Cognitive control refers to the ability to dynamically guide behavior by maintaining goal context and filtering out irrelevant information. Cognitive control deficits are well-documented in people with schizophrenia (PSZ), but the degree of impairment varies considerably depending upon the type of control being assessed. The present study examined three domains of cognitive control-selective attention to context, rule switching, and response conflict management-within a single paradigm to characterize different facets of cognitive control dysfunction in PSZ. Thirty-eight PSZ and 35 healthy control subjects (HCS) completed a cued task-switching paradigm that required participants to make a button-press response to different features of a target stimulus (letter, number, or color) depending upon the location that the target appeared on each trial. Prior to target onset, participants were presented with a cue indicating which stimulus dimension would be probed. PSZ were able to utilize the cue as effectively as HCS; however, when the relevant target dimension switched between trials (thus requiring a different stimulus-response mapping), PSZ showed greater switch costs compared to HCS. Finally, PSZ showed modestly impaired response conflict management when the irrelevant stimulus dimensions of the target corresponded to a different (incongruent) response compared to the relevant stimulus dimension. These findings suggest that selective attention to context is mostly intact, but response rule switching and response conflict management are impaired in PSZ.

Clinical psychology is a young science. Psychological suffering remains extensive, with core scientific issues the subject of ongoing study and debate. Clinical practice depends on the research base for elucidating etiology, systematic improvements in provision of mental health care, improvements in public health, and credibility with clients and the larger public. Science-oriented training programs endeavor to develop students into independent scientists, clinicians, and/or administrators who produce knowledge and translate it to improve clinical care. Existing training standards accommodate programs with a heavy clinical focus and little to no research training. To accelerate scientific progress, these standards must also accommodate increased scientific and research training by reducing generalist requirements and increasing curricular flexibility for students. On net, these changes would allow clinical psychologists more opportunities to work at the level of the clinic, system, policy, or laboratory and thereby accelerate scientific discovery and translation to understand and reduce mental health burdens in our society, all while existing programs, including practitioner-oriented programs, may continue to flourish.

BACKGROUND:The current study combined behavioral and electroencephalography (EEG) measures to investigate variations in attentional state during comprehension of spoken stories in a clinical sample that included participants with several major mental health disorders that often feature attentional control difficulties. METHODS:Participants with schizophrenia (SZ) (n = 62), bipolar disorder (BP) (n = 44), and major depressive disorder (MDD) (n = 51) and psychiatrically healthy control participants (HCs) (n = 82) completed a story-listening task and were periodically interrupted by attention probes. Attention probes assessed 3 different states of engagement via self-reports: on-task attention, partially off-task split-attention, and fully off-task lapsed attention. EEG was recorded to examine corresponding changes in periodic alpha band (8-13 Hz) power. RESULTS:We found that all patient groups reported significantly less time fully on-task during story listening than HCs but that individual patient groups reported distinct patterns of off-task attention. Reports of fully lapsed attention dominated off-task reports for participants with SZ, whereas participants with MDD reported a higher incidence of experiencing a distracted or split attentional state. The EEG results provided additional evidence that the 3 self-report attention probe categories tapped into biologically distinguishable attentional states, with split attention and fully lapsed attention associated with distinct neural signatures compared with on-task attention. Periodic alpha power was modulated by attentional state in all groups, although there were significant group differences. CONCLUSIONS:Our results demonstrate distinct behavioral and neurophysiological attentional control profiles in SZ and MDD compared with HCs during language comprehension.

