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Levinson T, Prettyman G, Savage C, White L, Moore TM, Calkins ME, Ruparel K, Gur RE, Gur RC, Satterthwaite TD, Wolf DH. Activation of Internal Correctness Monitoring Circuitry in Youths With Psychosis Spectrum Symptoms. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:542-550. [PMID: 37019760 PMCID: PMC10164703 DOI: 10.1016/j.bpsc.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Self-directed performance monitoring is a critical contributor to cognitive performance and general functioning and is impacted by psychiatric symptoms and personality traits, but has been understudied in psychosis-risk states. We have shown that ventral striatum (VS) responds to correctness during cognitive tasks where no explicit feedback is required, and this intrinsic reinforcement response is reduced in schizophrenia. METHODS Here, we examined this phenomenon in youths (n = 796, age range 11-22 years) from the Philadelphia Neurodevelopmental Cohort (PNC) performing a working memory functional magnetic resonance imaging task. We hypothesized that VS would respond to internal correctness monitoring, while classic salience network regions, such as dorsal anterior cingulate cortex and anterior insular cortex, would reflect internal error monitoring and that these responses would increase with age. We expected that neurobehavioral measures of performance monitoring would be reduced in youths with subclinical psychosis spectrum features and would correlate with amotivation severity. RESULTS Supporting these hypotheses, we found correct>incorrect activation in VS and incorrect>correct activation in anterior cingulate cortex and anterior insular cortex. Furthermore, VS activation was positively correlated with age, reduced in youths with psychosis spectrum features, and inversely correlated with amotivation. However, these patterns were not significant in anterior cingulate cortex and anterior insular cortex. CONCLUSIONS These findings advance our understanding of the neural underpinnings of performance monitoring and its impairment in adolescents with psychosis spectrum features. Such understanding can facilitate investigation of the developmental trajectory of normative and aberrant performance monitoring; contribute to early identification of youths at elevated risk for poor academic, occupational, or psychiatric outcomes; and provide potential targets for therapeutic development.
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Affiliation(s)
- Tess Levinson
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts
| | - Greer Prettyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chloe Savage
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren White
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kosha Ruparel
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Theodore D Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Lifespan Informatics and Neuroimaging Center, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.
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Reinforcement learning abnormalities in the attenuated psychosis syndrome and first episode psychosis. Eur Neuropsychopharmacol 2021; 47:11-19. [PMID: 33819817 PMCID: PMC8197752 DOI: 10.1016/j.euroneuro.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022]
Abstract
Prior studies indicate that chronic schizophrenia (SZ) is associated with a specific profile of reinforcement learning abnormalities. These impairments are characterized by: 1) reductions in learning rate, and 2) impaired Go learning and intact NoGo learning. Furthermore, each of these deficits are associated with greater severity of negative symptoms, consistent with theoretical perspectives positing that avolition and anhedonia are associated with impaired value representation. However, it is unclear whether these deficits extend to earlier phases of psychotic illness and when individuals are unmedicated. Two studies were conducted to examine reinforcement learning deficits in earlier phases of psychosis and in high risk patients. In study 1, participants included 35 participants with first episode psychosis (FEP) with limited antipsychotic medication exposure and 25 healthy controls (HC). Study 2 included 17 antipsychotic naïve individuals who were at clinical high-risk for psychosis (CHR) (i.e., attenuated psychosis syndrome) and 18 matched healthy controls (HC). In both studies, participants completed the Temporal Utility Integration Task, a measure of probabilistic reinforcement learning that contained Go and NoGo learning blocks. FEP displayed impaired Go and NoGo learning. In contrast, CHR did not display impairments in Go or NoGo learning. Impaired Go learning was not significantly associated with clinical outcomes in the CHR or FEP samples. Findings provide new evidence for areas of spared and impaired reinforcement learning in early phases of psychosis.
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Millman ZB, Gallagher K, Demro C, Schiffman J, Reeves GM, Gold JM, Rakhshan PJ, Fitzgerald J, Andorko N, Redman S, Buchanan R, Rowland L, Waltz JA. Evidence of reward system dysfunction in youth at clinical high-risk for psychosis from two event-related fMRI paradigms. Schizophr Res 2020; 226:111-119. [PMID: 30995969 PMCID: PMC6801019 DOI: 10.1016/j.schres.2019.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/11/2022]
Abstract
Abnormal reward processing is thought to play an important role in the development of psychosis, but relatively few studies have examined reward prediction errors, reinforcement learning (RL), and the reward circuitry that subserves these interconnected processes among individuals at clinical high-risk (CHR) for the disorder. Here, we present behavioral and functional neuroimaging results of two experimental tasks designed to measure overlapping aspects of reward processing among individuals at CHR (n = 22) and healthy controls (n = 19). We found no group differences in response times to positive, negative, or neutral outcome-signaling cues, and no significant differences in brain activation during reward anticipation or receipt. Youth at CHR, however, displayed clear RL impairments, as well as attenuated responses to rewards and blunted prediction error signals in the ventral striatum, dorsal anterior cingulate cortex (dACC), and ventromedial prefrontal cortex (vmPFC). Greater contrasts for cue valence (gain-loss) and outcome magnitude (large-small) in the vmPFC were associated with more severe negative symptoms, and deficits in dACC signaling during RL were associated with more depressive symptoms. Our results provide evidence for RL deficits and abnormal prediction error signaling in the brain's reward circuitry among individuals at CHR, while also suggesting that reward motivation may be relatively preserved at this stage in development. Longitudinal studies, medication-free participants, and comparison of neurobehavioral measures against both healthy and clinical controls are needed to better understand the role of reward system abnormalities in the development of psychosis.
