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Correlates of real-world goal-directed behavior in schizophrenia

Published online by Cambridge University Press:  12 November 2021

Jaisal T. Merchant Open the ORCID record for Jaisal T. Merchant [Opens in a new window] ,
Erin K. Moran ,
Michael J. Strube  and
Deanna M. Barch
Jaisal T. Merchant*
Affiliation:
Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
Erin K. Moran
Affiliation:
Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
Michael J. Strube
Affiliation:
Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
Deanna M. Barch
Affiliation:
Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
*
Author for correspondence: Jaisal T. Merchant, E-mail: [email protected]
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Abstract

Background

Deficits in goal-directed behavior (i.e. behavior conducted to achieve a specific goal or outcome) are core to schizophrenia, difficult to treat, and associated with poor functional outcomes. Factors such as negative symptoms, effort-cost decision-making, cognition, and functional skills have all been associated with goal-directed behavior in schizophrenia as indexed by clinical interviews or laboratory-based tasks. However, little work has examined whether these factors relate to the real-world pursuit of goal-directed activities in this population.

Methods

This study aimed to fill this gap by using Ecological Momentary Assessment (four survey prompts per day for 1 week) to test hypotheses about symptom, effort allocation, cognitive, and functional measures associated with planned and completed goal-directed behavior in the daily lives of 63 individuals with schizophrenia.

Results

Individuals with schizophrenia completed more goal-directed activities than they planned [t(62) = −4.01, p < 0.001]. Motivation and pleasure (i.e. experiential) negative symptoms, controlling for depressive symptoms, negatively related to planned goal-directed behavior [odds ratio (OR) 0.92, p = 0.005]. Increased effort expenditure for high probability rewards (planned: OR 1.01, p = 0.034, completed: OR 1.01, p = 0.034) along with performance on a daily functional skills task (planned: OR 1.04, p = 0.002, completed: OR 1.03, p = 0.047) negatively related to both planned and completed goal-directed activity.

Conclusions

Our results present correlates of real-world goal-directed behavior that largely align with impaired ability to make future estimations in schizophrenia. This insight could help identify targeted treatments for the elusive motivated behavior deficits in this population.

