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Blouzard E, Pouchon A, Polosan M, Bastin J, Dondé C. Effort-Cost Decision-making Among Individuals With Schizophrenia: A Systematic Review and Meta-analysis. JAMA Psychiatry 2023; 80:548-557. [PMID: 37043223 PMCID: PMC10099175 DOI: 10.1001/jamapsychiatry.2023.0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/31/2023] [Indexed: 04/13/2023]
Abstract
Importance Motivational impairments in schizophrenia are by definition associated with poor outcome. It is postulated that the reduction of goal-directed behavior arises from abnormal trade-offs between rewards and efforts. Objective To examine whether schizophrenia is associated with impairments in effort-cost decision-making. Data Sources For this systematic review and meta-analysis, the PubMed, ScienceDirect, PsycINFO, Embase, and ClinicalTrials.gov databases were searched from inception to July 2022 for studies that investigated effort-cost decision-making in schizophrenia. Search terms included effort, cost, and schizophrenia. Study Selection Consensual criteria for inclusion were peer-reviewed studies published in English that used a computerized effort-cost decision-making behavioral paradigm and compared individuals with schizophrenia with control individuals. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was used for abstracting data. Data were extracted independently by 2 authors and then pooled using random-effects sizes and bayesian approaches. Main Outcomes and Measures The main outcomes were performance on effort-cost decision-making tasks requiring an effort-reward trade-off, measured by Hedges g effect size. Effects of moderators were tested with meta-regressions and subgroup analyses. Results Twenty studies involving 1503 participants were included: 837 individuals with schizophrenia (541 [64.6%] male; mean [SD] age, 35.89 [6.70] years) and 666 control individuals without schizophrenia (360 [54.1%] male; mean [SD] age, 34.16 [5.92] years). Participants with schizophrenia had significantly reduced willingness to expend effort for rewards compared with controls (k = 20; effect size, 0.43; 95% CI, 0.30-0.56; P < .001; I2 = 33.1%; Q test P = .08). The magnitude of the deficit was significantly greater for high-reward trials. The severity of negative symptoms was negatively associated with effort-cost decision-making (k = 8; effect size, -0.33; 95% CI, -0.50 to -0.15; P < .001), while participants with a high number of negative symptoms had a significantly larger impairment in effort-cost decision-making (k = 5; effect size, 0.47; 95% CI, 0.10-0.84; P = .01). Conclusions and Relevance In this systematic review and meta-analysis, schizophrenia was associated with deficits in effort allocation as indexed by effort-cost decision-making tasks. Understanding the cognitive and neurobiological mechanisms driving effort allocation impairments may assist in developing novel interventions.
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Affiliation(s)
- Elodie Blouzard
- University Grenoble Alpes, Inserm, Grenoble Institut Neurosciences, Grenoble, France
| | - Arnaud Pouchon
- University Grenoble Alpes, Inserm, Grenoble Institut Neurosciences, Grenoble, France
- Adult Psychiatry Department, CHU Grenoble Alpes, Grenoble, France
| | - Mircea Polosan
- University Grenoble Alpes, Inserm, Grenoble Institut Neurosciences, Grenoble, France
- Adult Psychiatry Department, CHU Grenoble Alpes, Grenoble, France
| | - Julien Bastin
- University Grenoble Alpes, Inserm, Grenoble Institut Neurosciences, Grenoble, France
| | - Clément Dondé
- University Grenoble Alpes, Inserm, Grenoble Institut Neurosciences, Grenoble, France
- Adult Psychiatry Department, CHU Grenoble Alpes, Grenoble, France
- Adult Psychiatry Department, Centre Hospitalier Alpes-Isère, Saint-Egrève, France
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Renz KE, Lincoln TM. The effect of salience of rewards on effort-based decision making in psychotic disorders. BMC Psychiatry 2022; 22:643. [PMID: 36229803 PMCID: PMC9559256 DOI: 10.1186/s12888-022-04274-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although motivational negative symptoms account for reduced functioning and quality of life in individuals with psychotic disorders, the underlying mechanisms are yet not fully understood. Neuroimaging studies suggest that an impaired perception of reward cues could result in a lack of incentive value that then leads to a decrease in goal-directed behavior. Therefore, the aim of this study was to test the effect of increasing the salience of reward cues on goal-directed behavior. METHODS We recruited a sample of n = 30 participants with a psychotic disorder and at least mild negative symptoms and n = 30 healthy controls. We used the Balloon Effort Task, an effort-based decision-making paradigm, to assess amotivation on a behavioral level. We manipulated the salience of rewards in the paradigm by highlighting the monetary rewards in half of the trials. RESULTS Total effort expenditure did not differ between participants with and without psychotic disorders, but participants with psychotic disorders showed a significantly reduced effort allocation to the level of rewards. The salience of rewards manipulation significantly increased effort expenditure both in participants with psychotic disorders and in the healthy controls, but had no impact on effort allocation. CONCLUSIONS Increasing the salience of reward cues promotes goal-directed behavior. This opens up new possibilities for interventions addressing amotivation in individuals with negative symptoms by facilitating the perception of reward cues.
