Work

Pathways from performance monitoring to negative symptoms and functional outcomes in psychotic disorders

Year: 2020

Type: article

Abstract: 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 (β= 0.10); reduced Pe to global functioning was mediated by executive function and avolition (β= 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.

Source: Psychological Medicine

DOI: 10.1017/s0033291720000768