Pathways from performance monitoring to negative symptoms and functional outcomes in psychotic disorders

Dan Foti, Greg Perlman, Evelyn J. Bromet, Philip D. Harvey, Greg Hajcak, Daniel H. Mathalon, Roman Kotov

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background Performance monitoring entails rapid error detection to maintain task performance. Impaired performance monitoring is a candidate pathophysiological process in psychotic disorders, which may explain the broader deficit in executive function and its known associations with negative symptoms and poor functioning. The current study models cross-sectional pathways bridging neurophysiological measures of performance monitoring with executive function, symptoms, and functioning. Methods Data were from the 20-year assessment of the Suffolk County Mental Health Project. Individuals with psychotic disorders (N = 181) were originally recruited from inpatient psychiatric facilities. Data were also collected from a geographically and demographically matched group with no psychosis history (N = 242). Neural measures were the error-related negativity (ERN) and error positivity (Pe). Structural equation modeling tested mediation pathways. Results Blunted ERN and Pe in the clinical cohort related to impaired executive function (r = 0.26-0.35), negative symptom severity (r = 0.17-0.25), and poor real-world functioning (r = 0.17-0.19). Associations with executive function were consistent across groups. Multiple potential pathways were identified in the clinical cohort: reduced ERN to inexpressivity was mediated by executive function (β = 0.10); reduced Pe to global functioning was mediated by executive function and avolition (β = 0.10). Conclusions This supports a transdiagnostic model of psychotic disorders by which poor performance monitoring contributes to impaired executive function, which contributes to negative symptoms and poor real-world functioning. If supported by future longitudinal research, these pathways could inform the development of targeted interventions to address cognitive and functional deficits that are central to psychotic disorders.

Original languageEnglish (US)
Pages (from-to)2012-2022
Number of pages11
JournalPsychological medicine
Issue number12
StatePublished - Sep 2021


  • Cognition
  • ERN
  • ERP
  • executive function
  • psychosis
  • schizophrenia

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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