BACKGROUND AND HYPOTHESIS:People who hear voices may have strong prior expectations of speech, so that noisy auditory signals are resolved as speech. Data in non-clinical voice hearers suggest that voice hearing may involve sensitivity to speech in degraded stimuli. This has yet to be examined in people with schizophrenia (SZ). STUDY DESIGN:In this case-control study, we presented sine-wave-speech (SWS; made by replacing the formants in speech with pure tone whistles) to people with SZ (n = 63) and healthy controls (HC; n = 27). SWS is typically unintelligible on first exposure. However, once the listener knows that it is potentially intelligible as speech (by exposure to the unaltered speech template, which thus serves as a prior expectation), relatively high levels of comprehension are achieved. Our participants first listened to intelligible and unintelligible SWS and reported whether they heard speech. They were then exposed to the speech templates, and then the first phase was repeated. STUDY RESULTS:Compared to HC, people with SZ reported hearing more speech before template exposure. The Reveal increased both groups' false alarms and reporting of speech, but there was no interaction with group. Change in hit rates after the Reveal correlated with hallucinations, which is consistent with a greater influence of the priors enhancement in SZ patients who hear voices. CONCLUSIONS:These findings suggest that people with SZ have stronger expectations of speech. This task has validity for hallucinatory voice hearing. It is also simple and convenient to administer, and may prove useful in detecting prodromal risk, as well as acute exacerbation in voice hearing.

Importance:Healthy individuals typically show attractive serial dependence in working memory tasks, with responses biased toward recent inputs, whereas people with schizophrenia (SZ) reliably show the opposite-repulsive biases. Determining whether individuals with bipolar disorder (BD) and a history of psychosis exhibit similar or distinct serial-dependence patterns is essential for clarifying shared vs disorder-specific cognitive mechanisms across the psychosis spectrum. Objective:To determine whether people with BD exhibit the repulsive bias seen in people with SZ or the attractive bias seen in healthy control (HC) individuals. Design, Setting, and Participants:This case-control study included individuals who met DSM-5 criteria for SZ or BD with a history of psychosis, along with matched HC participants recruited across 5 US sites. Clinical samples were recruited from outpatient psychiatric clinics and day programs, and HC participants were recruited from the community. A working memory task was used in which participants remembered the orientation of a teardrop-shaped object and reproduced it using a computer mouse after a variable delay. The Brief Psychiatric Rating Scale was used to quantify symptom severity. The study was conducted from September 2023 to April 2025. Main Outcomes and Measures:The primary outcome measure was the bias index, used to evaluate the extent to which current-trial responses were biased toward or away from previous-trial targets. Exposures:Diagnostic group and the orientation of the previous trial's target during a spatial working memory paradigm. Results:A total of 41 participants were included in BD group (21 [51%] male; mean [SD] age, 37.02 [11.53] years), 30 in the SZ group (18 [60%] male; mean [SD] age, 37.5 [9.04] years), and 27 in the HC group (16 [59%] male; mean [SD] age, 39.98 [11.01] years). Overall bias differed across groups, with people with SZ (mean, -1.99; 95% CI, -2.74 to 1.23) demonstrating significantly greater repulsive bias than both people with BD (mean, 0.44; 95% CI, -0.25 to 1.13) and HC individuals (mean, 1.82; 95% CI, 1.31 to 2.32). Fifteen of 27 HC individuals exhibited attractive bias, with none showing repulsive bias, whereas 17 of 30 people with SZ exhibited repulsive bias, with none showing attractive bias. Attractive bias was common in people with BD (13 of 41), but some exhibited a repulsive bias (7 of 41). Conclusions and Relevance:In this case-control study, attractive and repulsive serial biases differed between HC individuals and people with SZ, with some people with BD showing the HC pattern and few showing the SZ pattern. These results suggest that serial bias may serve as a valuable biomarker for pathophysiology and precision psychiatry.

Computational psychiatry aims to quantify individual patients' psychiatric pathology by measuring behavior during psychophysical tasks and characterizing the neurocomputational parameters underlying specific decision-making systems. While this approach has great potential for informing us about specific computational processes associated with psychopathology, the fundamental psychometric properties of computational assessments remain understudied. Optimizing these psychometric properties, including test-retest reliability, is essential for clinical utility. To address this gap, we assessed the test-retest reliability of manifest behavior and computational model parameters of a probabilistic reward and reversal learning task, two-armed Bandit, using intraclass correlations (ICCs) in 179 adults, including those with various psychosis-spectrum disorders and undiagnosed controls. We studied two computational models from recent literature: regression modeling of choice strategies and a hidden Markov model. The test-retest reliability for both manifest behavior (0.24 ≤ ICCs ≤ 0.54) and computational parameters (0.30 ≤ ICCs ≤ 0.61) ranged from poor to moderate, which was not explained by practice effects. Computational parameters did not outperform manifest behavior parameters. The reliability of computational parameters was generally-though not significantly-higher in healthy adults, which may potentially reflect the internal heterogeneity of categorical psychiatric diagnoses. Computational modeling holds promise, but tasks and analyses must be optimized for greater reliability before proceeding into clinical use. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

