Effort-based decision-making impairment in patients with clinically-stabilized first-episode psychosis and its relationship with amotivation and psychosocial functioning.
Effort-based decision-making has recently been proposed as a potential mechanism contributing to motivational deficits (amotivation) in psychotic disorder. Previous research has identified altered effort allocation in chronic schizophrenia, but produced mixed results regarding its relationship with amotivation. No study has investigated effort allocation in first-episode psychosis (FEP). We examined effort-based decision-making in 45 clinically-stabilized FEP patients and 45 demographically-matched controls, using Effort-Expenditure for Reward Task (EEfRT) which measures allocation of physical effort for monetary reward at varying magnitude and probability levels. Our results showed that FEP patients did not demonstrate overall reduction in effort expenditure but displayed reduced willingness to expend effort for high-value/high-probability reward as compared to controls. In particular, such selective effort-related impairment was most pronounced in patients with high levels of amotivation. Furthermore, reduced allocation of greater effort for higher probability reward was related to poorer psychosocial functioning. Decreased effort exertion was generally unrelated to other symptom dimensions, self-report anhedonia, antipsychotic dose and cognitive deficits. This study thus provides the first evidence of effort-based decision-making impairment in FEP, and indicates that first-episode patients were not generally effort-averse but exhibited inefficient effort allocation by failing to make high-effort choices to maximize reward receipt. Our findings affirm the critical role of amotivation on aberrant effort allocation, and support the link between laboratory-based effort-cost measures and real-world psychosocial functioning in medicated FEP. Further longitudinal research is required to clarify trajectory of suboptimal effort allocation and its potential utility in predicting amotivation and functional outcomes in the early course of illness.
['Chang|Wing Chung|WC|', 'Chu|Angel On Ki|AOK|', 'Treadway|Michael T|MT|', 'Strauss|Gregory P|GP|', 'Chan|Sherry Kit Wa|SKW|', 'Lee|Edwin Ho Ming|EHM|', 'Hui|Christy Lai Ming|CLM|', 'Suen|Yi Nam|YN|', 'Chen|Eric Yu Hai|EYH|']
D000293:Adolescent D000328:Adult D059445:Anhedonia D014150:Antipsychotic Agents D003657:Decision Making D005260:Female D006801:Humans D008297:Male D009042:Motivation D011597:Psychomotor Performance D011618:Psychotic Disorders D011930:Reaction Time D012919:Social Behavior D055815:Young Adult
Motivational deficits Effort allocation Schizophrenia Early psychosis Effort-cost computation Negative symptoms