Impairments in goal-directed action and reversal learning in a proportion of individuals with psychosis

Abstract

Cognitive impairment in psychosis is one of the strongest predictors of functional decline. Problems with decision-making processes, such as goal-directed action and reversal learning, can reflect cortico-striatal dysfunction. The heterogenous symptoms and neurobiology observed in those with psychosis suggests that specific cognitive phenotypes may reflect differing causative mechanisms. As such, decision-making performance could identify subgroups of individuals with more severe cortico-striatal dysfunction and help to predict their functional decline. The present work evaluated the relationship between goal-directed action, reversal learning, and symptom profiles in those with psychosis. We assessed decision-making processes in healthy controls (N = 34) and those with persistent psychosis (N = 45), subclassifying subjects based on intact/impaired goal-directed action. Compared with healthy controls (<20%), a large proportion (58%) of those with persistent psychosis displayed impaired goal-directed action, predicting poor serial reversal learning performance. Computational approaches indicated that those with impaired goal-directed action had a decreased capacity to rapidly update their prior beliefs in the face of changing contingencies. Impaired decision-making also was associated with reduced levels of grandiosity and increased problems with abstract thinking. These findings suggest that prominent decision-making deficits, indicative of cortico-striatal dysfunction, are present in a large proportion of people with persistent psychosis. Moreover, these impairments would have significant functional implications in terms of planning and abstract thinking.

Neural Circuitry of Salience and Reward Processing in Psychosis

“…( 98 , 99 ) demonstrated that people with schizophrenia were able to understand that one outcome was worth less after devaluation but failed to alter their actions in response to this information. Our work suggests that this may occur in a specific subgroup of those with chronic psychosis and is less likely to be observed in early psychosis ( 97 ). These goal-directed action impairments were due to the inability to correctly relate outcomes causally to actions rather than problems in reward valuation ( 99 ).…”

“…Those at risk for psychosis exhibited less activation of the nucleus accumbens and ventromedial PFC in reward processing ( 58 ). In contrast, reinforcement learning studies conducted in those with early psychosis suggest that deficits may include punishment learning, specifically a decreased sensitivity to punishment ( 97 , 123 ). However, reversal learning impairments in early psychosis are less robust than in those with persistent schizophrenia, with some studies observing relatively intact performance ( 118 , 122 ).…”

“…In parallel to motivational and effort-based impairments, people with schizophrenia are less able to use reward information correctly when guiding their actions ( 89 ). A good example is the result obtained when patients with schizophrenia carry out outcome-specific devaluation tasks ( 96 , 97 ). Morris et al.…”

“…Decreased activation of the nucleus accumbens, anterior cingulate cortex, and dorsolateral PFC has been associated with impaired reward learning in those with schizophrenia ( 90 , 114 ). One consistently reported behavioral tendency in schizophrenia is reduced win-stay use in reversal learning tasks ( 50 , 66 , 97 , 110 , 115 ). Win-stay refers to a participant selecting the same stimulus after winning a reward on the prior trial.…”

Biopsychology of Physical Activity in People with Schizophrenia: An Integrative Perspective on Barriers and Intervention Strategies

“…Through this process of reinforcement learning, the formation of action–outcome associations may be purposefully built, which is especially relevant in people with schizophrenia who typically show difficulty in integrating action–outcome learning to guide choice. 9 , 45 …”