From Neuroimaging to Daily Functioning: A Multimethod Analysis of Reward Anticipation in People With Schizophrenia

Negative symptoms are a core clinical feature of schizophrenia that are only marginally responsive to current treatments. Recent work suggests that deficits in reinforcement learning and anticipatory responses to reward may be two mechanisms that help explain impairments in motivation in those with schizophrenia. The present study utilized a reinforcement-learning paradigm. which allowed us to examine both reward anticipation and reinforcement learning. Twenty-eight people with schizophrenia and 30 healthy controls completed a reinforcement-learning task while undergoing functional MRI. Participants with schizophrenia also completed a weeklong ecological momentary assessment protocol reporting anticipated motivation and pleasure in their daily activities. Unexpectedly, we found no significant group differences in performance or neural response in reinforcement learning. However, we found that poorer reward learning was associated with greater clinician ratings of negative symptoms and daily reports of anticipatory motivation and pleasure negative symptoms. In regards to anticipatory responses, we found that people with schizophrenia showed blunted activation in the anterior cingulate, insula, caudate, and putamen while anticipating reward. Further, blood oxygen level-dependent (BOLD) response in reward related regions during anticipation of reward was significantly related to both clinician-rated motivation and pleasure deficits as well as daily reports of motivation and pleasure. Our results provide further evidence of deficits during reward anticipation in individuals with schizophrenia, particularly for those with severe negative symptoms, and some evidence for worse reward learning among those with greater negative symptoms. Moreover, our findings suggest that these deficits show important relationships with emotional and motivational functioning in everyday life.