Skip to main content Accessibility help

Hot and cold executive functions in youth with psychotic symptoms

  • L. E. MacKenzie (a1) (a2) (a3), V. C. Patterson (a2) (a3), A. Zwicker (a2) (a3) (a4), V. Drobinin (a2) (a3) (a5), H. L. Fisher (a6), S. Abidi (a2) (a7), A. N. Greve (a8), A. Bagnell (a2) (a7), L. Propper (a2) (a7), M. Alda (a2) (a3), B. Pavlova (a2) (a3) and R. Uher (a1) (a2) (a3) (a4) (a5) (a6) (a7)...



Psychotic symptoms are common in children and adolescents and may be early manifestations of liability to severe mental illness (SMI), including schizophrenia. SMI and psychotic symptoms are associated with impairment in executive functions. However, previous studies have not differentiated between ‘cold’ and ‘hot’ executive functions. We hypothesized that the propensity for psychotic symptoms is specifically associated with impairment in ‘hot’ executive functions, such as decision-making in the context of uncertain rewards and losses.


In a cohort of 156 youth (mean age 12.5, range 7–24 years) enriched for familial risk of SMI, we measured cold and hot executive functions with the spatial working memory (SWM) task (total errors) and the Cambridge Gambling Task (decision-making), respectively. We assessed psychotic symptoms using the semi-structured Kiddie Schedule for Affective Disorders and Schizophrenia interview, Structured Interview for Prodromal Syndromes, Funny Feelings, and Schizophrenia Proneness Instrument – Child and Youth version.


In total 69 (44.23%) youth reported psychotic symptoms on one or more assessments. Cold executive functioning, indexed with SWM errors, was not significantly related to psychotic symptoms [odds ratio (OR) 1.36, 95% confidence interval (CI) 0.85–2.17, p = 0.204). Poor hot executive functioning, indexed as decision-making score, was associated with psychotic symptoms after adjustment for age, sex and familial clustering (OR 2.37, 95% CI 1.25–4.50, p = 0.008). The association between worse hot executive functions and psychotic symptoms remained significant in sensitivity analyses controlling for general cognitive ability and cold executive functions.


Impaired hot executive functions may be an indicator of risk and a target for pre-emptive early interventions in youth.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Hot and cold executive functions in youth with psychotic symptoms
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Hot and cold executive functions in youth with psychotic symptoms
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Hot and cold executive functions in youth with psychotic symptoms
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: R. Uher, 5909 Veterans’ Memorial Lane, Halifax, NS, B3H 2E2, Canada. (Email:


