The Hyperfocusing Hypothesis: A New Account of Cognitive Dysfunction in Schizophrenia

Is P3 amplitude associated with greater gaze distraction effect in schizotypy?

A recently proposed "Hyperfocusing hypothesis" suggests that schizotypy is associated with a more narrow but more intense way of allocating attention. The current study aims to test a vital prediction of this hypothesis in a social context, that schizotypy may be related to greater difficulty overcoming the distracting effects of gaze. This could cause a longer time to respond to targets that are invalidly cued by gaze. The current study tested this prediction in a modified Posner cueing paradigm by using P3 as an indicator for attentional resources. Seventy-four young healthy individuals with different levels of schizotypy were included, they were asked to detect the location of a target that was cued validly or invalidly by the gaze and head orientation. The results revealed that (a) schizotypy is associated with hyperfocusing on gaze direction, leading to greater difficulty overcoming the distracting effect of gaze. The higher the trait-schizotypy score, the more time needed to respond to targets that were invalidly cued by gaze (b) schizotypy is associated with reduced P3 which is directed by social communicative stimuli. The higher the trait-schizotypy score, the smaller the amplitude of P3 (c) the relationship between schizotypal traits and response times of the gaze-invalid condition is fully intermediated by P3. The findings of the current study suggest the P3 component may be a crucial neural mechanism underlying joint attention deficits in schizophrenia.

A meta-cognitive Wisconsin Card Sorting Test in people with schizophrenia and bipolar disorder: Self-assessment of sorting performance

People with serious mental illness have challenged self-awareness, including momentary monitoring of performance. A core feature of this challenge is in the domain of using external information to guide behavior, an ability that is measured very well by certain problem-solving tasks such as the Wisconsin Card Sorting Test (WCST) . We used a modified WCST to examine correct sorts and accuracy decisions regarding the correctness of sort. Participants with schizophrenia (n = 99) or bipolar disorder (n = 76) sorted 64 cards and then made judgments regarding correctness of each sort prior to feedback. Time series analyses examined the course of correct sorts and correct accuracy decisions by examining the momentary correlation and lagged correlation on the next sort. People with schizophrenia had fewer correct sorts, fewer categories, and fewer correct accuracy decisions (all p<.001). Positive response biases were seen in both groups. After an incorrect sort or accuracy decision, the groups were equally likely to be incorrect on the next sort or accuracy decision. Following correct accuracy decisions, participants with bipolar disorder were significantly (p=.003) more likely to produce a correct sort or accuracy decision. These data are consistent with previous studies implicating failures to consider external feedback for decision making. Interventions aimed at increasing consideration of external information during decision making have been developed and interventions targeting use of feedback during cognitive test performance are in development.

External cues improve visual working memory encoding in the presence of salient distractors in schizophrenia

BACKGROUND

People with schizophrenia (PSZ) are impaired in attentional prioritization of non-salient but relevant stimuli over salient distractors during visual working memory (VWM) encoding. Conversely, guidance of top-down attention by external predictive cues is intact. Yet, it is unknown whether this preserved ability can help PSZ encode more information in the presence of salient distractors.

METHODS

We employed a visuospatial change-detection task using four Gabor patches with differing orientations in 66 PSZ and 74 healthy controls (HCS). Two Gabor patches flickered which were designated either as targets or distractors and either a predictive or a non-predictive cue was displayed to manipulate top-down attention, resulting in four conditions.

RESULTS

We observed significant effects of group, salience and cue as well as significant interactions of salience by cue, group by salience and group by cue. Across all conditions, PSZ stored significantly less information in VWM than HCS. PSZ stored significantly less non-flickering than flickering information with a non-predictive cue. However, PSZ stored significantly more flickering and non-flickering information with a predictive cue.

CONCLUSIONS

Our findings indicate that control of attentional selection is impaired in schizophrenia. We demonstrate that additional top-down information significantly improves performance in PSZ. The observed deficit in attentional control suggests a disturbance of GABAergic inhibition in early visual areas. Moreover, our findings are indicative of a mechanism for enhancing attentional control in PSZ, which could be utilized by pro-cognitive interventions. Thus, the current paradigm is suitable to reveal both preserved and compromised cognitive component processes in schizophrenia.

Stronger tilt aftereffects in individuals diagnosed with schizophrenia spectrum disorders but not bipolar disorder

An altered use of context and experience to interpret incoming information has been posited to explain schizophrenia symptoms. The visual system can serve as a model system for examining how context and experience guide perception and the neural mechanisms underlying putative alterations. The influence of prior experience on current perception is evident in visual aftereffects, the perception of the "opposite" of a previously viewed stimulus. Aftereffects are associated with neural adaptation and concomitant change in strength of lateral inhibitory connections in visually responsive neurons. In a previous study, we observed stronger aftereffects related to orientation (tilt aftereffects) but not luminance (negative afterimages) in individuals diagnosed with schizophrenia, which we interpreted as potentially suggesting altered cortical (but not subcortical) adaptability and local changes in excitatory-inhibitory interactions. Here, we tested whether stronger tilt aftereffects were specific to individuals with schizophrenia or extended to individuals with bipolar disorder. We measured tilt aftereffects and negative afterimages in 32 individuals with bipolar disorder, and compared aftereffect strength to a previously reported group of 36 individuals with schizophrenia and 22 healthy controls. We observed stronger tilt aftereffects, but not negative afterimages, in individuals with schizophrenia as compared to both controls and individuals with bipolar disorder, who did not differ from each other. These results mitigate concerns that stronger tilt aftereffects in schizophrenia are a consequence of medication or of the psychosocial consequences of a severe mental illness.

Flexibility Retained: Unimpaired Updating of Expectations in Schizophrenia

Flexibly and actively updating expectations based on feedback is crucial for navigating daily life. Previous research has shown that people with schizophrenia (PSZ) have difficulty adjusting their expectations. However, there are studies suggesting otherwise. To explore this further, we used a novel trial-based expectation updating paradigm called attribute amnesia. In the task, the participants needed to report the location of a target stimulus among distractors in pre-surprise trials. In the surprise trial, they were unexpectedly asked to report the identity of the target before reporting its location. Afterward, control trials were conducted whereby the participants were asked the same questions as in the surprise trial. Notably, the surprise trial and control trials were nearly identical, except that the participants expected to be asked about identity information in the control trials but not in the surprise trial. Thus, an improvement in identity reporting accuracy in the control trials in comparison with the surprise trial indicated active updating of expectations. In the current study, a total of 63 PSZ and 60 healthy control subjects (HCS) were enrolled. We found that both the PSZ and the HCS were unable to report information that they had fully attended to (i.e., identity) in the surprise trial. However, both groups showed a significant improvement in reporting identity information even in the first control trial. Critically, there was no significant difference in the magnitude of improvement between the two groups. The current findings indicate that PSZ have the ability to update their expectations as quickly and flexibly as HCS, at least in the context of the current task. The possible factors that might contribute to the discrepancy regarding expectation updating are discussed.

[Attention deficit hyperactivity disorder in adults]

The article presents a review of scientific publications devoted to the study of the characteristics of the clinical picture and the dynamics of the main symptoms in adult patients with attention deficit hyperactivity disorder (ADHD). The authors present current data on the prevalence of this disease, leading clinical manifestations and the most common comorbid pathology. Research data on the impact of ADHD in adulthood on educational and professional activities are presented, and the economic and criminological aspects of ADHD are considered. The main methods of psychotherapeutic correction and pharmacological therapy are presented.

