Advancing Understanding of Treatment Response in Schizophrenia With Psychosis Using a Novel Dynamic Reward Task

Abstract

Background and Hypothesis Schizophrenia presents significant treatment challenges, particularly due to medication resistance observed in some patients receiving antipsychotics. Emerging research suggests a potential link between impaired reinforcement learning, the severity of psychotic symptoms, and dopamine system abnormalities. Exploring reinforcement learning in therapeutic settings could provide critical insights into the efficacy of antipsychotic treatments. This study aimed to investigate whether neurocognitive profiles, specifically choice strategies and model fitting parameters assessed using the Dynamic Reward Task (DRT), could provide insights into treatment response variability among patients with schizophrenia. Study Design We conducted a comprehensive neurocognitive assessment on chronic schizophrenia patients experiencing psychotic relapse, categorized by treatment response (high-response vs low-response). Participants underwent DRT, Wisconsin Card Sorting Test (WCST), and Continuous Performance Test (CPT) to evaluate reward processing, executive function, and sustained attention, respectively. We employed statistical analyses to compare task performance between groups and assess changes before and after antipsychotic treatment. Study Results We identified significant differences in treatment effects across different response groups in DRT scores, choice strategies, and model-fitting parameters. Conversely, all schizophrenia groups had consistent abnormalities on the WCST and CPT evaluations compared to controls. Conclusions Our findings highlight the efficacy of DRT, WCST, and CPT in delineating neurocognitive profiles relevant to treatment response in schizophrenia. Specifically, the DRT effectively differentiated between high- and low-response patients. Distinct deficits in reward processing and executive function identified here may serve as potential indicators, informing personalized treatment strategies tailored to individual responses to antipsychotic medication.