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Affiliation(s)
- Zachary B. Millman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Keith Gallagher
- Department of Psychiatry, University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore MD 21201 USA
| | - Caroline Demro
- Department of Psychiatry, University of Minnesota Medical School, 2312 S. 6th St., Floor 2, Suite F-275, Minneapolis, MD, 55454
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
| | - Gloria M. Reeves
- Department of Psychiatry, University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore MD 21201 USA
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD, 21228
| | - Pamela J. Rakhshan
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - John Fitzgerald
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Nicole Andorko
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Samantha Redman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Robert Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD, 21228
| | - Laura Rowland
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD, 21228
| | - James A. Waltz
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD, 21228
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Straub KT, Hua JPY, Karcher NR, Kerns JG. Psychosis risk is associated with decreased white matter integrity in limbic network corticostriatal tracts. Psychiatry Res Neuroimaging 2020; 301:111089. [PMID: 32442837 PMCID: PMC7293570 DOI: 10.1016/j.pscychresns.2020.111089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
It is thought that altered connectivity between the striatum and the cortex could contribute to psychosis. However, whether psychosis risk is associated with altered white matter connectivity between the striatum and any cortical region is still unclear. Further, no previous study has directly examined whether psychosis risk is associated with altered striatal connectivity with specific cortical networks. The current study examined the integrity of corticostriatal white matter tracts in psychosis risk (n=18) and in non-psychosis risk comparison participants (n=19). We used probabilistic tractography to identify white matter tracts connecting each of four different striatal subregions with their most functionally connected cortical network: limbic, default mode, frontoparietal, and motor networks. We then compared groups on fractional anisotropy in these four tracts. Psychosis risk was associated with decreased fractional anisotropy in white matter tracts connecting the limbic striatum with the limbic cortical network, especially in an anterior right external capsule segment and in tracts specifically connected to the right prefrontal cortex. In contrast, psychosis risk was not associated with decreased white matter integrity in other corticostriatal tracts. Hence, the current research suggests that psychosis risk is especially associated with decreased corticostriatal white matter integrity involved in processing emotional and personally relevant information.
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Affiliation(s)
- Kelsey T Straub
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Jessica P Y Hua
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Nicole R Karcher
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA.
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Structural and functional imaging markers for susceptibility to psychosis. Mol Psychiatry 2020; 25:2773-2785. [PMID: 32066828 PMCID: PMC7577836 DOI: 10.1038/s41380-020-0679-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Abstract
The introduction of clinical criteria for the operationalization of psychosis high risk provided a basis for early detection and treatment of vulnerable individuals. However, about two-thirds of people meeting clinical high-risk (CHR) criteria will never develop a psychotic disorder. In the effort to increase prognostic precision, structural and functional neuroimaging have received growing attention as a potentially useful resource in the prediction of psychotic transition in CHR patients. The present review summarizes current research on neuroimaging biomarkers in the CHR state, with a particular focus on their prognostic utility and limitations. Large, multimodal/multicenter studies are warranted to address issues important for clinical applicability such as generalizability and replicability, standardization of clinical definitions and neuroimaging methods, and consideration of contextual factors (e.g., age, comorbidity).
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Salfi F, Lauriola M, Tempesta D, Calanna P, Socci V, De Gennaro L, Ferrara M. Effects of Total and Partial Sleep Deprivation on Reflection Impulsivity and Risk-Taking in Deliberative Decision-Making. Nat Sci Sleep 2020; 12:309-324. [PMID: 32547280 PMCID: PMC7261660 DOI: 10.2147/nss.s250586] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/08/2020] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES To evaluate the effects of total and partial sleep deprivation on reflection impulsivity and risk-taking in tasks requiring deliberative decision-making processes. PARTICIPANTS AND METHODS Seventy-four healthy young adults were selected to participate in two independent experiments, each consisting of a crossover design. In Experiment 1, 32 participants were tested after one night of regular sleep (RS), and after one night of total sleep deprivation (TSD). In Experiment 2, 42 participants were tested following five nights of RS and after five nights of partial sleep deprivation (PSD), implying five hours of sleep per night. In both the experiments, two deliberative decision-making tasks were administered, involving different decision-making constructs. The Mosaic Task (MT) assessed reflection impulsivity, the tendency to gather information before making a decision. The Columbia Card Task cold version (CCTc) evaluated risk-taking propensity in a dynamic environment. RESULTS Unlike TSD, PSD led to an increment of reflection impulsivity and risk-taking. Nevertheless, analyses taking into account the individuals' baseline (RS) performance showed consistent results between the two experimental sleep manipulations. Participants who gathered more information to make decisions in the MT when well-rested, then relied on less evidence under sleep loss, and more cautious participants in the CCTc tended to make riskier decisions. CONCLUSION Results pointed to differential consequences of sleep deprivation depending on the habitual way to respond during decision-making involving deliberative reasoning processes. Results were interpreted according to a putative interaction between sleep loss effect and individual difference factors.
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Affiliation(s)
- Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Lauriola
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Daniela Tempesta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Pierpaolo Calanna
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Nucleus accumbens activation is linked to salience in social decision making. Eur Arch Psychiatry Clin Neurosci 2019; 269:701-712. [PMID: 30361926 DOI: 10.1007/s00406-018-0947-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
Aberrant salience may explain hasty decision making and psychotic symptoms in schizophrenia. In healthy individuals, final decisions in probabilistic reasoning tasks are related to Nucleus accumbens (Nacc) activation. However, research investigating the Nacc in social decision making is missing. Our study aimed at investigating the role of the Nacc for social decision making and its link to (aberrant) salience attribution. 47 healthy individuals completed a novel social jumping-to-conclusion (JTC) fMRI-paradigm, showing morphed faces simultaneously expressing fear and happiness. Participants decided on the 'current' emotion after each picture, and on the 'general' emotion of series of faces. Nacc activation was stronger during final decisions than in previous trials without a decision, particularly in fear rather than happiness series. A JTC-bias was associated with higher Nacc activation for last fearful, but not last happy faces. Apparently, mechanisms underlying probabilistic reasoning are also relevant for social decision making. The pattern of Nacc activation suggests salience, not reward, drives the final decision. Based on these findings, we hypothesize that aberrant salience might also explain social-cognitive deficits in schizophrenia.
