Pathways from performance monitoring to negative symptoms and functional outcomes in psychotic disorders.

BACKGROUND

Performance monitoring entails rapid error detection to maintain task performance. Impaired performance monitoring is a candidate pathophysiological process in psychotic disorders, which may explain the broader deficit in executive function and its known associations with negative symptoms and poor functioning. The current study models cross-sectional pathways bridging neurophysiological measures of performance monitoring with executive function, symptoms, and functioning.

METHODS

Data were from the 20-year assessment of the Suffolk County Mental Health Project. Individuals with psychotic disorders ( = 181) were originally recruited from inpatient psychiatric facilities. Data were also collected from a geographically and demographically matched group with no psychosis history ( = 242). Neural measures were the error-related negativity (ERN) and error positivity (Pe). Structural equation modeling tested mediation pathways.

RESULTS

Blunted ERN and Pe in the clinical cohort related to impaired executive function ( = 0.26-0.35), negative symptom severity ( = 0.17-0.25), and poor real-world functioning ( = 0.17-0.19). Associations with executive function were consistent across groups. Multiple potential pathways were identified in the clinical cohort: reduced ERN to inexpressivity was mediated by executive function ( = 0.10); reduced Pe to global functioning was mediated by executive function and avolition ( = 0.10).

CONCLUSIONS

This supports a transdiagnostic model of psychotic disorders by which poor performance monitoring contributes to impaired executive function, which contributes to negative symptoms and poor real-world functioning. If supported by future longitudinal research, these pathways could inform the development of targeted interventions to address cognitive and functional deficits that are central to psychotic disorders.