Visual Neuroscience ~2007!, 24, 183–189. Printed in the USA.

Copyright © 2007 Cambridge University Press 0952-5238007 $25.00

DOI: 10.10170S0952523807070253

Visual contrast sensitivity alterations in inferred magnocellular

pathways and anomalous perceptual experiences in people
at high-risk for psychosis

SZABOLCS KÉRI 1 and GYÖRGY BENEDEK 2

1
Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
2
University of Szeged, Department of Physiology, Szeged, Hungary
(Received October 31, 2006; Accepted March 9, 2007!

Abstract
Evidence suggests that patients with schizophrenia show impaired performances on tests assessing the magnocellular
~M! visual pathway. The aim of this study was to investigate M pathway functioning in persons at high-risk of
psychosis. Sixteen high-risk persons at the prodromal phase of psychosis and 20 healthy controls participated. Two
types of contrast sensitivity measurements were used, during which participants were asked to detect a briefly
presented target Gabor patch. In the pulsed-pedestal paradigm, the luminance of the background field was decreased
to saturate M pathways and to bias information processing to parvocellular ~P! pathways. In the steady-pedestal
paradigm, the luminance of the background field was constant and briefly presented targets were processed by the
M pathway. Anomalous perceptual experiences were assessed using the Structured Interview for Assessing
Perceptual Anomalies ~SIAPA!. Results revealed that the high-risk persons showed elevated contrast sensitivity
during the M pathway test, and normal sensitivity during the P pathway test. The visual SIAPA scores showed
significant positive correlations with the M pathway sensitivity values. These results suggest that the high-risk
mental state is associated with hyper-reactive M pathways, which may be responsible for some anomalous
perceptual experiences, including abnormal intensity of environmental stimuli, feelings of being flooded and
inundated, and inability to focus attention to relevant details.
Keywords: Schizophrenia, High-risk mental state, Prodrome, Visual perception, Magnocellular pathways, Contrast
sensitivity

Introduction ~Hawkins et al., 2003!, which is a “terra incognita” in the litera-

ture. We used the framework of the magnocellular ~M! and
Although standard clinical descriptions of schizophrenia do not
parvocellular ~P! visual pathways. M pathways ~transient chan-
emphasize visual symptoms, many patients report anomalous per-
nels! respond to small luminance changes, low spatial frequencies
ceptual experiences, including abnormal intensity of environmen-
~coarse resolution of objects!, and to rapid temporal changes ~brief
tal stimuli, feelings of being flooded and inundated, and inability
stimulus exposure and fast offset!. P pathways ~sustained channels!
to focus attention to relevant details ~Phillipson & Harris, 1985;
prefer static stimuli with high spatial frequencies ~fine details of
Bunney et al., 1999!. It is of particular importance that these visual
objects! and colors ~Van Essen & Gallant, 1994; Callaway, 2005!.
symptoms are especially pronounced in the initial and prodromal
Despite a substantial overlap and interaction between M and P
stage of the illness before the evolution of the full-blown syndrome
pathways in primary visual cortex ~Sincich & Horton, 2005!, M
or chronic states ~Klosterkötter et al., 2001; Parnas et al., 2001!.
pathways give a definite input to cortical areas responsible for
Therefore, people who experience anomalous visual perceptions,
motion perception, detection of spatial location, and visuo-motor
together with other cognitive, emotional, and social symptoms, are
coordination ~dorsal occipito-parietal stream!. P pathways project
at increased risk of psychosis.
to ventral occipito-temporal regions related to color perception and
The purpose of this study was to evaluate perceptual anomalies
object recognition ~Van Essen & Gallant, 1994!. Input from the M
and their psychophysical bases in people at high-risk of psychosis
pathways also plays an important role in the prompt mobilization
of attentional resources, which have a modifying effect on
information-processing in the ventral object recognition system
Address correspondence and reprint requests to: Szabolcs Kéri,
Semmelweis University, Department of Psychiatry and Psychotherapy,
~Vidyasagar, 1999!. Evidence suggests that the M pathway-dorsal
Ballassa u. 6, H1083, Budapest, Hungary. E-mail: szkeri@phys.szote.u- stream system is especially affected in patients with schizophrenia
szeged.hu and even in their unaffected relatives ~O’Donnell et al., 1996; Chen