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Bronstein MV, Pennycook G, Joormann J, Corlett PR, Cannon TD. Dual-process theory, conflict processing, and delusional belief. Clin Psychol Rev 2019; 72:101748. [PMID: 31226640 DOI: 10.1016/j.cpr.2019.101748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 01/10/2023]
Abstract
Many reasoning biases that may contribute to delusion formation and/or maintenance are common in healthy individuals. Research indicating that reasoning in the general population proceeds via analytic processes (which depend upon working memory and support hypothetical thought) and intuitive processes (which are autonomous and independent of working memory) may therefore help uncover the source of these biases. Consistent with this possibility, recent studies imply that impaired conflict processing might reduce engagement in analytic reasoning, thereby producing reasoning biases and promoting delusions in individuals with schizophrenia. Progress toward understanding this potential pathway to delusions is currently impeded by ambiguity about whether any of these deficits or biases is necessary or sufficient for the formation and maintenance of delusions. Resolving this ambiguity requires consideration of whether particular cognitive deficits or biases in this putative pathway have causal primacy over other processes that may also participate in the causation of delusions. Accordingly, the present manuscript critically evaluates whether impaired conflict processing is the primary initiating deficit in the generation of reasoning biases that may promote the development and/or maintenance of delusions. Suggestions for future research that may elucidate mechanistic pathways by which reasoning deficits might engender and maintain delusions are subsequently offered.
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Affiliation(s)
- Michael V Bronstein
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA.
| | - Gordon Pennycook
- Hill/Levene Schools of Business, University of Regina, Regina, Saskatchewan, Canada
| | - Jutta Joormann
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, 300 George Street, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA; Department of Psychiatry, Yale University, 300 George Street, New Haven, CT, USA
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Karcher NR, Hua JPY, Kerns JG. Probabilistic Category Learning and Striatal Functional Activation in Psychosis Risk. Schizophr Bull 2019; 45:396-404. [PMID: 29590478 PMCID: PMC6403050 DOI: 10.1093/schbul/sby033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Psychosis risk is associated with striatal dysfunction, including a previous behavioral study that found that psychosis risk is associated with impaired performance on a probabilistic category learning task (PCLT; ie, the Weather Prediction Task), a task strongly associated with striatal activation. The current study examined whether psychosis risk based on symptom levels was associated with both poor behavioral performance and task-related physiological dysfunction in specific regions of the striatum while performing the PCLT. METHODS There were 2 groups of participants: psychosis risk (n = 21) who had both (a) extreme levels of self-reported psychotic-like beliefs and experiences and (b) interview-rated current attenuated psychotic symptoms (APS); and a comparison group (n = 20) who had average levels of self-reported psychotic-like beliefs and experiences. Participants completed the PCLT during fMRI scanning. RESULTS The current research replicated previous work finding behavioral PCLT deficits at the end of the task in psychosis risk. Furthermore, as expected, the psychosis risk group exhibited decreased striatal activation on the task, especially in the associative striatum. The psychosis risk group also displayed decreased activation in a range of cortical regions connected to the associative striatum. In contrast, the psychosis risk group exhibited greater activation predominantly in cortical regions not connected to the associative striatum. CONCLUSIONS Psychosis risk was associated with both behavioral and striatal dysfunction during performance on the PCLT, suggesting that behavioral and imaging measures using this task could be a marker for psychosis risk.
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Affiliation(s)
- Nicole R Karcher
- Department of Psychological Sciences, University of Missouri, Columbia, MO,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO,To whom correspondence should be addressed; Department of Psychological Sciences, University of Missouri, 214 McAlester Hall, Columbia, MO 65211; tel: 573-882-8846, fax: 573-882-7710, e-mail:
| | - Jessica P Y Hua
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO
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Andreou C, Steinmann S, Leicht G, Kolbeck K, Moritz S, Mulert C. fMRI correlates of jumping-to-conclusions in patients with delusions: Connectivity patterns and effects of metacognitive training. NEUROIMAGE-CLINICAL 2018; 20:119-127. [PMID: 30094162 PMCID: PMC6077165 DOI: 10.1016/j.nicl.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Abstract
Background Reasoning biases such as the jumping-to-conclusions bias (JTC) are thought to contribute to delusions. Interventions targeting these biases such as metacognitive training (MCT) may improve delusions. So far, it is not clear whether JTC depends on dopaminergic reward areas that constitute the main action locus of antipsychotic drugs, or on additional cortical areas. The present study aimed to investigate fMRI activation and functional connectivity patterns underlying JTC, and their changes following MCT, in patients with delusions. Methods Participants were 25 healthy individuals and 26 patients with current delusions who were either medication-free or on stable medication without sufficient response. We assessed (1) BOLD activity in the task-positive (TPN), task-negative (TNN), and subcortical reward network (RN); (2) Psychophysiological interactions (PPI) of peak activation areas. Results Presence of JTC (irrespective of group) was associated with lower RN activity during conclusion events, and with increased effective connectivity between TPN and TNN during draw events. Following MCT, changes were observed in TPN activity and in effective connectivity of inferior parietal cortex (part of the TPN) with all three target networks. Conclusion JTC is associated not only with reward system areas that constitute the main target of antipsychotic drugs, but also with cortical areas, particularly of the TPN. Faulty evidence gathering (jumping to conclusions, JTC) is associated with delusions. We assessed data gathering with fMRI in patients with delusions vs healthy controls. JTC was associated with abnormal activity and connectivity patterns. Changes in the task-positive network were observed following metacognitive training.