If individuals at the highest mortality risk are also least likely to lapse a life insurance policy, then lapse-supported premiums magnify adverse selection costs. As an example, we model 'Term to 100' contracts, and risk as revealed by genetic test results. We identify three methods of managing lapse surplus: eliminating it by design; disposing of it retrospectively (through participation); or disposing of it prospectively (through lapse-supported premiums). We then assume a heterogeneous population in which: (a) insurers cannot identify individuals at high mortality risk; (b) a secondary market exists that prevents high-risk policies from lapsing; (c) financial underwriting is lax or absent; and (d) life insurance policies may even be initiated by third parties as a financial investment (STOLI). Adverse selection losses under (a) are typically very small, but under (b) can be increased by multiples, and under (c) and (d) increased almost without limit. We note that the different approaches to modeling lapses used in studies of adverse selection and genetic testing appear to be broadly equivalent and robust.

People who hear voices may have strong prior expectations of speech, so that noisy auditory signals are resolved as speech. Data in non-clinical voice hearers suggest that voice hearing may involve sensitivity to speech in degraded stimuli. This has yet to be examined in people with schizophrenia. In this case-control study, we presented sine-wave-speech (SWS; made by replacing the formants in speech with pure tone whistles) to people with schizophrenia (SZ, n=63) and healthy controls (HC; n=27). SWS is typically unintelligible on first exposure. However, once the listener knows that it is potentially intelligible as speech (by exposure to the unaltered speech template, which thus serves as a prior expectation), relatively high levels of comprehension are achieved. Our participants first listened to intelligible and unintelligible SWS and reported whether they heard speech. They were then exposed to the speech templates, and then the first phase was repeated. Compared to HC, people with SZ reported hearing more speech before template exposure. The Reveal increased both groups’ false alarms and reporting of speech, but there was no interaction with group. Change in hit rates after the Reveal correlated with hallucinations, which is consistent with a greater influence of the priors enhancement in SZ patients who hear voices. These findings suggest that people with SZ have stronger expectations of speech. This task has validity for hallucinatory voice hearing. It is also simple and convenient to administer, and may prove useful in detecting prodromal risk, as well as acute exacerbation in voice hearing.

Insurance risk assessment is based on probabilistic models of the timing and severity of the event insured against. In the presence of genetic risk factors, the problem is similar to estimating age‐related penetrance and survival rates. There are no data from insurers' past experience; all studies rely on the medical literature. Most actuarial research relates to severe single‐gene disorders, whose impact on insurance may be limited because of their rarity. Early research in respect of multifactorial disorders, mostly following genome‐wide association studies (GWAS), does not yet suggest substantial risk beyond the current limits of medical underwriting, but remains tentative. The UK moratorium on insurers' use of genetic tests in underwriting has proved to be a stable environment, but more recent moves towards statutory regulation elsewhere have been more restrictive. Where insurance is voluntary, applicants are usually charged different premiums according to the risk they bring to the portfolio. There is concern that life insurers will use genetic test results to charge higher premiums to persons at increased risk, leading to an uninsurable ‘genetic underclass’. Insurers are vulnerable to adverse selection if applicants are able to conceal information relevant to the risk. Severe, dominantly inherited, late‐onset single‐gene disorders do lead to significantly higher premiums but are sufficiently rare that it seems unlikely that adverse selection is a material risk. The genetic contribution to complex multifactorial disorders has yet to be shown to be more important than that of other, well‐understood, risk factors.

