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Research Paper
Open Access

Action selection in early stages of psychosis: an active inference approach

Franziska Knolle, Elisabeth Sterner, Michael Moutoussis, Rick A. Adams, Juliet D. Griffin, Joost Haarsma, Hilde Taverne, Ian M. Goodyer, Paul C. Fletcher and Graham K. Murray; for the NSPN Consortium
J Psychiatry Neurosci February 21, 2023 48 (1) E78-E89; DOI: https://doi.org/10.1503/jpn.220141
Franziska Knolle
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Elisabeth Sterner
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Michael Moutoussis
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Rick A. Adams
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Juliet D. Griffin
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Joost Haarsma
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Hilde Taverne
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Ian M. Goodyer
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Paul C. Fletcher
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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Graham K. Murray
From the Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany (Knolle, Sterner); the Department of Psychiatry, University of Cambridge, Cambridge, UK (Knolle, Griffin, Taverne, Goodyer, Fletcher, Murray); the Max Planck-UCL Centre for Computational Psychiatry and Ageing Research, London, UK (Moutoussis, Adams); the Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (Adams); the Wellcome Centre for Human Neuroimaging, University College London, London, UK (Haarsma); the University of Amsterdam, Amsterdam, NL (Taverne); Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK (Goodyer, Fletcher); Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK (Murray)
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    Figure 1

    Schematic illustration of orthogonalized go/no-go task.22,23,43

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    Figure 2:

    Overview of task performance. (A) Learning rate by group and trial type. Patients with first-episode psychosis performed worse (relative to controls) in the “avoid losing” conditions (lower plots). (B) Behavioural performance. Box plots show the medians as horizontal bars, means as small red dots, group means as large red dots and interquartile ranges as whiskers; significant group differences of the Tukey post hoc tests are shown (*p < 0.05, **p < 0.01, ***p < 0.001). ARMS = individuals with at-risk mental state, CON = control group, FEP = patients with first-episode psychosis.

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    Figure 3:

    Group comparisons of active inference parameters and model fit from robust analysis of variance based on trimmed means using the bootstrap method. Significant results from robust post hoc analyses are shown (*p < 0.05, **p < 0.01). Horizontal bars of boxplots mark the median and whiskers indicate the interquartile range. ARMS = patients with at-risk mental state, CON = control group, FEP = patients with first-episode psychosis.

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    Figure 4:

    Receiver operating characteristic curves for group comparisons based on classification models using (A) modelling parameters, (B) performance measures and (C) a combination of modelling parameters and performance measures. ARMS = individuals with at-risk mental state, AUC = area under the curve, CON = control group, FEP = patients with first-episode psychosis.

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    Table 1

    Summary demographic information and clinical measures by group

    VariableControlsIndividuals with ARMSPatients with FEPGroup comparison
    nMean ± SDnMean ± SDnMean ± SDStatisticp value
    Total no. of participants312326
    Age, yr3022.57 ± 3.682321.22 ± 3.402524.56 ± 4.67F2,75 = 4.38*0.016
    Genderχ22 = 8.06†0.018
     Female1463
     Male161722
    Antipsychotic medicationχ22 = 43.43†< 0.001
     Yes0219
     No29217
    Clinical measures‡
     WASI2730.52 ± 3.391827.56 ± 4.712128.48 ± 5.11F2,63 = 2.77*0.070
     CAARMS intensity and frequency265.46 ± 3.842129.52 ± 6.712433.67 ± 6.23H2 = 51.28§< 0.001
     SPQ298.21 ± 6.342135.43 ± 12.102334.22 ± 19.60H2 = 37.70§< 0.001
     PANSS positiveNANA2116.86 ± 2.782221.27 ± 6.22t29.36 = −3.03¶0.005
     PANSS negativeNANA2114.48 ± 5.952214.82 ± 7.37W = 239.5**0.845
     CAPSNANA2111.62 ± 7.262211.45 ± 9.43W = 235.5**0.922
     PDINANA217.76 (4.39)229.14 (5.69)t39.31 = −0.89¶0.380
     MFQNANA2129.67 (15.04)2431.00 (26.32)W = 269.5**0.699
    • ARMS = at-risk mental state, CAARMS = Comprehensive Assessment of At-Risk Mental States (excluding 2 items on aggression and suicidality), CAPS = Clinician-Administered PTSD Scale, FEP = first-episode psychosis, MFQ = Mood and Feelings Questionnaire, NA = not applicable, PANSS = Positive And Negative Symptoms Scale, PDI = Peters et al. Delusions Inventory, SD = standard deviation, SPQ = Schizotypal Personality Questionnaire, WASI = Wechsler Abbreviated Scale of Intelligence.

