Persistence, diagnostic specificity and genetic liability for context-processing deficits in schizophrenia

Clarifying Cognitive Control Deficits in Psychosis via Drift Diffusion Modeling and Attractor Dynamics

BACKGROUND AND HYPOTHESIS

Cognitive control deficits are prominent in individuals with psychotic psychopathology. Studies providing evidence for deficits in proactive control generally examine average performance and not variation across trials for individuals-potentially obscuring detection of essential contributors to cognitive control. Here, we leverage intertrial variability through drift-diffusion models (DDMs) aiming to identify key contributors to cognitive control deficits in psychosis.

STUDY DESIGN

People with psychosis (PwP; N = 122), their first-degree biological relatives (N = 78), and controls (N = 50) each completed 120 trials of the dot pattern expectancy (DPX) cognitive control task. We fit full hierarchical DDMs to response and reaction time (RT) data for individual trials and then used classification models to compare the DDM parameters with conventional measures of proactive and reactive control.

STUDY RESULTS

PwP demonstrated slower drift rates on proactive control trials suggesting less efficient use of cue information. Both PwP and relatives showed protracted nondecision times to infrequent trial sequences suggesting slowed perceptual processing. Classification analyses indicated that DDM parameters differentiated between the groups better than conventional measures and identified drift rates during proactive control, nondecision time during reactive control, and cue bias as most important. DDM parameters were associated with real-world functioning and schizotypal traits.

CONCLUSIONS

Modeling of trial-level data revealed that slow evidence accumulation and longer preparatory periods are the strongest contributors to cognitive control deficits in psychotic psychopathology. This pattern of atypical responding during the DPX is consistent with shallow basins in attractor dynamic models that reflect difficulties in maintaining state representations, possibly mediated by excess neural excitation or poor connectivity.

Clarifying Cognitive Control Deficits in Psychosis via Drift Diffusion Modeling

Cognitive control deficits are consistently identified in individuals with schizophrenia and other psychotic psychopathologies. In this analysis, we delineated proactive and reactive control deficits in psychotic psychopathology via hierarchical Drift Diffusion Modeling (hDDM). People with psychosis (PwP; N=123), their first-degree relatives (N=79), and controls (N=51) completed the Dot Pattern Expectancy task, which allows differentiation between proactive and reactive control. PwP demonstrated slower drift rates on proactive control trials suggesting less efficient use of cue information for proactive control. They also showed longer non-decision times than controls on infrequent stimuli sequences suggesting slower perceptual processing. An explainable machine learning analysis indicated that the hDDM parameters were able to differentiate between the groups better than conventional measures. Through DDM, we found that cognitive control deficits in psychosis are characterized by slower motor/perceptual time and slower evidence-integration primarily in proactive control.

Validity and reliability of the Vigour Assessment Scale in avolitional schizophrenia outpatients

A few items of existing schizophrenia scales measure avolition, but no research has been reported on vigour in schizophrenia, including whether avolition would be more or less the inverse of vigour. Such research requires a valid and reliable measure of vigour. In the absence of this, this study developed and examined the validity and the reliability of the Vigour Assessment Scale (VAS) among 242 avolitional schizophrenia outpatients in relation to measures of workplace vigour, behavioral inhibition and activation, procrastination, fatigue, anxiety, depressive features, and active involvement in personal growth. Convergent validity was found in moderate to strong correlations (r = 0.5 to 0.714) between the VAS and measures approximate to vigour. Discriminant validity was found in lower and/or inverse correlations with depression (r = -0.423), anxiety (r = -0.279), behaviour inhibition (r = -0.045), procrastination (r = -0.656), and fatigue (r = -0.684). Internal consistency was good with Cronbach's alpha coefficients above 0.8, and strong correlations for split-half (r = 0.71) and test-retest (r = 0.77) reliability. The standard error of measurement was seven on a scale of 145 points. An exploratory factor analysis yielded a 27-item version with a six-factor structure accounting for 61.9% of the cumulative variance. These results suggest that the VAS is a valid and reliable instrument in avolitional schizophrenia outpatients, suitable for use in further research on vigour and when vigour is pursued therapeutically or in efficacy studies. Subject to further validation, the VAS may be used in other clinical populations (e.g., in depression) and healthy populations where vigour may be pursued as a desirable attribute.