Prolonged neural encoding of visual information in autism

Autism spectrum disorder (ASD) is associated with a hyper-focused visual attentional style, impacting higher-order social and affective domains. The understanding of such peculiarity can benefit from the use of multivariate pattern analysis (MVPA) of high-resolution electroencephalography (EEG) data, which has proved to be a powerful technique to investigate the hidden neural dynamics orchestrating sensory and cognitive processes. Here, we recorded EEG in typically developing (TD) children and in children with ASD during a visuo-spatial attentional task where attention was exogenously captured by a small (zoom-in) or large (zoom-out) cue in the visual field before the appearance of a target at different eccentricities. MVPA was performed both in the cue-locked period, to reveal potential differences in the modulation of the attentional focus, and in the target-locked period, to reveal potential cascade effects on stimulus processing. Cue-locked MVPA revealed that while in the TD group the pattern of neural activity contained information about the cue mainly before the target appearance, the ASD group showed a temporally sustained and topographically diffuse significant decoding of the cue neural response even after the target onset, suggesting a delayed extinction of cue-related neural activity. Crucially, this delayed extinction positively correlated with behavioral measures of attentional hyperfocusing. Results of target-locked MVPA were coherent with a hyper-focused attentional profile, highlighting an earlier and stronger decoding of target neural responses in small cue trials in the ASD group. The present findings document a spatially and temporally overrepresented encoding of visual information in ASD, which can constitute one of the main reasons behind their peculiar cognitive style.

The role of executive functions in mediating the relationship between adult ADHD symptoms and hyperfocus in university students

BACKGROUND

Hyperfocus, a state of intense, narrow and prolonged attentional focus, has been associated with symptoms of attention-deficit/hyperactivity disorder (ADHD) in both clinical and non-clinical populations. Hyperfocus may be explained by difficulties in executive control, typically observed in ADHD.

AIMS

To investigate (1) whether ADHD and executive functions (EF) are associated with hyperfocus and (2) whether EF mediate the relationship between ADHD symptoms and hyperfocus.

METHODS AND PROCEDURES

A non-clinical sample of 380 university students (264 females) completed self-reports of ADHD, EF, hyperfocus and hyperfocus during rewarding activities.

OUTCOMES AND RESULTS

Increased difficulties in EF and severity of ADHD symptoms were significantly and positively correlated with a higher frequency of hyperfocus. Moreover, EF difficulties partially mediated the relationship between ADHD and hyperfocus (after controlling for sex and substance use), but not the relationship between ADHD and hyperfocus during rewarding activities.

CONCLUSIONS AND IMPLICATIONS

Difficulties in EF partially explained the higher frequency of hyperfocus, but not of hyperfocus during rewarding activities, among university students reporting more severe ADHD symptoms. Future research should investigate whether and how specific EF and other ADHD-related neurocognitive difficulties (e.g., reward sensitivity) contribute to various types of hyperfocus experiences in ADHD. WHAT THIS PAPER ADDS?: This paper is a first attempt to explain the relationship between adult ADHD symptoms and hyperfocus experiences. Our findings suggest that, although highly correlated, existing self-reports of hyperfocus measure different aspects of this experience: hyperfocus and reward-related hyperfocus. We replicate previous findings that indicated a greater frequency of both types of hyperfocus in ADHD. Additionally, we demonstrate a connection between EF difficulties and different aspects of hyperfocus. Finally, we extend previous findings by proposing that EF difficulties partially explain the relationship between ADHD and hyperfocus, but not the relationship between ADHD and reward-related hyperfocus. We hypothesize that other neurocognitive difficulties (e.g., reward sensitivity) may contribute to explain the relationship between ADHD and different aspects of hyperfocus.

Aberrant hyperfocusing in schizophrenia indicated by elevated theta phase-gamma amplitude coupling

OBJECTIVE

We aimed to investigate electroencephalographic (EEG) markers of aberrant hyperfocusing, a novel framework of impaired selective attention, in schizophrenia patients by using theta phase-gamma amplitude coupling (TGC).

METHODS

Fifty-four schizophrenia patients and 73 healthy controls (HCs) underwent EEG recording during an auditory oddball paradigm. For the standard and target conditions, TGC was calculated using the source signals from 25 brain regions of interest (ROIs) related to attention networks and sensory processing; TGC values were then compared across groups and conditions using two-way analysis of covariance. Correlations of altered TGC with performance on the Trail Making Test Parts A and B (TMT-A/B), were explored.

RESULTS

Compared to HCs, schizophrenia patients showed elevated TGC in the left inferior frontal gyrus (IFG) and superior temporal gyrus in the standard condition but not in the target condition. Correlation analyses revealed that the TGC in the left IFG was positively correlated with the TMT-A/B completion times.

CONCLUSIONS

Aberrant hyperfocusing, as reflected by elevated TGC in attention-related brain regions, was related to behavioral performance on the TMT-A/B in schizophrenia patients.

SIGNIFICANCE

This study suggests that TGC is a electrophysiological marker for aberrant hyperfocusing of attentional processes that may result in cognitive impairments in schizophrenia patients.

The Distractor Positivity Component and the Inhibition of Distracting Stimuli

There has been a long-lasting debate about whether salient stimuli, such as uniquely colored objects, have the ability to automatically distract us. To resolve this debate, it has been suggested that salient stimuli do attract attention but that they can be suppressed to prevent distraction. Some research supporting this viewpoint has focused on a newly discovered ERP component called the distractor positivity (PD), which is thought to measure an inhibitory attentional process. This collaborative review summarizes previous research relying on this component with a specific emphasis on how the PD has been used to understand the ability to ignore distracting stimuli. In particular, we outline how the PD component has been used to gain theoretical insights about how search strategy and learning can influence distraction. We also review alternative accounts of the cognitive processes indexed by the PD component. Ultimately, we conclude that the PD component is a useful tool for understanding inhibitory processes related to distraction and may prove to be useful in other areas of study related to cognitive control.

Medial Prefrontal Cortex Dysfunction Mediates Working Memory Deficits in Patients With Schizophrenia

Background

Schizophrenia (SCZ) is marked by working memory (WM) deficits, which predict poor functional outcome. While most functional magnetic resonance imaging studies of WM in SCZ have focused on the dorsolateral prefrontal cortex (PFC), some recent work suggests that the medial PFC (mPFC) may play a role. We investigated whether task-evoked mPFC deactivation is associated with WM performance and whether it mediates deficits in SCZ. In addition, we investigated associations between mPFC deactivation and cortical dopamine release.

Methods

Patients with SCZ (n = 41) and healthy control participants (HCs) (n = 40) performed a visual object n-back task during functional magnetic resonance imaging. Dopamine release capacity in mPFC was quantified with [11C]FLB457 in a subset of participants (9 SCZ, 14 HCs) using an amphetamine challenge. Correlations between task-evoked deactivation and performance were assessed in mPFC and dorsolateral PFC masks and were further examined for relationships with diagnosis and dopamine release.

Results

mPFC deactivation was associated with WM task performance, but dorsolateral PFC activation was not. Deactivation in the mPFC was reduced in patients with SCZ relative to HCs and mediated the relationship between diagnosis and WM performance. In addition, mPFC deactivation was significantly and inversely associated with dopamine release capacity across groups and in HCs alone, but not in patients.

Conclusions

Reduced WM task-evoked mPFC deactivation is a mediator of, and potential substrate for, WM impairment in SCZ, although our study design does not rule out the possibility that these findings could relate to cognition in general rather than WM specifically. We further present preliminary evidence of an inverse association between deactivation during WM tasks and dopamine release capacity in the mPFC.