183
184 S. Keri and G. Benedek

et al., 1999; Braus et al., 2002; Kéri et al., 2004; Butler et al., 2001,
2005; but see e.g. Slaghuis, 1998; Delord et al., 2006!. M pathway
dysfunctions may lead to inability to process rapidly changing
stimuli, dysfunctional visuo-motor coordination, and attentional
problems, and these symptoms may be related to the genetic
background of schizophrenia.
To investigate M and P pathway functions, a new contrast
sensitivity paradigm was used ~Pokorny & Smith, 1997; Leonova
et al., 2003!. The task was the detection of a briefly presented
low-contrast target Gabor patch ~Fig. 1!. In the pulsed-pedestal
paradigm, the test ~target detection! period is preceded by an
adaptation period during which a homogeneous adapting field with
high luminance is presented. During the test period, the luminance
of the background field containing the target is decreased. This
abrupt onset of the luminance pedestal causes a large transient
response that saturates the M pathways. The P pathway, which is
more sustained, is not saturated and is left to respond to the Gabor
patch. Therefore, the pulsed-pedestal paradigm favors the P path-
ways. When there is no sudden change in the luminance of the
background field ~steady-pedestal paradigm!, briefly presented

Fig. 1. The contrast sensitivity paradigms. The task was to detect a briefly presented Gabor patch. In the pulsed-pedestal paradigm, the
luminance of the background field is decreased to saturate magnocellular ~M! pathways and bias information processing to
parvocellular ~P! pathways. In the steady-pedestal paradigm, the luminance of the background field is constant and briefly presented
targets are processed by the M pathway.
Visual contrast sensitivity alterations
Fig. 2. Mean SIAPA ~Structured Interview for Assessing Perceptual Anomalies! scores. The high-risk persons showed elevated values
in the auditory, visual, and olfactory modality ~*p ⬍ 0.005, t-test!.
targets are processed by the M pathway ~Fig. 1!. These contrast
sensitivity paradigms reliably show the spatial frequency prefer-
ence of M and P pathways: in the steady-pedestal paradigm ~M
pathway!, sensitivity is higher at low spatial frequencies, whereas
in the pulsed-pedestal paradigm ~P pathway!, sensitivity is higher
as spatial frequency increases ~Pokorny & Smith, 1997; Leonova
et al., 2003!.
We hypothesized that persons at high-risk of psychosis show
altered contrast sensitivity functions, which is more pronounced in
the steady-pedestal paradigm favoring M pathways. Furthermore,
we aimed to investigate the relationship between contrast sensi-
tivity and anomalous perceptual experiences.
Materials and methods
Participants
Sixteen persons ~nine men, seven women! were recruited from the
crisis management and psychosis prevention outpatient unit of the
Department of Psychiatry, University of Szeged. All high-risk
participants fulfilled the criteria of Attenuated Psychotic Symp-
toms ~APS! and Brief Limited Intermittent Psychotic Symptoms
~BLIPS! according to the Comprehensive Assessment of At Risk
Mental States ~CAARMS! criteria ~Yung et al., 2004, 2005!
~Table 1!. General intellectual abilities were determined with the
revised Wechsler Adult Intelligence Scale ~WAIS-R! ~Wechsler,
1981!. All participants received toxicological screening for psy-
choactive substances, head MRI, and EEG. The mean age was 21.2
years ~SD ⫽ 3.2!, the mean years of education was 11.6 years
~SD ⫽ 2.7!, the mean IQ was 98.7 ~SD ⫽ 12.4!. Controls were 20
185
healthy volunteers without any medication ~11 men, 9 women!
from the acquaintances of the university staff ~mean age: 20.6
years ~SD ⫽ 5.8!, mean years of education: 12.2 years ~SD ⫽ 3.8!,
mean IQ ⫽ 101.5 ~SD ⫽ 11.8!!. All participants had normal or
corrected-to-normal visual acuity. All participants received the
Mini-International Neuropsychiatric Interview Plus ~Sheehan et al.,
1998!. Neither of them met the criteria of DSM-IV psychiatric
disorders. The study was done in accordance with the Declaration
of Helsinki. All participants were fully informed and gave their
written informed consent.
Assessment of anomalous perceptual experiences
The Structured Interview for Assessing Perceptual Anomalies
~SIAPA! ~Bunney et al., 1999! investigates hypersensitivity, inun-
dation or flooding, and selective attention to external stimuli in the
five sensory modalities using a 1 ~never occurred!–5 ~always
present! scale. Participants were rated by two independent asses-
sors ~kappa ⬎ 0.7!.
Contrast sensitivity measurements
We adapted the method of Pokorny and Smith ~1997!, Leonova
et al. ~2003!, and Alexander et al. ~2005!. Stimuli were presented
on a gamma-corrected ViewSonic PF815 monitor ~resolution:
800 ⫻ 600 pixel; refresh rate: 100 Hz; VSG graphic card, version
5.02, Cambridge Research System Ltd, Rochester, UK!. The mon-
itor was controlled by an IBM-compatible PC. Stimuli were Gabor
patches ~size: 2.58 ⫻ 2.58! with a luminance-contrast profile formed
by the multiplication of a sinusoidal waveform with a Gaussian
186 S. Keri and G. Benedek

