Premature commitment to uncertain beliefs during human NMDA receptor hypofunction

In uncertain environments, accurate decision-making requires integrating ambiguous or conflicting signals - a cognitive inference process thought to require n-methyl-d-aspartate (NMDA) synaptic receptors. Here we characterized the causal impact of human NMDA receptor hypofunction on cognitive inference using placebo-controlled infusions of ketamine in a visual cue combination task. Participants tested under ketamine showed elevated uncertainty, together with impaired cognitive inference despite intact visual processing. This behavioral effect of ketamine was associated in patterns of electrical brain activity with degraded and unbalanced coding of presented cues in associative cortex, followed by premature response preparation in motor cortex. Through quantitative simulations, we propose that these cognitive alterations reflect an urge to explain away the elevated uncertainty triggered by ketamine. This compensatory mechanism may cause the emergence of psychotic symptoms observed under chronic NMDA receptor dysfunction, but also forge unusually strong beliefs when confronted with uncertainty in everyday life.