Dense attention network identifies EEG abnormalities during working memory performance of patients with schizophrenia

Introduction

Patients with schizophrenia typically exhibit deficits in working memory (WM) associated with abnormalities in brain activity. Alterations in the encoding, maintenance and retrieval phases of sequential WM tasks are well established. However, due to the heterogeneity of symptoms and complexity of its neurophysiological underpinnings, differential diagnosis remains a challenge. We conducted an electroencephalographic (EEG) study during a visual WM task in fifteen schizophrenia patients and fifteen healthy controls. We hypothesized that EEG abnormalities during the task could be identified, and patients successfully classified by an interpretable machine learning algorithm.

Methods

We tested a custom dense attention network (DAN) machine learning model to discriminate patients from control subjects and compared its performance with simpler and more commonly used machine learning models. Additionally, we analyzed behavioral performance, event-related EEG potentials, and time-frequency representations of the evoked responses to further characterize abnormalities in patients during WM.

Results

The DAN model was significantly accurate in discriminating patients from healthy controls, ACC = 0.69, SD = 0.05. There were no significant differences between groups, conditions, or their interaction in behavioral performance or event-related potentials. However, patients showed significantly lower alpha suppression in the task preparation, memory encoding, maintenance, and retrieval phases F(1,28) = 5.93, p = 0.022, η2 = 0.149. Further analysis revealed that the two highest peaks in the attention value vector of the DAN model overlapped in time with the preparation and memory retrieval phases, as well as with two of the four significant time-frequency ROIs.

Discussion

These results highlight the potential utility of interpretable machine learning algorithms as an aid in diagnosis of schizophrenia and other psychiatric disorders presenting oscillatory abnormalities.

Association between Empathy and Clinical Symptoms among Overweight and Non-Overweight Chinese Chronic Schizophrenia Patients

Patients with schizophrenia are afflicted by severe clinical symptoms and serious cognitive dysfunction. The aim of this study is to investigate the potential relationships between clinical symptoms and empathy and their variations between overweight and non-overweight schizophrenia patients. To address this problem, a group of 776 inpatients diagnosed with chronic schizophrenia (504 overweight patients and 272 non-overweight patients) was recruited. The Positive and Negative Syndrome Scale (PANSS) and its five-factor model were employed to assess clinical symptoms, while empathy levels were measured using the Interpersonal Reactivity Index (IRI). The overweight patients had lower education levels but higher positive symptoms than the non-overweight patients (all p < 0.05). In addition, the overweight patients performed significantly better with respect to empathy (FDR-corrected p < 0.05). Additional multiple regression analyses indicated significant associations between the total score of the IRI and PANSS negative symptoms, gender, and family history of psychiatric disorders among the overweight group; among non-overweight patients, there was a significant correlation between suicide and the total score of the IRI. This study provides evidence suggesting that chronic schizophrenia patients who are overweight may have distinct clinical characteristics, particularly with respect to their empathy, compared with non-overweight patients. Moreover, different variables are associated with empathy in different groups.

Confidence, accuracy judgments and feedback in schizophrenia and bipolar disorder: a time series network analysis

BACKGROUND

Inaccurate self-assessment of performance is common among people with serious mental illness, and it is associated with poor functional outcomes independent from ability. However, the temporal interdependencies between judgments of performance, confidence in accuracy, and feedback about performance are not well understood.

METHODS

We evaluated two tasks: the Wisconsin Card Sorting Test (WCST) and the Penn Emotion recognition task (ER40). These tasks were modified to include item-by-item confidence and accuracy judgments, along with feedback on accuracy. We evaluated these tasks as time series and applied network modeling to understand the temporal relationships between momentary confidence, accuracy judgments, and feedback. The sample constituted participants with schizophrenia (SZ; N = 144), bipolar disorder (BD; N = 140), and healthy controls (HC; N = 39).

RESULTS

Network models for both WCST and ER40 revealed denser and lagged connections between confidence and accuracy judgments in SZ and, to a lesser extent in BD, that were not evidenced in HC. However, associations between feedback regarding accuracy with subsequent accuracy judgments and confidence were weaker in SZ and BD. In each of these comparisons, the BD group was intermediate between HC and SZ. In analyses of the WCST, wherein incorporating feedback is crucial for success, higher confidence predicted worse subsequent performance in SZ but not in HC or BD.

CONCLUSIONS

While network models are exploratory, the results suggest some potential mechanisms by which challenges in self-assessment may impede performance, perhaps through hyperfocus on self-generated judgments at the expense of incorporation of feedback.

The Psychosis Human Connectome Project: Design and rationale for studies of visual neurophysiology

Visual perception is abnormal in psychotic disorders such as schizophrenia. In addition to hallucinations, laboratory tests show differences in fundamental visual processes including contrast sensitivity, center-surround interactions, and perceptual organization. A number of hypotheses have been proposed to explain visual dysfunction in psychotic disorders, including an imbalance between excitation and inhibition. However, the precise neural basis of abnormal visual perception in people with psychotic psychopathology (PwPP) remains unknown. Here, we describe the behavioral and 7 tesla MRI methods we used to interrogate visual neurophysiology in PwPP as part of the Psychosis Human Connectome Project (HCP). In addition to PwPP (n = 66) and healthy controls (n = 43), we also recruited first-degree biological relatives (n = 44) in order to examine the role of genetic liability for psychosis in visual perception. Our visual tasks were designed to assess fundamental visual processes in PwPP, whereas MR spectroscopy enabled us to examine neurochemistry, including excitatory and inhibitory markers. We show that it is feasible to collect high-quality data across multiple psychophysical, functional MRI, and MR spectroscopy experiments with a sizable number of participants at a single research site. These data, in addition to those from our previously described 3 tesla experiments, will be made publicly available in order to facilitate further investigations by other research groups. By combining visual neuroscience techniques and HCP brain imaging methods, our experiments offer new opportunities to investigate the neural basis of abnormal visual perception in PwPP.

Dynamics of task-based confidence in schizophrenia using seasonal decomposition approach

Objective

Introspective Accuracy (IA) is a metacognitive construct that refers to alignment of self-generated accuracy judgments, confidence, and objective information regarding performance. IA not only refers to accuracy and confidence during tasks, but also predicts functional outcomes. The consistency and magnitude of IA deficits suggest a sustained disconnect between self-assessments and actual performance. The cognitive origins of IA are unclear and are not simply due to poor performance. We tried to capture task and diagnosis-related differences through examining confidence as a timeseries.

Method

This relatively large sample (N = 171; Bipolar = 71, Schizophrenia = 100) study used item by item confidence judgments for tasks including the Wisconsin Card Sorting Task (WCST) and the Emotion Recognition task (ER-40). Using a seasonal decomposition approach and AutoRegressive, Integrative and Moving Averages (ARIMA) time-series analyses we tested for the presence of randomness and perseveration.

Results

For the WCST, comparisons across participants with schizophrenia and bipolar disorder found similar trends and residuals, thus excluding perseverative or random responding. However, seasonal components were weaker in participants with schizophrenia, reflecting a reduced impact of feedback on confidence. In contrast, for the ER40, which does not require identification of a sustained construct, seasonal, trend, and residual analyses were highly comparable.

Conclusion

Seasonal analysis revealed that confidence judgments in participants with schizophrenia on tasks requiring responses to feedback reflected diminished incorporation of external information, not random or preservative responding. These analyses highlight how time series analyses can specify potential faulty processes for future intervention.

