Altered experiential, but not hypothetical, delay discounting in schizophrenia

A systematic review and meta-analysis of test-retest reliability and stability of delay and probability discounting

In this meta-analysis, we describe a benchmark value of delay and probability discounting reliability and stability that might be used to (a) evaluate the meaningfulness of clinically achieved changes in discounting and (b) support the role of discounting as a valid and enduring measure of intertemporal choice. We examined test-retest reliability, stability effect sizes (dz; Cohen, 1992), and relevant moderators across 30 publications comprising 39 independent samples and 262 measures of discounting, identified via a systematic review of PsychInfo, PubMed, and Google Scholar databases. We calculated omnibus effect-size estimates and evaluated the role of proposed moderators using a robust variance estimation meta-regression method. The meta-regression output reflected modest test-retest reliability, r = .670, p < .001, 95% CI [.618, .716]. Discounting was most reliable when measured in the context of temporal constraints, in adult respondents, when using money as a medium, and when reassessed within 1 month. Testing also suggested acceptable stability via nonsignificant and small changes in effect magnitude over time, dz = 0.048, p = .31, 95% CI [-0.051, 0.146]. Clinicians and researchers seeking to measure discounting can consider the contexts when reliability is maximized for specific cases.

Association of temporal discounting with transdiagnostic symptom dimensions

Temporal discounting (TD), the tendency to devalue future rewards as a function of delay until receipt, is aberrant in many mental disorders. Identifying symptom patterns and transdiagnostic dimensions associated with TD could elucidate mechanisms responsible for clinically impaired decision-making and facilitate identifying intervention targets. Here, we tested in a general population sample (N = 731) the extent to which TD was related to different symptom patterns and whether effects of time framing (dates/delay units) and monetary magnitude (large/small) had particularly strong effects in people scoring higher on specific symptom patterns. Analyses revealed that TD was related to symptom patterns loading on anxious-depression and inattention-impulsivity-overactivity dimensions. Moreover, TD was lower in the date than the delay version and with higher magnitudes, especially in people scoring higher on the inattention-impulsivity-overactivity dimension. Overall, this study provides evidence for TD as a transdiagnostic process across affective and impulsivity-related dimensions. Future studies should test framing interventions in clinical populations characterized by impulsivity.Preregistration: This research was preregistered at https://osf.io/fg9sc .

Reduced access to reinforcement drives delay discounting during experienced delays

Rewards lose value as a function of delay. Previous studies suggest that delays have a bigger effect on reward value when people must wait during the delay. However, whether delays involve waiting or postponing has often been confounded with whether choices are about hypothetical or real rewards. The current study characterized the effects of waiting and postponing in hypothetical and experiential choice contexts separately. In Experiment 1 we observed steeper delay discounting for waiting than for postponing in choices about both hypothetical money and about experienced computer game points. Two factors potentially contributing to steeper discounting in choices about waiting are reduced access to other rewards and direct costs of waiting. In Experiment 2, we adapted the experiential delay-discounting task to manipulate each factor separately. Reduced access to other reinforcers had a bigger effect on delay discounting than direct costs of waiting. These results underscore the importance of considering the unique influence of waiting and associated opportunity costs in both basic delay-discounting research and in applied contexts.

Maladaptive explore/exploit trade-offs in schizophrenia

Schizophrenia is a complex disorder that remains poorly understood, particularly at the systems level. In this opinion article we argue that the explore/exploit trade-off concept provides a holistic and ecologically valid framework to resolve some of the apparent paradoxes that have emerged within schizophrenia research. We review recent evidence suggesting that fundamental explore/exploit behaviors may be maladaptive in schizophrenia during physical, visual, and cognitive foraging. We also describe how theories from the broader optimal foraging literature, such as the marginal value theorem (MVT), could provide valuable insight into how aberrant processing of reward, context, and cost/effort evaluations interact to produce maladaptive responses.

Neuroanatomical foundations of delayed reward discounting decision making II: Evaluation of sulcal morphology and fractal dimensionality

Delayed reward discounting (DRD) is a form of decision-making reflecting valuation of smaller immediate rewards versus larger delayed rewards, and high DRD has been linked to several health behaviors, including substance use disorders, attention-deficit/hyperactivity disorder, and obesity. Elucidating the underlying neuroanatomical factors may offer important insights into the etiology of these conditions. We used structural MRI scans of 1038 Human Connectome Project participants (M_age = 28.86, 54.7% female) to explore two novel measures of neuroanatomy related to DRD: 1) sulcal morphology (SM; depth and width) and 2) fractal dimensionality (FD), or cortical morphometric complexity, of parcellated cortical and subcortical regions. To ascertain unique contributions to DRD preferences, indicators that displayed significant partial correlations with DRD after family-wise error correction were entered into iterative mixed-effect models guided by the association magnitude. When considering only SM indicators, the depth of the right inferior and width of the left central sulci were uniquely associated with DRD preferences. When considering only FD indicators, the FD of the left middle temporal gyrus, right lateral orbitofrontal cortex, and left lateral occipital and entorhinal cortices uniquely contributed DRD. When considering SM and FD indicators simultaneously, the right inferior frontal sulcus depth and left central sulcus width; and the FD of the left middle temporal gyrus, lateral occipital cortex and entorhinal cortex were uniquely associated with DRD. These results implicate SM and FD as features of the brain that underlie variation in the DRD decision-making phenotype and as promising candidates for understanding DRD as a biobehavioral disease process.