Global disruption in excitation-inhibition balance can cause localized network dysfunction and Schizophrenia-like context-integration deficits

Poor context integration, the process of incorporating both previous and current information in decision making, is a cognitive symptom of schizophrenia. The maintenance of the contextual information has been shown to be sensitive to changes in excitation-inhibition (EI) balance. Many regions of the brain are sensitive to EI imbalances, however, so it is unknown how systemic manipulations affect the specific regions that are important to context integration. We constructed a multi-structure, biophysically-realistic agent that could perform context-integration as is assessed by the dot pattern expectancy task. The agent included a perceptual network, a memory network, and a decision making system and was capable of successfully performing the dot pattern expectancy task. Systemic manipulation of the agent’s EI balance produced localized dysfunction of the memory structure, which resulted in schizophrenia-like deficits at context integration. When the agent’s pyramidal cells were less excitatory, the agent fixated upon the cue and initiated responding later than the default agent, which were like the deficits one would predict that individuals on the autistic spectrum would make. This modelling suggests that it may be possible to parse between different types of context integration deficits by adding distractors to context integration tasks and by closely examining a participant’s reaction times.

Schizophrenia is a debilitating mental health disorder and its underlying etiology is currently unknown. Neural imbalances in the neural excitation and inhibition of specific regions of the brain have been hypothesized to cause symptoms of schizophrenia. Most regions of the brain have specific excitation-inhibition balances that permit their functioning in the processing of information. How systemic changes in the excitation-inhibition balance cause specific deficits and dysfunction within neural circuits is unknown. A common cognitive deficit in schizophrenia is difficulty with context integration, which is the ability to successfully use previous and current information when making decisions. We assessed how this symptom could be caused by an imbalance in neural excitation and inhibition by simulating the effects of potential imbalances in a model agent. Global imbalances in the agent’s neural excitation and inhibition led to impairment of specific circuits. These dysfunctional circuits produced behavioral deficits that were like those observed in individuals with schizophrenia. These simulations suggested how specific neural circuits may be disrupted by global changes in excitation or inhibition, ways to improve the assessment of context integration, new approaches to analyzing behavior, and why it may be beneficial to assess context integration in autism spectrum disorder.

One-Year Stability of Frontoparietal Cognitive Control Network Connectivity in Recent Onset Schizophrenia: A Task-Related 3T fMRI Study

Kraepelinian theory posits that schizophrenia (SZ) is a degenerative disorder that worsens throughout the lifespan. Behavioral studies of cognition have since challenged that viewpoint, particularly in the early phases of illness. Nonetheless, the extent to which cognition remains functionally stable during the early course of illness is unclear, particularly with regard to task-associated connectivity in cognition-related brain networks. In this study, we examined the 1-year stability of the frontoparietal control network during the AX-Continuous Performance Task (AX-CPT) from a new baseline sample of 153 participants scanned at 3T, of which 29 recent onset individuals with SZ and 42 healthy control (HC) participants had follow-up data available for analysis. Among individuals that had both baseline and follow-up data, reduced functional connectivity in SZ was observed between the dorsolateral prefrontal cortex (DLPFC) and superior parietal cortex (SPC) during the high control (B cue) condition. Furthermore, this deficit was stable over time, as no significant time × diagnosis interaction or effects of time were observed and intraclass correlation coefficients were greater than 0.6 in HCs and SZ. Previous 1.5T findings showing stable deficits with no evidence of degeneration in performance or DLPFC activation in an independent SZ sample were replicated. Overall, these results suggest that the neuronal circuitry supporting cognitive control is stably impaired during the early course of illness in SZ across multiple levels of analysis with no evidence of functional decline.