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Affiliation(s)
- Christina Andreou
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland; Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Saskia Steinmann
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Kolbeck
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre for Psychiatry and Psychotherapy, Justus-Liebig-University, Giessen, Germany
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Monocausal Attributions Along Cross-Sections of Psychosis Development and Links with Psychopathology and Data Gathering Style. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9907-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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12
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Lin P, Wang X, Zhang B, Kirkpatrick B, Öngür D, Levitt JJ, Jovicich J, Yao S, Wang X. Functional dysconnectivity of the limbic loop of frontostriatal circuits in first-episode, treatment-naive schizophrenia. Hum Brain Mapp 2017; 39:747-757. [PMID: 29094787 DOI: 10.1002/hbm.23879] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/02/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022] Open
Abstract
Frontostriatal circuits dysfunction has been implicated in the etiology and psychopathology of patients with schizophrenia (SZ). However, few studies have investigated SZ-related functional connectivity (FC) alterations in discrete frontostriatal circuits and their relationship with pathopsychology in first-episode schizophrenia (FESZ). The goal of this study was to identify dysfunctions in discrete frontostriatal circuits that are associated with key features of FESZ. To this end, a case-control, cross-sectional study was conducted, wherein resting-state (RS) functional magnetic resonance (fMRI) data were collected from 37 treatment-naïve FESZ patients and 29 healthy control (HC) subjects. Seed-based FC analyses were performed by placing six bilateral pairs of seeds within a priori defined subdivisions of the striatum. We observed significantly decreased FC for the FESZ group relative to the HC group [p < .05, family-wise error (FWE)-corrected] in the limbic loop, but not in the sensorimotor or associative loops, of frontostriatal circuitry. Moreover, bilaterally decreased inferior ventral striatum/nucleus accumbens (VSi)-dorsal anterior cingulate cortex (dACC) FC within the limbic loop correlated inversely with overall FESZ symptom severity and the disorganization factor score of PANSS. These findings provide new insight into the role of frontostriatal limbic loop hypoconnectivity in early-stage schizophrenia pathology and suggest potential novel therapeutic targets.
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Affiliation(s)
- Pan Lin
- Key Laboratory of Cognitive Science, College of Biomedical Engineering, South-Central University for Nationalities, Wuhan, 430074, China
| | - Xiaosheng Wang
- Department of Human Anatomy and Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410013, China
| | - Bei Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.,Department of Psychology, Experimental Psychology, Ludwig-Maximilians-Universität München, 80802, Munich, Germany
| | - Brian Kirkpatrick
- Department of Psychiatry & Behavioral Sciences, University of Nevada School of Medicine, Reno, Nevada, 89509
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, Massachusetts, 02478
| | - James J Levitt
- Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System, Boston, Massachusetts, 02215
| | - Jorge Jovicich
- Center for Mind/Brain Sciences, University of Trento, Mattarello, 38100, Italy
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
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Mier D, Eisenacher S, Rausch F, Englisch S, Gerchen MF, Zamoscik V, Meyer-Lindenberg A, Zink M, Kirsch P. Aberrant activity and connectivity of the posterior superior temporal sulcus during social cognition in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2017; 267:597-610. [PMID: 27770284 DOI: 10.1007/s00406-016-0737-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/25/2016] [Indexed: 12/31/2022]
Abstract
Schizophrenia is associated with significant impairments in social cognition. These impairments have been shown to go along with altered activation of the posterior superior temporal sulcus (pSTS). However, studies that investigate connectivity of pSTS during social cognition in schizophrenia are sparse. Twenty-two patients with schizophrenia and 22 matched healthy controls completed a social-cognitive task for functional magnetic resonance imaging that allows the investigation of affective Theory of Mind (ToM), emotion recognition and the processing of neutral facial expressions. Moreover, a resting-state measurement was taken. Patients with schizophrenia performed worse in the social-cognitive task (main effect of group). In addition, a group by social-cognitive processing interaction was revealed for activity, as well as for connectivity during the social-cognitive task, i.e., patients with schizophrenia showed hyperactivity of right pSTS during neutral face processing, but hypoactivity during emotion recognition and affective ToM. In addition, hypoconnectivity between right and left pSTS was revealed for affective ToM, but not for neutral face processing or emotion recognition. No group differences in connectivity from right to left pSTS occurred during resting state. This pattern of aberrant activity and connectivity of the right pSTS during social cognition might form the basis of false-positive perceptions of emotions and intentions and could contribute to the emergence and sustainment of delusions.
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Affiliation(s)
- Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany.
| | - Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Franziska Rausch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Vera Zamoscik
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
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14
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Balzan RP, Ephraums R, Delfabbro P, Andreou C. Beads task vs. box task: The specificity of the jumping to conclusions bias. J Behav Ther Exp Psychiatry 2017; 56:42-50. [PMID: 27568886 DOI: 10.1016/j.jbtep.2016.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous research involving the probabilistic reasoning 'beads task' has consistently demonstrated a jumping-to-conclusions (JTC) bias, where individuals with delusions make decisions based on limited evidence. However, recent studies have suggested that miscomprehension may be confounding the beads task. The current study aimed to test the conventional beads task against a conceptually simpler probabilistic reasoning "box task" METHODS: One hundred non-clinical participants completed both the beads task and the box task, and the Peters et al. Delusions Inventory (PDI) to assess for delusion-proneness. The number of 'draws to decision' was assessed for both tasks. Additionally, the total amount of on-screen evidence was manipulated for the box task, and two new box task measures were assessed (i.e., 'proportion of evidence requested' and 'deviation from optimal solution'). RESULTS Despite being conceptually similar, the two tasks did not correlate, and participants requested significantly less information on the beads task relative to the box task. High-delusion-prone participants did not demonstrate hastier decisions on either task; in fact, for box task, this group was observed to be significantly more conservative than low-delusion-prone group. LIMITATIONS Neither task was incentivized; results need replication with a clinical sample. CONCLUSION Participants, and particularly those identified as high-delusion-prone, displayed a more conservative style of responding on the novel box task, relative to the beads task. The two tasks, whilst conceptually similar, appear to be tapping different cognitive processes. The implications of these results are discussed in relation to the JTC bias and the theoretical mechanisms thought to underlie it.
