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Both unmedicated and medicated individuals with schizophrenia show impairments across a wide array of cognitive and reinforcement learning tasks

Published online by Cambridge University Press:  17 August 2020

Erin K. Moran*
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
James M. Gold
Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
Cameron S. Carter
Department of Psychiatry, University of California, Davis, CA, USA
Angus W. MacDonald III
Department of Psychology, University of Minnesota, Minneapolis, MN, USA
J. Daniel Ragland
Department of Psychiatry, University of California, Davis, CA, USA
Steven M. Silverstein
Department of Psychiatry, Rutgers Robert Wood Johnson Medical School Hospital, Piscataway, NJ, USA
Steven J. Luck
Department of Psychology, University of California, Davis, CA, USA
Deanna M. Barch
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
Author for correspondence: Erin K. Moran, E-mail:



Schizophrenia is a disorder characterized by pervasive deficits in cognitive functioning. However, few well-powered studies have examined the degree to which cognitive performance is impaired even among individuals with schizophrenia not currently on antipsychotic medications using a wide range of cognitive and reinforcement learning measures derived from cognitive neuroscience. Such research is particularly needed in the domain of reinforcement learning, given the central role of dopamine in reinforcement learning, and the potential impact of antipsychotic medications on dopamine function.


The present study sought to fill this gap by examining healthy controls (N = 75), unmedicated (N = 48) and medicated (N = 148) individuals with schizophrenia. Participants were recruited across five sites as part of the CNTRaCS Consortium to complete tasks assessing processing speed, cognitive control, working memory, verbal learning, relational encoding and retrieval, visual integration and reinforcement learning.


Individuals with schizophrenia who were not taking antipsychotic medications, as well as those taking antipsychotic medications, showed pervasive deficits across cognitive domains including reinforcement learning, processing speed, cognitive control, working memory, verbal learning and relational encoding and retrieval. Further, we found that chlorpromazine equivalency rates were significantly related to processing speed and working memory, while there were no significant relationships between anticholinergic load and performance on other tasks.


These findings add to a body of literature suggesting that cognitive deficits are an enduring aspect of schizophrenia, present in those off antipsychotic medications as well as those taking antipsychotic medications.

Original Articles
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Both unmedicated and medicated individuals with schizophrenia show impairments across a wide array of cognitive and reinforcement learning tasks
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