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Affiliation(s)
- Katharina E. Renz
- grid.9026.d0000 0001 2287 2617Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Tania M. Lincoln
- grid.9026.d0000 0001 2287 2617Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
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Shetty JJ, Nicholas C, Nelson B, McGorry PD, Lavoie S, Markulev C, Schäfer MR, Thompson A, Yuen HP, Yung AR, Nieman DH, de Haan L, Amminger GP, Hartmann JA. Greater preference for eveningness is associated with negative symptoms in an ultra-high risk for psychosis sample. Early Interv Psychiatry 2021; 15:1793-1798. [PMID: 33538110 DOI: 10.1111/eip.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 01/16/2023]
Abstract
AIM Investigating biological processes in at-risk individuals may help elucidate the aetiological mechanisms underlying psychosis development, refine prediction models and improve intervention strategies. This study examined the associations between sleep disturbances, chronotype, depressive and psychotic symptoms in individuals at ultra-high risk for psychosis. METHODS A sample of 81 ultra-high risk patients completed clinical interviews and self-report assessments of chronotype and sleep during the Neurapro clinical trial. Mixed regression was used to investigate the cross-sectional associations between symptoms and sleep disturbances/chronotype. RESULTS Sleep disturbances were significantly associated with increased depressive and attenuated positive psychotic symptoms. Greater preference for eveningness was significantly associated with increased negative symptoms, but not with depressive or attenuated positive psychotic symptoms. CONCLUSION Sleep disturbances and chronotype may impact the emerging psychopathology experienced by ultra-high risk individuals. Further, the preliminary relationship observed between greater preference for eveningness and negative symptoms offers a unique opportunity to treat negative symptoms through chronobiological approaches.
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Affiliation(s)
- Jashmina J Shetty
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christian Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Connie Markulev
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Miriam R Schäfer
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Thompson
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hok Pan Yuen
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alison R Yung
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | - G Paul Amminger
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica A Hartmann
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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Pretus C, Bergé D, Guell X, Pérez V, Vilarroya Ó. Brain activity and connectivity differences in reward value discrimination during effort computation in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:647-659. [PMID: 32494887 DOI: 10.1007/s00406-020-01145-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022]
Abstract
Negative symptoms in the motivational domain are strongly correlated with deficits in social and occupational functioning in schizophrenia. However, the neural substrates underlying these symptoms remain largely unknown. Twenty-eight adults with schizophrenia and twenty healthy volunteers underwent functional magnetic resonance while completing a lottery game designed to capture reward-related cognitive processes. Each trial demanded an initial investment of effort in form of key presses to increase the odds of winning. Brain activity in response to different reward cues (1 euro versus 1 cent) was compared between groups. Whereas controls invested more effort in improving their chances to win 1 euro compared to 1 cent in the lottery game, patients invested similarly high amounts of effort in both reward conditions. The neuroimaging analysis revealed lower neural activity in the bilateral caudate and cingulo-opercular circuits and decreased effective connectivity between reward-associated areas and neural nodes in the frontoparietal and salience network in response to high- versus low-reward conditions in schizophrenia patients compared to controls. Effective connectivity differences across conditions were associated with amotivation symptoms in patients. Overall, our data provide the evidence of alterations in neural activity in the caudate and cingulo-opercular "task maintenance" circuits and frontoparietal effective connectivity with reward-associated nodes as possible underlying mechanisms of reward value discrimination deficits affecting effort computation in schizophrenia.
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Affiliation(s)
- Clara Pretus
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Daniel Bergé
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain.,Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Xavier Guell
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Victor Pérez
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain.,Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Óscar Vilarroya
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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Hegelstad WTV, Kreis I, Tjelmeland H, Pfuhl G. Psychosis and Psychotic-Like Symptoms Affect Cognitive Abilities but Not Motivation in a Foraging Task. Front Psychol 2020; 11:1632. [PMID: 32903697 PMCID: PMC7438796 DOI: 10.3389/fpsyg.2020.01632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective Goal-directed behavior is a central feature of human functioning. It requires goal appraisal and implicit cost-benefit analyses, i.e., how much effort to invest in the pursuit of a certain goal, against its value and a confidence judgment regarding the chance of attainment. Persons with severe mental illness such as psychosis often struggle with reaching goals. Cognitive deficits, positive symptoms restricting balanced judgment, and negative symptoms such as anhedonia and avolition may compromise goal attainment. The objective of this study was to investigate to what degree symptom severity is related to cognitive abilities, metacognition, and effort-based decision-making in a visual search task. Methods Two studies were conducted: study 1: N = 52 (healthy controls), and study 2: N = 46 (23 patients with psychosis/23 matched healthy controls). Symptoms were measured by the CAPE-42 (study 1) and the PANSS (study 2). By using a visual search task, we concomitantly measured (a) accuracy in short-term memory, (b) perceived accuracy by participants making a capture area or confidence interval, and (c) effort by measuring how long one searched for the target. Perseverance was assessed in trials in which the target was omitted and search had to be abandoned. Results Higher levels of positive symptoms, and having a diagnosis of psychosis, were associated with larger errors in memory. Participants adjusted both their capture area and their search investment to the error of their memory. Perseverance was associated with negative symptoms in study 1 but not in study 2. Conclusion By simultaneously assessing error and confidence in one's memory, as well as effort in search, we found that memory was affected by positive, not negative, symptoms in healthy controls, and was reduced in patients with psychosis. However, impaired memory did not concur with overconfidence or less effort in search, i.e., goal directed behavior was unrelated to symptoms or diagnosis. Metacognition and motivation were neither affected by cognitive abilities nor by negative symptoms. Clinically, this could indicate that struggles with goal directed behavior in psychosis may not solely be dependent on primary illness factors.
