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The neural underpinnings of cognitive flexibility and their disruption in psychotic illness
Open accessAbstract
Schizophrenia (SZ) has long been associated with a variety of cognitive deficits, including reduced cognitive flexibility. More recent findings, however, point to tremendous inter-individual variability among patients on measures of cognitive flexibility/set-shifting. With an eye toward shedding light on potential sources of variability in set-shifting abilities among SZ patients, I examine the neural substrates of underlying probabilistic reversal learning (PRL) - a paradigmatic measure of cognitive flexibility - as well as neuromodulatory influences upon these systems. Finally, I report on behavioral and neuroimaging studies of PRL in SZ patients, discussing the potentially influences of illness profile and antipsychotic medications on cognitive flexibility in SZ.
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“Deficits in the ability to flexibly update behaviour are manifest in a wide range of neurological and psychiatric disorders, including autism, obsessive–compulsive disorder, major depressive disorder and schizophrenia [23–30]”
From Linking haploinsufficiency of the autism- and schizophrenia-associated gene Cyfip1 with striatal-limbic-cortical network dysfunction and cognitive inflexibility (2024) · cites this paper as [29]
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“Moreover, our results are in keeping with deficits in the ability to flexibly update behaviour observed in neurological and psychiatric disorders such as Parkinson’s Disease, schizophrenia and autism [23–31].”
From Linking haploinsufficiency of the autism- and schizophrenia-associated gene Cyfip1 with striatal-limbic-cortical network dysfunction and cognitive inflexibility (2024) · cites this paper as [29]
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“Just as in the general population, frontostriatal circuitry appears to be linked with variability of cognitive flexibility performance in schizophrenia96.”
From Cognitive and behavioural flexibility: Neural mechanisms and clinical considerations (2021) · cites this paper as [96]
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Citations
Cites
Dissociable intrinsic connectivity networks for salience processing and executive control
Seeley, W. W., Menon, V., Schatzberg, A. F., Keller, J., Glover, G. H., Kenna, H., Reiss, A. L., & Greicius, M. D. (2007) · The Journal of Neuroscience · doi:10.1523/jneurosci.5587-06.2007 · Cited by 7,426 · cited 1×
“…of both activating executive control network (ECN) structures, in the service of goal-directed behavior, and suppressing activity in default mode network (DMN) structures that are most active when the brain is “idling” (Seeley et al., 2007, Sridharan et al., 2008, Menon and Uddin, 2010).”
BackgroundInsensitivity to future consequences following damage to human prefrontal cortex
Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994) · Cognition · doi:10.1016/0010-0277(94)90018-3 · Cited by 6,128 · cited 11×
“The Iowa Gambling Task (Bechara et al., 1994, Bechara et al., 1997) is a reinforcement learning paradigm that was designed to focus on punishment sensitivity, with early studies showing dramatic impairment in individuals with frontal lobe (Bechara et al., 1994) or amygdala (Bechara et al., 1999) lesions.”
BackgroundResultInfluentialSaliency, switching, attention and control: a network model of insula function
Menon, V., & Uddin, L. Q. (2010) · Brain Structure and Function · doi:10.1007/s00429-010-0262-0 · Cited by 5,592 · cited 1×
“…of both activating executive control network (ECN) structures, in the service of goal-directed behavior, and suppressing activity in default mode network (DMN) structures that are most active when the brain is “idling” (Seeley et al., 2007, Sridharan et al., 2008, Menon and Uddin, 2010).”
BackgroundDeciding advantageously before knowing the advantageous strategy
Bechara, A., Damasio, H., Tranel, D., & Damasio, A. R. (1997) · Science · doi:10.1126/science.275.5304.1293 · Cited by 3,547 · cited 1×
“The Iowa Gambling Task (Bechara et al., 1994, Bechara et al., 1997) is a reinforcement learning paradigm that was designed to focus on punishment sensitivity, with early studies showing dramatic impairment in individuals with frontal lobe (Bechara et al., 1994) or amygdala (Bechara et al., 1999)…”
BackgroundSridharan, D., Levitin, D. J., & Menon, V. (2008) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0800005105 · Cited by 2,892 · cited 1×
“…of both activating executive control network (ECN) structures, in the service of goal-directed behavior, and suppressing activity in default mode network (DMN) structures that are most active when the brain is “idling” (Seeley et al., 2007, Sridharan et al., 2008, Menon and Uddin, 2010).”
BackgroundNeurocognitive deficit in schizophrenia: A quantitative review of the evidence.