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Affiliation(s)
- Ryan P Balzan
- School of Psychology, Flinders University, South Australia, Australia.
| | - Rachel Ephraums
- School of Psychology, Flinders University, South Australia, Australia
| | - Paul Delfabbro
- School of Psychology, University of Adelaide, South Australia, Australia
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
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15
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Eisenacher S, Zink M. Holding on to false beliefs: The bias against disconfirmatory evidence over the course of psychosis. J Behav Ther Exp Psychiatry 2017; 56:79-89. [PMID: 27608522 DOI: 10.1016/j.jbtep.2016.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The ability to integrate evidence into a reasoning process is crucial in order to react to changing information, e.g. to adapt one's beliefs according to new evidence or to generate new beliefs when facing better alternatives. Evidence integration ability is thus associated with belief flexibility. A specific bias of evidence integration, a bias against disconfirmatory evidence (BADE), can be found in patients with schizophrenia and has been linked to delusion development and maintenance. Knowledge about whether the BADE occurs already in risk constellations of psychosis can clarify its role in the pathogenesis of psychosis. METHODS This article reviews the current literature on BADE. Many studies demonstrate BADE over the course of illness, ranging from healthy controls with subclinical properties of schizotypy, over patients with at-risk mental states (ARMS) and patients with a first episode of psychosis to patients with chronic schizophrenia. These data allow a comparison of competences and deficits over the course of illness. Underlying mechanisms of BADE are discussed, including interrelations with neurocognitive performance and dopaminergic processes. RESULTS The BADE could be found in different phases of psychosis development and can be regarded as a cognitive marker of the beginning psychotic state. LIMITATIONS The presented findings are derived from independent cross-sectional studies. So far, no comprehensive longitudinal assessment has been published. CONCLUSIONS Treatments of metacognitive deficits in general and as early as in the ARMS might interfere with the cognitive pathogenesis of psychosis, and thereby ameliorate, postpone or even prevent the transition to psychosis.
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Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany.
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
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16
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Caravaggio F, Gerretsen P, Mar W, Chung JK, Plitman E, Nakajima S, Kim J, Iwata Y, Patel R, Chakravarty MM, Remington G, Graff-Guerrero A, Menon M. Intranasal oxytocin does not modulate jumping to conclusions in schizophrenia: Potential interactions with caudate volume and baseline social functioning. Psychoneuroendocrinology 2017; 81:80-87. [PMID: 28431278 DOI: 10.1016/j.psyneuen.2017.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/21/2017] [Accepted: 03/18/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with schizophrenia (SCZ) tend to sample less information when making a decision, jumping to conclusions (JTC) without sufficient evidence. This "JTC bias" may be a trait marker of the disease and may not improve with antipsychotic treatment. We conducted a double-blind, placebo-controlled trial to test whether intranasal oxytocin could reduce JTC in stable, medicated patients with SCZ and healthy controls (HCs). We also explored whether striatal volume, clinical symptoms, and baseline social functioning (SF) was related to JTC performance. METHODS Forty-three male, medicated SCZ patients (Mean Age: 40.81±11.44) and sixteen HCs (Mean Age: 30.38±9.85) participated in a double-blind, placebo-controlled, cross-over study. Participants completed the Beads Task on two separate visits (minimum 20days apart). Participants were randomized to receive either intranasal oxytocin (50IU in solution) or intranasal placebo (saline). Twenty of the SCZ patients and all sixteen HCs also provided T1 MRIs (3-T). RESULTS Patients with SCZ took fewer draws to decision (DTD) than HCs (t(57)=2.78, p=0.007). Oxytocin did not significantly change DTD in patients (t(42)=-1.11, p=0.27), nor in HCs (t(15)=-0.62, p=0.55). Exploratory analyses found ventral caudate volumes were negatively correlated with DTD (r(18)=-0.50, p=0.03) in patients. Moreover, oxytocin was more likely to improve JTC in patients with lower baseline SF. However, these exploratory findings did not survive correction for multiple comparisons. CONCLUSIONS We replicate increased JTC in SCZ. However, acute intranasal oxytocin did not modify JTC. Future studies with larger samples should explore how brain morphology and SF are related to JTC performance in patients with SCZ.
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Affiliation(s)
- Fernando Caravaggio
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Philip Gerretsen
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
| | - Wanna Mar
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Jun Ku Chung
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Eric Plitman
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo Japan
| | - Julia Kim
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Yusuke Iwata
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Raihaan Patel
- Department of Biological & Biomedical Engineering, McGill University, Montreal, Quebec, H4H 1R3, Canada; Cerebral Imaging Centre, Douglas Mental Health Institute, McGill University, Montreal, Quebec, H4H 1R3, Canada
| | - M Mallar Chakravarty
- Department of Psychiatry, McGill University, Montreal, Quebec, H4H 1R3, Canada; Department of Biological & Biomedical Engineering, McGill University, Montreal, Quebec, H4H 1R3, Canada; Cerebral Imaging Centre, Douglas Mental Health Institute, McGill University, Montreal, Quebec, H4H 1R3, Canada
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, British Columbia, V6T 2A1, Canada
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17
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Eisenacher S, Zink M. The Importance of Metamemory Functioning to the Pathogenesis of Psychosis. Front Psychol 2017; 8:304. [PMID: 28321200 PMCID: PMC5337512 DOI: 10.3389/fpsyg.2017.00304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 02/17/2017] [Indexed: 11/13/2022] Open
Abstract
Many studies up to date have implied that biases in the metacognition of memory, so called metamemory, contribute to the development and maintenance of positive symptoms in schizophrenia. However, no study exists which has longitudinally followed patients experiencing positive symptoms. The present article therefore reviews cross-sectional studies on retrospective metamemory abilities in participants within different stages of a schizophrenia spectrum disorder, with heterogeneous symptom severities, creating a pseudo-longitudinal overview. Summarized, a deterioration of these abilities correlating with psychosis development can be inferred. The reviewed publications indicate that metamemory biases can already be found in patients with an at-risk mental state for psychosis (ARMS). Patients in their first episode of psychosis (FEP) seem to be more severely impaired than ARMS-patients but similarly affected compared to chronic patients. The contribution of these biases to the pathogenesis of psychosis is discussed, giving consideration to relations with other cognitive- and metacognitive functions, neurochemical processes and neural correlates. It is hypothesized that the biases represent early cognitive markers of the beginning and persisting psychotic state. An early treatment program could help patients to ameliorate the general course of illness or even to prevent the risk of a transition to psychosis.
