title: Effort-Based Decision-Making Paradigms for Clinical Trials in Schizophrenia: Part 2—External Validity and Correlates.
abstract: Effort-based decision making has strong conceptual links to the motivational disturbances that define a key subdomain of negative symptoms. However, the extent to which effort-based decision-making performance relates to negative symptoms, and other clinical and functionally important variables has yet to be systematically investigated. In 94 clinically stable outpatients with schizophrenia, we examined the external validity of 5 effort-based paradigms, including the Effort Expenditure for Rewards, Balloon Effort, Grip Strength Effort, Deck Choice Effort, and Perceptual Effort tasks. These tasks covered 3 types of effort: physical, cognitive, and perceptual. Correlations between effort related performance and 6 classes of variables were examined, including: (1) negative symptoms, (2) clinically rated motivation and community role functioning, (3) self-reported motivational traits, (4) neurocognition, (5) other psychiatric symptoms and clinical/demographic characteristics, and (6) subjective valuation of monetary rewards. Effort paradigms showed small to medium relationships to clinical ratings of negative symptoms, motivation, and functioning, with the pattern more consistent for some measures than others. They also showed small to medium relations with neurocognitive functioning, but were generally unrelated to other psychiatric symptoms, self-reported traits, antipsychotic medications, side effects, and subjective valuation of money. There were relatively strong interrelationships among the effort measures. In conjunction with findings from a companion psychometric article, all the paradigms warrant further consideration and development, and 2 show the strongest potential for clinical trial use at this juncture.
authors.affiliation: Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA; UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA; UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA; horan@ucla.edu.
authors.forename: William P
authors.initials: WP
authors.lastname: Horan
authors.affiliation: Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA; UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA;
authors.forename: L Felice
authors.initials: LF
authors.lastname: Reddy
authors.affiliation: Departments of Psychology, Psychiatry and Radiology, Washington University, St. Louis, MO;
authors.forename: Deanna M
authors.initials: DM
authors.lastname: Barch
authors.affiliation: Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD;
authors.forename: Robert W
authors.initials: RW
authors.lastname: Buchanan
authors.affiliation: Amgen Inc., Thousand Oaks, CA;
authors.forename: Eduardo
authors.initials: E
authors.lastname: Dunayevich
authors.affiliation: Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD;
authors.forename: James M
authors.initials: JM
authors.lastname: Gold
authors.affiliation: Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA; UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA;
authors.forename: Steven R
authors.initials: SR
authors.lastname: Marder
authors.affiliation: Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA; UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA;
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Wynn
authors.affiliation: Department of Psychiatry, University of California San Diego, San Deigo, CA; Research Service, VA San Diego Healthcare System, San Diego, CA.
authors.forename: Jared W
authors.initials: JW
authors.lastname: Young
authors.affiliation: Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA; UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA;
authors.forename: Michael F
authors.initials: MF
authors.lastname: Green
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D003657:Decision Making / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation / Q000502:physiology*; D009483:Neuropsychological Tests; D011594:Psychometrics / Q000295:instrumentation*; D011597:Psychomotor Performance / Q000502:physiology*; D015203:Reproducibility of Results; D012201:Reward; D012559:Schizophrenia / Q000175:diagnosis* / Q000503:physiopathology
keywords: decision making; effort; functional outcome; schizophrenia