models with such mechanisms is their ability to link multiple levels of explanation. This is key to improving how we understand the experience of psychosis. Moreover, it points us towards more comprehensive avenues for therapeutic research by providing a putative mechanism that could allow for the generation of new treatments from first principles. In order to demonstrate this, our conceptual paper will discuss the application of the insights from previous computational models to an important and complex set of evidence-based clinical interventions with strong social elements, such as coordinated specialty care clinics in early psychosis and assertive community treatment. These interventions may include but also go beyond psychopharmacology, providing, we argue, structure and predictability for patients experiencing psychosis. We develop the argument that this structure and predictability directly counteract the relatively low precision afforded to sensory information in psychosis, while also providing the patient more access to external cognitive resources in the form of providers and the structure of the programs themselves. We discuss how computational models explain the resulting reduction in symptoms, as well as the predictions these models make about potential responses of patients to modifications or to different variations of these interventions. We also link, via the framework of computational models, the experiences of patients and response to interventions to putative neurobiology.