Measuring the function of decision-making systems reliably is a key goal to assess cognitive functions that underlie psychopathology. However, few metrics are demonstrably reliable, clinically relevant, and able to capture complex overlapping cognitive domains while quantifying heterogeneity across individuals. The WebSurf task is a reverse-translational human experiential foraging paradigm that indexes naturalistic and clinically relevant decision-making. To determine its potential clinical utility, we examined the psychometric properties and clinical correlates of behavioral parameters extracted from WebSurf in an initial exploratory experiment (N = 132) and a preregistered validation experiment (N = 109). Behavior was stable over repeated administrations of the task, as were individual differences. The ability to measure decision-making consistently supports WebSurf's potential utility to predict treatment response, monitor clinical change, and define neurocognitive profiles associated with psychopathology. Moreover, specific WebSurf metrics were predicted by psychiatric symptoms in a replicable manner. Mania and externalizing symptom profiles predicted variability in reward pursuit, while externalizing profiles also predicted reward evaluation. These replicable results suggest that WebSurf and similar paradigms offer promising platforms for computational psychological methods, providing reliable, clinically relevant metrics of decision-making that may enhance psychiatric assessment and personalize treatment approaches.

Spite sensitivity, or the fear that a person is willing to intentionally take a loss to ensure that another person will as well, may be a key component in understanding persecutory ideation (the belief that others want to harm you). We implemented a co-twin control design to examine potentially causal relationships among persecutory ideation, spite sensitivity, and neural activity and connectivity. Sixty-nine participants (23 monozygotic twin pairs and an additional 23 unpaired monozygotic twins) completed the Minnesota Trust Game-a social decision-making game played asynchronously with an anonymous partner that targets spite sensitivity by varying the incentives of the partner. Participants with more self-reported persecutory ideation (relative to those with lower persecutory ideation) trusted less even when the partner was incentivized to be fair. Similarly, computational modeling showed that increased persecutory ideation was associated with greater beliefs of a partner's spitefulness. Twins with greater beliefs of a partner's spitefulness (relative to their co-twins) also reported higher persecution. In addition, twin differences in left lateral OFC activation during the task were associated with spite sensitivity. These results point towards a potentially causal role of the lateral OFC on spite sensitivity, and in turn effects of spite sensitivity on persecutory ideation.

The distinction between the concepts of schizophrenia and bipolar disorder is fundamental to the Kraepelinian tradition in psychiatry. One mechanism undergirding this distinction, a difference in reward sensitivity, has been championed by a number of scholars. As part of the Cognitive Neuroscience Test Reliability and Clinical applications for Serious mental illnesses consortium, 225 participants including people with schizophrenia (n = 69), schizoaffective disorder (n = 55), and bipolar affective disorder (n = 53) performed a probabilistic reversal learning task. This task switches the rewarded stimulus at various times throughout the task. Our analyses leveraged a Hidden Markov Model to examine trial-by-trial decisions of participants to reveal the differences between patient groups in their response to reward feedback. Whereas no patient group showed difficulty reversing their preferred categories after a switch in the task's contingencies and bipolar patient performance was spared in some other ways, all patient groups made more errors throughout the task because of a greater tendency to shift away from rewarded categories (i.e., win-switching). Furthermore, patients' cognitive ability is specifically related to this aspect of the task. Rather than validating a Kraepelinian dichotomy, these findings suggest that a failure to exploit rewards may reflect a mechanistic deficit common across both affective and nonaffective psychoses related to cognitive impairments in patients. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Given the culturally diverse landscape of mental healthcare and research, ensuring that our psychological constructs are measured equivalently across diverse populations is critical. One construct for which there is significant potential for inequitable assessment is paranoia, a prominent feature in psychotic disorders that can also be driven by culture and racial marginalization. This study examined measurement invariance-an analytic technique to rigorously investigate whether a given construct is being measured similarly across groups-of the Revised-Green Paranoid Thought Scale (R-GPTS; Freeman et al., 2021) across Black and White Americans in the general population. Racial group differences in self-reported paranoia were also examined. The analytic sample consisted of 480 non-Hispanic White and 459 non-Hispanic Black Americans. Analyses demonstrated full invariance (i.e., configural, metric, and scalar invariance) of the R-GPTS across groups, indicating that the R-GPTS appropriately captures self-reported paranoia between Black and White Americans. Accordingly, it is reasonable to compare group endorsement: Black participants endorsed significantly higher scores on both the ideas of reference and ideas of persecution subscales of the R-GPTS (Mean +/- SD = 10.91 +/- 7.12 versus 8.21 +/- 7.17 and Mean +/- SD = 10.18 +/- 10.03 versus 6.35 +/- 8.35, for these subscales respectively). Generalized linear modeling revealed that race remained a large and statistically significant predictor of R-GPTS total score (beta = -0.38756, p < 0.001) after controlling for relevant demographic factors (e.g., sex, age). This study addresses a critical gap within the existing literature as it establishes that elevations in paranoia exhibited by Black Americans in the R-GPTS reflect actual differences between groups rather than measurement artifacts.

