Cognitive effort and amotivation in first-episode psychosis

Impaired cognition and amotivation are considered core features of psychotic disorders. Amotivation may manifest as reduced willingness to expend effort on cognitive tasks. It remains unclear whether reduced effort is responsible for any of the observed cognitive deficits in these patients, as we do not generally assess continuous effort during testing. In the current study, we tested whether disengagement of effort is greater during cognitive performance in individuals with first-episode psychosis (FEP) compared with healthy community members. We used a novel task called Cognitive Effort and DisEngagement (CEDE), which increases in difficulty and permits skipping any trial without penalty. No additional monetary incentives were used, and skips were used as an index of effort disengagement. We found that FEP patients had lower overall accuracy on the CEDE, but they also skipped significantly more, specifically on difficult trials. Self-reported amotivation significantly predicted skips among patients. The present results suggest that disengagement of effort may account for a portion of cognitive test performance among individuals with FEP. This possibility is relevant to cognitive remediation, as effort and ability may optimally be targeted by different interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).