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Reduced willingness to expend effort for rewards is associated with risk for conversion and negative symptom severity in youth at clinical high-risk for psychosis

Published online by Cambridge University Press:  14 June 2021

Gregory P. Strauss ,
Lisa A. Bartolomeo  and
Lauren Luther
Gregory P. Strauss*
Affiliation:
Department of Psychology, University of Georgia, Athens, GA, USA
Lisa A. Bartolomeo
Affiliation:
Department of Psychology, University of Georgia, Athens, GA, USA
Lauren Luther
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
*
Author for correspondence: Gregory P. Strauss, E-mail: gstrauss@uga.edu
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Abstract

Background

Schizophrenia (SZ) is typically preceded by a prodromal (i.e. pre-illness) period characterized by attenuated positive symptoms and declining functional outcome. Negative symptoms are prominent among individuals at clinical high-risk (CHR) for psychosis (i.e. those with prodromal syndromes) and predictive of conversion to illness. Mechanisms underlying negative symptoms are unclear in the CHR population.

Methods

The current study evaluated whether CHR participants demonstrated deficits in the willingness to expend effort for rewards and whether these impairments are associated with negative symptoms and greater risk for conversion. Participants included 44 CHR participants and 32 healthy controls (CN) who completed the Effort Expenditure for Reward Task (EEfRT).

Results

Compared to CN, CHR participants displayed reduced likelihood of exerting high effort for high probability and magnitude rewards. Among CHR participants, reduced effort expenditure was associated with greater negative symptom severity and greater probability of conversion to a psychotic disorder on a cross-sectional risk calculator.

Conclusions

Findings suggest that effort-cost computation is a marker of illness liability and a transphasic mechanism underlying negative symptoms in the SZ spectrum.

Keywords

Negative symptomsprodromereward processingschizophrenia
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 3 , February 2023 , pp. 714 - 721
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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