The role of cognitive control in the positive symptoms of psychosis

Charlotte M. Horne; Angad Sahni; Sze W. Pang; Lucy D. Vanes; Timea Szentgyorgyi; Bruno Averbeck; Rosalyn J. Moran; Sukhwinder S. Shergill

doi:10.1016/j.nicl.2022.103004

The role of cognitive control in the positive symptoms of psychosis

Charlotte M. Horne, Angad Sahni, Sze W. Pang, Lucy D. Vanes, Timea Szentgyorgyi, Bruno Averbeck, Rosalyn J. Moran, Sukhwinder S. Shergill

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

BACKGROUND: Positive symptoms of psychosis (e.g., hallucinations) often limit everyday functioning and can persist despite adequate antipsychotic treatment. We investigated whether poor cognitive control is a mechanism underlying these symptoms. METHODS: 97 patients with early psychosis (30 with high positive symptoms (HS) and 67 with low positive symptoms (LS)) and 40 healthy controls (HC) underwent fMRI whilst performing a reward learning task with two conditions; low cognitive demand (choosing between neutral faces) and high cognitive demand (choosing between angry and happy faces - shown to induce an emotional bias). Decision and feedback phases were examined. RESULTS: Both patient groups showed suboptimal learning behaviour compared to HC and altered activity within a core reward network including occipital/lingual gyrus (decision), rostral Anterior Cingulate Cortex, left pre-central gyrus and Supplementary Motor Cortex (feedback). In the low cognitive demand condition, HS group showed significantly reduced activity in Supplementary Motor Area (SMA)/pre-SMA during the decision phase whilst activity was increased in LS group compared to HC. Recruitment of this region suggests a top-down compensatory mechanism important for control of positive symptoms. With additional cognitive demand (emotional vs. neutral contrast), HS patients showed further alterations within a subcortical network (increased left amygdala activity during decisions and reduced left pallidum and thalamus activity during feedback) compared to LS patients. CONCLUSIONS: The findings suggest a core reward system deficit may be present in both patient groups, but persistent positive symptoms are associated with a specific dysfunction within a network needed to integrate social-emotional information with reward feedback.

Original language	English
Pages (from-to)	103004
Number of pages	1
Journal	NeuroImage. Clinical
Volume	34
DOIs	https://doi.org/10.1016/j.nicl.2022.103004
Publication status	Published - 2022

Keywords

Cognitive control
fMRI
Positive symptoms
Psychosis
Reward learning

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10.1016/j.nicl.2022.103004

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title = "The role of cognitive control in the positive symptoms of psychosis",

abstract = "BACKGROUND: Positive symptoms of psychosis (e.g., hallucinations) often limit everyday functioning and can persist despite adequate antipsychotic treatment. We investigated whether poor cognitive control is a mechanism underlying these symptoms. METHODS: 97 patients with early psychosis (30 with high positive symptoms (HS) and 67 with low positive symptoms (LS)) and 40 healthy controls (HC) underwent fMRI whilst performing a reward learning task with two conditions; low cognitive demand (choosing between neutral faces) and high cognitive demand (choosing between angry and happy faces - shown to induce an emotional bias). Decision and feedback phases were examined. RESULTS: Both patient groups showed suboptimal learning behaviour compared to HC and altered activity within a core reward network including occipital/lingual gyrus (decision), rostral Anterior Cingulate Cortex, left pre-central gyrus and Supplementary Motor Cortex (feedback). In the low cognitive demand condition, HS group showed significantly reduced activity in Supplementary Motor Area (SMA)/pre-SMA during the decision phase whilst activity was increased in LS group compared to HC. Recruitment of this region suggests a top-down compensatory mechanism important for control of positive symptoms. With additional cognitive demand (emotional vs. neutral contrast), HS patients showed further alterations within a subcortical network (increased left amygdala activity during decisions and reduced left pallidum and thalamus activity during feedback) compared to LS patients. CONCLUSIONS: The findings suggest a core reward system deficit may be present in both patient groups, but persistent positive symptoms are associated with a specific dysfunction within a network needed to integrate social-emotional information with reward feedback.",

keywords = "Cognitive control, fMRI, Positive symptoms, Psychosis, Reward learning",

author = "Horne, {Charlotte M.} and Angad Sahni and Pang, {Sze W.} and Vanes, {Lucy D.} and Timea Szentgyorgyi and Bruno Averbeck and Moran, {Rosalyn J.} and Shergill, {Sukhwinder S.}",

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year = "2022",

doi = "10.1016/j.nicl.2022.103004",

language = "English",

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pages = "103004",

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T1 - The role of cognitive control in the positive symptoms of psychosis

AU - Horne, Charlotte M.

