Cost Evaluation During Decision-Making in Patients at Early Stages of Psychosis

Jumping to conclusions during probabilistic reasoning is a cognitive bias reliably observed in psychosis, and linked to delusion formation. Although the reasons for this cognitive bias are unknown, one suggestion is that psychosis patients may view sampling information as more costly. However, previous computational modelling has provided evidence that patients with chronic schizophrenia jump to conclusion because of noisy decision making. We developed a novel version of the classical beads-task, systematically manipulating the cost of information gathering in four blocks. For 31 individuals with early symptoms of psychosis and 31 healthy volunteers, we examined the numbers of ‘draws to decision’ when information sampling had no, a fixed, or an escalating cost. Computational modelling involved estimating a cost of information sampling parameter and a cognitive noise parameter. Overall patients sampled less information than controls. However, group differences in numbers of draws became less prominent at higher cost trials, where less information was sampled. The attenuation of group difference was not due to floor effects, as in the most costly block participants sampled more information than an ideal Bayesian agent. Computational modelling showed that, in the condition with no objective cost to information sampling, patients attributed higher costs to information sampling than controls (Mann-Whiney U=289, p=0.007), with marginal evidence of differences in noise parameter estimates (t=1.86 df=60, p=0.07). In patients, individual differences in severity of psychotic symptoms were statistically significantly associated with higher cost of information sampling (rho=0.6, p=0.001) but not with more cognitive noise (rho=0.27, p=0.14); in controls cognitive noise predicted aspects of schizotypy (preoccupation and distress associated with delusion-like ideation on the Peters Delusion Inventory). Using a psychological manipulation and computational modelling, we provide evidence that early psychosis patients jump to conclusions because of attributing higher costs to sampling information, not because of being primarily noisy decision makers.