Abstract
Introduction: The cognitive profiles of people with methamphetamine use disorder are characterized by impulsivity and impairment in social cognition. However, previous studies have not fully accounted for the presence and impact of co-occurring mental health problems on these domains. For instance, psychotic symptoms are commonly experienced by people who use methamphetamine and may influence cognitive performance. We aimed to examine decision making and emotion recognition in individuals with methamphetamine use, compared to healthy controls, to map the nature and degree of impairments in relation to the presence of psychotic symptoms. Method: In this naturalistic study, we assessed reward-based decision-making and facial emotion recognition across three groups, methamphetamine-using individuals with (MAP, n = 29) and without psychotic symptoms (MNP, n = 70), and healthy controls (HC, n = 32). Results: In comparison to healthy controls, methamphetamine-using individuals presented with poorer performance on tasks of decision-making and emotion recognition. Emotion recognition was impaired across all methamphetamine-using individuals, with significantly poorer recognition of anger and sadness in those with psychotic symptoms. Conclusion: We found specific impairments in emotion recognition in relation to psychotic symptoms in people who use methamphetamine regularly. This builds on previous evidence on cognitive profiles in methamphetamine use disorder, highlighting the need to assess co-morbid mental health and psychotic symptoms. Our finding that methamphetamine-using individuals with psychotic symptoms present with particular difficulties recognizing anger has implications for frontline clinicians.
Highlights
The cognitive profiles of people with methamphetamine use disorder are characterized by impulsivity and impairment in social cognition
Post-hoc tests comparing each group revealed the health controls (HC) group had significantly better performance on the Iowa Gambling Task compared to both MA using groups, with no difference between the methamphetamine-related psychosis (MAP) and methamphetamine using participants without psychotic symptoms (MNP) groups
For the Delay Discounting Task, post-hoc testing found significantly higher levels of impulsivity (k score) in the MNP group compared to the HC group, with no significant difference between the HC and MAP groups
Summary
The cognitive profiles of people with methamphetamine use disorder are characterized by impulsivity and impairment in social cognition. A study examining persistent MAP identified impairments in verbal learning and memory, and executive function and decision making that were comparable to those found in a chronic schizophrenia comparison group, with poorer performance compared to both healthy controls or people who used methamphetamine regularly and did not have psychosis [8]. Two studies assessing cognition in transient MAP found impairments in executive function and memory compared to healthy controls, with MAP participants and individuals with schizophrenia presenting with (similar) deficit profiles [12, 13]. Impairments in similar cognitive domains, verbal memory, have been demonstrated in studies investigating first episode psychosis [14], contributing to a growing body of evidence pointing to commonalities in the process of psychosis in MAP and primary psychotic disorders [5]. Deficits in facial emotion recognition (FER), a specific domain of social cognition, have been consistently found in both ultra-high risk (for psychosis) and first episode psychosis populations [16], suggesting these impairments may be pre-existing, and independent of the stage of psychotic illness
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