title: Reward Learning, Neurocognition, Social Cognition, and Symptomatology in Psychosis.
abstract: BACKGROUND
  Patients with psychosis spectrum disorders exhibit deficits in social and neurocognition, as well as hallmark abnormalities in motivation and reward processing. Aspects of reward processing may overlap behaviorally and neurobiologically with some elements of cognitive functioning, and abnormalities in these processes may share partially overlapping etiologies in patients. However, whether reward processing and cognition are associated across the psychoses and linked to state and trait clinical symptomatology is unclear.
  
  
  METHODS
  The present study examined associations between cognitive functioning, reward learning, and clinical symptomatology in a cross-diagnostic sample. Patients with schizophrenia (SZ; n = 37), bipolar I disorder with psychosis (BD; n = 42), and healthy controls (n = 29) were assessed for clinical symptoms (patients only), neurocognitive functioning using the MATRICS Battery (MCCB) and reward learning using the probabilistic reward task (PRT). Groups were compared on neurocognition and PRT response bias, and associations between PRT response bias and neurocognition or clinical symptoms were examined controlling for demographic variables and PRT task difficulty (discriminability).
  
  
  RESULTS
  Patients with SZ performed worse than controls on most measures of neurocognition; patients with BD exhibited deficits in some domains between the level of patients with SZ and controls. The SZ - but not BD - group exhibited deficits in social cognition compared to controls. Patients and controls did not differ on PRT response bias, but did differ on PRT discriminability. Better response bias across the sample was associated with poorer social cognition, but not neurocognition; conversely, discriminability was associated with neurocognition but not social cognition. Symptoms of psychosis, particularly negative symptoms, were associated with poorer response bias across patient groups.
  
  
  CONCLUSIONS
  Reward learning was associated with symptoms of psychosis - in particular negative symptoms - across diagnoses, and was predictive of worse social cognition. Reward learning was not associated with neurocognitive performance, suggesting that, across patient groups, social cognition but not neurocognition may share common pathways with this aspect of reinforcement learning. Better understanding of how cognitive dysfunction and reward processing deficits relate to one another, to other key symptom dimensions (e.g., psychosis), and to diagnostic categories, may help clarify shared etiological pathways and guide efforts toward targeted treatment approaches.
authors.affiliation: Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Lewandowski
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA.
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Whitton
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Pizzagalli
authors.affiliation: Schizophrenia and Bipolar Disorder Program, McLean Hospital , Belmont, MA , USA.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Norris
authors.affiliation: Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Dost
authors.initials: D
authors.lastname: Ongur
authors.affiliation: Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Hall
keywords: bipolar disorder; cognition; psychosis; response bias; reward; schizophrenia; social cognition