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Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim Mannheim, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty MannheimMannheim, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital AnsbachAnsbach, Germany
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18
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Goulet-Kennedy J, Labbe S, Fecteau S. The involvement of the striatum in decision making. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27069380 PMCID: PMC4826771 DOI: 10.31887/dcns.2016.18.1/sfecteau] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Decision making has been extensively studied in the context of economics and from a group perspective, but still little is known on individual decision making. Here we discuss the different cognitive processes involved in decision making and its associated neural substrates. The putative conductors in decision making appear to be the prefrontal cortex and the striatum. Impaired decision-making skills in various clinical populations have been associated with activity in the prefrontal cortex and in the striatum. We highlight the importance of strengthening the degree of integration of both cognitive and neural substrates in order to further our understanding of decision-making skills. In terms of cognitive paradigms, there is a need to improve the ecological value of experimental tasks that assess decision making in various contexts and with rewards; this would help translate laboratory learnings into real-life benefits. In terms of neural substrates, the use of neuroimaging techniques helps characterize the neural networks associated with decision making; more recently, ways to modulate brain activity, such as in the prefrontal cortex and connected regions (eg, striatum), with noninvasive brain stimulation have also shed light on the neural and cognitive substrates of decision making. Together, these cognitive and neural approaches might be useful for patients with impaired decision-making skills. The drive behind this line of work is that decision-making abilities underlie important aspects of wellness, health, security, and financial and social choices in our daily lives.
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Affiliation(s)
- Julie Goulet-Kennedy
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale. Centre de recherche de l'Institut universitaire en santé mentale de Québec; Faculté de médecine, Université Laval, Québec, Canada
| | - Sara Labbe
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale. Centre de recherche de l'Institut universitaire en santé mentale de Québec; Faculté de médecine, Université Laval, Québec, Canada
| | - Shirley Fecteau
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale. Centre de recherche de l'Institut universitaire en santé mentale de Québec; Faculté de médecine, Université Laval, Québec, Canada
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19
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Rausch F, Eisenacher S, Elkin H, Englisch S, Kayser S, Striepens N, Lautenschlager M, Heinz A, Gudlowski Y, Janssen B, Gaebel W, Michel TM, Schneider F, Lambert M, Naber D, Juckel G, Krueger-Oezguerdal S, Wobrock T, Hasan A, Riedel M, Moritz S, Müller H, Klosterkötter J, Bechdolf A, Zink M, Wagner M. Evaluation of the 'Jumping to conclusions' bias in different subgroups of the at-risk mental state: from cognitive basic symptoms to UHR criteria. Psychol Med 2016; 46:2071-2081. [PMID: 27094404 DOI: 10.1017/s0033291716000465] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients with psychosis display the so-called 'Jumping to Conclusions' bias (JTC) - a tendency for hasty decision-making in probabilistic reasoning tasks. So far, only a few studies have evaluated the JTC bias in 'at-risk mental state' (ARMS) patients, specifically in ARMS samples fulfilling 'ultra-high risk' (UHR) criteria, thus not allowing for comparisons between different ARMS subgroups. METHOD In the framework of the PREVENT (secondary prevention of schizophrenia) study, a JTC task was applied to 188 patients either fulfilling UHR criteria or presenting with cognitive basic symptoms (BS). Similar data were available for 30 healthy control participants matched for age, gender, education and premorbid verbal intelligence. ARMS patients were identified by the Structured Interview for Prodromal Symptoms (SIPS) and the Schizophrenia Proneness Instrument - Adult Version (SPI-A). RESULTS The mean number of draws to decision (DTD) significantly differed between ARM -subgroups: UHR patients made significantly less draws to make a decision than ARMS patients with only cognitive BS. Furthermore, UHR patients tended to fulfil behavioural criteria for JTC more often than BS patients. In a secondary analysis, ARMS patients were much hastier in their decision-making than controls. In patients, DTD was moderately associated with positive and negative symptoms as well as disorganization and excitement. CONCLUSIONS Our data indicate an enhanced JTC bias in the UHR group compared to ARMS patients with only cognitive BS. This underscores the importance of reasoning deficits within cognitive theories of the developing psychosis. Interactions with the liability to psychotic transitions and therapeutic interventions should be unravelled in longitudinal studies.