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.

Delay discounting in youth at clinical high-risk for psychosis and adults with schizophrenia

BACKGROUND

Schizophrenia (SZ) is typically preceded by a prodromal (i.e. pre-illness) period characterized by attenuated positive symptoms and declining functional outcome. Negative symptoms are prominent among individuals at clinical high-risk (CHR) for psychosis (i.e. those with prodromal syndromes) and highly predictive of conversion to illness. Mechanisms underlying negative symptoms in the CHR population are unclear. Two studies were conducted to evaluate whether abnormalities in a reward processing mechanism thought to be core to negative symptoms in SZ, value representation, also exist in CHR individuals and whether they are associated with negative symptoms transphasically.

METHODS

Study 1 included 33 individuals in the chronic phase of illness who have been diagnosed with schizophrenia or schizoaffective disorder (SZ) and 40 healthy controls (CN). Study 2 included 37 CHR participants and 45 CN. In both studies, participants completed the delay discounting (DD) task as a measure of value representation and the Brief Negative Symptom Scale was rated to measure negative symptoms.

RESULTS

Results indicated that patients with SZ had steeper discounting rates than CN, indicating impairments in value representation. However, CHR participants were unimpaired on the DD task. In both studies, steeper discounting was associated with greater severity of negative symptoms.

CONCLUSIONS

These findings suggest that deficits in value representation are associated with negative symptoms transphasically.

Computerized Assessment of Psychosis Risk

Early detection and intervention with young people at clinical high risk (CHR) for psychosis is critical for prevention efforts focused on altering the trajectory of psychosis. Early CHR research largely focused on validating clinical interviews for detecting at-risk individuals; however, this approach has limitations related to: (1) specificity (i.e., only 20% of CHR individuals convert to psychosis) and (2) the expertise and training needed to administer these interviews is limited. The purpose of our study is to develop the computerized assessment of psychosis risk (CAPR) battery, consisting of behavioral tasks that require minimal training to administer, can be administered online, and are tied to the neurobiological systems and computational mechanisms implicated in psychosis. The aims of our study are as follows: (1A) to develop a psychosis-risk calculator through the application of machine learning (ML) methods to the measures from the CAPR battery, (1B) evaluate group differences on the risk calculator score and test the hypothesis that the risk calculator score of the CHR group will differ from help-seeking and healthy controls, (1C) evaluate how baseline CAPR battery performance relates to symptomatic outcome two years later (i.e., conversion and symptomatic worsening). These aims will be explored in 500 CHR participants, 500 help-seeking individuals, and 500 healthy controls across the study sites. This project will provide a next-generation CHR battery, tied to illness mechanisms and powered by cutting-edge computational methods that can be used to facilitate the earliest possible detection of psychosis risk.

The prevalence and features of schizophrenia among individuals with gambling disorder

BACKGROUND-OBJECTIVES

Few studies have analyzed the comorbid presence of gambling disorder (GD) with schizophrenia, its sociodemographic correlates and clinical implications. This study estimated the prevalence of the dual diagnosis (GD with schizophrenia) and the differences in the profiles of patients with and without the dual condition.

METHOD

The sample included n = 3,754 patients consecutively accepted for treatment for GD. Sociodemographics, gambling-related variables, psychopathological state and personality traits were assessed and compared between the groups.

RESULTS

The prevalence of schizophrenia within patients who met clinical criteria for GD was 4.4% (95% confidence interval: 3.8%-5.1%). Variables related to the dual presence of GD with schizophrenia were single marital status, lower education level, inactive working status, socioeconomic disadvantage, younger age, earlier onset of gambling problems, worse global psychopathological state and more dysfunctional personality profile (higher level in harm avoidance and lower level in cooperativeness, reward dependence, persistence and self-directedness).

CONCLUSION

The presence of schizophrenia among patients with GD was around 4 times higher than the prevalence rate estimated in the reference general population. The differences in the profiles of GD patients with and without schizophrenia suggest that individuals with the dual diagnosis condition require unique assessment considerations and tailored treatment interventions specifically designed for the clinical and functioning higher risk.

Delay discounting abnormalities are seen in first-episode schizophrenia but not in bipolar disorder

Delay discounting (DD) is the phenomenon of individuals discounting future rewards as a function of time. It has been studied extensively in chronic schizophrenia (SZ) and the results of these studies have been variable. Comorbidity in chronic samples could be one reason for the mixed findings and studies in first-episode (FE) samples are surprisingly lacking. Bipolar disorder (BP) which shares some genetic and symptom features with SZ could serve as an interesting comparison group for DD but has been underexplored. Here we present the first study that combines FE SZ, FE BP with psychotic features, as well as healthy controls and study DD with two versions of the task. We found that SZ showed steeper discounting than HC and BP on the well-validated Kirby DD task. SZ showed no difference than HC on a separate DD task with smaller rewards presented with decimal places and shorter delays. As a preliminary finding, DD was found to be positively related to positive symptoms in FE SZ, while no relationship was found between negative symptoms and DD. In addition, we found comparable DD in BP compared to HC. Ultimately, our data may help elucidate the psychopathology in SZ and BP during intertemporal decision making.

