Disruption of conscious access in psychosis is associated with altered structural brain connectivity
Open accessAbstract
According to global neuronal workspace (GNW) theory, conscious access relies on long-distance cerebral connectivity to allow a global neuronal ignition coding for conscious content. In patients with schizophrenia and bipolar disorder, both alterations in cerebral connectivity and an increased threshold for conscious perception have been reported. The implications of abnormal structural connectivity for disrupted conscious access and the relationship between these two deficits and psychopathology remain unclear. The aim of this study was to determine the extent to which structural connectivity is correlated with consciousness threshold, particularly in psychosis. We used a visual masking paradigm to measure consciousness threshold, and diffusion MRI tractography to assess structural connectivity in 97 humans of either sex with varying degrees of psychosis: healthy control subjects (n = 46), schizophrenia patients (n = 25), and bipolar disorder patients with (n = 17) and without (n = 9) a history of psychosis. Patients with psychosis (schizophrenia and bipolar disorder with psychotic features) had an elevated masking threshold compared with control subjects and bipolar disorder patients without psychotic features. Masking threshold correlated negatively with the mean general fractional anisotropy of white matter tracts exclusively within the GNW network (inferior frontal-occipital fasciculus, cingulum, and corpus callosum). Mediation analysis demonstrated that alterations in long-distance connectivity were associated with an increased masking threshold, which in turn was linked to psychotic symptoms. Our findings support the hypothesis that long-distance structural connectivity within the GNW plays a crucial role in conscious access, and that conscious access may mediate the association between impaired structural connectivity and psychosis.
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Tractography has reoriented neurosurgical planning, enabled in vivo studies of language and motor pathways, and provided a framework for rethinking neurological and psychiatric disorders as disorders of networks.
“It has reoriented neurosurgical planning (Yang et al., 2021), enabled in vivo studies of language and motor pathways, and provided a framework for rethinking neurological and psychiatric disorders as disorders of networks (Berkovitch et al., 2021).”
From 40 Years of diffusion MRI in the brain: From history to emerging frontiers (2026) · cites this paper as Berkovitch et al., 2021
The Introduction and Discussion (page numbers unavailable) describe using tractography to study structural connectivity in psychosis and link impaired connectivity with psychotic symptoms. This supports the psychiatric-network aspect, but the paper does not establish the broader claim about neurological disorders or in vivo studies of language and motor pathways. The neurosurgical-planning clause is cited to Yang et al., not Berkovitch et al. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMore focused work has linked long-distance structural connectivity within the global neuronal workspace to impaired conscious access and psychotic symptoms.
“More focused work has linked long-distance structural connectivity within the global neuronal workspace to impaired conscious access and psychotic symptoms (Berkovitch et al., 2021).”
From 40 Years of diffusion MRI in the brain: From history to emerging frontiers (2026) · cites this paper as Berkovitch et al., 2021
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Intact subliminal processing and delayed conscious access in multiple sclerosis
Reuter, F., Del Cul, A., Audoin, B., Malikova, I., Naccache, L., Ranjeva, J. P., Lyon-Caen, O., Ali Chérif, A., Cohen, L., Dehaene, S., et al. (2007) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2007.04.010 · Cited by 31 · cited 1× · see citing works
“Stimuli and procedures were identical to those in the study by Del Cul et al. (2009), using a variant of the masking paradigm adapted for normal and clinical populations (Del Cul et al., 2006, 2007; Reuter et al., 2007, 2009; Charles et al., 2017; Berkovitch et al., 2018; Fig.”
MethodSelf-citationHigashima, M., Takeda, T., Kikuchi, M., Nagasawa, T., Hirao, N., Oka, T., Nakamura, M., & Koshino, Y. (2006) · Psychiatry Research · doi:10.1016/j.psychres.2005.05.020 · Cited by 28 · see citing works
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Divergent backward masking performance in schizophrenia and bipolar disorder: Association with COMT
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- Authors
- Berkovitch, L., Charles, L., Del Cul, A., Hamdani, N., Delavest, M., Sarrazin, S., Mangin, J.-F., Guevara, P., Ji, E., d'Albis, M.-A., Gaillard, R., Bellivier, F., Poupon, C., Leboyer, M., Tamouza, R., Dehaene, S., & Houenou, J.
- Affiliations
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives (FR)
- University College London (GB)
- Assistance Publique – Hôpitaux de Paris (FR)
- University of Concepción (CL)
- Inserm (FR)
- Collège de France (FR)
- ORCID
- Venue
- The Journal of Neuroscience
- Publisher
- Society for Neuroscience
- Published
- 2020-11-23
- Volume
- 41
- Issue
- 3
- Pages
- 513-523
- ISSN
- 0270-6474 (ISSN-L)
- 1529-2401
- PMC
- PMC7821858
- OpenAlex
- W3107465964
- Cited by
- 36
- References
- 93
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 11 · 2023: 5 · 2022: 7 · 2021: 7
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Neuroscience (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Fondation pour la Recherche Médicale (40532, DIC20161236445)
- MINEDUC | Comisión Nacional de Investigación Científica y Tecnológica (1161427, ACT172121, FB0008)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Keywords
- conscious access, consciousness threshold, global neuronal workspace theory, structural brain connectivity, schizophrenia, bipolar disorder, psychosis, visual masking, fractional anisotropy, inferior fronto-occipital fasciculus, cingulum, corpus callosum, white matter tracts
- MeSH terms
- Adolescent, Adult, Bipolar Disorder, Brain, Consciousness, Female, Humans, Male, Middle Aged, Neural Pathways, Perceptual Masking, Psychotic Disorders, Schizophrenia, Schizophrenic Psychology, Sensory Thresholds, Young Adult, Diffusion Tensor Imaging, White Matter
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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