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Affiliation(s)
- F Rausch
- Central Institute of Mental Health,Medical Faculty Mannheim,Heidelberg University,Germany
| | - S Eisenacher
- Central Institute of Mental Health,Medical Faculty Mannheim,Heidelberg University,Germany
| | - H Elkin
- Central Institute of Mental Health,Medical Faculty Mannheim,Heidelberg University,Germany
| | - S Englisch
- Central Institute of Mental Health,Medical Faculty Mannheim,Heidelberg University,Germany
| | - S Kayser
- Department of Psychiatry and Psychotherapy,University of Bonn,Germany
| | - N Striepens
- Department of Psychiatry and Psychotherapy,University of Bonn,Germany
| | - M Lautenschlager
- Department of Psychiatry and Psychotherapy,Charité University Medicine Campus Mitte,Berlin,Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy,Charité University Medicine Campus Mitte,Berlin,Germany
| | - Y Gudlowski
- Department of Psychiatry and Psychotherapy,Charité University Medicine Campus Mitte,Berlin,Germany
| | - B Janssen
- Department of Psychiatry and Psychotherapy,Heinrich-Heine-University Duesseldorf,Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy,Heinrich-Heine-University Duesseldorf,Germany
| | - T M Michel
- Department of Psychiatry, Psychotherapy and Psychosomatics,University Aachen,Germany
| | - F Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics,University Aachen,Germany
| | - M Lambert
- Department for Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Germany
| | - D Naber
- Department for Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Germany
| | - G Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine,Ruhr University Bochum,Germany
| | - S Krueger-Oezguerdal
- Department of Psychiatry, Psychotherapy, and Preventive Medicine,Ruhr University Bochum,Germany
| | - T Wobrock
- Department of Psychiatry and Psychotherapy,Georg-August-University Goettingen,Goettingen,Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy,Ludwig-Maximilians-University,Munich,Germany
| | - M Riedel
- Department of Psychiatry and Psychotherapy,Ludwig-Maximilians-University,Munich,Germany
| | - S Moritz
- Department for Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Germany
| | - H Müller
- Department of Psychiatry and Psychotherapy,University of Cologne,Germany
| | - J Klosterkötter
- Department of Psychiatry and Psychotherapy,University of Cologne,Germany
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy,University of Cologne,Germany
| | - M Zink
- Central Institute of Mental Health,Medical Faculty Mannheim,Heidelberg University,Germany
| | - M Wagner
- Department of Psychiatry and Psychotherapy,University of Bonn,Germany
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20
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Eisenacher S, Rausch F, Mier D, Fenske S, Veckenstedt R, Englisch S, Becker A, Andreou C, Moritz S, Meyer-Lindenberg A, Kirsch P, Zink M. Bias against disconfirmatory evidence in the 'at-risk mental state' and during psychosis. Psychiatry Res 2016; 238:242-250. [PMID: 27086240 DOI: 10.1016/j.psychres.2016.02.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/27/2022]
Abstract
Prior studies have confirmed a bias against disconfirmatory evidence (BADE) in schizophrenia which has been associated with delusions. However, its role in the pathogenesis of psychosis is yet unclear. The objective was to investigate BADE for the first time in subjects with an at-risk-mental-state for psychosis (ARMS), patients with a first episode of psychosis without antipsychotic treatment (FEP) and healthy controls (HC). A standard BADE test presenting written scenarios was employed. In addition, psychometric rating scales and a neuropsychological test battery were applied. A three-staged image was revealed. FEP-patients showed a significant BADE compared to the other groups. The performance of ARMS-patients lay in between HC and FEP-patients. A trend towards significance became evident for a bias against confirmatory evidence (BACE) in FEP-patients. Results were not attributable to antipsychotic or other medication or depressive symptoms. Correlations with delusions reached medium effect sizes but failed significance after Bonferroni-corrections. These results provide evidence for aberrations in evidence integration in the pathogenesis of psychosis and contribute to our knowledge of metacognitive functioning which can be used for (meta-)cognitive intervention in psychosis.
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Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany.
| | - Franziska Rausch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Sabrina Fenske
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Anna Becker
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
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21
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Eisenacher S, Rausch F, Ainser F, Mier D, Veckenstedt R, Schirmbeck F, Lewien A, Englisch S, Andreou C, Moritz S, Meyer-Lindenberg A, Kirsch P, Zink M. Investigation of metamemory functioning in the at-risk mental state for psychosis. Psychol Med 2015; 45:3329-3340. [PMID: 26201365 DOI: 10.1017/s0033291715001373] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Metamemory describes the monitoring and knowledge about one's memory capabilities. Patients with schizophrenia have been found to be less able in differentiating between correct and false answers (smaller confidence gap) when asked to provide retrospective confidence ratings in previous studies. Furthermore, higher proportions of very-high-confident but false responses have been found in this patient group (high knowledge corruption). Whether and how these biases contribute to the early pathogenesis of psychosis is yet unclear. This study thus aimed at investigating metamemory function in the early course of psychosis. METHOD Patients in an at-risk mental state for psychosis (ARMS, n = 34), patients with a first episode of psychosis (FEP, n = 21) and healthy controls (HCs, n = 38) were compared on a verbal recognition task combined with retrospective confidence-level ratings. RESULTS FEP patients showed the smallest confidence gap, followed by ARMS patients, followed by HCs. All groups differed significantly from each other. Regarding knowledge corruption, FEP patients differed significantly from HCs, whereas a statistical trend was revealed in comparison of ARMS and FEP groups. Correlations were revealed between metamemory, measures of positive symptoms and working memory performance. CONCLUSIONS These data underline the presence of a metamemory bias in ARMS patients which is even more pronounced in FEP patients. The bias might represent an early cognitive marker of the beginning psychotic state. Longitudinal studies are needed to unravel whether metacognitive deficits predict the transition to psychosis and to evaluate therapeutic interventions.