Deconstructing Mechanisms of Abnormal Categorical Perception of Emotional Facial Expressions in Schizophrenia Patients

OBJECTIVE

The current study aims to find out the potential reasons why most schizophrenia patients have a relatively low sensitivity to the classification of emotional facial expressions.

METHODS

By using an emotional categorical perception task, eighty-three schizophrenia patients and seventy-one healthy adults are provided with morphed emotional continuums with two emotional facial expressions (a positive emotional valence: happy; a negative emotional valence: sad).

RESULTS

Through comparing the difference between schizophrenia patients and healthy adults in the processes of estimating facial expressions with ambiguous emotions, we find that the pattern of emotional categorical perception for schizophrenia patients is significantly different from that of healthy controls when they process signals on the local facial areas. Compared to healthy people, schizophrenia patients have a significantly separate classification pattern in processing emotional signals between the eyes and mouth regions. It indicates that compared to healthy adults, schizophrenia patients have larger conflicts in integrating emotional signals from different facial areas. To overcome conflicts, more cognitive resources are required. Unfortunately, the lack of cognitive resources leads to the failure of integration, which further increases the difficulty of estimating facial expressions with ambiguous emotions, and finally leads to the relatively low sensitivity of emotional facial expressions classification.

CONCLUSION

To sum up, the deficit of abnormal perceptions of emotional facial expressions in schizophrenia patients results from an integrated deficit of signals on facial areas.

The flickering spotlight of visual attention: Characterizing abnormal object-based attention in schizophrenia

Schizophrenia is associated with deficits in both object perception and visual attention. However, few studies in schizophrenia have investigated object-based attention, which is dissociable from other forms of visuospatial attention. Recent research in healthy populations has shown that the 'spotlight' of sustained visual attention flickers in a rhythmic, oscillatory fashion at specific frequencies in the 4-12 Hz range. In healthy samples, this oscillatory signature has been used to investigate spatiotemporal dynamics of object-based attention, showing that the attentional spotlight spreads to uncued locations within cued objects, and also periodically alternates focus between cued and uncued objects. In this study, we adapted a performance-based visual object cueing task to investigate object-based attention in individuals with a schizophrenia diagnosis and healthy controls. In controls, spatiotemporal patterns of object-based attention closely resembled those reported in previous studies of healthy individuals. In the schizophrenia group, the oscillatory signature of attention also appeared in the location of the cue and on uncued objects, similar to the effects in controls. Indeed, the oscillatory signature of attention at the spatial location of the cue was stronger in the schizophrenia group than in controls. However, attention did not spread across the cued object in schizophrenia; rather, attention appeared to remain hyperfocused at the spatial location of the cue. These findings provide the first evidence that visual attention has oscillatory characteristics in schizophrenia, as in the general population. The results also show that the fundamental process of attentional spreading which underlies object-based attention is abnormal in schizophrenia.

Working Memory in People with Schizophrenia

Working memory (WM) refers to the ability to maintain a small number of representations in an activated, easily accessible state for a short period of time in the service of ongoing cognitive processing and behavior. Because WM is a resource critical for multiple forms of complex cognition and executive control of behavior, it is of central interest in the study of disorders such as schizophrenia that involve a broad compromise of cognitive function and in the regulation of goal-directed behavior. There is now robust evidence that WM impairment is characteristic of people with schizophrenia. The impairment includes both elementary storage capacity as well as more complex forms of WM that involve the manipulation and updating of WM representations. These impairments appear to underlie a substantial portion of the generalized cognitive deficit in schizophrenia. Neuroimaging studies have implicated widespread abnormalities in the broad neural system that subserves WM performance, consistent with the evidence of broad cognitive impairment seen in PSZ.

Attention in Schizophrenia

Attention is clearly a core area of cognitive dysfunction in schizophrenia, but the concept of "attention" is complex and multifaceted. This chapter focuses on three different aspects of attentional function that are of particular interest in schizophrenia. First, we discuss the evidence that schizophrenia involves a reduction in global alertness, leading to an inward focusing of attention and a neglect of external stimuli and tasks. Second, we discuss the control of attention, the set of processes that allow general goals to be translated into shifts of attention toward task-relevant information. When a goal is adequately represented, people with schizophrenia often show no deficit in using the goal to direct attention in the visual modality unless challenged by stimuli that strongly activate the magnocellular processing pathway. Finally, we discuss the implementation of selection, the processes that boost relevant information and suppress distractors once attention has been directed to a given source of information. Although early evidence indicated an impairment in selection, more recent evidence indicating that people with schizophrenia actually focus their attention more narrowly and more intensely that healthy individuals (hyperfocusing). However, this hyperfocused attention may be directed toward goal-irrelevant information, creating the appearance of impaired attentional filtering.

Rethinking delusions: A selective review of delusion research through a computational lens

Delusions are rigid beliefs held with high certainty despite contradictory evidence. Notwithstanding decades of research, we still have a limited understanding of the computational and neurobiological alterations giving rise to delusions. In this review, we highlight a selection of recent work in computational psychiatry aimed at developing quantitative models of inference and its alterations, with the goal of providing an explanatory account for the form of delusional beliefs in psychosis. First, we assess and evaluate the experimental paradigms most often used to study inferential alterations in delusions. Based on our review of the literature and theoretical considerations, we contend that classic draws-to-decision paradigms are not well-suited to isolate inferential processes, further arguing that the commonly cited 'jumping-to-conclusion' bias may reflect neither delusion-specific nor inferential alterations. Second, we discuss several enhancements to standard paradigms that show promise in more effectively isolating inferential processes and delusion-related alterations therein. We further draw on our recent work to build an argument for a specific failure mode for delusions consisting of prior overweighting in high-level causal inferences about partially observable hidden states. Finally, we assess plausible neurobiological implementations for this candidate failure mode of delusional beliefs and outline promising future directions in this area.

Interactive effects of maintenance decay and interference on working memory updating in schizophrenia

BACKGROUND

Deficits in working memory have been identified as a core cognitive impairment in schizophrenia. Prior work has identified a unique pattern of rapidly decreasing accuracy following intact encoding and updating of a single visuospatial target in patients with schizophrenia. Understanding whether these deficits are related to disruption of working memory stores following retrieval or part of a broader maintenance dysfunction may help elucidate the specific subprocesses underlying working memory deficits in schizophrenia.

METHODS

Participants were 71 patients with a schizophrenia spectrum disorder and 43 healthy controls who completed a working memory paradigm that parametrically varied maintenance demands from 1000 to 8000 ms.

RESULTS

Patients with a schizophrenia spectrum disorder were comparable to healthy controls at delays of 1000 ms. However, when delays were extended to 2000 and 4000 ms, the patient group showed significantly decreased accuracy. Additionally, the patient group showed a greater decline in accuracy following a second delay.

CONCLUSIONS

These findings suggest that early encoding of one item is intact in patients with a schizophrenia spectrum disorder, but information rapidly decays from working memory stores with extended delays. Accuracy further decreased when information was retrieved from working memory, suggesting that working memory stores may also be susceptible to disruption from internal stimuli. Thus, working memory stores in patients with a schizophrenia spectrum disorder may be vulnerable to both rapid decay and interference.

Cross-species evidence that nicotine widens the attentional window

RATIONALE

The ability to spread attention over items or locations is as important for everyday functioning as the ability to focus narrowly. Little is known about neuronal processes involved in broad monitoring, but indirect evidence suggests a role of nicotinic acetylcholine receptors (nAChRs).

