Transdiagnostic Predictors of Everyday Functioning: Examining the Relationships of Depression and Reinforcement Learning

Author:

Dalloul Nada1,Moran Erin K2ORCID,Gold James M3ORCID,Carter Cameron S4,MacDonald Angus W5,Ragland J Daniel4,Silverstein Steven M6ORCID,Luck Steven J7ORCID,Barch Deanna M128ORCID

Affiliation:

1. Department of Psychological & Brain Sciences, Washington University , St. Louis, MO , USA

2. Department of Psychiatry, Washington University School of Medicine , St. Louis, MO , USA

3. Department of Psychiatry, Maryland Psychiatric Research Center , Baltimore, MD , USA

4. Department of Psychiatry, University of California , Davis, CA , USA

5. Department of Psychology, University of Minnesota , Minneapolis, MN , USA

6. Department of Psychiatry, University of Rochester , Rochester, NY , USA

7. Department of Psychology, University of California , Davis, CA , USA

8. Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine , St. Louis, MO , USA

Abstract

Abstract Background and Hypothesis Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across domains of neurocognition, assess whether reinforcement learning is related to function, identify if predictors of function are transdiagnostic, determine whether depression and positive symptoms contribute to function, and to explore whether the modality of assessment impacts observed relationships. Study Design Data from 274 participants were examined with schizophrenia/schizoaffective disorder (SZ; n = 195) and bipolar disorder (BD; n = 79). To reduce dimensionality, a PCA was completed on neurocognitive tasks which resulted in 3 components. These components and clinical interview data were used to investigate predictors of functional domains across measures of function (self- and informant-report SLOF and UPSA). Results Two components, working memory/processing speed/episodic memory (βs = 0.18–0.42), and negative/positive reinforcement learning (β = −0.04), predicted different functional domains. Predictors of function were largely transdiagnostic with two exceptions: reinforcement learning had a positive association with self-reported interpersonal relationships for SZ and a negative association for BD (β = 0.34), and the negative association between positive symptoms and self-reported social acceptability was stronger for BD than for SZ (β = 0.93). Depression robustly predicted self-reported but not informant-reported function, and anhedonia predicted all domains of informant-reported function. Conclusions These findings imply that reinforcement learning may differentially relate to function across disorders, traditional domains of neurocognition can be effective transdiagnostic targets for interventions, and positive symptoms and depression play a critical role in self-perceived functional impairments.

Funder

National Institute of Mental Health

Publisher

Oxford University Press (OUP)

Subject

Psychiatry and Mental health

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