Hide All
Arseneault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffit, TE, Caspi, A (2011). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Bechara, A (2004). The role of emotion in decision-making: evidence from neurological patients with orbitofrontal damage. Brain and Cognition 55, 3040.
Bechara, A, Damasio, H, Damasio, AR (2000). Emotion, decision making and the orbitofrontal cortex. Cerebral Cortex 10, 295307.
Bechara, A, Damasio, H, Damasio, AR, Lee, GP (1999). Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making. Journal of Neuroscience 19, 54735481.
Blanchard, MM, Jacobson, S, Clarke, MC, Connor, D, Kelleher, I, Garavan, H, Harley, M, Cannon, M (2010). Language, motor and speed of processing deficits in adolescents with subclinical psychotic symptoms. Schizophrenia Research 123, 7176.
Bora, E, Harrison, BJ, Yücel, M, Pantelis, C (2013). Cognitive impairment in euthymic major depressive disorder: a meta-analysis. Psychological Medicine 43, 20172026.
Bora, E, Pantelis, C (2015). Meta-analysis of cognitive impairment in first-episode bipolar disorder: comparison with first-episode schizophrenia and healthy controls. Schizophrenia Bulletin 41, 10951104.
Bora, E, Yucel, M, Pantelis, C (2009). Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders 113, 120.
Chan, RCK, Shum, D, Toulopoulou, T, Chen, EYH (2008). Assessment of executive functions: review of instruments and identification of critical issues. Archives of Clinical Neuropsychology 23, 201216.
Cullen, AE, Dickson, H, West, SA, Morris, RG, Mould, GL, Hodgins, S, Murray, RM, Laurens, KR (2010). Neurocognitive performance in children aged 9–12 years who present putative antecedents of schizophrenia. Schizophrenia Research 121, 1523.
Diamond, A, Lee, K (2011). Interventions shown to aid executive function development in children 4 to 12 years old. Science 333, 959964.
Dickson, H, Cullen, AE, Reichenberg, A, Hodgins, S, Campbell, DD, Morris, RG, Laurens, KR (2014). Cognitive impairment among children at-risk for schizophrenia. Journal of Psychiatric Research 50, 9299.
Fisher, HL, Caspi, A, Poulton, R, Meier, MH, Houts, R, Harrington, H, Arseneault, L, Moffitt, TE (2013). Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychological Medicine 43, 20772086.
Fux, L, Walger, P, Schimmelmann, BG, Schultze-Lutter, F (2013). The schizophrenia proneness instrument, child and youth version (SPI-CY): practicability and discriminative validity. Schizophrenia Research 146, 6978.
Grafman, J, Litvan, I (1999). Importance of deficits in executive functions. Lancet 354, 19211923.
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? [see comments]. American Journal of Psychiatry 153, 321330.
Hutton, SB, Murphy, FC, Joyce, EM, Rogers, RD, Cuthbert, I, Barnes, TRE, McKenna, PJ, Sahakian, BJ, Robbins, TW (2002). Decision making deficits in patients with first-episode and chronic schizophrenia. Schizophrenia Research 55, 249257.
Jameson, KG, Nasrallah, HA, Northern, TG, Welge, JA (2011). Executive function impairment in first-degree relatives of persons with schizophrenia: a meta-analysis of controlled studies. Asian Journal of Psychiatry 4, 9699.
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, Williamson, D, Ryan, ND (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 36, 980988.
Kelleher, I, Connor, D, Clarke, MC, Devlin, N, Harley, M, Cannon, M (2012 a). Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychological Medicine 42, 18571863.
Kelleher, I, Jenner, JA, Cannon, M (2010). Psychotic symptoms in the general population - An evolutionary perspective. British Journal of Psychiatry 197, 167169.
Kelleher, I, Murtagh, A, Clarke, MC, Murphy, J, Rawdon, C, Cannon, M (2012 b). Neurocognitive performance of a community-based sample of young people at putative ultra high risk for psychosis: support for the processing speed hypothesis. Cognitive Neuropsychiatry 18, 117.
Li, Y, Cao, F, Shao, D, Xue, J (2014). Ecological assessment of executive functions in adolescents genetically at high risk for schizophrenia. Comprehensive Psychiatry 55, 13501357.
MacKenzie, LE, Abidi, S, Fisher, HL, Propper, L, Bagnell, A Morash-Conway, J, Glover, JM, Cumby, J, Hajek, T, Schultze-Lutter, F, Pajer, K, Alda, M, Uher, R (2016). Stimulant medication and psychotic symptoms in offspring of parents with mental illness. Pediatrics 137, e20152486.
