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The role of cognitive control in the positive symptoms of psychosis

Horne, Charlotte M., Sahni, Angad, Pang, Sze W., Vanes, Lucy D., Szentgyorgyi, Timea, Averbeck, Bruno, Moran, Rosalyn J., Shergill, Sukhwinder S. (2022) The role of cognitive control in the positive symptoms of psychosis. NeuroImage: Clinical, 34 . Article Number 103004. ISSN 2213-1582. (doi:10.1016/j.nicl.2022.103004) (KAR id:96361)


BACKGROUND: Positive symptoms of psychosis (e.g., hallucinations) often limit everyday functioning and can persist despite adequate antipsychotic treatment. We investigated whether poor cognitive control is a mechanism underlying these symptoms. METHODS: 97 patients with early psychosis (30 with high positive symptoms (HS) and 67 with low positive symptoms (LS)) and 40 healthy controls (HC) underwent fMRI whilst performing a reward learning task with two conditions; low cognitive demand (choosing between neutral faces) and high cognitive demand (choosing between angry and happy faces - shown to induce an emotional bias). Decision and feedback phases were examined. RESULTS: Both patient groups showed suboptimal learning behaviour compared to HC and altered activity within a core reward network including occipital/lingual gyrus (decision), rostral Anterior Cingulate Cortex, left pre-central gyrus and Supplementary Motor Cortex (feedback). In the low cognitive demand condition, HS group showed significantly reduced activity in Supplementary Motor Area (SMA)/pre-SMA during the decision phase whilst activity was increased in LS group compared to HC. Recruitment of this region suggests a top-down compensatory mechanism important for control of positive symptoms. With additional cognitive demand (emotional vs. neutral contrast), HS patients showed further alterations within a subcortical network (increased left amygdala activity during decisions and reduced left pallidum and thalamus activity during feedback) compared to LS patients. CONCLUSIONS: The findings suggest a core reward system deficit may be present in both patient groups, but persistent positive symptoms are associated with a specific dysfunction within a network needed to integrate social-emotional information with reward feedback.

Item Type: Article
DOI/Identification number: 10.1016/j.nicl.2022.103004
Uncontrolled keywords: Cognitive control, fMRI, Positive symptoms, Psychosis, Reward learning
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Funders: European Research Council (
National Institute for Health Research (
South London and Maudsley NHS Foundation Trust (
King's College London (
Guy's and St Thomas' Charity (
Maudsley Charity (
Depositing User: Rachael Heller
Date Deposited: 27 Sep 2022 13:15 UTC
Last Modified: 04 Mar 2024 15:29 UTC
Resource URI: (The current URI for this page, for reference purposes)

University of Kent Author Information

Shergill, Sukhwinder S..

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