Hegelstad Wenche Ten Velden, Kreis Isabel, Tjelmeland Håkon, Pfuhl Gerit
TIPS Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.
Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.
Front Psychol. 2020 Jul 31;11:1632. doi: 10.3389/fpsyg.2020.01632. eCollection 2020.
Goal-directed behavior is a central feature of human functioning. It requires goal appraisal and implicit cost-benefit analyses, i.e., how much effort to invest in the pursuit of a certain goal, against its value and a confidence judgment regarding the chance of attainment. Persons with severe mental illness such as psychosis often struggle with reaching goals. Cognitive deficits, positive symptoms restricting balanced judgment, and negative symptoms such as anhedonia and avolition may compromise goal attainment. The objective of this study was to investigate to what degree symptom severity is related to cognitive abilities, metacognition, and effort-based decision-making in a visual search task.
Two studies were conducted: study 1: = 52 (healthy controls), and study 2: = 46 (23 patients with psychosis/23 matched healthy controls). Symptoms were measured by the CAPE-42 (study 1) and the PANSS (study 2). By using a visual search task, we concomitantly measured (a) accuracy in short-term memory, (b) perceived accuracy by participants making a capture area or confidence interval, and (c) effort by measuring how long one searched for the target. Perseverance was assessed in trials in which the target was omitted and search had to be abandoned.
Higher levels of positive symptoms, and having a diagnosis of psychosis, were associated with larger errors in memory. Participants adjusted both their capture area and their search investment to the error of their memory. Perseverance was associated with negative symptoms in study 1 but not in study 2.
By simultaneously assessing error and confidence in one's memory, as well as effort in search, we found that memory was affected by positive, not negative, symptoms in healthy controls, and was reduced in patients with psychosis. However, impaired memory did not concur with overconfidence or less effort in search, i.e., goal directed behavior was unrelated to symptoms or diagnosis. Metacognition and motivation were neither affected by cognitive abilities nor by negative symptoms. Clinically, this could indicate that struggles with goal directed behavior in psychosis may not solely be dependent on primary illness factors.
目标导向行为是人类机能的核心特征。它需要目标评估和隐含的成本效益分析，即针对某个目标的价值以及对实现可能性的信心判断，决定在追求该目标时投入多少努力。患有严重精神疾病（如精神病）的人在实现目标方面常常面临困难。认知缺陷、限制平衡判断的阳性症状以及诸如快感缺失和意志缺乏等阴性症状可能会影响目标的达成。本研究的目的是调查在视觉搜索任务中，症状严重程度与认知能力、元认知以及基于努力的决策之间的关联程度。
进行了两项研究：研究1：n = 52（健康对照），研究2：n = 46（23名精神病患者/23名匹配的健康对照）。症状通过CAPE - 42（研究1）和PANSS（研究2）进行测量。通过使用视觉搜索任务，我们同时测量了：（a）短期记忆的准确性，（b）参与者通过划定捕捉区域或置信区间所感知到的准确性，以及（c）通过测量搜索目标的时长来评估努力程度。在目标被省略且必须放弃搜索的试验中评估坚持性。
较高水平的阳性症状以及被诊断为精神病与记忆中的较大错误相关。参与者根据其记忆错误调整了他们的捕捉区域和搜索投入。在研究1中，坚持性与阴性症状相关，但在研究2中并非如此。
通过同时评估对自身记忆的错误和信心以及搜索中的努力程度，我们发现，在健康对照中，记忆受阳性而非阴性症状影响，在精神病患者中记忆能力下降。然而，记忆受损与过度自信或搜索中较少努力并无关联，即目标导向行为与症状或诊断无关。元认知和动机既不受认知能力影响，也不受阴性症状影响。临床上，这可能表明精神病患者在目标导向行为方面的困难可能不仅仅取决于原发性疾病因素。
