Avolition predicts variability in optimal risk-taking in early psychosis

Background: Adolescence and early adulthood are associated with increased risk-taking, with a growing understanding that risk-taking may be adaptive during this developmental period. In psychosis, failure to appropriately engage in optimal risk-taking due to altered reward processing may contribute to poor social and role functioning. We investigated differences in optimal risk-taking in early psychosis (EP), as well as the relationship between optimal risk-taking and the negative symptom of avolition. Methods: Fifty-six EP participants and 52 healthy controls (HC) completed a modified version of the Balloon Analog Risk Task (BART). In the BART, individuals inflated a virtual balloon to gain points; if the balloon exploded, no points were gained. We manipulated degree of risk, such that trials were low-risk (high probability of reward, low probability of punishment) or high-risk (low probability of reward, high probability of punishment). We investigated differences between EP and HC in (1) risk-propensity on low- and high-risk trials, (2) total adverse outcomes, and (3) behavior changes following punishment. Results: There were no significant differences between EP and HC on any BART metrics; however, in EP, the negative symptom of avolition was associated with reduced risk-propensity on low-risk trials and reduced risk-taking immediately following punishment on low-risk trials. In the high-risk condition, avolition was not associated with risk-propensity, number of adverse outcomes, or behavior following punishment. Conclusions: These results suggest that risk-taking and response to punishment in high-risk situations may be preserved in psychosis, and that in lower-risk situations that allow for greater variability, behavior may be moderated by negative symptom severity.