Table 1. Clinical characteristics of the high-risk participants

Brief Limited Intermittent

Attenuated Psychosis Psychotic Symptoms

Number of participants
Definition
Disorder of thought content, delusional
intensity ~severity scale score of 6!
Perceptual abnormalities, hallucination
intensity ~severity scale score of 5– 6!
Disorganized speech, disorder of thought
~severity scale score of 6!
Blunted affect ~score of 3 or above on the
SANS scale!
10 6
A. Subthreshold intensity: - Severity scale score of 6 on disorder of
- severity scale score of 3–5 on disorder of thought content subscale, 5– 6 on perceptual
thought content subscale, 3– 4 on perceptual abnormalities subscale and0or 6 on
abnormalities subscale and0or 4–5 on disorganized speech subscale of the
disorganized speech subscale of the CRAARMS
CAARMS - Frequency scale score of 4– 6
- frequency scale score of 3– 6 for at least a - Each episode is present for less than one
week or frequency scale score of 2 on more week and symptoms spontaneously remit on
than two occasions every occasion
B. Subthreshold frequency: - Symptoms present in past year and for not
- severity scale score of 6 on disorder of longer than five years
thought content subscale, 5– 6 on perceptual
abnormalities subscale and0or 6 on
disorganized speech subscale of the
CRAARMS
- frequency scale score of 3
C. Symptoms present in past year and for not
longer than five years
4010 606
3010 606
3010 606
6010 406

