Transcranial Ultrasound Modulation of Delusional Salience: An FGIR-Based Hypothesis and Therapeutic Prospectus

A randomised, sham-controlled crossover pilot study has reported that a single ten-minute session of transcranial ultrasound stimulation of the right globus pallidus interna reduced delusion severity in ten people with schizophrenia or schizoaffective disorder. The difference from sham persisted for one week. Hallucinations and cognition showed no significant change, although a sample of ten cannot establish that they were unaffected. We propose an explanatory hypothesis drawn from Fisher-Generative Informational Realism, which models a viable system through dispositional, operative, sustentative and corporeal domains ordered along a transverse axis. Each domain carries traits whose intangible and tangible poles are ordered along a lateral axis. We read a delusion as an operative configuration held in place by high imperative curvature, the dispositional-operative relation λ = J/I. We read psychosis as a decoupling of the intangible and tangible trait poles across cognition, affect, and conation. We also read the stimulation as a corporeal perturbation that may widen the operative field and thereby lower that curvature. Since λ is a qualitative relation, we estimate it through a proxy, λproxy = Jproxy/Iproxy, built from an aberrant-salience inventory and a disconfirmatory-evidence task. From the weekly trajectory of that proxy we derive proxies for informational inertia, torsion and trajectory resonance. We also use the marginal imperative , the rate at which dispositional potential changes with the operative field. A widening of the operative field lowers λ only while is below λ. We specify a closed-loop rule that adjusts weekly stimulation intensity within established biophysical safety limits, withholds a session on torsional fragmentation, steps intensity down when trajectory resonance falls and tapers it when the estimated marginal imperative exceeds λ. A reproducible simulation of 1000 replicates of four hand-set profiles shows that the rule holds a responder and a balanced profile within a reference band where fixed dosing overshoots. For a fragile profile the rule trades efficacy for preserved sustentative coherence. For a profile whose dispositional domain mobilises as its operative field widens, the rule alone escalates stimulation while λ rises, and the marginal safeguard detects this and cuts the cumulative dose by about three quarters. We state nine falsifiable hypotheses and a validation protocol that must be completed before any clinical use.