OBJECTIVE

The present study tested whether the prototypical nAChR agonist nicotine enhances the ability of humans and rodents to maintain a broad attentional window.

METHODS

Fifty-three never-smokers wearing a nicotine (7 mg/24 h) or placebo patch performed an attention task requiring detection of stimuli presented randomly in one of four peripheral locations, with a central cue predicting the target location or indicating the need to spread attention over all locations. Nineteen rats performed the 5-choice serial reaction time task requiring detection of stimuli presented randomly in a horizontal array of five locations. Performance after nicotine (0.1 and 0.2 mg/kg) or vehicle administration was analyzed as a function of target location eccentricity.

RESULTS

In human subjects, nicotine caused greater reaction time reduction when all locations were monitored than when a single location was cued. In rats, nicotine attenuated the decline in stimulus detections and the increase in omission errors with greater target location eccentricity.

CONCLUSIONS

The findings represent cross-species evidence that nAChR agonism facilitates the ability to spread attention broadly. This suggests that nAChR hypofunction may be central to broad monitoring deficits as seen, for example, in schizophrenia. The homology of findings between the rodent and the human paradigm contributes to validating a translational strategy for treatment development.

Atypical attentional filtering of visual information in youth with chromosome 22q11.2 deletion syndrome as indexed by event-related potentials

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Attentional control measured in 22q youth and typically developing control group.

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Differences in attentional control indexed by N2pc and PD event-related potentials.

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22q youth exhibited sustained focus on distractor cues and reduced suppression.

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No relationships between attentional control and psychosis-proneness in 22q youth.

Background

Youth with chromosome 22q11.2 deletion syndrome (22q) face one of the highest genetic risk factors for the development of schizophrenia. Previous research suggests impairments in attentional control and potential interactions with elevated anxiety and reduced adaptive functioning may increase the risk for developing psychosis in this population. Here, we examined how variations in attentional control relate to the presence or severity of psychosis-proneness symptoms in these individuals.

Methods

To achieve this, we measured attentional control in youth (12–18 years) with 22q (N = 35) compared to a typically developing group (N = 45), using a flanker task (the Distractor Target task) while measuring neural activity with event-related potentials.

Results

Similar to previous findings observed in people with schizophrenia, greater attentional capture by, and reduced suppression of, non-target flanker stimuli characterized participants with 22q and was indexed by the N2pc (N2-posterior-contralateral) and P_D (distractor positivity) components. Although we observed no relationships between these components and measures of psychosis-proneness in youth with 22q, these individuals endorsed a relatively low incidence of positive symptoms overall.

Conclusions

Our results provide neural evidence of an attentional control impairment in youth with 22q that suggests these individuals experience sustained attentional focus on irrelevant information and reduced suppression of distracting stimuli in their environment. Impairments in attentional control might be a valid biomarker of the potential to develop attenuated positive symptoms or frank psychosis in high-risk individuals long before the age at which such symptoms typically arise. The evaluation of such a hypothesis, and the preventive potential for the putative biomarker, should be the focus of future studies.

Impaired Filtering and Hyperfocusing: Neural Evidence for Distinct Selective Attention Abnormalities in People with Schizophrenia

Although schizophrenia is classically thought to involve impaired attentional filtering, people with schizophrenia (PSZ) exhibit a more intense and more exclusive attentional focus than healthy control subjects (HCS) in many tasks. To resolve this contradiction, this functional magnetic resonance imaging study tested the impact of attentional control demands on the modulation of stimulus-induced activation in the fusiform face area and parahippocampal place area when participants (43 PSZ and 43 HCS) were looking for a target face versus house. Stimuli were presented individually, or as face-house overlays that challenged attentional control. Responses were slower for house than face stimuli and when prioritizing houses over faces in overlays, suggesting a difference in salience. Blood-oxygen-level-dependent activity reflected poorer attentional selectivity in PSZ than HCS when attentional control was challenged most, that is, when stimuli were overlaid and the task required detecting the lower-salience house target. By contrast, attentional selectivity was exaggerated in PSZ when control was challenged least, that is, when stimuli were presented sequentially and the task required detecting the higher-salience face target. These findings are consistent with 2 distinct attentional abnormalities in schizophrenia leading to impaired and exaggerated selection under different conditions: attentional control deficits, and hyperfocusing once attention has been directed toward a stimulus.

Preliminary evidence for the phosphodiesterase type-4 inhibitor, roflumilast, in ameliorating cognitive flexibility deficits in patients with schizophrenia

BACKGROUND

Cognitive flexibility deficits are present in patients with schizophrenia and are strong predictors of functional outcome but, as yet, have no pharmacological treatments.

AIMS

The purpose of this study was to investigate whether the phosphodiesterase type-4 inhibitor, roflumilast, can improve cognitive flexibility performance and functional brain activity in patients with schizophrenia.

METHODS

This was a within-subject, randomised, double-blind, placebo-controlled, three-period crossover study using a version of the Intradimensional/Extradimensional (ID/ED) task, optimised for functional magnetic resonance imaging (fMRI), in 10 patients with schizophrenia who were scanned after receiving placebo, 100 µg or 250 µg roflumilast for 8 consecutive days. Data from an additional fMRI ID/ED study of 18 healthy participants on placebo was included to contextualise the schizophrenia-related performance and activations. The fMRI analyses included a priori driven region of interest (ROI) analysis of the dorsal frontoparietal attention network.

RESULTS

Patients on placebo demonstrated broad deficits in task performance compared to the healthy comparison group, accompanied by preserved network activity for solution search, but reduced activity in left ventrolateral prefrontal cortex (VLPFC) and posterior parietal cortex for attentional set-shifting and reduced activity in left dorsolateral prefrontal cortex (DLPFC) for reversal learning. These ROI deficits were ameliorated by 250 µg roflumilast, whereas during solution search 100 µg roflumilast reduced activity in the left orbitofrontal cortex, right DLPFC and bilateral PPC, which was associated with an improvement in formation of attentional sets.

CONCLUSIONS

The results suggest roflumilast has dose-dependent cognitive enhancing effects on the ID/ED task in patients with schizophrenia, and provides sufficient support for larger studies to test roflumilast's role in improving cognitive flexibility deficits in this clinical population.

Fronto-parietal network function during cued visual search in the first-episode schizophrenia spectrum

Cognitive impairments account for significant morbidity in schizophrenia and are present at disease onset. Controlled processes are particularly susceptible and may contribute to pervasive selective attention deficits. The present study assessed fronto-parietal attention network (FPAN) functioning during cue presentation on a visual search task in first-episode schizophrenia spectrum patients (FE) and its relation to symptom burden and community functioning. Brain activity was recorded with magnetoencephalography from 38 FE and 38 healthy controls (HC) during blocks of pop-out and serial search target detection. Activity during cue presentation was compared between groups across bilateral FPAN regions (frontal eye fields (FEF), inferior frontal gyrus (IFG), midcingulate cortex (MCC), and intraparietal sulcus (IPS)). FE exhibited greater right hemisphere IFG activity despite worse performance relative to HC. Performance and FPAN activity were not correlated in HC. Among FE, however, stronger activity within right hemisphere FEF and IFG was associated with faster responses. Stronger right IPS and left IFG activity in patients was also associated with reduced negative symptoms and improved community functioning, respectively. Increased reliance on the FPAN for task completion suggests an inefficient cognitive control network and might reflect a compensation for impaired attentional deployment during target detection, a strategy employed by those with less severe illness. These findings represent a critical step towards identifying the neural substrates of negative symptoms and impaired neurocognition at disease onset.

