Zhang JZ, Wang TT, Zhang J, Wang XY, Liu XH, Wang J, Zhou ZH. Neural mechanisms and circuit foundations of conscious and unconscious dysfunction in schizophrenia. World J Psychiatry 2026; 16(9): 120999 [DOI: 10.5498/wjp.120999]
Corresponding Author of This Article
Zhen-He Zhou, MD, PhD, Chief Physician, Professor, Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, No. 156 Qianrong Road, Wuxi 214151, Jiangsu Province, China. zhouzh@jiangnan.edu.cn
Research Domain of This Article
Psychiatry
Article-Type of This Article
review-article
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Zhang JZ, Wang TT, Zhang J, Wang XY, Liu XH, Wang J, Zhou ZH. Neural mechanisms and circuit foundations of conscious and unconscious dysfunction in schizophrenia. World J Psychiatry 2026; 16(9): 120999 [DOI: 10.5498/wjp.120999]
Jia-Zhao Zhang, Tian-Tian Wang, Jing Zhang, Xin-Yu Wang, Xiao-Hong Liu, Jun Wang, Zhen-He Zhou, Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi 214151, Jiangsu Province, China
Co-first authors: Jia-Zhao Zhang and Tian-Tian Wang.
Author contributions: Zhou ZH designed the study and contributed as corresponding author; Zhang JZ and Wang TT collected and organized the literature, drafted and revised the manuscript and contributed equally as co-first authors; Zhang J, Wang XY, Liu XH, Wang J assisted with literature collection and manuscript revision; and all authors contributed to the manuscript revision and approved the final version of the manuscript.
AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.
Supported by the Wuxi Taihu Talent Project, No. WXTTP2021.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Zhen-He Zhou, MD, PhD, Chief Physician, Professor, Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, No. 156 Qianrong Road, Wuxi 214151, Jiangsu Province, China. zhouzh@jiangnan.edu.cn
Received: March 13, 2026 Revised: May 2, 2026 Accepted: June 26, 2026 Published online: September 19, 2026 Processing time: 164 Days and 18.7 Hours
Abstract
Schizophrenia is associated with marked abnormalities in consciousness, specifically in the interplay between implicit and explicit cognitive processing. However, whether these deficits originate from early sensory degradation or late-stage access failures remains heavily debated. This narrative review synthesizes psychophysical, electrophysiological, and neuroimaging literature to evaluate these contrasting models. Visual masking and mismatch negativity paradigms suggest abnormalities extending from preattentive stages to conscious access. Metacognitive impairments in error and source monitoring further suggest that implicit processing may fail to achieve stable explicit representation. These abnormalities have been linked to predictive coding errors, thalamocortical dysconnectivity, and aberrant neural synchrony. This integrated framework seeks to connect micro-level sensory deficits with macro-level psychotic phenomenology and may help guide future transdiagnostic neuromodulatory interventions.
Core Tip: Schizophrenia features a stage-dependent dissociation between conscious and unconscious processing, challenging the simple preserved-implicit vs impaired-explicit dichotomy. While basic subliminal extraction often remains intact, patients exhibit profound deficits in preattentive sensory gating, mismatch negativity, late-stage conscious access, and metacognitive self-evaluation. These abnormalities stem from disrupted large-scale neural synchronization, thalamocortical dysconnectivity, and impaired predictive coding. By mapping these specific circuit-level dysfunctions, this review provides a mechanistic framework linking foundational sensory deficits to clinical psychotic phenomenology, highlighting novel targets for transdiagnostic neuromodulation.
