Neurobiological mechanisms and clinical implications of scene perception impairment in schizophrenia

Table 1 Electrophysiological markers associated with impaired scene perception in schizophrenia

Ref.	Task domain	Main findings	Explanatory value	Level of evidence
[6]	VMMN	Meta-analysis showed reduced VMMN amplitude (g = -0.63), consistent with impaired automatic visual prediction error signal	Support for early predictive coding interference in scene change detection	Meta-analysis
[16,17]	The role of N170 and LPP in face/emotion processing	Abnormal N170 and reduced late positive responses indicate lower face encoding efficiency and later social-emotional integration	It is suggested that the scene perception deficit extends from face-sensitive processing to the evaluation phase	Event-related potentials in humans
[18,19]	Early visual processing/environmental regulation	The background of the early visual magnification and abnormal dependent contrast modulation means less gain control	4 associate low levels of sensory instability with later scene integration difficulties	Research on human mechanisms
[35,36]	Eye movement and eye fixation-related signals	Changes in fixation-related saccades and abnormalities in fixation-related potentials can be observed during natural fixation	Emphasis on active visual sampling as part of the clinically relevant scene perception	Naturalistic human research

VMMN: Visual mismatch negative wave; LPP: Late positive potential.

Table 2 Functional neuroimaging performance: Hierarchical visual processing, effective connection and naturalistic paradigm

Ref.	Imaging focus	Main findings	Relevance to scene perception	Level of evidence
[3]	Third visual pathway/MT+/pSTS	Real and implied movement of activation means less sensitive to exercise social perception and processing	Disturbances in support of the process of translating dynamic visual input into socially meaningful scene information	Task functional magnetic resonance imaging
[7]	Dynamic causal models during gaze processing	Abnormal top-down effective connectivity from the dmPFC to the pSTS and inferior parietal regions has been linked to symptoms and social functioning	Provides direct evidence that feedforward feedback coordination is disrupted	Effective connectivity research
[20]	Lateral occipital cortex dynamic connectivity	LOC connectivity is abnormally reconfigured during resting and task states	During the prompt changes in the demand of the scene, unstable coordinate object processing hub	Dynamic connectivity research
[21]	Natural fMRI of first-episode psychosis	Movie-like stimulation reveals alterations in whole-brain connectivity and network topology in the early stages of psychosis	Improve ecological validity and complement task-based findings	Natural fMRI
[22-25]	ACC, DMN, salience, executive control, and coupling studies	Large-scale connectivity impairments reduce coordination between sensory input, salience allocation, and internal guidance control	This explains why scene interpretation fails even when some visual information is retained	Network-level human body imaging

MT+: Middle temporal visual area complex; pSTS: Posterior temporal channel; dmPFC: Dorso-medial prefrontal cortex; LOC: The lateral occipital cortex; fMRI: Functional magnetic resonance imaging; ACC: Anterior cingulate cortex; DMN: Default mode network.

Table 3 Structural and white matter magnetic resonance imaging evidence associated with impaired scene perception in schizophrenia

Ref.	Structural MRI domains	Key findings	The structure and meaning	Level of evidence
[8]	Visual cortex retraction/thickness	V1, V2, and the MT+ area increase, the MT+ area selective thinning	This shows that the visual system forms in the center of the perceptual organization and motion analysis area had changed	Directional structure of MRI
[26]	Gray matter in the fusiform gyrus	Fusiform gray matter decreased with facial emotion recognition disorders; reduced spindle volume was associated with diminished N170 responses	Provides a bridge between anatomy and electrophysiology	Structure research
[27]	Rotational phenomena in the schizophrenia spectrum	There was an increase in gyri across the schizophrenia spectrum, consistent with early neurodevelopmental bias	Support the view that the scene perception of vulnerability may partly reflect the change of cortical development	Spectrum structure of MRI
[28]	Local cortical volume abnormality	Extensive cortical volume differences are associated with symptoms and cognition	It is suggested that deficits in scene perception may be limited by a broader load on occipitotemporal and related structures	Clinical form metrology research
[22]	Corpus callosum white matter organization	Structure - function abnormalities involved hemispheres pathways and visual correlation circuits	Means that the complex scene perception required massive consolidation efficiency reduced	Structure and multimodal MRI

MRI: Magnetic resonance imaging; V1: Primary visual cortex; V2: Secondary visual cortex; MT+: Temporal middle visual area complex.

Table 4 Potential of scene perception disorders based on gene-molecules-cell-loop-behavior mechanism

Ref.	Level	Key mechanisms	The impact of speculation on scene perception	Level of evidence
[9-11]	Gene receptor	Connectivity disorders associated with NMDA receptors and NMDA receptor hypofunction alter predictive coding, recurrent gain, and long-term coordination	Impaired efficient updating of accurate weighting and scenario-based predictions	Imaging genetics + mechanistic review
[12,13,29]	Cell oscillations	PV - interneurons defects and abnormal reduces the gamma band suppression time and coordination	Affecting feature binding, context stabilization, and rapid integration of scene elements	Cell-type review + oscillation review
[14,15]	Inflammation of glial cells	Microglia and astrocytes abnormalities may interfere with synaptic pruning, inflammation, signaling communication - glial cells and neurons	May disrupt sensory acquisition control and plasticity associated with situational processing	System evaluation
[10-15]	Circuit calculation	Predictive coding failure, E/I imbalance, and inflammatory regulation converge at the circuit level	Provides a multi-level interpretation of the partial distribution of quasibut unstable scene interpretation	Integrated interpretation
[3,6,16-21,35,36]	Behavior	The scene-sensing phenotype includes impaired gist extraction, weak contextual modulation, abnormal social scene interpretation, and erratic active visual sampling	Defines the observable behavior level and the mechanism of low assumptions involved	Integrated human evidence

NMDA: N-methyl-D-aspartate; PV: Parvalbumin; E/I: Excitation-inhibition.

Table 5 Mechanism-based translational research directions and future priority research topics

Ref.	Directions	Existing evidence	Practical implications	Level of evidence
[30]	Visual restoration	Contrast processing repair improves low-level visual performance in patients with schizophrenia	This is a promising entry point, but the transfer to real-world scene understanding still needs to be demonstrated	Preliminary clinical trials
[31-33]	Based on VR and social cognitive intervention	Early VR studies have shown the feasibility and preliminary efficacy of theory of mind and social cognitive training	It can be used in ecological task design and may be used in scenario-based rehabilitation	Pilot study
[34-36]	Biomarker-guided stratification	Multimodal image classifiers and eye movement markers can distinguish patients and index active visual sampling abnormalities	It may help to identify subgroups and personalize intervention targets	Studies of biomarkers
[37]	Ecological assessment	Smartphones and game-based assessment/intervention approaches are moving beyond the clinic	Encourage measurement of real-world outcomes, not symptom-based endpoints alone	Review points
[10-15,21,22]	Future research priorities	Need longitudinal modal design, better defined scenarios, and stronger structure-function analysis	Will clarify period, reactive mechanism, and therapy	Comprehensive synthesis

VR: Virtual reality.