Discussion This study provides novel evidence that delusional and referential symptoms in schizophrenia are associated with altered RPE-related brain activation, particularly in the basal ganglia and prefrontal regions. These findings present a nuanced challenge to the aberrant salience hypothesis. Whereas that theory proposes that delusions arise from increased dopamine-driven salience signals, leading to heightened RPE responses, this study found the opposite: patients with more pronounced delusions/referentiality showed reduced, not increased, RPE-related activity. The study is not without limitations. All patients were medicated, which could influence dopamine-related processes, though medication effects were accounted for in the analyses. The sample, while substantial, included patients with moderate symptom severity, potentially limiting the strength of symptom correlations. Moreover, delusions were not categorized by subtype; it remains to be seen whether specific delusional themes are more tightly linked to altered RPE signaling than others. Nonetheless, the results underscore the importance of RPE mechanisms in understanding the subjective experience of delusions and referential thoughts. Informaciones Psiquiátricas 2025 - nº 258 65 ARE DELUSIONS AND/OR REFERENTIALITY ASSOCIATED WITH ABERRANT REWARD PREDICTION ERROR (RPE) SIGNALING?
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