Miller, TJ, Mcglashan, TH, Rosen, JL, Cadenhead, K, Ventura, J, Mcfarlane, W, Perkins, DO, Pearlson, GD, Woods, SW (1995). Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin 29, 703716.
Murphy, FC, Rubinsztein, JS, Michael, A, Rogers, RD, Robbins, TW, Paykel, ES, Sahakian, BJ (2001). Decision-making cognition in mania and depression. Psychological Medicine 31, 679693.
Niarchou, M, Zammit, S, Walters, J, Lewis, G, Owen, MJ, Owen, MJ, van den Bree, MB (2013). Defective processing speed and nonclinical psychotic experiences in children: longitudinal analyses in a large birth cohort. American Journal of Psychiatry 170, 550557.
Polanczyk, G, Moffitt, TE, Arseneault, L, Cannon, M, Ambler, A, Richard, SEK, Houts, R, Odgers, CL, Caspi, A (2010). Etiological and clinical features of childhood psychotic symptoms: results from a birth cohort. Archives of General Psychiatry 67, 328338.
Poulton, R, Caspi, A, Moffitt, TE, Cannon, M, Murray, R, Harrington, H (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.
Rabe-Hesketh, S, Skrondal, A (2016). Generalized linear latent and mixed modeling. In Handbook of Item Response Theory: Models, Statistical Tools, and Applications (Vol. I) (ed. van der Linden, W.J.), pp. 503526. CRC Press: Boca Raton.
Reininghaus, U, Kempton, MJ, Valmaggia, L, Craig, TKJ, Garety, P, Onyejiaka, A, Gayer-Anderson, C, So, SH, Hubbard, K, Beards, S, Dazzan, P, Pariante, C, Mondelli, V, Fisher, HL, Mills, JG, Viechtbauer, W, McGuire, P, van Os, J, Murray, RM, Wykes, T, Myin-Germeys, I, Morgan, C (2016). Stress sensitivity, aberrant salience, and threat anticipation in early psychosis: an experience sampling study. Schizophrenia Bulletin 42, 712722.
Roiser, JP, Sahakian, BJ (2013). Hot and cold cognition in depression. CNS Spectrums 18, 139149.
Rushworth, MFS, Owen, AM (1998). The functional organization of the lateral frontal cortex: conjecture of conjuncture in the electrophysiology literature? Trends in Cognitive Sciences 2, 4653.
Sahakian, BJ, Owen, AM (1992). Computerized assessment in neuropsychiatry using CANTAB: discussion paper. Journal of the Royal Society of Medicine 85, 399402.
Schimmelmann, B, Walger, P, Schultze-Lutter, F (2013). The significance of at-risk symptoms for psychosis in children and adolescents. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 58, 3240.
Snyder, HR (2013). Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review. Psychological Bulletin 139, 81132.
Uher, R, Cumby, J, MacKenzie, LE, Morash-Conway, J, Glover, JM, Aylott, A, Propper, L, Abidi, S, Bagnell, A, Pavlova, B, Hajek, T, Lovas, D, Pajer, K, Gardner, W, Levy, A, Alda, M (2014). A familial risk enriched cohort as a platform for testing early interventions to prevent severe mental illness. BMC Psychiatry 14, 344.
Underwood, R, Peters, E, Kumari, V (2015). Psychobiology of threat appraisal in the context of psychotic experiences: a selective review. European Psychiatry 30, 817829.
Wechsler, D (1999). Wechsler Abbreviated Scale of Intelligence. Psychological Corporation: San Antonio.
Welham, J, Scott, J, Williams, G, Najman, J, Bor, W, O’Callaghan, M, McGrath, J (2009). Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study. Psychological Medicine 39, 625634.
Westerhausen, R, Kompus, K, Hugdahl, K (2011). Impaired cognitive inhibition in schizophrenia: a meta-analysis of the Stroop interference effect. Schizophrenia Research 133, 172181.
Zammit, S, Hamshere, M, Dwyer, S, Georgiva, L, Timpson, N, Moskvina, V, Richards, A, Evans, DM, Lewis, G, Jones, P, Owen, MJ, O’Donovan, MC (2014). A population-based study of genetic variation and psychotic experiences in adolescents. Schizophrenia Bulletin 40, 12541262.
Zammit, S, Kounali, D, Cannon, M, David, AS, Gunnell, D, Heron, J Jones, PB, Lewis, S, Sullivan, S, Wolke, D, Lewis, G (2013). Psychotic experiences and psychotic disorders at age 18 in relation to psychotic experiences at age 12 in a longitudinal population-based cohort study. American Journal of Psychiatry 170, 742750.


Hot and cold executive functions in youth with psychotic symptoms

  • L. E. MacKenzie (a1) (a2) (a3), V. C. Patterson (a2) (a3), A. Zwicker (a2) (a3) (a4), V. Drobinin (a2) (a3) (a5), H. L. Fisher (a6), S. Abidi (a2) (a7), A. N. Greve (a8), A. Bagnell (a2) (a7), L. Propper (a2) (a7), M. Alda (a2) (a3), B. Pavlova (a2) (a3) and R. Uher (a1) (a2) (a3) (a4) (a5) (a6) (a7)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed