Abstract
BackgroundDysfunction in risky decision-making has been regarded as one potential contributing factor to functional impairment exhibited in patients with schizophrenia. Literature has revealed suboptimal risky decision-making in chronic schizophrenia patients. However, abnormality in risky decision-making has not been investigated in the early stage of illness. This study aimed to examine whether early schizophrenia patients displayed aberrant risky decision-making using two well-validated paradigms including Balloon Analogue Risk Task (BART; Lejuez et al., 2002) and Risky-Gains Task (RGT; Paulus et al., 2003).MethodsThirty-three clinically-stable patients diagnosed with DSM-V schizophrenia-spectrum disorder (including schizophrenia, schizoaffective disorder or schizophreniform disorder) were recruited from specialized early intervention service for psychosis in Hong Kong. A group of healthy controls (n=32), matched with age, gender and educational levels, was enrolled for comparison. All participants were evaluated with a brief battery of cognitive assessment and two computerized risky decision-making tasks. Symptom assessment was also conducted for patients.ResultsIn both BART and RGT, patients with early schizophrenia-spectrum disorder performed worse than healthy controls regarding total points gained and reaction time. In BART, patients had significantly lower adjusted scores (F(1,63)=7.8, p<0.05) and lower balloon exploration rates than controls (F(1,63)=11.5, p<0.001), indicating that patients exhibited a tendency toward risk-aversion. In GRT, three-way analysis of variance revealed significant group x response interaction (F(1,63)=7.8, p<0.05), with post-hoc independent t-test showing that patients significantly preferred safe over risky options than controls (t=2.6, p<0.05). There were no significant correlations of risky decision-making parameters with symptom ratings and cognitive functions.DiscussionWe extend previous findings of chronic samples to patients with early schizophrenia-spectrum disorder and indicate that suboptimal risky decision-making with risk-aversion preference has also been observed in the early course of illness. Further research is warranted to clarify the longitudinal change of aberrant risk-aversive behavioral patterns and its relationship with prospective functional and symptom outcomes.
Highlights
Recent studies have linked inflammation, obesity, and lipid dysregulation with cognitive impairment, a core feature of schizophrenia
We conducted an exploratory analysis to investigate the potential influence of inflammation, obesity and lipid metabolism on changes in symptom severity and cognitive performance in patients with schizophrenia treated with lurasidone
Lurasidone treatment was associated with significant reduction in symptom severity as assessed by Positive and Negative Syndrome Scale (PANSS), CGI-S, and MADRS change scores from baseline to week 6, independent of wide-range CRP (wr-CRP), high-density lipoprotein (HDL) and HOMA-IR levels at study baseline
Summary
Working memory and cognitive control deficits are hallmarks of schizophrenia It is not known how gating mechanisms that regulate memory may be disrupted in schizophrenia. Patients performed poorly on trials where participants could use only an input gating strategy (selective first). Preliminary data suggest that performance in patients tended to be slightly worse for selective first trials where the distractor was presented before the relevant item (i.e. on trials where input gating would be required to keep the distractor out of working memory). Discussion: The current study supports the feasibility of using the cognitive control task selected to investigate gating mechanisms in the schizophrenia patient population. Preliminary data suggest disruption in the ability for patients to optimally use gating strategies and handle cognitive load. Chan1 1Institute of Psychology, Chinese Academy of Sciences; 2School of Health Management, Guangzhou Medical University; 3North China Electric Power University,
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