Are psychoticlike experiences in adolescents associated with altered prefrontal and striatal activation during reward processing?
In this cohort study of 298 adolescents, those with an elevated rate of psychoticlike experiences at age 14 years demonstrated reduced activation in prefrontal and limbic cortical areas during reward processing compared with adolescents with no psychoticlike experiences. However, by age 19 years, the group with the elevated rate of psychoticlike experiences showed differentially increased activation of the right prefrontal cortex and reduced activation of dorsal striatum.
Adolescents with an elevated rate of psychoticlike experiences show differential activation in frontostriatal brain areas engaged during reward processing compared with control adolescents; given the nonclinical nature of the sample, the increase in prefrontal cortical activation from early to late adolescence may reflect a compensatory cognitive mechanism in the presence of abnormal striatal reward processing to contextualize these abnormal experiences.
Psychoticlike experiences (PLEs) are subclinical manifestations of psychotic symptoms and may reflect an increased vulnerability to psychotic disorders. Contemporary models of psychosis propose that dysfunctional reward processing is involved in the cause of these clinical illnesses.
To examine the neuroimaging profile of healthy adolescents at 14 and 19 years old points with PLEs, using a reward task.
Design, Setting, and Participants
A community-based cohort study, using both a cross-sectional and longitudinal design, was conducted in academic centers in London, Nottingham, United Kingdom, and Dublin, Ireland; Paris, France; and Berlin, Hamburg, Mannheim, and Dresden, Germany. A group of 1434 healthy adolescent volunteers was evaluated, and 2 subgroups were assessed at ages 14 and 19 years. Those who scored as either high or low PLE (based on the upper and lower deciles) on the Community Assessment of Psychic Experiences Questionnaire (CAPE-42) at age 19 years were included in the analysis. The study was conducted from January 1, 2016, to January 1, 2017.
Main Outcomes and Measures
Participants were assessed at age 14 and 19 year points using functional magnetic resonance imaging while performing a monetary incentive delay reward task. A first-level model focused on 2 predefined contrasts of anticipation and feedback of a win. The second-level analysis examined activation within the reward network using an a priori–defined region of interest approach. The main effects of group, time, and their interaction on brain activation were examined.
Of the 1434 adolescents, 2 groups (n = 149 each) (high PLEs, n = 149, 50 [33.6%] male; low PLEs, n = 149, 84 [56.4%] male) were compared at ages 14 and 19 years. Two regions within the left and right middle frontal gyri showed a main effect of time on brain activation (F1, 93 = 5.559; P = .02; F1, 93 = 5.009; P = .03, respectively); there was no main effect of group. One region within the right middle frontal gyrus demonstrated a significant time × group interaction (F1, 93 = 7.448; P = .01).
Conclusion and Relevance
The findings are consistent with evidence implicating alterations in prefrontal and striatal function during reward processing in the etiology of psychosis. Given the nature of this nonclinical sample this may reflect a combination of aberrant salience yielding abnormal experiences and a compensatory cognitive control mechanism necessary to contextualize them.
Papanastasiou E, Mouchlianitis E, Joyce DW, et al. Examination of the Neural Basis of Psychoticlike Experiences in Adolescence During Reward Processing. JAMA Psychiatry. 2018;75(10):1043–1051. doi:10.1001/jamapsychiatry.2018.1973
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