Longitudinal stability of cognitive control in early psychosis: Nondegenerative deficits across diagnoses

Cognitive impairment, particularly in the domain of cognitive control, is characteristic of schizophrenia (SZ) spectrum and bipolar disorders (BDs). The longitudinal trajectory of these impairments, however, remains unclear. Indeed, some studies have observed degeneration and others stability or even improvement over time in these illnesses. Here we examined the longitudinal stability of the AX-Continuous Performance Task (AX-CPT), a cognitive control task, in 52 patients with recent-onset SZ (<2 years from first study measurement), 20 patients with recent-onset BD Type I with psychotic features, and 70 healthy control subjects. Subjects performed the AX-CPT at 2 time points separated by an average of 365 days (range 270-620). Previously identified deficits in cognitive control were replicated in both patient groups. No effects of time or interactions between time and diagnosis were observed. Intraclass correlation coefficients also suggested AX-CPT performance was stable across time for all diagnostic groups. Although performance was stable on average, a positive association was noted between change in cognitive control and change in disorganization symptom severity across patient groups. In conclusion, the present findings suggest that deficits in cognitive control are present in both disorders and stable over the early course of psychotic illness. No evidence was observed for progression or deterioration of cognitive control or differential recovery in SZ compared to BD. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Impaired Context Processing is Attributable to Global Neuropsychological Impairment in Schizophrenia and Psychotic Bipolar Disorder

BACKGROUND

Context processing may reflect a specific cognitive impairment in schizophrenia. Whether impaired context processing is observed across psychotic disorders or among relatives of affected individuals, and whether it is a deficit that is independent from the generalized neuropsychological deficits seen in psychotic disorders, are less established.

METHODS

Schizophrenia, schizoaffective, and psychotic bipolar probands (n = 660), their first-degree relatives (n = 741), and healthy individuals (n = 308) studied by the Bipolar-Schizophrenia Network on Intermediate Phenotypes consortium performed an expectancy task requiring use of contextual information to overcome a pre-potent response. Sensitivity for target detection and false alarm rates on trials requiring inhibition or goal maintenance were measured.

RESULTS

Proband groups and relatives with psychosis spectrum personality traits demonstrated reduced target sensitivity and elevated false alarm rates. False alarm rate was higher under inhibition vs goal maintenance conditions although this difference was attenuated in schizophrenia and schizoaffective proband groups. After accounting for global neuropsychological impairment, as reflected by the composite score from the Brief Assessment of Cognition in Schizophrenia neuropsychological battery, deficits in schizophrenia and bipolar proband groups were no longer significant. Performance measures were moderately familial.

CONCLUSION

Reduced target detection, but not a specific deficit in context processing, is observed across psychotic disorders. Impairments in both goal maintenance and response inhibition appear to contribute comparably to deficits in schizophrenia and schizoaffective disorder, whereas greater difficulty with response inhibition underlies deficits in bipolar disorder. Yet, these deficits are not independent from the generalized neurocognitive impairment observed in schizophrenia and psychotic bipolar disorder.

Monkey Prefrontal Neurons Reflect Logical Operations for Cognitive Control in a Variant of the AX Continuous Performance Task (AX-CPT)

Cognitive control is the ability to modify the behavioral response to a stimulus based on internal representations of goals or rules. We sought to characterize neural mechanisms in prefrontal cortex associated with cognitive control in a context that would maximize the potential for future translational relevance to human neuropsychiatric disease. To that end, we trained monkeys to perform a dot-pattern variant of the AX continuous performance task that is used to measure cognitive control impairment in patients with schizophrenia (MacDonald, 2008;Jones et al., 2010). Here we describe how information processing for cognitive control in this task is related to neural activity patterns in prefrontal cortex of monkeys, to advance our understanding of how behavioral flexibility is implemented by prefrontal neurons in general, and to model neural signals in the healthy brain that may be disrupted to produce cognitive control deficits in schizophrenia. We found that the neural representation of stimuli in prefrontal cortex is strongly biased toward stimuli that inhibit prepotent or automatic responses. We also found that population signals encoding different stimuli were modulated to overlap in time specifically in the case that information from multiple stimuli had to be integrated to select a conditional response. Finally, population signals relating to the motor response were biased toward less frequent and therefore less automatic actions. These data relate neuronal activity patterns in prefrontal cortex to logical information processing operations required for cognitive control, and they characterize neural events that may be disrupted in schizophrenia.