AU - Sahni, Angad

AU - Pang, Sze W.

AU - Vanes, Lucy D.

AU - Szentgyorgyi, Timea

AU - Averbeck, Bruno

AU - Moran, Rosalyn J.

AU - Shergill, Sukhwinder S.

PY - 2022

Y1 - 2022

N2 - BACKGROUND: Positive symptoms of psychosis (e.g., hallucinations) often limit everyday functioning and can persist despite adequate antipsychotic treatment. We investigated whether poor cognitive control is a mechanism underlying these symptoms. METHODS: 97 patients with early psychosis (30 with high positive symptoms (HS) and 67 with low positive symptoms (LS)) and 40 healthy controls (HC) underwent fMRI whilst performing a reward learning task with two conditions; low cognitive demand (choosing between neutral faces) and high cognitive demand (choosing between angry and happy faces - shown to induce an emotional bias). Decision and feedback phases were examined. RESULTS: Both patient groups showed suboptimal learning behaviour compared to HC and altered activity within a core reward network including occipital/lingual gyrus (decision), rostral Anterior Cingulate Cortex, left pre-central gyrus and Supplementary Motor Cortex (feedback). In the low cognitive demand condition, HS group showed significantly reduced activity in Supplementary Motor Area (SMA)/pre-SMA during the decision phase whilst activity was increased in LS group compared to HC. Recruitment of this region suggests a top-down compensatory mechanism important for control of positive symptoms. With additional cognitive demand (emotional vs. neutral contrast), HS patients showed further alterations within a subcortical network (increased left amygdala activity during decisions and reduced left pallidum and thalamus activity during feedback) compared to LS patients. CONCLUSIONS: The findings suggest a core reward system deficit may be present in both patient groups, but persistent positive symptoms are associated with a specific dysfunction within a network needed to integrate social-emotional information with reward feedback.

AB - BACKGROUND: Positive symptoms of psychosis (e.g., hallucinations) often limit everyday functioning and can persist despite adequate antipsychotic treatment. We investigated whether poor cognitive control is a mechanism underlying these symptoms. METHODS: 97 patients with early psychosis (30 with high positive symptoms (HS) and 67 with low positive symptoms (LS)) and 40 healthy controls (HC) underwent fMRI whilst performing a reward learning task with two conditions; low cognitive demand (choosing between neutral faces) and high cognitive demand (choosing between angry and happy faces - shown to induce an emotional bias). Decision and feedback phases were examined. RESULTS: Both patient groups showed suboptimal learning behaviour compared to HC and altered activity within a core reward network including occipital/lingual gyrus (decision), rostral Anterior Cingulate Cortex, left pre-central gyrus and Supplementary Motor Cortex (feedback). In the low cognitive demand condition, HS group showed significantly reduced activity in Supplementary Motor Area (SMA)/pre-SMA during the decision phase whilst activity was increased in LS group compared to HC. Recruitment of this region suggests a top-down compensatory mechanism important for control of positive symptoms. With additional cognitive demand (emotional vs. neutral contrast), HS patients showed further alterations within a subcortical network (increased left amygdala activity during decisions and reduced left pallidum and thalamus activity during feedback) compared to LS patients. CONCLUSIONS: The findings suggest a core reward system deficit may be present in both patient groups, but persistent positive symptoms are associated with a specific dysfunction within a network needed to integrate social-emotional information with reward feedback.

KW - Cognitive control

KW - fMRI

KW - Positive symptoms

KW - Psychosis

KW - Reward learning

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SN - 2213-1582

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JO - NeuroImage. Clinical

JF - NeuroImage. Clinical

ER -

The role of cognitive control in the positive symptoms of psychosis

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Keywords

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