Oculomotor inhibition and location priming in schizophrenia

Schizophrenia is widely thought to involve elevated distractibility, which may reflect a general impairment in top-down inhibitory processes. Schizophrenia also appears to involve increased priming of previously performed actions. Here, we used a highly refined eye-tracking paradigm that makes it possible to concurrently assess distractibility, inhibition, and priming. In both healthy control subjects (HCS, N = 41) and people with schizophrenia (PSZ, N = 46), we found that initial saccades were actually less likely to be directed toward a salient "singleton" distractor than toward less salient distractors, reflecting top-down suppression of the singleton. Remarkably, this oculomotor suppression effect was as strong or stronger in PSZ than in HCS, indicating intact inhibitory control. In addition, saccades were frequently directed to the location of the previous-trial target in both groups, but this priming effect was much stronger in PSZ than in HCS. Indeed, PSZ directed gaze toward the location of the previous-trial target as often as they directed gaze to the location of the current-trial target. These results demonstrate that-at least in the context of visual search-PSZ are no more distractable than HCS and are fully capable of inhibiting salient-but-irrelevant stimuli. However, PSZ do exhibit exaggerated priming, focusing on recently attended locations even when this is not beneficial for goal attainment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Autobiographical memory in schizophrenia: The role of metacognition

BACKGROUND

Autobiographical memory is an important component of declarative memory, which refers to the ability to recall personal events that happened in the past. This requires that the person senses or experiences himself/herself in the past (i.e., conscious recollection). For people with schizophrenia, conscious recollection can be particularly difficult, resulting in difficulty accessing detailed, specific autobiographical information. Our hypothesis is that the ability to monitor and think about one's cognitive processes (metacognition) is a requisite for conscious recollection, and that it mediates the association between having schizophrenia and recalling fewer specific, personal memories.

METHODS

Participants were 30 adults with schizophrenia and 30 matched healthy controls. The main assessment instruments were the Metacognition Assessment Scale-Abbreviated (MAS-A) and the Autobiographical Memory Test (AMT). Severity of symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Cognitive performance was measured with the Screen for Cognitive Impairment in Psychiatry (SCIP). Mediation analysis was conducted following Baron and Kenny's procedure.

RESULTS

People with schizophrenia had more semantic associations and fewer specific memories than controls in the AMT. Metacognition (MAS-A total score) partially mediated the association between having schizophrenia and recalling fewer specific past events, even after controlling for cognitive impairment as a potential confounding source.

CONCLUSIONS

Metacognitive ability, which can be improved with available programs, intervenes in the process of accessing autobiographical memories in people with schizophrenia. Practical implications of this finding are discussed.

The Imbalanced Plasticity Hypothesis of Schizophrenia-Related Psychosis: A Predictive Perspective

A considerable number of studies have attempted to account for the psychotic aspects of schizophrenia in terms of the influential predictive coding (PC) hypothesis. We argue that the prediction-oriented perspective on schizophrenia-related psychosis may benefit from a mechanistic model that: 1) gives due weight to the extent to which alterations in short- and long-term synaptic plasticity determine the degree and the direction of the functional disruption that occurs in psychosis; and 2) addresses the distinction between the two central syndromes of psychosis in schizophrenia: disorganization and reality-distortion. To accomplish these goals, we propose the Imbalanced Plasticity Hypothesis - IPH, and demonstrate that it: 1) accounts for commonalities and differences between disorganization and reality distortion in terms of excessive (hyper) or insufficient (hypo) neuroplasticity, respectively; 2) provides distinct predictions in the cognitive and electrophysiological domains; and 3) is able to reconcile conflicting PC-oriented accounts of psychosis.

Transdiagnostic comparison of visual working memory capacity in bipolar disorder and schizophrenia

BACKGROUND

Impaired working memory is a core cognitive deficit in both bipolar disorder and schizophrenia. Its study might yield crucial insights into the underpinnings of both disorders on the cognitive and neurophysiological level. Visual working memory capacity is a particularly promising construct for such translational studies. However, it has not yet been investigated across the full spectrum of both disorders. The aim of our study was to compare the degree of reductions of visual working memory capacity in patients with bipolar disorder (PBD) and patients with schizophrenia (PSZ) using a paradigm well established in cognitive neuroscience.

METHODS

62 PBD, 64 PSZ, and 70 healthy controls (HC) completed a canonical visual change detection task. Participants had to encode the color of four circles and indicate after a short delay whether the color of one of the circles had changed or not. We estimated working memory capacity using Pashler's K.

RESULTS

Working memory capacity was significantly reduced in both PBD and PSZ compared to HC. We observed a small effect size (r = .202) for the difference between HC and PBD and a medium effect size (r = .370) for the difference between HC and PSZ. Working memory capacity in PSZ was also significantly reduced compared to PBD with a small effect size (r = .201). Thus, PBD showed an intermediate level of impairment.

CONCLUSIONS

These findings provide evidence for a gradient of reduced working memory capacity in bipolar disorder and schizophrenia, with PSZ showing the strongest degree of impairment. This underscores the importance of disturbed information processing for both bipolar disorder and schizophrenia. Our results are compatible with the cognitive manifestation of a neurodevelopmental gradient affecting bipolar disorder to a lesser degree than schizophrenia. They also highlight the relevance of visual working memory capacity for the development of both behavior- and brain-based transdiagnostic biomarkers.

What Can Performance in the IEDS Task Tell Us About Attention Shifting in Clinical Groups?

The Intra-Extra-dimensional set shift task (IEDS) is a widely used test of learning and attention, believed to be sensitive to aspects of executive function. The task proceeds through a number of stages, and it is generally claimed that patterns of errors across stages can be used to discriminate between reduced attention switching and more general reductions in rates of learning. A number of papers have used the IEDS task to argue for specific attention shifting difficulties in Autism Spectrum Disorder (ASD) and Schizophrenia, however, it remains unclear how well the IEDS really differentiates between reduced attention shifting and other causes of impaired performance. To address this issue, we introduce a simple computational model of performance in the IEDS task, designed to separate the competing effects of attention shifting and general learning rate. We fit the model to data from ASD and comparison individuals matched on age and IQ, as well as to data from four previous studies which used the IEDS task. Model fits do not show consistent evidence for reductions in attention shifting rates in ASD and Schizophrenia. Instead, we find performance is better explained by differences in learning rate, particularly from punishment, which we show correlates with IQ. We, therefore, argue that the IEDS task is not a good measure of attention shifting in clinical groups. LAY SUMMARY: The Intra-Extra-Dimensional Set shift task (IEDS) is often given to autistic individuals, who tend to make more errors relative to comparison groups. This higher error rate is taken to mean that autistic individuals struggle with attention control. Our computational model of the IEDS shows that the performance of ASD and some other clinical groups can be explained instead by differences in learning rate, rather than differences in attention control.

Impaired inhibition of return during free-viewing behaviour in patients with schizophrenia

Schizophrenia affects various aspects of cognitive and behavioural functioning. Eye movement abnormalities are commonly observed in patients with schizophrenia (SZs). Here we examined whether such abnormalities reflect an anomaly in inhibition of return (IOR), the mechanism that inhibits orienting to previously fixated or attended locations. We analyzed spatiotemporal patterns of eye movement during free-viewing of visual images including natural scenes, geometrical patterns, and pseudorandom noise in SZs and healthy control participants (HCs). SZs made saccades to previously fixated locations more frequently than HCs. The time lapse from the preceding saccade was longer for return saccades than for forward saccades in both SZs and HCs, but the difference was smaller in SZs. SZs explored a smaller area than HCs. Generalized linear mixed-effect model analysis indicated that the frequent return saccades served to confine SZs' visual exploration to localized regions. The higher probability of return saccades in SZs was related to cognitive decline after disease onset but not to the dose of prescribed antipsychotics. We conclude that SZs exhibited attenuated IOR under free-viewing conditions, which led to restricted scene scanning. IOR attenuation will be a useful clue for detecting impairment in attention/orienting control and accompanying cognitive decline in schizophrenia.