Keywords

Anticipationcognitive functionecological momentary assessmenteffort-cost decision-makinggoal-directed behaviormotivationnegative symptomsschizophreniaworking memory
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 6 , April 2023 , pp. 2409 - 2417
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Aleman, A., Lincoln, T. M., Bruggeman, R., Melle, I., Arends, J., Arango, C., & Knegtering, H. (2017). Treatment of negative symptoms: Where do we stand, and where do we go? Schizophrenia Research, 186, 55–62. https://doi.org/10.1016/j.schres.2016.05.015.CrossRefGoogle ScholarPubMed
Barch, D. M., Pagliaccio, D., & Luking, K. (2015). Mechanisms underlying motivational deficits in psychopathology: Similarities and differences in depression and schizophrenia. In Simpson, E. H. & Balsam, P. D. (Eds.), Behavioral neuroscience of motivation (pp. 411–449). Cham: Springer International Publishing. https://doi.org/10.1007/7854_2015_376.CrossRefGoogle Scholar
Barch, D. M., Treadway, M., & Schoen, N. (2014). Effort, anhedonia, and function in schizophrenia: Reduced effort allocation predicts amotivation and functional impairment. Journal of Abnormal Psychology, 123(2), 387–397. https://doi.org/10.1037/a0036299.CrossRefGoogle ScholarPubMed
Bates, D., Maechler, M., Bolker, , Aut, B., Cre, , Walker, S., Christensen, R. H. B., … simulate.formula, K., P. N. (shared copyright on. (2021). lme4: Linear Mixed-Effects Models using “Eigen” and S4 (Version 1.1–27.1). Retrieved from https://CRAN.R-project.org/package=lme4.Google Scholar
Beck, A., Steer, R., & Brown, G. (1996). Manual for the Beck Depression Inventory-II.CrossRefGoogle Scholar
Bowie, C. R., Reichenberg, A., Patterson, T. L., Heaton, R. K., & Harvey, P. D. (2006). Determinants of real-world functional performance in schizophrenia subjects: Correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry, 163, 418–425.CrossRefGoogle ScholarPubMed
Culbreth, A. J., Moran, E. K., & Barch, D. M. (2018). Effort-cost decision-making in psychosis and depression: Could a similar behavioral deficit arise from disparate psychological and neural mechanisms? Psychological Medicine, 48(6), 889–904. https://doi.org/10.1017/S0033291717002525.CrossRefGoogle ScholarPubMed
Culbreth, A. J., Moran, E. K., Kandala, S., Westbrook, A., & Barch, D. M. (2020). Effort, avolition, and motivational experience in schizophrenia: Analysis of behavioral and neuroimaging data with relationships to daily motivational experience. Clinical Psychological Science, 8(3), 555–568. https://doi.org/10.1177/2167702620901558.CrossRefGoogle ScholarPubMed
Edwards, C. J., Cella, M., Emsley, R., Tarrier, N., & Wykes, T. H. M. (2018). Exploring the relationship between the anticipation and experience of pleasure in people with schizophrenia: An experience sampling study. Schizophrenia Research, 202, 72–79. https://doi.org/10.1016/j.schres.2018.06.040.CrossRefGoogle ScholarPubMed
Fervaha, G., Foussias, G., Agid, O., & Remington, G. (2014a). Impact of primary negative symptoms on functional outcomes in schizophrenia. European Psychiatry, 29(7), 449–455. https://doi.org/10.1016/j.eurpsy.2014.01.007.CrossRefGoogle ScholarPubMed
Fervaha, G., Foussias, G., Agid, O., & Remington, G. (2014b). Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia. Acta Psychiatrica Scandinavica, 130(4), 290–299. https://doi.org/10.1111/acps.12289.CrossRefGoogle Scholar
Foussias, G., Mann, S., Zakzanis, K. K., van Reekum, R., Agid, O., & Remington, G. (2011). Prediction of longitudinal functional outcomes in schizophrenia: The impact of baseline motivational deficits. Schizophrenia Research, 132(1), 24–27. https://doi.org/10.1016/j.schres.2011.06.026.CrossRefGoogle ScholarPubMed
Gard, D. E., Kring, A. M., Gard, M. G., Horan, W. P., & Green, M. F. (2007). Anhedonia in schizophrenia: Distinctions between anticipatory and consummatory pleasure. Schizophrenia Research, 93(1), 253–260. https://doi.org/10.1016/j.schres.2007.03.008.CrossRefGoogle ScholarPubMed
Gard, D. E., Sanchez, A. H., Cooper, K., Fisher, M., Garrett, C., & Vinogradov, S. (2014). Do people with schizophrenia have difficulty anticipating pleasure, engaging in effortful behavior, or both? Journal of Abnormal Psychology, 123(4), 771–782. https://doi.org/10.1037/abn0000005.CrossRefGoogle ScholarPubMed
Gold, J. M., Barch, D. M., Feuerstahler, L. M., Carter, C. S., MacDonald, A. W., Ragland, J. D., … Luck, S. J. (2019). Working memory impairment across psychotic disorders. Schizophrenia Bulletin, 45(4), 804–812. https://doi.org/10.1093/schbul/sby134.CrossRefGoogle ScholarPubMed
