Brain network mechanisms of visual perceptual organization in schizophrenia and bipolar disorder

Visual shape completion is a canonical perceptual process that integrates spatially distributed edge information into unified representations of objects. People with schizophrenia show difficulty in discriminating completed shapes but the brain networks and functional connections underlying this perceptual difference remain poorly understood. Also unclear is whether similar neural differences arise in bipolar disorder or vary across the schizo-bipolar spectrum. To address these topics, we scanned (fMRI) people with schizophrenia, bipolar disorder, or no psychiatric illness during rest and during a task in which they discriminated configurations that formed or failed to form completed shapes (illusory and fragmented condition, respectively). Illusory/fragmented task activation differences ('modulations'), resting-state functional connectivity, and multivariate pattern differences were identified on the cortical surface using 360 predefined parcels and 12 functional networks composed of such parcels. Brain activity flow mapping was used to evaluate the likely involvement of resting-state connections for shape completion. Dorsal attention network modulations distinguished people with schizophrenia (AUCs>.85) and could trans-diagnostically predict cognitive disorganization severity. Activity flow over functional connections from the dorsal attention network could predict secondary visual network modulations in each group, except among those with schizophrenia. Task modulations among patients were more heterogeneous and dispersed over a larger number of networks compared to controls. In summary, abnormal dorsal attention network activity emerges during perceptual organization in schizophrenia and may be related to improper attention-related feedback into secondary visual areas. Patients with either disorder may compensate for abnormal perception by an idiosyncratic recruitment of regions across multiple non-visual networks.