Cognitive disengagement and task switching in patients with Schizophrenia

Background: Schizophrenia is associated with impaired cognition as a core feature (1) and also with amotivation (2) and reductions or abnormalities in willingness to expend effort (3, 4). It remains unclear whether reduced effort is responsible for any of the observed cognitive defcit, as we do not generally assess continuous effort during testing. Methods: In the current study, we use a novel paradigm to test whether disengagement of effort is greater during cognitive performance in individuals with frst-episode psychosis (FEP) compared with healthy community members. We used a novel task called the Cognitive Effort and DisEngagement (CEDE), which increases in diffculty and requires task-switching, a function with a well-documented link with cognitive effort (5). Participants had the option to skip any trial without penalty. No additional monetary incentives were used. Skips were used as an index of effort disengagement. We also used a self-report measure of amotivation. Results: FEP patients had lower overall accuracy on the task-switching task (P =.030), but they also made signifcantly more skips (P =.018). When only examining trials with attempted answers, FEP patients still had reduced accuracy, but it did not reach signifcance (P =.348), and the effect size was reduced by 80%. Groups did not differ signifcantly in number of incorrect responses (P =.547). Self-reported amotivation signifcantly predicted skips in the entire sample (B =.41, P =.023) and separately among individuals with FEP (B =.64, P =.035). Conclusion: Disengagement of effort is likely to account for a portion of cognitive test performance among individuals with psychosis. The present results call into question the degree to which observed performance defcits in FEP are caused by true reductions in ability versus lack of motivation and sustained effort. This is an optimistic possibility, as effort is a more pliable phenomenon and may be more easily augmented with intervention than cognitive ability.