title: Neuropsychological impairment in patients with major depressive disorder: the effects of feedback on task performance.
abstract: BACKGROUND
  Recent evidence suggests that an abnormal response to performance feedback may contribute to the wide-ranging neuropsychological deficits typically associated with depressive illness. The present research sought to determine whether the inability of depressed patients to utilize performance feedback advantageously is equally true for accurate and misleading feedback.
  
  
  METHODS
  Patients with major depression and matched controls completed: (1) a visual discrimination and reversal task that featured intermittent and misleading negative feedback; and (2) feedback and no-feedback versions of a computerised test of spatial working memory. In the feedback version, negative feedback was accurate, highly informative, and could be used as a mnemonic aid.
  
  
  RESULTS
  On the Probability Reversal task, depressed patients were impaired in their ability to maintain response set in the face of misleading negative feedback as shown by their increased tendency to switch responding to the 'incorrect' stimulus following negative reinforcement, relative to that of controls. Patients' ability to acquire and reverse the necessary visual discrimination was unimpaired. On the Spatial Working Memory task, depressed patients made significantly more between-search errors than controls on the most difficult trials, but their ability to use negative feedback to facilitate performance remained intact.
  
  
  CONCLUSIONS
  The present results suggest that feedback can have different effects in different contexts. Misleading, negative feedback appears to disrupt the performance of depressed patients, whereas negative but accurate feedback does not. These findings are considered in the context of recent studies on reinforcement systems and their associated neurobiological substrates.
authors.affiliation: Department of Psychiatry, University of Cambridge.
authors.forename: F C
authors.initials: FC
authors.lastname: Murphy
authors.forename: A
authors.initials: A
authors.lastname: Michael
authors.forename: T W
authors.initials: TW
authors.lastname: Robbins
authors.forename: B J
authors.initials: BJ
authors.lastname: Sahakian
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D001676:Biofeedback, Psychology; D016022:Case-Control Studies; D003071:Cognition; D003866:Depressive Disorder / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D007721:Knowledge of Results, Psychological; D008297:Male; D008568:Memory; D009042:Motivation; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D013028:Space Perception / Q000502:physiology