SANS—Scale for the Assessment of Negative Symptoms

CAARMS—Comprehensive Assessment of At Risk Mental States

envelope ~Fig. 1!. The target was presented in the center of a
square luminance pedestal ~7.68 on a side, mean luminance: 12
cd0m 2 !. The pedestal was presented in the center of a homo-
geneous adapting field ~12.08 on a side, mean luminance: 25
cd0m 2 !, producing a luminance decrement ~Fig. 1!. The contrast of
the Gabor patch was determined as the difference between its
maximal luminance and the luminance of the pedestal divided by
the luminance of the pedestal.
Two testing paradigms were used. In the steady-pedestal para-
digm, the pedestal was presented continuously. During the test
period, the target Gabor patch was presented in the center of the
pedestal for 45 ms. In the pulsed-pedestal paradigm, the pedestal
was presented only during the test period, together with the target
Gabor patch for 45 ms. A 30-s adaptation period preceded the test
period in each paradigm ~Fig. 1!.
Before the experiment, each participant was given a practice
run. Each trial was initiated by the participant by pressing the
space bar on the keyboard. After a brief warning tone, the stimulus
was presented. The task was to judge whether the Gabor patch was
horizontal or vertical by pressing two different keys on the key-
board ~“1” for vertical and “0” for horizontal!. The next trial was
initiated by the response of the participant. Responses with reac-
tion time ⬎2000 ms were not taken into consideration. The order
of steady- and pulsed-pedestal paradigm was randomized. In each
paradigm, contrast thresholds were determined at 5 spatial frequen-
cies ~0.25, 0.5, 1, 2, 4 cycles0degree @c0d#! using a two-alternative,
forced-choice staircase procedure with a targeted correct value of
80%. The staircase steps were determined by an adaptive method,
taking into consideration the step on the preceding trial, the initial
contrast value, the cumulative number of reversals, and the tar-
geted percent correct value ~Treutwein, 1995!:
X n⫹1 ⫽ X n ⫺ c0~2 ⫹ m shift !~Z n ⫺ f!
X n —step size on trial n; c—initial contrast value ~40%!; m shift —
cumulative number of reversals; Z n —observer’s response ~0 or 1!;
f—targeted percent correct value ~80%!.
The staircase was terminated after the 12 th reversal. The con-
trast threshold was the average of the last 6 reversals. There were
2 randomly interleaved staircases: 1 for vertical and 1 for hori-
zontal orientation. There were no significant differences between
the contrast thresholds for vertical and horizontal orientations, and
therefore these data were analyzed together. Contrast sensitivity
was the inverse of the contrast threshold.
Data analysis
Contrast sensitivity values were logarithmically transformed and
were entered into an analysis of variance ~ANOVA! in which
group ~high-risk persons vs. controls! was the between-subject
factor and contrast sensitivity paradigm ~steady-pedestal and
pulsed-pedestal! and spatial frequency were the within-subject
factors. Student’s two-tailed t-tests were used for post hoc com-
parisons and for the analysis of the SIAPA scores. Spearman’s
correlation coefficients were calculated between SIAPA scores
and contrast sensitivity values. The level of significance was
a ⬍ 0.05.
Visual contrast sensitivity alterations
Results
SIAPA scores
The high-risk persons achieved higher scores in the visual, audi-
tory, and olfactory modality compared with the controls ~t~34! ⬎
3, p ⬍ 0.005 in all 3 modalities! ~Fig. 2!.
Contrast sensitivity
The ANOVA revealed significant main effects of group ~F~1,34! ⫽
12.57, p ⬍ 0.005!, contrast sensitivity paradigm ~F~1,34! ⫽
126.35, p ⬍ 0.0001!, and spatial frequency ~F~4,136! ⫽ 19.03,
p ⬍ 0.0001!. The interactions between group and contrast sensi-
tivity paradigm ~F~1,34! ⫽ 21.94, p ⬍ 0.001! and between
contrast sensitivity paradigm and spatial frequency ~F~4,136! ⫽
67.07, p ⬍ 0.0001! were significant. Post hoc comparisons re-
vealed significantly higher contrast sensitivity values in the high-
risk persons in the steady-pedestal ~M pathway! paradigm compared
with the controls ~t~34! ⬎ 3, p ⬍ 0.001 at each spatial frequency!.
No such differences were found during the pulsed-pedestal ~P
pathway! paradigm ~t~34! ⬍ 1, p ⬎ 0.5 at each spatial frequency!
~Fig. 3!.
Correlation between SIAPA scores and contrast sensitivity
In the high-risk group, there were significant correlations between
visual SIAPA scores and steady-pedestal ~M pathway! contrast
sensitivity values ~0.5 c0d: R ⫽ 0.58, 1 c0d: R ⫽ 0.62, 2 c0d: R ⫽
0.58, p ⬍ 0.05 at each spatial frequency!. There was no significant
relationship between SIAPA scores and pulsed-pedestal ~P path-
Fig. 3. Mean contrast sensitivity values. The high-risk persons showed elevated contrast sensitivities in the M pathway test ~*p ⬍ 0.001
at each spatial frequency, t-test!. c0d—cycles0degree.
187
way! contrast sensitivity values. In the control group, only the
steady-pedestal ~M pathway! contrast sensitivity value at 0.25 c0d
