Hot and cold executive functions in youth with psychotic symptoms

Abstract

Background. Psychotic symptoms are common in children and adolescents and may be early manifestations of liability to severe mental illness (SMI), including schizophrenia. SMI and psychotic symptoms are associated with impairment in executive functions. However, previous studies have not differentiated between 'cold' and 'hot' executive functions. We hypothesized that the propensity for psychotic symptoms is specifically associated with impairment in 'hot' executive functions, such as decision-making in the context of uncertain rewards and losses.Methods. In a cohort of 156 youth (mean age 12.5, range 7-24 years) enriched for familial risk of SMI, we measured cold and hot executive functions with the spatial working memory (SWM) task (total errors) and the Cambridge Gambling Task (decision-making), respectively. We assessed psychotic symptoms using the semi-structured Kiddie Schedule for Affective Disorders and Schizophrenia interview, Structured Interview for Prodromal Syndromes, Funny Feelings, and Schizophrenia Proneness Instrument -Child and Youth version.Results. In total 69 (44.23%) youth reported psychotic symptoms on one or more assessments. Cold executive functioning, indexed with SWM errors, was not significantly related to psychotic symptoms [odds ratio (OR) 1.36, 95% confidence interval (CI) 0.85-2.17, p = 0.204). Poor hot executive functioning, indexed as decision-making score, was associated with psychotic symptoms after adjustment for age, sex and familial clustering (OR 2.37, 95% CI 1.25-4.50, p = 0.008). The association between worse hot executive functions and psychotic symptoms remained significant in sensitivity analyses controlling for general cognitive ability and cold executive functions.Conclusions. Impaired hot executive functions may be an indicator of risk and a target for pre-emptive early interventions in youth.

Hot and cold executive functions in the brain: A prefrontal-cingular network

“…Deficient cognitive control, processing speed, memory (verbal, working), and reasoning are commonly reported cold EF deficits in schizophrenia ( Table 3 ). However, impaired hot EFs, including risky decision-making, theory of mind, and emotion recognition are also reported in schizophrenic patients, and associated with psychotic symptoms ( MacKenzie et al, 2017 ; Ruiz-Castañeda et al, 2020 ). Regarding treatment approaches, therapeutic targeting of cold EF deficits aligns, however, best with the fundamentally involved cold cognitive profile and pathophysiological characteristics of the disease.…”

Reliability of multimodal MRI brain measures in youth at risk for mental illness

“…Socioeconomic status was captured as a composite variable (range 0–5) indexing: (i) maternal and (ii) paternal levels of education (iii) family household annual income, (iv) ownership of primary residence, and (v) ratio of bedrooms to residents in household, as previously described (MacKenzie et al, 2017; Zwicker et al, 2019). Higher numeric value reflects higher SES.…”

Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective

“…working memory) and “hot” (e.g. decision making) functions, there are specific relationship between “hot” executive functioning (decision making ability) and psychotic symptom severity (MacKenzie et al 2017), suggesting that certain aspects of these broad cognitive domains are more critical for understanding relationships with current and impending psychotic experiences. Finally, specific analysis of latent inhibition, a learning process dependent on both attentional and perceptual resources, identified a deficit in latent inhibition in ultra-high risk individuals, indicating impaired ability to learn from past experiences to adjust expectations for future experiences (Kraus et al 2016).…”