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31. Evidence of reward system dysfunction in youth at clinical high-risk for psychosis from two event-related fMRI paradigms
Abnormal reward processing may be involved in the development of psychosis, but relatively little is known about reinforcement learning (RL), reward prediction error (RPE) signaling, and the neurocircuitry associated with these processes among people at clinical high-risk (CHR). We present behavioral and functional neuroimaging results from two experimental tasks designed to measure related aspects of reward processing among people at CHR and healthy controls. Individuals at CHR displayed behavioral deficits in RL and attenuated RPE signals in the ventral striatum, dorsal anterior cingulate cortex, and ventromedial prefrontal cortex, alongside heightened prediction error signals in the amygdala. By contrast, neurobehavioral indicators of reward anticipation and integration appeared relatively intact in the average CHR participant. Neural signals representing several aspects of reward processing (i.e., reward valence, magnitude, and RPE) were associated with more role functioning impairments and more severe negative, depressive, and general psychiatric symptoms. These findings suggest that neural correlates of reward-based learning may be altered among people at CHR, but that reward anticipation may be relatively preserved at this stage in development. Longitudinal studies, medication-free participants, and studies including both healthy and clinical controls are needed to better understand the role of reward processing abnormalities in the development of psychosis.