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Meta-analysis finds no evidence for atypical reliance on prior expectations in schizophrenia-spectrum psychosisLarge review finds no evidence that psychosis involves unusual reliance on expectations

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Key Takeaway
Interpret meta-analysis cautiously; no evidence found for atypical reliance on priors in psychosis or associations with delusions/hallucinations.

A systematic review and meta-analysis examined evidence for aberrant reliance on prior expectations in psychosis across perceptual tasks. The analysis included 904 adults with schizophrenia-spectrum psychosis and 1,039 healthy controls. The primary outcome was evidence for atypical reliance on priors in psychosis, with secondary analyses exploring associations with delusions and hallucinations. The study design was observational, and risk of bias was assessed using the Newcastle-Ottawa Scale.

The meta-analysis found no evidence for atypical reliance on priors in psychosis compared to healthy controls, with a Hedges' g effect size of .03 (95% CI [-0.27, 0.34]; p = .818). Secondary analyses found no evidence for associations with delusions (r = -.16, 95% CI [-0.51, 0.19]; p = .293; n=183) or with hallucinations (r = .04, 95% CI [-0.28, 0.36]; p = .780; n=370). A two-level hierarchical model of priors did not account for conflicting results in the literature (F(1,32) = 0.1, p = .758).

Safety and tolerability data were not reported. Key limitations were not reported in the provided data. The authors note the findings do not suggest psychosis is associated with a generalized predictive processing deficit spanning multiple aspects of perception. The evidence is observational, and causality cannot be inferred. Practice relevance was not reported.

Researchers conducted a large review to test a theory about psychosis. The theory suggests that people with conditions like schizophrenia might process sensory information differently by relying too much or too little on their past expectations. The analysis combined data from many previous studies, involving 904 adults with schizophrenia-spectrum psychosis and 1,039 healthy adults for comparison. They looked at how people used their expectations during various perception tasks.

The main finding was that, overall, there was no evidence that people with psychosis used their prior expectations in an unusual way compared to healthy individuals. The analysis also specifically checked if this was connected to two major symptoms: delusions and hallucinations. It found no clear link between how someone used expectations and whether they experienced these symptoms.

This was a meta-analysis, which means it combined results from many smaller observational studies. This type of research can identify patterns but cannot prove that one thing causes another. The authors note their findings do not support the idea that psychosis involves a broad, general problem with how the brain predicts and processes sensory information across different situations.

For readers, this research helps refine scientific theories about how the brain works in psychosis. It suggests that if there are differences in how expectations guide perception, they might be more specific or complex than a simple overall shift. The results are important for guiding future, more detailed research rather than for immediate changes in understanding or treatment.

What this means for you:
A large review found no link between psychosis and how people use expectations to perceive the world.

Study Details

Study typeMeta analysis
Sample sizen = 904
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
Background: The highly influential predictive processing theory of psychosis posits that symptoms arise from imbalances in the weighting of predictions (priors) and sensory evidence. Despite this theory's increasing prominence, studies often present conflicting results. This is particularly problematic as findings from single tasks with modest sample sizes are frequently used to advance a theory for a generalised altered reliance on priors in psychosis. Methods: This study presents a random-effects, multi-level meta-analysis (PROSPERO CRD42024574379) evaluating evidence for aberrant reliance on priors in psychosis across perceptual tasks. The search identified articles in Embase, MEDLINE, APA PsycINFO, and APA PsycArticles published between 1st January 2005 and 31st October 2024, with risk of bias assessed using the Newcastle-Ottawa Scale. Included articles (34 results from 27 studies) compared adults with schizophrenia-spectrum psychosis (SZ; n = 904) to healthy controls (n = 1,039) on behavioural measures representing reliance on priors. Results: Results provided no evidence for atypical reliance on priors in psychosis (g = .03, 95% CI [-0.27, 0.34]; p = .818) or associations with delusions (6 results; SZ = 183; r = -.16, 95% CI [-0.51, 0.19]; p = .293) or hallucinations (10 results; SZ = 370; r = .04, 95% CI [-0.28, 0.36]; p = .780). In contrast with the theory that psychosis may differentially affect priors at different levels of the cognitive hierarchy, a sub-group analysis indicated that a two-level hierarchical model of priors did not account for conflicting results (F(1,32) = 0.1, p = .758). Conclusion: These findings do not suggest that psychosis is associated with a generalised predictive processing deficit spanning multiple aspects of perception. Key words: psychosis, schizophrenia, predictive processing, prior expectations, perception
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