Decreased value-sensitivity in schizophrenia

Modeling Decision-Making in Schizophrenia: Associations Between Computationally Derived Risk Propensity and Self-Reported Risk Perception

BACKGROUND AND HYPOTHESIS

Schizophrenia is associated with a decreased pursuit of risky rewards during uncertain-risk decision-making. However, putative mechanisms subserving this disadvantageous risky reward pursuit, such as contributions of cognition and relevant traits, remain poorly understood.

STUDY DESIGN

Participants (30 schizophrenia/schizoaffective disorder [SZ]; 30 comparison participants [CP]) completed the Balloon Analogue Risk Task (BART). Computational modeling captured subprocesses of uncertain-risk decision-making: Risk Propensity, Prior Belief of Success, Learning Rate, and Behavioral Consistency. IQ, self-reported risk-specific processes (ie, Perceived Risks and Expected Benefit of Risks), and non-risk-specific traits (ie, defeatist beliefs; hedonic tone) were examined for relationships with Risk Propensity to determine what contributed to differences in risky reward pursuit.

STUDY RESULTS

On the BART, the SZ group exhibited lower Risk Propensity, higher Prior Beliefs of Success, and comparable Learning Rates. Furthermore, Risk Propensity was positively associated with IQ across groups. Linear models predicting Risk Propensity revealed 2 interactions: 1 between group and Perceived Risk, and 1 between IQ and Perceived Risk. Specifically, in both the SZ group and individuals with below median IQ, lower Perceived Risks was related to lower Risk Propensity. Thus, lower perception of financial risks was associated with a less advantageous pursuit of uncertain-risk rewards.

CONCLUSIONS

Findings suggest consistently decreased risk-taking on the BART in SZ may reflect risk imperception, the failure to accurately perceive and leverage relevant information to guide the advantageous pursuit of risky rewards. Additionally, our results highlight the importance of cognition in uncertain-risk decision-making.

Decision-making under risk and its correlates in schizophrenia

Schizophrenia spectrum disorders (SSD) are associated with pervasive cognitive impairments, including deficits in decision-making under risk. However, there is inconclusive evidence regarding specific mechanisms underlying altered decision-making patterns. In this study, participants (33 SSD and 28 non-SSD) completed the Columbia Card Task, an explicit risk-taking task, to better understand risk preference and adjustment in dynamic decision-making. We found that while there is no group difference in overall risk-taking, risk preference, or optimal decision-making, risk adjustment to contextual factors (e.g., loss probability) is blunted in SSD. We also found associations between risk-taking/suboptimal decision-making and disorganized symptoms, excited symptoms, and role functioning, but no associations between decision-making and working memory. These results suggest that during a complex, dynamic risk-taking task, individuals with SSD exhibit less adaption to changing information about risk, which may reflect risk imperception.

Aberrant Salience Inventory: A meta-analysis to investigate its psychometric properties and identify screening cutoff scores

INTRODUCTION

The Aberrant Salience Inventory (ASI) is a useful tool to measure salience abnormalities among the general population. There is strong clinical and scientific evidence that salience alteration is linked to psychosis. To the present day, no meta-analysis evaluating ASI's psychometric properties and screening potential has been published.

MATERIALS AND METHODS

PubMed, Google Scholar, Scopus, and Embase were searched using terms including "psychosis," "schizophrenia," and "Aberrant Salience Inventory." Observational and experimental studies employing ASI on populations of non-psychotic controls and patients with psychosis were included. ASI scores and other demographic measures (age, gender, ethnicity) were extracted as outcomes. Individual patients' data (IPD) were collected. Exploratory factor analysis (EFA) was performed on the IPD.

RESULTS

Eight articles were finally included in the meta-analysis. ASI scores differ significantly between psychotic and non-psychotic populations; a novel three-factor model is proposed regarding subscales structure. Theoretical positive predictive values (PPVs) and negative predictive values (NPVs) were calculated and presented together with different cutoff points depending on preselected specific populations of interest.