Hyperfocus: the forgotten frontier of attention

'Hyperfocus' is a phenomenon that reflects one's complete absorption in a task, to a point where a person appears to completely ignore or 'tune out' everything else. Hyperfocus is most often mentioned in the context of autism, schizophrenia, and attention deficit hyperactivity disorder, but research into its effect on cognitive and neural functioning is limited. We propose that hyperfocus is a critically important aspect of cognition, particularly with regard to clinical populations, and that it warrants significant investigation. Hyperfocus, though ostensibly self-explanatory, is poorly defined within the literature. In many cases, hyperfocus goes undefined, relying on the assumption that the reader inherently knows what it entails. Thus, there is no single consensus to what constitutes hyperfocus. Moreover, some studies do not refer to hyperfocus by name, but describe processes that may be related. In this paper, we review how hyperfocus (as well as possibly related phenomena) has been defined and measured, the challenges associated with hyperfocus research, and assess how hyperfocus affects both neurotypical and clinical populations. Using this foundation, we provide constructive criticism about previously used methods and analyses. We also propose an operational definition of hyperfocus for researchers to use moving forward.

Schizotypy is associated with difficulty maintaining multiple hypotheses

Among neurocognitive accounts of delusions, there is a growing consensus that it is the certainty with which delusions are held, rather than their content that defines some beliefs as delusional. On a continuum model of psychosis, this inappropriate certainty ought to be present (albeit in an attenuated form) in healthy adults who score highly in schizotypy. It was hypothesised that this might be most evident in circumstances where the environment provides incomplete or probabilistic information, which thereby forces the participant to hold two imperfectly supported, concurrent hypotheses in mind. A cued visual search task was used to measure people's capacity to use partially predictive information (i.e., a cue that predicted the target may occur in one of the two locations) to facilitate speeded responding. As hypothesised, people's performance on the trials that required holding two hypotheses in mind concurrently was significantly and specifically associated with the positive components of schizotypy. This finding is consistent with a hyperfocusing of attention in schizophrenia, and may help explain why delusion-prone individuals have a tendency to "jump to conclusions" or be resistant to disconfirming information when faced with multiple, partially supported hypotheses.

Correlations between age, biomedical variables, and cognition in patients with schizophrenia

Objective

To illustrate the influence of clinical variables on cognition performance in patients with schizophrenia (SCZ).

Methods

Using the 66nao Brain Training device (a novel measurement tool), the cognitive performance of 99 patients with SCZ was evaluated. Patients were diagnosed by the ICD-10 diagnostic criteria for SCZ, and their age were 16–68 years old. Furthermore, we explored the relationship between age, biomedical variables and specific cognitive domains in patients with SCZ. Patients were divided into two groups: various of cognitive domains impairment group and non-impairment group according to the norm scores. All data were analyzed using RStudio Version 1.0.44 (RStudio, Inc.)

Results

Patients with SCZ had obvious cognitive impairment in total and five subdomains of cognitive function. We found that 1) SCZ patients with impaired cognitive total score experienced significant older age and longer illness duration compared with those with normal cognitive total score. 2) SCZ patients with impaired memory experienced significant older age compared with those with normal memory. 3) SCZ patients with impaired attention showed significant lower serum triglyceride (TG) level compared with those with normal attention. 4) SCZ patients with impaired flexibility performed significant longer illness duration compared with those with normal flexibility. 5) SCZ patients with impaired cognitive agility performed significant older age, longer duration, and higher systolic blood pressure (SBP) compared with those with normal cognitive agility. 6) The age, illness duration and SBP in patients with impaired time perception were marginally different from those of subjects with normal time perception.

Conclusion

There are five dimensions (memory, attention, flexibility, cognitive agility, and time perception) of cognitive dysfunction in SCZ patients. Age, illness duration, TG, and SBP might play vital roles in various subdomains of the cognitive deficits respectively in patients with SCZ.

Increased repulsion of working memory representations in schizophrenia

Computational neuroscience models propose that working memory (WM) involves recurrent excitatory feedback loops that maintain firing over time along with lateral inhibition that prevents the spreading of activity to other feature values. In behavioral paradigms, this lateral inhibition appears to cause a repulsion of WM representations away from each other and from other strong sources of input. Recent computational models of schizophrenia have proposed that reduction in the strength of inhibition relative to strength of excitation may underlie impaired cognition, and this leads to the prediction that repulsion effects should be reduced in people with schizophrenia spectrum disorders (PSZ) relative to healthy control subjects (HCS). We tested this hypothesis in 2 experiments measuring WM repulsion effects. In Experiment 1, 45 PSZ and 32 HCS remembered the location of a single object relative to a centrally presented visual landmark and reported this location after a short delay. The reported location was repelled away from the landmark in both groups, but this repulsion effect was increased rather than decreased in PSZ relative to HCS. In Experiment 2, 41 PSZ and 34 HCS remembered 2 sequentially presented orientations and reported each orientation after a short delay. The reported orientations were biased away from each other in both groups, and this repulsion effect was again more pronounced in PSZ than in HCS. Contrary to the widespread hypothesis of reduced inhibition in schizophrenia, we provide robust evidence from 2 experiments showing that the behavioral performance of PSZ exhibited an exaggeration rather than a reduction of competitive inhibition. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

People with schizophrenia do not show the normal benefits of social versus nonsocial attentional cues

OBJECTIVE

Schizophrenia is associated with impairments in social motivation. Social attention has been proposed as an underlying mechanism for social motivation. However, studies in schizophrenia have rarely examined social attention, and none of these studies examined the effects with rapidly presented stimuli.

METHOD

The current study examined whether individuals with schizophrenia have reduced social attention and whether reduced social attention was related to social motivation deficits (measured with the Clinical Assessment Interview for Negative Symptoms) and decreased social functioning (Role Functioning Scale). Thirty-seven outpatients with schizophrenia and 29 healthy participants completed a gaze cueing task with directional social cues (eye gaze) and nonsocial cues (arrows) at varying stimulus onset asynchronies.

RESULTS

As predicted, schizophrenia participants had reduced social attention relative to nonsocial attention, compared with healthy participants. Healthy participants were quicker to respond to social cues than nonsocial cues, but schizophrenia participants did not exhibit this same pattern. Schizophrenia participants showed higher accuracy when targets appeared in the same location as a directional cue (i.e., congruency) for nonsocial, but not social, cues. Contrary to expectations, reduced social attention was not significantly correlated with clinically rated social motivation deficits or decreased social functioning in the schizophrenia group.