We revisit surplus on general life insurance contracts, represented by Markov models. We classify technical bases in terms of boundary conditions in Thiele's equation(s), allowing more general regulations than Scandinavian-style `first-order/second-order' regimes, and replacing the traditional retrospective policy value. We propose a `canonical' model with three technical bases (premium, valuation, accumulation) and show how each pair of bases defines premium loadings and surplus. Along with a `true' or `real-world' experience basis, this expands fundamental results of Ramlau-Hansen (1988a). We conclude with two applications: lapse-supported business; and the retrospectively-oriented regime proposed by M{\o}ller & Steffensen (2007).

Background and Hypothesis The current study investigated the extent to which changes in attentional control contribute to performance on a visual perceptual discrimination task, on a trial-by-trial basis in a transdiagnostic clinical sample.Study Design Participants with schizophrenia (SZ; N = 58), bipolar disorder (N = 42), major depression disorder (N = 51), and psychiatrically healthy controls (N = 92) completed a visual perception task in which stimuli appeared briefly. The design allowed us to estimate the lapse rate and the precision of perceptual representations of the stimuli. Electroencephalograms (EEG) were recorded to examine pre-stimulus activity in the alpha band (8-13 Hz), overall and in relation to behavior performance on the task.Study Results We found that the attention lapse rate was elevated in the SZ group compared with all other groups. We also observed group differences in pre-stimulus alpha activity, with control participants showing the highest levels of pre-stimulus alpha when averaging across trials. However, trial-by-trial analyses showed within-participant fluctuations in pre-stimulus alpha activity significantly predicted the likelihood of making an error, in all groups. Interestingly, our analysis demonstrated that aperiodic contributions to the EEG signal (which affect power estimates across frequency bands) serve as a significant predictor of behavior as well.Conclusions These results confirm the elevated attention lapse rate that has been observed in SZ, validate pre-stimulus EEG markers of attentional control and their use as a predictor of behavior on a trial-by-trial basis, and suggest that aperiodic contributions to the EEG signal are an important target for further research in this area, in addition to alpha-band activity.

BACKGROUND: People with psychosis and mood disorders experience disruptions in working memory; however, the underlying mechanism remains unknown. We focused on 2 potential mechanisms: poor attentional engagement should be associated with elevated levels of prestimulus alpha-band activity within the electroencephalogram (EEG), whereas impaired working memory encoding should be associated with reduced poststimulus alpha suppression. METHODS: We collected EEG data from 68 people with schizophrenia, 43 people with bipolar disorder with a history of psychosis, 53 people with major depressive disorder, and 90 healthy comparison subjects while they completed a spatial working memory task. We quantified attention lapsing, memory precision, and memory capacity from the behavioral responses, and we quantified alpha using traditional wavelet analysis as well as a novel approach for isolating oscillatory alpha power from aperiodic elements of the EEG signal. RESULTS: We found that 1) greater prestimulus alpha power estimated using traditional wavelet analysis predicted behavioral errors; 2) poststimulus alpha suppression was reduced in the patient groups; and 3) reduced suppression was associated with a lower likelihood of memory storage. However, we also observed that the prestimulus alpha was larger among healthy control participants than patients, and single-trial analyses showed that it was the aperiodic elements of the prestimulus EEG-not oscillatory alpha-that predicted behavioral errors. DISCUSSION: These results suggest that working memory impairments in serious mental illness primarily reflect an impairment in the poststimulus encoding processes rather than reduced attentional engagement prior to stimulus onset.