DISCUSSION

PPV and NPV values reached levels adequate for ASI to be considered a viable screening tool for psychosis. The factor analysis highlights the presence of a novel subscale that was named "Unveiling experiences." Implications regarding the meaning of the new factor structure are discussed, as well as ASI's potential as a screening tool.

The traps of adaptation: Addiction as maladaptive referent-dependent evaluation

Referent-dependent evaluation theories propose that the ongoing context influences how the brain attributes value to stimuli. What are the implications of these theories for understanding addiction? The paper asks this question by casting this disorder as a form of maladaptive referent-dependent evaluation. Specifically, addiction is proposed to arise from the establishment of an excessive reference point following repeated drug consumption. Several key aspects of the disorder emerge from this perspective, including withdrawal, tolerance, enhanced craving, negative mood, and diminished stimulus discriminability. As highlighted in the paper, this formulation has important analogies with classical accounts of addiction, such as set point theories and associative learning theories. Moreover, this picture fits with the pattern of striatal dopaminergic activity observed in addiction, a key neural signature of the disorder. Overall, the referent-dependent evaluation approach emerges as a useful add-on to the theoretical toolkit adopted to interpret addiction. This also supports the idea that referent-dependent evaluation might offer a general framework to understand various disorders characterised by disrupted motivation.

A review of risky decision-making in psychosis-spectrum disorders

The investigation of risky decision-making has a prominent place in clinical science, with sundry behavioral tasks aimed at empirically quantifying the psychological construct of risk-taking. However, use of differing behavioral tasks has resulted in lack of agreement on risky decision-making within psychosis-spectrum disorders, as findings fail to converge upon the typical, binary conceptualization of increased risk-seeking or risk-aversion. The current review synthesizes the behavioral, risky decision-making literature to elucidate how specific task parameters may contribute to differences in task performance, and their associations with psychosis symptomatology and cognitive functioning. A paring of the literature suggests that: 1) Explicit risk-taking may be characterized by risk imperception, evidenced by less discrimination between choices of varying degrees of risk, potentially secondary to cognitive deficits. 2) Ambiguous risk-taking findings are inconclusive with few published studies. 3) Uncertain risk-taking findings, consistently interpreted as more risk-averse, have not parsed risk attitudes from confounding processes that may impact decision-making (e.g. risk imperception, reward processing, motivation). Thus, overgeneralized interpretations of task-specific risk-seeking/aversion should be curtailed, as they may fail to appropriately characterize decision-making phenomena. Future research in psychosis-spectrum disorders would benefit from empirically isolating contributions of specific processes during risky decision-making, including the newly hypothesized risk imperception.

Cognition and Reward Circuits in Schizophrenia: Synergistic, Not Separate

Schizophrenia has been studied from the perspective of cognitive or reward-related impairments, yet it cannot be wholly related to one or the other process and their corresponding neural circuits. We posit a comprehensive circuit-based model proposing that dysfunctional interactions between the brain's cognitive and reward circuits underlie schizophrenia. The model is underpinned by how the relationship between glutamatergic and dopaminergic dysfunction in schizophrenia drives interactions between cognition and reward circuits. We argue that this interaction is synergistic: that is, deficits of cognition and reward processing interact, and this interaction is a core feature of schizophrenia. In adopting this position, we undertake a focused review of animal physiology and human clinical data, and in proposing this synergistic model, we highlight dopaminergic afferents from the ventral tegmental area to nucleus accumbens (mesolimbic circuit) and frontal cortex (mesocortical circuit). We then expand on the role of glutamatergic inputs to these dopamine circuits and dopaminergic modulation of critical excitatory pathways with attention given to the role of glutamatergic hippocampal outputs onto nucleus accumbens. Finally, we present evidence for how in schizophrenia, dysfunction in the mesolimbic and mesocortical circuits and their corresponding glutamatergic inputs gives rise to clinical and cognitive phenotypes and is associated with positive and negative symptom dimensions. The synthesis attempted here provides an impetus for a conceptual shift that links cognitive and motivational aspects of schizophrenia and that can lead to treatment approaches that seek to harmonize network interactions between the brain's cognition and reward circuits with ameliorative effects in each behavioral domain.

