Differentiating predictors of physical and cognitive effort expenditure in early psychosis: A study of reinforcement environment, negative symptoms, and cognitive control

Schizophrenia patients compared to controls show reduced physical and cognitive effort allocation despite higher rewards offered. Negative symptoms, cognitive control deficits, and functional impairments are all implicated in reduced effort allocation, suggesting compromised cognitive-reward systems drive patient outcomes. However, patterns and predictors of decisions to expend different types of effort remain underexplored in early psychosis (EP). This study investigated predictors of effort allocation in 34 EP outpatients. We used Generalized Estimating Equations to evaluate the following as predictors of decisions to expend effort: (1) changes in reinforcement environment (reward, probability, expected value), and (2) patient characteristics (expressive and motivation/pleasure symptoms, cognitive control). Assessments included the Effort Expenditure for Rewards Task (physical), a parallel cognitive effort task adapted by our team, AX-Continuous Performance Test, and clinical symptom interviews (e.g., Brief Negative Symptom Scale). Patients modulated physical effort based on integrated assessments of reward and probability. Cognitive control, measured as the proactive maintenance of goal-relevant information and resources, predicted physical effort expenditure, but only at low expressive symptom severity. In contrast, patients showed inefficient effort modulation and a risk-aversive probabilistic assessment on the cognitive effort task. By early psychosis, patients exhibit conservative cognitive effort allocation, disregarding high-value rewards, despite intact capacity. Our findings indicated that negative symptoms and cognitive control had a minimal direct influence on effort decisions in early psychosis. This suggests that the illness burden in early stages may be less pronounced than in chronic psychotic illness, potentially leading to different mechanistic pathways for effort allocation.