Neurofunctional representations of instrumental learning in psychosis: a meta-analysis of neuroimaging studies

Establishing appropriate action-outcome associations can allow animals and humans to control behavior and the environment in a goal-directed manner. Deficits in instrumental learning in psychosis have been widely reported in past studies, but the results remain elusive.

To explore the consistent neural representations of instrumental learning in functional magnetic resonance imaging (fMRI) in individuals with psychosis, a total of 18 studies (458 individuals with psychosis and 454 controls) were included in our coordinate-based meta-analysis.

Patients with psychosis presented increased activation in the left middle occipital gyrus, insula, and lingual and postcentral gyri; decreased activation in cortico-striato-thalamo-cortical (CSTC) networks, including the dorsal striatum, insula, thalamus, middle cingulate cortex, posterior cingulate cortex, dorsolateral, orbital, and medial prefrontal cortices (DLPFC, OFC, and mPFC), cerebellum, and associated sensory areas, during instrumental learning. Moreover, mPFC hypoactivation was negatively associated with the percentage of first-generation antipsychotic users, and insula hyperactivation was negatively associated with the percentage of medicated individuals.

Our study revealed that the CSTC circuit could facilitate action-based reward learning in psychosis and may help explain the neuropathological mechanisms underlying these deficits in this disorder.