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Front Behav Neurosci. 2014 Nov 18;8:382. doi: 10.3389/fnbeh.2014.00382. eCollection 2014.

Symptom dimensions are associated with reward processing in unmedicated persons at risk for psychosis.

Author information

1
University Hospital of Psychiatry Zurich, the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) Zurich, Switzerland ; Department of Neuroradiology, University Hospital of Zurich Zurich, Switzerland ; Collegium Helveticum, A Joint Research Institute between the University of Zurich and the Swiss Federal Institute of Technology Zurich Zurich, Switzerland.
2
University Hospital of Psychiatry Zurich, the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) Zurich, Switzerland ; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland.
3
Department of Neuroradiology, University Hospital of Zurich Zurich, Switzerland ; Center for MR Research, University Children's Hospital Zurich Zurich, Switzerland.
4
University Hospital of Psychiatry Zurich, the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) Zurich, Switzerland ; Department of Neuroradiology, University Hospital of Zurich Zurich, Switzerland.
5
Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg Heidelberg, Germany.
6
Department of Neuroradiology, University Hospital of Zurich Zurich, Switzerland.
7
University Hospital of Psychiatry Zurich, the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) Zurich, Switzerland ; Collegium Helveticum, A Joint Research Institute between the University of Zurich and the Swiss Federal Institute of Technology Zurich Zurich, Switzerland ; Laboratory of Neuroscience (LIM-27), Institute of Psychiatry, University of Sao Paulo Sao Paulo, Brazil.
8
Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland ; Center for Integrative Human Physiology, University of Zurich Zurich, Switzerland.

Abstract

There is growing evidence that reward processing is disturbed in schizophrenia. However, it is uncertain whether this dysfunction predates or is secondary to the onset of psychosis. Studying 21 unmedicated persons at risk for psychosis plus 24 healthy controls (HCs) we used a incentive delay paradigm with monetary rewards during functional magnetic resonance imaging. During processing of reward information, at-risk individuals performed similarly well to controls and recruited the same brain areas. However, while anticipating rewards, the high-risk sample exhibited additional activation in the posterior cingulate cortex, and the medio- and superior frontal gyrus, whereas no significant group differences were found after rewards were administered. Importantly, symptom dimensions were differentially associated with anticipation and outcome of the reward. Positive symptoms were correlated with the anticipation signal in the ventral striatum (VS) and the right anterior insula (rAI). Negative symptoms were inversely linked to outcome-related signal within the VS, and depressive symptoms to outcome-related signal within the medial orbitofrontal cortex (mOFC). Our findings provide evidence for a reward-associated dysregulation that can be compensated by recruitment of additional prefrontal areas. We propose that stronger activations within VS and rAI when anticipating a reward reflect abnormal processing of potential future rewards. Moreover, according to the aberrant salience theory of psychosis, this may predispose a person to positive symptoms. Additionally, we report evidence that negative and depressive symptoms are differentially associated with the receipt of a reward, which might demonstrate a broader vulnerability to motivational and affective symptoms in persons at-risk for psychosis.

KEYWORDS:

anterior insula; at-risk mental state; dopamine; functional magnetic resonance imaging (fMRI); psychosis; reward; salience processing; ventral striatum

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