Gold, J. M., Strauss, G. P., Waltz, J. A., Robinson, B. M., Brown, J. K., & Frank, M. J. (2013). Negative symptoms of schizophrenia are associated with abnormal effort-cost computations. Biological Psychiatry, 74(2), 130–136. https://doi.org/10.1016/j.biopsych.2012.12.022.CrossRefGoogle ScholarPubMed
Granholm, E., Ben-Zeev, D., Link, P. C., Bradshaw, K. R., & Holden, J. L. (2012). Mobile assessment and treatment for schizophrenia (MATS): A pilot trial of an interactive text-messaging intervention for medication adherence, socialization, and auditory hallucinations. Schizophrenia Bulletin, 38(3), 414–425. psyh (2012-15724-010). https://doi.org/10.1093/schbul/sbr155.CrossRefGoogle Scholar
Granholm, E., Holden, J. L., Mikhael, T., Link, P. C., Swendsen, J., Depp, C., … Harvey, P. D. (2020). What do people with schizophrenia do all day? Ecological momentary assessment of real-world functioning in schizophrenia. Schizophrenia Bulletin, 46(2), 242–251. https://doi.org/10.1093/schbul/sbz070.Google ScholarPubMed
Hartig, F., & Lohse, L. (2021). DHARMa: Residual Diagnostics for Hierarchical (Multi-Level / Mixed) Regression Models (Version 0.4.3). Retrieved from https://CRAN.R-project.org/package=DHARMa.Google Scholar
Heerey, E., & Gold, J. (2007). Patients with schizophrenia demonstrate dissociation between affective experience and motivated behavior. Journal of Abnormal Psychology, 116, 268–278. https://doi.org/10.1037/0021-843X.116.2.268.CrossRefGoogle ScholarPubMed
Holt, D. V., Wolf, J., Funke, J., Weisbrod, M., & Kaiser, S. (2013). Planning impairments in schizophrenia: Specificity, task independence and functional relevance. Schizophrenia Research, 149(1), 174–179. https://doi.org/10.1016/j.schres.2013.06.018.CrossRefGoogle ScholarPubMed
Horan, W. P., Kring, A. M., Gur, R. E., Reise, S. P., & Blanchard, J. J. (2011). Development and psychometric validation of the clinical assessment interview for negative symptoms (CAINS). Schizophrenia Research, 132(2), 140–145. https://doi.org/10.1016/j.schres.2011.06.030.CrossRefGoogle ScholarPubMed
Huang, J., Yang, X., Lan, Y., Zhu, C., Liu, X., Wang, Y., … Chan, R. C. K. (2016). Neural substrates of the impaired effort expenditure decision making in schizophrenia. Neuropsychology, 30(6), 685–696. https://doi.org/10.1037/neu0000284.CrossRefGoogle ScholarPubMed
Keefe, R. S. E., Poe, M., Walker, T. M., & Harvey, P. D. (2006). The relationship of the brief assessment of cognition in schizophrenia (BACS) to functional capacity and real-world functional outcome. Journal of Clinical and Experimental Neuropsychology, 28(2), 260–269. https://doi.org/10.1080/13803390500360539.CrossRefGoogle ScholarPubMed
Kraus, M. S., Gold, J. M., Barch, D. M., Walker, T. M., Chun, C. A., Buchanan, R. W., … Keefe, R. S. E. (2020). The characteristics of cognitive neuroscience tests in a schizophrenia cognition clinical trial: Psychometric properties and correlations with standard measures. Schizophrenia Research: Cognition, 19, 100161. https://doi.org/10.1016/j.scog.2019.100161.Google Scholar
Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., & Reise, S. P. (2013). The clinical assessment interview for negative symptoms (CAINS): Final development and validation. American Journal of Psychiatry, 170(2), 165–172. https://doi.org/10.1176/appi.ajp.2012.12010109.CrossRefGoogle ScholarPubMed
Mausbach, B. T., Bowie, C. R., Harvey, P. D., Twamley, E. W., Goldman, S. R., Jeste, D. V., & Patterson, T. L. (2008). Usefulness of the UCSD performance-based skills assessment (UPSA) for predicting residential independence in patients with chronic schizophrenia. Journal of Psychiatric Research, 42(4), 320–327. https://doi.org/10.1016/j.jpsychires.2006.12.008.CrossRefGoogle ScholarPubMed
Mausbach, B. T, Harvey, P. D, Goldman, S. R, Jeste, D. V, & Patterson, T. L. (2006). Development of a Brief Scale of Everyday Functioning in Persons with Serious Mental Illness. Schizophrenia Bulletin, 33(6), 1364–1372. http://dx.doi.org/10.1093/schbul/sbm014.CrossRefGoogle Scholar
McCarthy, J. M., Treadway, M. T., Bennett, M. E., & Blanchard, J. J. (2016). Inefficient effort allocation and negative symptoms in individuals with schizophrenia. Schizophrenia Research, 170(2), 278–284. https://doi.org/10.1016/j.schres.2015.12.017.CrossRefGoogle ScholarPubMed
Moran, E. K., Culbreth, A. J., & Barch, D. M. (2017). Ecological momentary assessment of negative symptoms in schizophrenia: Relationships to effort-based decision making and reinforcement learning. Journal of Abnormal Psychology, 126(1), 96–105. https://doi.org/10.1037/abn0000240.CrossRefGoogle ScholarPubMed
Moran, E. K., & Kring, A. M. (2018). Anticipatory emotion in schizophrenia. Clinical Psychological Science, 6(1), 63–75. https://doi.org/10.1177/2167702617730877.CrossRefGoogle ScholarPubMed