SIGNIFICANCE STATEMENT

Functional imaging studies have demonstrated that cognitive control deficits in schizophrenia are associated with reduced activation of the dorsolateral prefrontal cortex (MacDonald et al., 2005). However, these data do not reveal how the disease has disrupted the function of prefrontal neurons to produce the observed deficits in cognitive control. Relating cognitive control to neurophysiological signals at a cellular level in prefrontal cortex is a necessary first step toward understanding how disruption of these signals could lead to cognitive control failure in neuropsychiatric disease. To that end, we translated a task that measures cognitive control deficits in patients with schizophrenia to monkeys and describe here how neural signals in prefrontal cortex relate to performance.

Measuring Attention in Rodents: Comparison of a Modified Signal Detection Task and the 5-Choice Serial Reaction Time Task

Neuropsychiatric research has utilized cognitive testing in rodents to improve our understanding of cognitive deficits and for preclinical drug development. However, more sophisticated cognitive tasks have not been as widely exploited due to low throughput and the extensive training time required. We developed a modified signal detection task (SDT) based on the growing body of literature aimed at improving cognitive testing in rodents. This study directly compares performance on the modified SDT with a traditional test for measuring attention, the 5-choice serial reaction time task (5CSRTT). Adult male Sprague-Dawley rats were trained on either the 5CSRTT or the SDT. Briefly, the 5CSRTT required rodents to pay attention to a spatial array of five apertures and respond with a nose poke when an aperture was illuminated. The SDT required the rat to attend to a light panel and respond either left or right to indicate the presence of a signal. In addition, modifications were made to the reward delivery, timing, control of body positioning, and the self-initiation of trials. It was found that less training time was required for the SDT, with both sessions to criteria and daily session duration significantly reduced. Rats performed with a high level of accuracy (>87%) on both tasks, however omissions were far more frequent on the 5CSRTT. The signal duration was reduced on both tasks as a manipulation of task difficulty relevant to attention and a similar pattern of decreasing accuracy was observed on both tasks. These results demonstrate some of the advantages of the SDT over the traditional 5CSRTT as being higher throughput with reduced training time, fewer omission responses and their body position was controlled at stimulus onset. In addition, rats performing the SDT had comparable high levels of accuracy. These results highlight the differences and similarities between the 5CSRTT and a modified SDT as tools for assessing attention in preclinical animal models.

Remediation of context-processing deficits in schizophrenia: preliminary data with ambiguous sentences

BACKGROUND

Processing of contextual information is essential for the establishment of good interpersonal relations and communicational interactions. Nevertheless, it is known that schizophrenic patients present impairments in the processing of contextual information. The aim of this study is to explore the influence of the remediation of context processing in schizophrenic patients.

METHODS

Thirty-one schizophrenic patients and 28 matched healthy participants were included in this study. All participants were assessed on verbal knowledge (Mill-Hill test) and depression intensity (Beck Depression Scale 21 items). Schizophrenic patients were also assessed on thought, language, and communication disorders (Thought, Language and Communication scale). All participants completed a disambiguation task with two different levels of contextualization (high or low context) and a context-processing remediation task containing social scenarios that included ambiguous words and were presented with two different types of instruction: with or without context explanation.

RESULTS

For the disambiguation task, results showed no effect of group, but a main effect of context, with better performances in the high-context than the low-context condition. For the context-processing remediation task, results showed a main effect of group: The performance of schizophrenic patients who had received explanations differed from that both of healthy participants and of schizophrenic patients who had not received explanations.

CONCLUSION

This study revealed that for all participants, the structuring of context had a positive effect on the contextual integration of ambiguous words. Concerning the remediation task, explanations about the strategies that could be used to take context into account improved the schizophrenic patients' performances. This allows us to consider new methods of remediation that could improve social interaction in schizophrenia.