correlated with the visual SIAPA scores.
Discussion
The main finding of this study was that persons at high-risk of
psychosis showed elevated visual contrast sensitivity in the steady-
pedestal paradigm, which is devoted to the assessment of M
pathways. The pulsed-pedestal ~P pathway! values were spared.
Higher contrast sensitivity was associated with more intensive
anomalous perceptual experiences in the visual modality.
Fig. 3 indicates that contrast sensitivity values in the pulsed-
pedestal ~P pathway! task are lower than in the steady-pedestal ~M
pathway! task, which can be explained by the fact that the M
pathways show higher contrast sensitivity than the P pathways.
However, at 4 c0d, when the visual system is biased towards P
pathways, contrast sensitivity was similar in both tasks.
In a group of young, unmedicated patients with schizophrenia,
we found increased contrast sensitivity for oscillating low spatial
frequency stimuli ~Kéri et al., 2000!, which is consistent with the
present data. In contrast, patients receiving antipsychotic drugs
showed decreased contrast sensitivity ~Kéri et al., 2002!. Chen
et al. ~2003! replicated these findings and concluded that dopami-
nergic blockade by antipsychotics affects sensory processes in
schizophrenia, shifting visual contrast detection from hypersensi-
tivity in the unmedicated state to normal or hyposensitive state in
the medicated state. Here we extended these findings, demonstrat-
ing that hypersensitivity persists even in the prodromal phase and
may contribute to the experience of abnormal intensity of envi-
188
ronmental stimuli, feelings of being flooded and inundated, and
inability to focus attention to relevant details. This is consistent
with data from unmedicated patients, suggesting that M pathway
abnormalities may contribute to a decreased ability to rapidly
identify the complex natural environment and to focus attention to
perceptual details ~Kéri et al., 2005!.
The hypothesis of overactive M pathways is not new in schizo-
phrenia research. Studies using visual backward masking tasks,
during which participants are asked to detect a stimulus ~e.g. a
letter! immediately followed by a mask, raised the possibility that
the mask, which is processed by the overactive M pathways, may
have an abnormally strong influence on target detection leading to
lower performances ~Merritt & Balogh, 1989; Green et al., 1994;
Butler et al., 2003; Bedwell et al., 2003!. Although not all studies
were able to find parsimonious evidence for this hypothesis ~Sla-
ghuis, 1998; Delord et al., 2006!, and the masking deficit may
reflect more complex neuronal disintegration, our data indicate
that in certain phases of the illness M pathways may be indeed
overactive, especially in unmedicated patients at the initial stage of
the illness. It does not mean, however, that overactivity is associ-
ated with superior performance in each and every task related to
the M pathway; potentially, increased sensitivity may have a
detrimental effect on task performance when greater inhibition and
more focused activity are necessary. Overactive M pathways may
reflect anatomical and0or physiological dysfunctions rather than
better or more sensitive M pathways.
According to contrast sensitivity studies ~Kéri et al., 2000,
2002; Chen et al., 2003!, M pathways can be suppressed by
dopamine receptor antagonist antipsychotic drugs. However, some
studies indicated that patients on and off antipsychotic medication
show similar backward masking performances ~e.g., Butler et al.,
2003!, which is against the hypothesis that the backward masking
deficit can be explained by overactive M pathways as indicated by
the contrast sensitivity studies. In contrast, others found that
medications reduced the backward masking deficit ~Braff & Sac-
cuzzo, 1982!. To further clarify this issue, double-blind, controlled
follow-up studies are necessary, which take into consideration the
type and dose of antipsychotic drugs, the duration of previous
treatment, and the stage of the illness.
This study has two major limitations. First, the sample size was
small and therefore the study was underpowered, with a special
reference to the correlation analysis. Second, it is unknown whether
the high-risk persons indeed developed psychosis or there was a
spontaneous remission of the prodromal phase. This is particularly
important because cognitive and perceptual abnormalities may be
more pronounced in high-risk persons who later develop full-
blown psychosis ~Brewer et al., 2006!. Therefore, it is of special
importance to separately consider cognitive and perceptual dys-
functions in high-risk persons who develop psychosis and in those
who do not. In this study, we demonstrated that perceptual hyper-
sensitivity and M pathway dysfunction are potential new candi-
dates for such studies, which hopefully will refine the definition of
high-risk mental state of psychosis.
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