Abnormal cognitive effort allocation and its association with amotivation in first-episode psychosis
Abnormal cognitive effort allocation and its association with amotivation in first-episode psychosis
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DOI：
10.1017/s0033291719002769
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发表时间：
2020-11-01
影响因子：
6.9
通讯作者：
Chen, E. Y. H.
中科院分区：
文献类型：
--
作者：
Chang, W. C.;Westbrook, A.;Chen, E. Y. H.
研究背景基于努力的异常决策是精神障碍患者动机缺陷的潜在机制。先前的研究发现了慢性精神分裂症的努力分配障碍，并且主要集中在身体努力方式上。方法采用认知努力折扣（COGED）范式，对40例首发精神病（FEP）患者和44例人口统计学匹配的健康对照者进行认知努力分配的研究。基于参数变化的认知需求（N-back任务的N级）的货币奖励的连续折扣。研究了奖励折扣与动机之间的关系。奖励幅度和努力成本的敏感性，这些敏感性指数与amotivation.ResultsPatients显示显着更大的奖励折扣比对照组的差异进行了探讨。特别是，这种折扣是最明显的患者与高水平的动机，即使当N-回性能和奖励的基础金额被考虑在内。此外，与对照组相比，患者表现出降低的奖励-收益敏感性和努力-成本敏感性，并且对奖励-收益而非努力-成本的敏感性降低与动机减弱相关。奖励折扣和敏感性指数一般不相关的其他症状的尺寸，抗精神病药物的剂量和认知deficits.ConclusionThis研究提供了第一个证据的认知努力为基础的决策功能障碍的FEP，并表明，努力支出减少与动机。我们的研究结果进一步表明，不正常的努力分配和动机可能主要与钝奖励估值。前瞻性研究需要澄清效用的努力为基础的措施，在预测动机和功能的结果在FEP。
BackgroundAbnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP).MethodCognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants' willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored.ResultsPatients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits.ConclusionThis study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.