Visual context processing dysfunctions in youth at high risk for psychosis: Resistance to the ebbinghaus illusion and its symptom and social and role functioning correlates

Impaired visual context processing is closely linked with expression of symptoms in people with psychosis. However, to date, there have been no investigations of this phenomenon in the critical ultra high-risk (UHR) period immediately preceding the onset of psychosis. In total, 73 participants (33 UHR, 40 control) were evaluated with clinical and global functioning interviews and with a computerized task that required comparing the size of 2 target circles. Targets could appear by themselves (no-context condition), or within a context that made size judgment easier (helpful condition) or more difficult (misleading condition). Susceptibility to illusion was measured as the accuracy differences between the no-context and the helpful (i.e., helpful-index) and the misleading (i.e., misleading-index) conditions. Both groups exhibited approximately the same percentage of accurate responses to the no-context condition. However, the UHR subjects exhibited significantly less susceptibility to the illusion, performing superior to controls on the misleading index. The UHR group also showed less susceptibility on the helpful index, but this was not significant. Lower susceptibility on the misleading index was associated with increased negative symptoms and role functioning at a trend level. Lower susceptibility on the helpful index was significantly associated with increased negative symptoms and both poor role and social functioning. These results indicate that visual context processing is impaired during the UHR period, and is related to core illness features, suggesting that this task may be a useful biomarker in studies of UHR participants.