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Psychobiology of threat appraisal in the context of psychotic experiences: A selective review

Published online by Cambridge University Press:  16 April 2020

R. Underwood
Affiliation:
King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, UK
E. Peters
Affiliation:
King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, UK
V. Kumari*
Affiliation:
King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, UK
*
*Corresponding author. Department of Psychology, King's College London, Institute of Psychiatry, Henry Wellcome Building, De Crespigny Park, PO78, London SE5 8AF, UK. E-mail address: veena.kumari@kcl.ac.uk (V. Kumari).
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Abstract

A key factor in the transition to psychosis is the appraisal of anomalous experiences as threatening. Cognitive models of psychosis have identified attentional and interpretative biases underlying threat-based appraisals. While much research has been conducted into these biases within the clinical and cognitive literature, little examination has occurred at the neural level. However, neurobiological research in social cognition employing threatening stimuli mirror cognitive accounts of maladaptive appraisal in psychosis. This review attempted to integrate neuroimaging data regarding social cognition in psychosis with the concepts of attentional and interpretative threat biases. Systematic review methodology was used to identify relevant articles from Medline, PsycINFO and EMBASE, and PubMed databases. The selective review showed that attentional and interpretative threat biases relate to abnormal activation of a range of subcortical and prefrontal structures, including the amygdala, insula, hippocampus, anterior cingulate, and prefrontal cortex, as well as disrupted connectivity between these regions, when processing threatening and neutral or ambiguous stimuli. Notably, neural findings regarding the misattribution of threat to neutral or ambiguous stimuli presented a more consistent picture. Overall, however, the findings for any specific emotion were mixed, both in terms of the specific brain areas involved and the direction of effects (increased/decreased activity), possibly owing to confounds including small sample sizes, varying experimental paradigms, medication, and heterogeneous, in some cases poorly characterised, patient groups. Further neuroimaging research examining these biases by employing experimentally induced anomalous perceptual experiences and well-characterised large samples is needed for greater aetiological specificity.

Type
Review
Copyright
European Psychiatric Association 2015

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Psychobiology of threat appraisal in the context of psychotic experiences: A selective review
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