Delay Discounting as a Transdiagnostic Process in Psychiatric Disorders: A Meta-analysis

IMPORTANCE

Delay discounting is a behavioral economic index of impulsive preferences for smaller-immediate or larger-delayed rewards that is argued to be a transdiagnostic process across health conditions. Studies suggest some psychiatric disorders are associated with differences in discounting compared with controls, but null findings have also been reported.

OBJECTIVE

To conduct a meta-analysis of the published literature on delay discounting in people with psychiatric disorders.

DATA SOURCES

PubMed, MEDLINE, PsycInfo, Embase, and Web of Science databases were searched through December 10, 2018. The psychiatric keywords used were based on DSM-IV or DSM-5 diagnostic categories. Collected data were analyzed from December 10, 2018, through June 1, 2019.

STUDY SELECTION

Following a preregistered Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol, 2 independent raters reviewed titles, abstracts, and full-text articles. English-language articles comparing monetary delay discounting between participants with psychiatric disorders and controls were included.

DATA EXTRACTION AND SYNTHESIS

Hedges g effect sizes were computed and random-effects models were used for all analyses. Heterogeneity statistics, one-study-removed analyses, and publication bias indices were also examined.

MAIN OUTCOMES AND MEASURES

Categorical comparisons of delay discounting between a psychiatric group and a control group.

RESULTS

The sample included 57 effect sizes from 43 studies across 8 diagnostic categories. Significantly steeper discounting for individuals with a psychiatric disorder compared with controls was observed for major depressive disorder (Hedges g = 0.37; P = .002; k = 7), schizophrenia (Hedges g = 0.46; P = .004; k = 12), borderline personality disorder (Hedges g = 0.60; P < .001; k = 8), bipolar disorder (Hedges g = 0.68; P < .001; k = 4), bulimia nervosa (Hedges g = 0.41; P = .001; k = 4), and binge-eating disorder (Hedges g = 0.34; P = .001; k = 7). In contrast, anorexia nervosa exhibited statistically significantly shallower discounting (Hedges g = -0.30; P < .001; k = 10). Modest evidence of publication bias was indicated by a statistically significant Egger test for schizophrenia and at the aggregate level across studies.

CONCLUSIONS AND RELEVANCE

Results of this study appear to provide empirical support for delay discounting as a transdiagnostic process across most of the psychiatric disorders examined; the literature search also revealed limited studies in some disorders, notably posttraumatic stress disorder, which is a priority area for research.

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.

Risk tolerance measured by probability discounting among individuals with primary mood and psychotic disorders

OBJECTIVE

Change in risk tolerance is a feature of multiple psychiatric disorders and may contribute to adverse outcomes. We used a probability discounting (PD) task to measure risk-taking behavior among individuals with bipolar disorder (BPAD), major depressive disorder (MDD), schizoaffective disorder (SCAD), and schizophrenia (SCZ).

METHOD

A PD task was administered to 117 patients and 88 healthy controls (HCs), along with a cognitive battery using the Cambridge Neuropsychological Test Automated Battery, and relevant symptomatology scales. We examined differences in PD rates between diagnostic groups, and compared with HCs, while controlling for potential confounding factors including measures of cognitive functioning.

RESULTS

Individuals with a diagnosis of BPAD or SCAD/SCZ prefer smaller, more guaranteed rewards rather than larger, less likely rewards as compared with healthy controls (p = .002 and p = .034, respectively). There was no effect of performance on cognitive tasks, antipsychotic treatment, or symptomatology on the rate of probability discounting.

CONCLUSION

This study supports the transdiagnostic measurement of risk-taking behaviors, even when such behaviors are not the primary area of psychopathology. Quantifying risk-taking may enable targeted therapeutic strategies across disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Time preferences are reliable across time-horizons and verbal versus experiential tasks

Individual differences in delay-discounting correlate with important real world outcomes, for example education, income, drug use, and criminality. As such, delay-discounting has been extensively studied by economists, psychologists and neuroscientists to reveal its behavioral and biological mechanisms in both human and non-human animal models. However, two major methodological differences hinder comparing results across species. Human studies present long time-horizon options verbally, whereas animal studies employ experiential cues and short delays. To bridge these divides, we developed a novel language-free experiential task inspired by animal decision-making studies. We found that the ranks of subjects' time-preferences were reliable across both verbal/experiential and second/day differences. Yet, discount factors scaled dramatically across the tasks, indicating a strong effect of temporal context. Taken together, this indicates that individuals have a stable, but context-dependent, time-preference that can be reliably assessed using different methods, providing a foundation to bridge studies of time-preferences across species.

Editorial note

This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).