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Affiliation(s)
- S Eisenacher
- Department of Psychiatry and Psychotherapy,Central Institute of Mental Health,University of Heidelberg/Medical Faculty Mannheim,Mannheim,Germany
| | - F Rausch
- Department of Psychiatry and Psychotherapy,Central Institute of Mental Health,University of Heidelberg/Medical Faculty Mannheim,Mannheim,Germany
| | - F Ainser
- Department of Psychiatry and Psychotherapy,Central Institute of Mental Health,University of Heidelberg/Medical Faculty Mannheim,Mannheim,Germany
| | - D Mier
- Department of Clinical Psychology,Central Institute of Mental Health,University of Heidelberg/Medical Faculty MannheimMannheim,Germany
| | - R Veckenstedt
- Department of Psychiatry and Psychotherapy,University Medical Centre Hamburg-Eppendorf,Hamburg,Germany
| | - F Schirmbeck
- Department of Psychiatry and Psychotherapy,Central Institute of Mental Health,University of Heidelberg/Medical Faculty Mannheim,Mannheim,Germany
| | - A Lewien
- Department of Psychiatry and Psychotherapy,Central Institute of Mental Health,University of Heidelberg/Medical Faculty Mannheim,Mannheim,Germany
| | - S Englisch
- Department of Psychiatry and Psychotherapy,Central Institute of Mental Health,University of Heidelberg/Medical Faculty Mannheim,Mannheim,Germany
| | - C Andreou
- Department of Psychiatry and Psychotherapy,University Medical Centre Hamburg-Eppendorf,Hamburg,Germany
| | - S Moritz
- Department of Psychiatry and Psychotherapy,University Medical Centre Hamburg-Eppendorf,Hamburg,Germany
| | - A Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy,Central Institute of Mental Health,University of Heidelberg/Medical Faculty Mannheim,Mannheim,Germany
| | - P Kirsch
- Department of Clinical Psychology,Central Institute of Mental Health,University of Heidelberg/Medical Faculty MannheimMannheim,Germany
| | - M Zink
- Department of Psychiatry and Psychotherapy,Central Institute of Mental Health,University of Heidelberg/Medical Faculty Mannheim,Mannheim,Germany
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22
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Lancaster TM, Ihssen N, Brindley LM, Tansey KE, Mantripragada K, O'Donovan MC, Owen MJ, Linden DEJ. Associations between polygenic risk for schizophrenia and brain function during probabilistic learning in healthy individuals. Hum Brain Mapp 2015; 37:491-500. [PMID: 26510167 PMCID: PMC4949629 DOI: 10.1002/hbm.23044] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 12/18/2022] Open
Abstract
A substantial proportion of schizophrenia liability can be explained by additive genetic factors. Risk profile scores (RPS) directly index risk using a summated total of common risk variants weighted by their effect. Previous studies suggest that schizophrenia RPS predict alterations to neural networks that support working memory and verbal fluency. In this study, we apply schizophrenia RPS to fMRI data to elucidate the effects of polygenic risk on functional brain networks during a probabilistic‐learning neuroimaging paradigm. The neural networks recruited during this paradigm have previously been shown to be altered to unmedicated schizophrenia patients and relatives of schizophrenia patients, which may reflect genetic susceptibility. We created schizophrenia RPS using summary data from the Psychiatric Genetic Consortium (Schizophrenia Working Group) for 83 healthy individuals and explore associations between schizophrenia RPS and blood oxygen level dependency (BOLD) during periods of choice behavior (switch–stay) and reflection upon choice outcome (reward–punishment). We show that schizophrenia RPS is associated with alterations in the frontal pole (PWHOLE‐BRAIN‐CORRECTED = 0.048) and the ventral striatum (PROI‐CORRECTED = 0.036), during choice behavior, but not choice outcome. We suggest that the common risk variants that increase susceptibility to schizophrenia can be associated with alterations in the neural circuitry that support the processing of changing reward contingencies. Hum Brain Mapp 37:491–500, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Thomas M Lancaster
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom.,School of Psychology, Cardiff University, Cardiff University Brain Research Imaging Centre (CUBRIC), 70 Park Place, Cardiff, CF10 3AT, Wales, United Kingdom.,Cardiff School of Medicine, Cardiff University, MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom
| | - Niklas Ihssen
- School of Psychology, Cardiff University, Cardiff University Brain Research Imaging Centre (CUBRIC), 70 Park Place, Cardiff, CF10 3AT, Wales, United Kingdom.,Cardiff School of Medicine, Cardiff University, MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom
| | - Lisa M Brindley
- School of Psychology, Cardiff University, Cardiff University Brain Research Imaging Centre (CUBRIC), 70 Park Place, Cardiff, CF10 3AT, Wales, United Kingdom.,Cardiff School of Medicine, Cardiff University, MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom
| | - Katherine E Tansey
- Cardiff School of Medicine, Cardiff University, MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom
| | - Kiran Mantripragada
- Cardiff School of Medicine, Cardiff University, MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom
| | - Michael C O'Donovan
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom.,Cardiff School of Medicine, Cardiff University, MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom
| | - Michael J Owen
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom.,Cardiff School of Medicine, Cardiff University, MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom
| | - David E J Linden
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom.,School of Psychology, Cardiff University, Cardiff University Brain Research Imaging Centre (CUBRIC), 70 Park Place, Cardiff, CF10 3AT, Wales, United Kingdom.,Cardiff School of Medicine, Cardiff University, MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, United Kingdom
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23
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Abstract
Schizophrenia is a mental disorder associated with a variety of symptoms, including hallucinations, delusions, social withdrawal, and cognitive dysfunction. Impairments on decision-making tasks are routinely reported: evidence points to a particular deficit in learning from and revising behavior following feedback. In addition, patients tend to make hasty decisions when probabilistic judgments are required. This is known as "jumping to conclusions" (JTC) and has typically been demonstrated by presenting participants with colored beads drawn from one of two "urns" until they claim to be sure which urn the beads are being drawn from (the proportions of colors vary in each urn). Patients tend to make early decisions on this task, and there is evidence to suggest that a hasty decision-making style might be linked to delusion formation and thus be of clinical relevance. Various accounts have been proposed regarding what underlies this behavior. In this review, we briefly introduce the disorder and the decision-making deficits associated with it. We then explore the evidence for each account of JTC in the context of a wider decision-making deficit and then go on to summarize work exploring JTC in healthy controls using pharmacological manipulations and functional imaging. Finally, we assess whether JTC might have a role in therapy.
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Affiliation(s)
- Simon L Evans
- School of Psychology, University of Sussex, Brighton, East Sussex, UK
| | - Bruno B Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Nicholas Furl
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
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