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Affiliation(s)
- Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Isabel Kreis
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Håkon Tjelmeland
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gerit Pfuhl
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
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Kreis I, Moritz S, Pfuhl G. Objective Versus Subjective Effort in Schizophrenia. Front Psychol 2020; 11:1469. [PMID: 32742265 PMCID: PMC7365134 DOI: 10.3389/fpsyg.2020.01469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/02/2020] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives Performance on cognitive tasks is often impaired in individuals with schizophrenia (SCZ), possibly resulting from either cognitive deficits (e.g., limited working memory capacity) or diminished mental effort or both. Investment of mental effort itself can be affected by cognitive resources, task load, and motivational factors and has thus proven difficult to measure. Pupil dilation during task performance has been proposed as an objective measure, but it remains unclear to what extent this converges with self-reports of perceived task demands, motivation, and invested effort. The current study tried to elucidate this question. Methods A visual version of the digit span task was administered in a sample of 29 individuals with a diagnosis from the SCZ spectrum and 30 individuals without any psychiatric disorder. Pupil size was recorded during the task, whereas self-reported invested effort and task demand were measured afterward. Results No group difference was found for working memory capacity, but individuals with SCZ showed diminished trial-by-trial recall accuracy, showed reduced pupil dilation across all task load conditions, and reported higher perceived task demands. Conclusion Results indicate reduced effort investment in patients with SCZ, but it remains unclear to what extent this alone could explain the lower recall performance. The lack of a direct link between objective and subjective measures of effort further suggests that both may assess different facets of effort. This has important implications for clinical and research settings that rely on the reliability of neuropsychological test results when assessing cognitive capacity in this patient group.
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Affiliation(s)
- Isabel Kreis
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerit Pfuhl
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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Yang JH, Presby RE, Cayer S, Rotolo RA, Perrino PA, Fitch RH, Correa M, Chesler EJ, Salamone JD. Effort-related decision making in humanized COMT mice: Effects of Val 158Met polymorphisms and possible implications for negative symptoms in humans. Pharmacol Biochem Behav 2020; 196:172975. [PMID: 32593787 DOI: 10.1016/j.pbb.2020.172975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/05/2020] [Accepted: 06/21/2020] [Indexed: 01/05/2023]
Abstract
Catechol-o-methyltransferase (COMT) is an enzyme that metabolizes catecholamines, and is crucial for clearance of dopamine (DA) in prefrontal cortex. Val158Met polymorphism, which causes a valine (Val) to methionine (Met) substitution at codon 158, is reported to be associated with human psychopathologies in some studies. The Val/Val variant of the enzyme results in higher dopamine metabolism, which results in reduced dopamine transmission. Thus, it is important to investigate the relation between Val158Met polymorphisms using rodent models of psychiatric symptoms, including negative symptoms such as motivational dysfunction. In the present study, humanized COMT transgenic mice with two genotype groups (Val/Val (Val) and Met/Met (Met) homozygotes) and wild-type (WT) mice from the S129 background were tested using a touchscreen effort-based choice paradigm. Mice were trained to choose between delivery of a preferred liquid diet that reinforced panel pressing on various fixed ratio (FR) schedules (high-effort alternative), vs. intake of pellets concurrently available in the chamber (low-effort alternative). Panel pressing requirements were controlled by varying the FR levels (FR1, 2, 4, 8, 16) in ascending and descending sequences across weeks of testing. All mice were able to acquire the initial touchscreen operant training, and there was an inverse relationship between the number of reinforcers delivered by panel pressing and pellet intake across different FR levels. There was a significant group x FR level interaction in the ascending limb, with panel presses in the Val group being significantly lower than the WT group in FR1-8, and lower than Met in FR4. These findings indicate that the humanized Val allele in mice modulates FR/pellet-choice performance, as marked by lower levels of panel pressing in the Val group when the ratio requirement was moderately high. These studies may contribute to the understanding of the role of COMT polymorphisms in negative symptoms such as motivational dysfunctions in schizophrenic patients.
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Affiliation(s)
- Jen-Hau Yang
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, Storrs, CT, USA; Present address: Dept. of Psychiatry, Yale University, New Haven, CT, USA
| | - Rose E Presby
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Suzanne Cayer
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Renee A Rotolo
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Peter A Perrino
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - R Holly Fitch
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Merce Correa
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, Storrs, CT, USA; Area de Psicobiologia, Universitat Jaume I, Castelló, Spain
| | | | - John D Salamone
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, Storrs, CT, USA.
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