    • ↵* Calculated using 1-way analysis of variance.

    • ↵† Calculated using the Pearson χ2 test.

    • ↵‡ Scores ranged as follows: CAARMS 0–48, SPQ 0–74, PANSS positive 7–49, PANSS negative 7–49, CAPS 0–32, PDI 0–21, MFQ 0–66.

    • ↵§ Calculated using the Kruskal–Wallis test.

    • ↵¶ Calculated using the Welch t test.

    • ↵** Calculated using the Wilcoxon rank-sum test.

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    Table 2

    Summary of descriptive statistics for active inference parameters by group

    ParameterControlsIndividuals with ARMSPatients with FEPGroup comparison*Controls v. patients with FEPControls v. individuals with ARMSIndividuals with ARMS v. patients with FEP
    nMean ± SDnMean ± SDnMean ± SDFtp valueξ†Ψ (95% CI)p valueΨ (95% CI)p valueΨ (95% CI)p value
    Optimism prior310.50 ± 0.05230.51 ± 0.05260.52 ± 0.051.040.3670.23
    Pavlovian win prior310.55 ± 0.07230.55 ± 0.05260.56 ± 0.070.240.7970.11
    Pavlovian loss prior310.52 ± 0.05230.50 ± 0.06260.53 ± 0.051.370.2700.26
    Outcomes sensitivity315.08 ± 0.10235.06 ± 0.03265.04 ± 0.061.360.2780.25
    Forgetting310.41 ± 0.16230.42 ± 0.21260.54 ± 0.175.080.0130.42−0.14 (−0.26 to −0.02)0.0090.01 (−0.13 to 0.15)0.836−0.15 (−0.29 to −0.00)0.016
    Prior on policy precision311.69 ± 0.65231.56 ± 0.34261.35 ± 0.642.880.0770.380.33, (−0.11 to 0.68)0.0700.05 (−0.22 to 0.36)0.6730.28 (−0.15 to 0.55)0.082
    Free energy31−62.89 ± 23.0423−71.77 ± 14.9724−79.53 ± 22.342.970.0890.4019.44 (1.23 to 36.45)0.0119.29 (−6.57 to 24.79)0.14010.15 (−5.29 to 24.50)0.136
    Maximum likelihood31−60.94 ± 23.1623−69.73 ± 14.7926−78.58 ± 21.454.260.0280.4521.46 (4.04 to 36.88)0.0038.59 (−6.17 to 22.52)0.15412.87 (−0.81 to 24.86)0.025
    • ARMS = at-risk for mental health, CI = confidence interval, FEP = first-episode psychosis, SD = standard deviation.

    • ↵* Robust ANOVA analysis of group differences of modelled parameters based on trimmed means using the bootstrap method.

    • ↵† Explanatory measure of effect size (ξ) values of 0.10, 0.30 and 0.50 correspond to small, medium and large effect sizes.

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Journal of Psychiatry and Neuroscience: 48 (1)
J Psychiatry Neurosci
Vol. 48, Issue 1
21 Feb 2023
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Action selection in early stages of psychosis: an active inference approach
Franziska Knolle, Elisabeth Sterner, Michael Moutoussis, Rick A. Adams, Juliet D. Griffin, Joost Haarsma, Hilde Taverne, Ian M. Goodyer, Paul C. Fletcher, Graham K. Murray
J Psychiatry Neurosci Feb 2023, 48 (1) E78-E89; DOI: 10.1503/jpn.220141

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Action selection in early stages of psychosis: an active inference approach
Franziska Knolle, Elisabeth Sterner, Michael Moutoussis, Rick A. Adams, Juliet D. Griffin, Joost Haarsma, Hilde Taverne, Ian M. Goodyer, Paul C. Fletcher, Graham K. Murray
J Psychiatry Neurosci Feb 2023, 48 (1) E78-E89; DOI: 10.1503/jpn.220141
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