Delay discounting and affective priming in individuals with negative schizotypy

Previous studies have demonstrated that patients with schizophrenia and individuals with schizotypy experience decreased anticipatory pleasure. However, it is unclear whether this decrease is contributed by altered reward processing at the proximal or distal future. In order to investigate the preference for receiving rewards in the proximal or distal future for individuals with schizophrenia spectrum disorders, individuals with either high or low levels of negative schizotypy performed a delay discounting task under positive, neutral and negative affective priming conditions. Compared with individuals with low levels of negative schizotypy, individuals with high levels of schizotypy exhibited increased delay discounting, preferring to choose immediate but smaller rewards instead of delayed but larger rewards across all three affective priming conditions. Negative affective priming elevated discounting for both groups compared with both the positive and neutral affective conditions. After dividing delayed temporal distance into the proximal and distal future, the results showed that individuals with high levels of negative schizotypy exhibited more preference for immediate but smaller rewards in the distal instead of proximal future compared with controls. Our results suggest that individuals with high levels of negative schizotypy have altered anticipatory reward processing, which is mainly attributed to alterations in representing rewards in the distal future. These findings extend the alterations in representing reward values from schizophrenia patients to schizotypal individuals, and suggest that diminished anticipatory pleasure in schizophrenia spectrum disorders may be due to changes in processing anticipatory rewards in the distal future.

Reduced willingness to invest effort in schizophrenia with high negative symptoms regardless of reward stimulus presentation and reward value

BACKGROUND

Negative symptoms in schizophrenia, which are related to poor functioning, are thought to be grounded on aberrant functioning in the reward system. We aimed to disentangle how negative symptoms and two cognitive aspects of goal-directed behavior, mental representation of reward and reward value, affect willingness to invest effort to attain a reward in schizophrenia.

AIMS AND PROCEDURES

To this purpose, 43 schizophrenia patients and 35 healthy controls were assessed for negative symptoms and general functioning, and completed an effort-based reward task. Patients were split in high and low negative symptoms scorers. A series of ANOVA tests were conducted in order to test the effects of group controlling for representation of reward (Task 1) and balance between reward value and effort (Task 2) on will to invest effort to attain a reward.

MAIN FINDINGS

Schizophrenia patients with high negative symptoms chose to invest lower amounts of effort for a reward compared both to low negative symptoms patients and to controls in both tasks. Neither mental representation of reward (Task 1) nor reward value (Task 2) did differentially affect will to invest effort between-groups.

CONCLUSIONS

These findings suggest that the lower willingness to invest effort observed in schizophrenia patients with high negative symptoms may not be related to cognitive aspects of goal-oriented behavior.

Risk preference and choice stochasticity during decisions for other people

In several contexts, such as finance and politics, people make choices that are relevant for others but irrelevant for oneself. Focusing on decision-making under risk, we compared monetary choices made for one's own interest with choices made on behalf of an anonymous individual. Consistent with the previous literature, other-interest choices were characterized by an increased gambling propensity. We also investigated choice stochasticity, which captures how much decisions vary in similar conditions. An aspect related to choice stochasticity is how much decisions are tuned to the option values, and we found that this was higher during self-interest than during other-interest choices. This effect was observed only in individuals who reported a motivation to distribute rewards unequally, suggesting that it may (at least partially) depend on a motivation to make accurate decisions for others. Our results indicate that, during decision-making under risk, choices for other people are characterized by a decreased tuning to the values of the options, in addition to enhanced risk seeking.