Myin-Germeys, I., Nicolson, N. A., & Delespaul, P. A. E. G. (2001). The context of delusional experiences in the daily life of patients with schizophrenia. Psychological Medicine, 31(3), 489–498. https://doi.org/10.1017/s0033291701003646.CrossRefGoogle ScholarPubMed
Patterson, T. L., Goldman, S., McKibbin, C. L., Hughs, T., & Jeste, D. V. (2001). UCSD performance-based skills assessment: Development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin, 27(2), 235–245. https://doi.org/10.1093/oxfordjournals.schbul.a006870.CrossRefGoogle ScholarPubMed
R Core Team. (2021). R: A Language and Environment for Statistical Computing (Version 1.4.1106) [R Foundation for Statistical Computing]. Vienna, Austria.Google Scholar
Schneider, L. C, & Struening, E. L. (1983). SLOF: a behavioral rating scale for assessing the mentally ill. Social Work Research and Abstracts, 19(3), 9–21. http://dx.doi.org/10.1093/swra/19.3.9.CrossRefGoogle ScholarPubMed
Semkovska, M., Bédard, M.-A., Godbout, L., Limoge, F., & Stip, E. (2004). Assessment of executive dysfunction during activities of daily living in schizophrenia. Schizophrenia Research, 69(2), 289–300. https://doi.org/10.1016/j.schres.2003.07.005.CrossRefGoogle ScholarPubMed
Seter, C., Giovannetti, T., Kessler, R. K., & Worth, S. (2011). Everyday action planning in schizophrenia. Neuropsychological Rehabilitation, 21(2), 27. https://doi.org/10.1080/09602011.2010.544519.CrossRefGoogle ScholarPubMed
Siddiqui, I., Saperia, S., Fervaha, G., Da Silva, S., Jeffay, E., Zakzanis, K. K., … Foussias, G. (2019). Goal-directed planning and action impairments in schizophrenia evaluated in a virtual environment. Schizophrenia Research, 206, 400–406. https://doi.org/10.1016/j.schres.2018.10.012.CrossRefGoogle Scholar
Sitnikova, T., Goff, D., & Kuperberg, G. R. (2009). Neurocognitive abnormalities during comprehension of real-world goal-directed behaviors in schizophrenia. Journal of Abnormal Psychology, 118(2), 256. https://doi.org/10.1037/a0015619.CrossRefGoogle ScholarPubMed
Strassnig, M. T., Harvey, P. D., Miller, M. L., Depp, C. A., & Granholm, E. (2021). Real world sedentary behavior and activity levels in patients with schizophrenia and controls: An ecological momentary assessment study. Mental Health and Physical Activity, 20, 100364. https://doi.org/10.1016/j.mhpa.2020.100364.CrossRefGoogle ScholarPubMed
Strassnig, M. T., Raykov, T., O'Gorman, C., Bowie, C. R., Sabbag, S., Durand, D., … Harvey, P. D. (2015). Determinants of different aspects of everyday outcome in schizophrenia: The roles of negative symptoms, cognition, and functional capacity. Schizophrenia Research, 165(1), 76–82. psyh (2015-43647-012). https://doi.org/10.1016/j.schres.2015.03.033.CrossRefGoogle ScholarPubMed
Treadway, M. T., Buckholtz, J. W., Schwartzman, A. N., Lambert, W. E., & Zald, D. H. (2009). Worth the ‘EEfRT’? The effort expenditure for rewards task as an objective measure of motivation and anhedonia. PLoS ONE, 4(8), e6598. https://doi.org/10.1371/journal.pone.0006598.CrossRefGoogle ScholarPubMed
Treadway, M. T., Peterman, J. S., Zald, D. H., & Park, S. (2015). Impaired effort allocation in patients with schizophrenia. Schizophrenia Research, 161(2), 382–385. https://doi.org/10.1016/j.schres.2014.11.024.CrossRefGoogle ScholarPubMed
Twamley, E. W., Doshi, R. R., Nayak, G. V., Palmer, B. W., Golshan, S., Heaton, R. K., … Jeste, D. V. (2002). Generalized cognitive impairments, ability to perform everyday tasks, and level of independence in community living situations of older patients with psychosis. American Journal of Psychiatry, 159(12), 2013–2020. https://doi.org/10.1176/appi.ajp.159.12.2013.CrossRefGoogle ScholarPubMed
Vachon, H., Viechtbauer, W., Rintala, A., & Myin-Germeys, I. (2019). Compliance and retention with the experience sampling method over the continuum of severe mental disorders: Meta-analysis and recommendations. Journal of Medical Internet Research, 21(12), e14475. https://doi.org/10.2196/14475.CrossRefGoogle ScholarPubMed
Velthorst, E., Koeter, M., Gaag, M., Nieman, D., Fett, A.-K., Smit, F., … de Haan, L. (2015). Adapted cognitive-behavioural therapy required for targeting negative symptoms in schizophrenia: Meta-analysis and meta-regression. Psychological Medicine, 45, 453–465. https://doi.org/10.1017/S0033291714001147.CrossRefGoogle ScholarPubMed
Whitton, A. E., Merchant, J. T., & Lewandowski, K. E. (2020). Dissociable mechanisms underpinning effort-cost decision-making across the psychosis spectrum. Schizophrenia Research, 224, 133–140. https://doi.org/10.1016/j.schres.2020.09.014.CrossRefGoogle ScholarPubMed
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