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

Published online by Cambridge University Press:  22 April 2020

Dan Foti Open the ORCID record for Dan Foti [Opens in a new window] ,
Greg Perlman ,
Evelyn J. Bromet ,
Philip D. Harvey ,
Greg Hajcak ,
Daniel H. Mathalon  and
Roman Kotov
Dan Foti*
Affiliation:
Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
Greg Perlman
Affiliation:
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
Evelyn J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
Philip D. Harvey
Affiliation:
University of Miami Miller School of Medicine, Miami, FL, USA
Greg Hajcak
Affiliation:
Department of Psychology and Biomedical Science, Florida State University, Tallahassee, FL, USA
Daniel H. Mathalon
Affiliation:
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
Roman Kotov
Affiliation:
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
*
Author for correspondence: Dan Foti, E-mail: [email protected]
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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.

Keywords

CognitionERNERPexecutive functionpsychosisschizophrenia
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 12 , September 2021 , pp. 2012 - 2022
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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