Pathways from performance monitoring to negative symptoms and functional outcomes in psychotic disorders
Pathways from performance monitoring to negative symptoms and functional outcomes in psychotic disorders
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DOI：
10.1017/s0033291720000768
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发表时间：
2021-09-01
影响因子：
6.9
通讯作者：
Kotov, Roman
中科院分区：
文献类型：
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作者：
Foti, Dan;Perlman, Greg;Kotov, Roman
后台性能监控需要快速检测错误以维护任务性能。表现监控受损是精神障碍的一个可能的病理生理过程，这可能解释了执行功能的更广泛的缺陷及其与阴性症状和功能低下的已知联系。目前的研究建立了横截面路径模型，将执行功能、症状和功能与绩效监测的神经生理学措施联系起来。方法数据来自萨福克县精神卫生项目20年的评估。精神障碍患者(N=181)最初是从住院精神病院招募的。数据也来自一组地理和人口统计相匹配的无精神病病史的患者(N=242)。神经指标为错误相关负性(ERN)和错误阳性(Pe)。结构方程模型检验了中介路径。结果在临床队列中，钝化的ERN和Pe与执行功能受损(r=0.26-0.35)、阴性症状严重程度(r=0.17-0.25)和现实生活功能差(r=0.17-0.19)有关。与执行功能的关联在不同的组中是一致的。在临床队列中发现了多条可能的途径：ERN减少到不表达是由执行功能介导的(β=0.10)；Pe减少到整体功能是由执行功能和AVOLITY介导的(β=0.10)。结论这支持一种精神障碍的跨诊断模型，在该模型中，糟糕的绩效监控会导致执行功能受损，从而导致阴性症状和现实世界功能低下。如果得到未来纵向研究的支持，这些途径可以为开发有针对性的干预措施提供信息，以解决认知和功能缺陷，这些缺陷是精神障碍的核心。
Background Performance monitoring entails rapid error detection to maintain task performance. Impaired performance monitoring is a candidate pathophysiological process in psychotic disorders, which may explain the broader deficit in executive function and its known associations with negative symptoms and poor functioning. The current study models cross-sectional pathways bridging neurophysiological measures of performance monitoring with executive function, symptoms, and functioning. Methods Data were from the 20-year assessment of the Suffolk County Mental Health Project. Individuals with psychotic disorders (N = 181) were originally recruited from inpatient psychiatric facilities. Data were also collected from a geographically and demographically matched group with no psychosis history (N = 242). Neural measures were the error-related negativity (ERN) and error positivity (Pe). Structural equation modeling tested mediation pathways. Results Blunted ERN and Pe in the clinical cohort related to impaired executive function (r = 0.26-0.35), negative symptom severity (r = 0.17-0.25), and poor real-world functioning (r = 0.17-0.19). Associations with executive function were consistent across groups. Multiple potential pathways were identified in the clinical cohort: reduced ERN to inexpressivity was mediated by executive function (beta = 0.10); reduced Pe to global functioning was mediated by executive function and avolition (beta = 0.10). Conclusions This supports a transdiagnostic model of psychotic disorders by which poor performance monitoring contributes to impaired executive function, which contributes to negative symptoms and poor real-world functioning. If supported by future longitudinal research, these pathways could inform the development of targeted interventions to address cognitive and functional deficits that are central to psychotic disorders.