CONCLUSION

These findings provide evidence for social attention deficits in schizophrenia, but without a clear mapping of its influence on social motivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Antisaccade Deficits in Schizophrenia Can Be Driven by Attentional Relevance of the Stimuli

The antisaccade task is considered a test of cognitive control because it creates a conflict between the strong bottom-up signal produced by the cue and the top-down goal of shifting gaze to the opposite side of the display. Antisaccade deficits in schizophrenia are thought to reflect impaired top-down inhibition of the prepotent bottom-up response to the cue. However, the cue is also a highly task-relevant stimulus that must be covertly attended to determine where to shift gaze. We tested the hypothesis that difficulty in overcoming the attentional relevance of the cue, rather than its bottom-up salience, is key in producing impaired performance in people with schizophrenia (PSZ). We implemented 3 versions of the antisaccade task in which we varied the bottom-up salience of the cue while holding its attentional relevance constant. We found that difficulty in performing a given antisaccade task-relative to a prosaccade version using the same stimuli-was largely independent of the cue's bottom-up salience. The magnitude of impairment in PSZ relative to control subjects was also independent of bottom-up salience. The greatest impairment was observed in a version where the cue lacked bottom-up salience advantage over other locations. These results indicate that the antisaccade deficit in PSZ does not reflect an impairment in overcoming bottom-up salience of the cue, but PSZ are instead impaired at overcoming its attentional relevance. This deficit may still indicate an underlying inhibitory control impairment but could also reflect a hyperfocusing of attentional resources on the cue.

Reduced Dorsal Visual Oscillatory Activity During Working Memory Maintenance in the First-Episode Schizophrenia Spectrum

Cognitive deficits in people with schizophrenia are among the hardest to treat and strongly predict functional outcome. The ability to maintain sensory precepts in memory over a short delay is impacted early in the progression of schizophrenia and has been linked to reliable neurophysiological markers. Yet, little is known about the mechanisms of these deficits. Here, we investigated possible neurophysiological mechanisms of impaired visual short-term memory (vSTM, aka working memory maintenance) in the first-episode schizophrenia spectrum (FESz) using magnetoencephalography (MEG). Twenty-eight FESz and 25 matched controls performed a lateralized change detection task where they were cued to selectively attend and remember colors of circles presented in either the left or right peripheral visual field over a 1 s delay. Contralateral alpha suppression (CAS) during the delay period was used to assess selective attention to cued visual hemifields held in vSTM. Delay-period CAS was compared between FESz and controls and between trials presenting one vs three items per visual hemifield. CAS in dorsal visual cortex was reduced in FESz compared to controls in high-load trials, but not low-load trials. Group differences in CAS were found beginning 100 ms after the disappearance of the memory set, suggesting deficits were not due to the initial deployment of attention to the cued visual hemifield prior to stimulus presentation. CAS was not greater for high-load vs low-load trials in FESz subjects, although this effect was prominent in controls. Further, lateralized gamma (34-40 Hz) power emerged in dorsal visual cortex prior to the onset of CAS in controls but not FESz. Gamma power in this cluster differed between groups at both high and low load. CAS deficits observed in FESz were correlated with change detection accuracy, working memory function, estimated IQ, and negative symptoms. Our results implicate deficits in CAS in trials requiring broad, but not narrow, focus of attention to spatially distributed objects maintained in vSTM in FESz, possibly due to reduced ability to broadly distribute visuospatial attention (alpha) or disruption of object-location binding (gamma) during encoding/consolidation. This early pathophysiology may shed light upon mechanisms of emerging working memory deficits that are intrinsic to schizophrenia.

Cortical hyperactivation at low working memory load: A primary processing abnormality in people with schizophrenia?

A frequent finding when studying substrates of working memory (WM) deficits in people with schizophrenia (PSZ) is task-induced hyperactivation relative to healthy control subjects (HCS) when WM load is low. Hyperactivation accompanying similar performance is commonly attributed to cognitive deficits rendering relatively easy operations more resource-consuming. To test if hyperactivation at low load really is secondary to cognitive impairment in PSZ, we re-analyzed functional MRI data showing left posterior parietal cortex (PPC) hyperactivation in PSZ when holding a single color-item in WM. In subgroups matched for the number of items successfully stored in WM (K) by excluding the highest-performing HCS and lowest-performing PSZ, performance was almost identical across all set sizes (1-7). While BOLD activation at the larger set sizes did not differ between groups, PSZ still robustly hyperactivated left PPC when a single item had to be maintained. The same pattern was observed in subgroups matched for model-based estimates of WM capacity or attentional lapse rate. Given that in the K-matched subsamples PSZ performed as well as HCS even in the most challenging load conditions and that no BOLD signal difference was seen at high loads, it is implausible that PSZ over-recruited WM-related neural structures because they were more challenged by maintaining a single item in WM. Instead, the findings are consistent with a primary schizophrenia-related processing abnormality as proposed by the hyperfocusing hypothesis, which suggests that an abnormally narrow but intense focusing of processing resources is central to many aspects of impaired cognition in PSZ.

Increased influence of a previously attended feature in people with schizophrenia

Everyday functioning requires the appropriate allocation of visual attention, which is achieved through multiple mechanisms of attentional guidance. Traditional theories have focused on top-down and bottom-up factors, but implicit learning from recent experience ("selection history") also has a substantial impact on attentional allocation. The present experiment examined the influence of intertrial priming on attentional guidance in people with schizophrenia and matched control subjects. Participants searched for a color pop-out target, which switched randomly between a red target among blue distractors and a blue target among red distractors. We found that performance on the current trial was more influenced by the previous-trial target color in people with schizophrenia than in control subjects. Moreover, this implicit priming effect was greater in individuals with lower working memory capacity (as measured in a separate task). These results suggest that intertrial priming has an exaggerated impact on attentional guidance in people with schizophrenia and that this is associated with other aspects of impaired cognition. Overall, these results are consistent with the hyperfocusing hypothesis, which proposes that a single underlying attentional abnormality may explain a range of atypical effects across perception, attention, and cognition in schizophrenia. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Assessing the information content of ERP signals in schizophrenia using multivariate decoding methods

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This study took multivariate decoding methods that are widely used to assess the nature of neural representations in neurotypical people and applied them to a comparison of people with schizophrenia and matched control subjects.

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Participants performed a visual working memory task that required remembering 1–5 items from one side of the display and ignoring an equal number of items on the other side of the display.

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We attempted to decode which side was being held in working memory from the scalp distribution of the ERP activity during the delay period of the working memory task, and we found greater decoding accuracy in people with schizophrenia than in control subjects when a single item was being held in memory.

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These results support the hyperfocusing hypothesis of cognitive dysfunction in schizophrenia, and they provide an important proof of concept for applying multivariate decoding methods to comparisons of neural representations in psychiatric and non-psychiatric populations.

Multivariate pattern classification (decoding) methods are commonly employed to study mechanisms of neurocognitive processing in typical individuals, where they can be used to quantify the information that is present in single-participant neural signals. These decoding methods are also potentially valuable in determining how the representation of information differs between psychiatric and non-psychiatric populations. Here, we examined ERPs from people with schizophrenia (PSZ) and healthy control subjects (HCS) in a working memory task that involved remembering 1, 3, or 5 items from one side of the display and ignoring the other side. We used the spatial pattern of ERPs to decode which side of the display was being held in working memory. One might expect that decoding accuracy would be inevitably lower in PSZ as a result of increased noise (i.e., greater trial-to-trial variability). However, we found that decoding accuracy was greater in PSZ than in HCS at memory load 1, consistent with previous research in which memory-related ERP signals were larger in PSZ than in HCS at memory load 1. We also observed that decoding accuracy was strongly related to the ratio of the memory-related ERP activity and the noise level. In addition, we found similar noise levels in PSZ and HCS, counter to the expectation that PSZ would exhibit greater trial-to-trial variability. Together, these results demonstrate that multivariate decoding methods can be validly applied at the individual-participant level to understand the nature of impaired cognitive function in a psychiatric population.