Heinrichs, R. W., & Zakzanis, K. K. (1998) · Neuropsychology · doi:10.1037/0894-4105.12.3.426 · Cited by 2,798 · cited 1×
“…impairments in both the formation and overriding of prepotent responses could stem from working memory deficits (Gold et al., 1997, Glahn et al., 2000, Hartman et al., 2003), which are prevalent in schizophrenia (Heinrichs and Zakzanis, 1998, Lee and Park, 2005), but not specific to the condition.”
BackgroundDaw, N. D., Niv, Y., & Dayan, P. (2005) · Nature Neuroscience · doi:10.1038/nn1560 · Cited by 2,533 · cited 1×
“In the context of probabilistic reversal learning tasks, individuals can achieve learning in multiple ways: by either integrating reward prediction errors in model-free way, or by inducing a rule in a model-based way (Daw et al., 2005, Chen et al., 2015, Costa et al., 2015).”
BackgroundA Modified Card Sorting Test Sensitive to Frontal Lobe Defects
Nelson, H. E. (1976) · Cortex · doi:10.1016/s0010-9452(76)80035-4 · Cited by 2,454 · cited 1×
“Early studies revealed that patients with frontal lobe lesions frequently exhibited a characteristic behavior on the WCST: they showed particularly difficulty in shifting from one sorting criterion to another, in the face of negative feedback (Milner, 1963, Nelson, 1976, Stuss et al., 2000).”
BackgroundEffect of COMT Val 108/158 Met genotype on frontal lobe function and risk for schizophrenia
Egan, M. F., Goldberg, T. E., Kolachana, B. S., Callicott, J. H., Mazzanti, C. M., Straub, R. E., Goldman, D. A., & Weinberger, D. R. (2001) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.111134598 · Cited by 2,416 · cited 4×
“Studies of the role of dopamine transmission in reversal learning have focused on three sites: presynaptic dopamine transporters (DATs), post-synaptic dopamine receptors, and the catechol-Omethyltransferase (COMT) enzyme, which acts mainly to metabolize dopamine in the PFC (Egan et al., 2001).”
BackgroundInfluentialEffects of Different Brain Lesions on Card Sorting: The Role of the Frontal Lobes
MILNER, B. (1963) · Archives of Neurology · doi:10.1001/archneur.1963.00460070100010 · Cited by 2,217 · cited 3×
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript Barnett JH, Jones PB, Robbins TW, Muller U. Effects of the catechol-O-methyltransferase Val158Met polymorphism on executive function: a meta-analysis of the Wisconsin Card Sort Test in schizophrenia and healthy controls.”
BackgroundResult
Cited by
Sorted by citations
Cognitive and behavioural flexibility: Neural mechanisms and clinical considerations
Uddin, L. Q. (2021) · Nature Reviews Neuroscience · doi:10.1038/s41583-021-00428-w · Cited by 698
Dopamine, psychosis and schizophrenia: the widening gap between basic and clinical neuroscience
Kesby, J. P., Eyles, D. W., McGrath, J. J., & Scott, J. G. (2018) · Translational Psychiatry · doi:10.1038/s41398-017-0071-9 · Cited by 382
Towards an understanding of psychedelic-induced neuroplasticity
Calder, A. E., & Hasler, G. (2023) · Neuropsychopharmacology · doi:10.1038/s41386-022-01389-z · Cited by 313
“circuits originating in the PFC [141, 142], and ayahuasca and psilocybin have been shown to promote certain aspects of cognitive flexibility [143–147].”
BackgroundReset of hippocampal–prefrontal circuitry facilitates learning
Park, A. J., Harris, A. Z., Martyniuk, K. M., Chang, C., Abbas, A. I., Lowes, D. C., Kellendonk, C., Gogos, J. A., & Gordon, J. A. (2021) · Nature · doi:10.1038/s41586-021-03272-1 · Cited by 153
“group (10 models; Two-way RM ANOVA test, F(1,18) = 25.”
BackgroundMethodInfluentialParanoia as a deficit in non-social belief updating
Reed, E., Uddenberg, S., Suthaharan, P., Mathys, C. D., Taylor, J. R., Groman, S. M., & Corlett, P. R. (2020) · eLife · doi:10.7554/elife.56345 · Cited by 143
“A prior study in people with schizophrenia described excessive win-switch behavior that correlated with the severity of delusional beliefs and hallucinations (Waltz, 2017).”
BackgroundPredictive processing, source monitoring, and psychosis
Griffin, J. D., & Fletcher, P. C. (2017) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032816-045145 · Cited by 133
“This could affect domains of belief (So et al. 2012, Woodward et al. 2008), cognition (Waltz 2016), thought (Lysaker & Lysaker 2002), speech (Andreasen 1979, Barr et al. 1989), mood (Lincoln et al. 2015), and behavior (Kraepelin 1976, Ridley 1994).”
BackgroundDysregulation of Midbrain Dopamine System and the Pathophysiology of Schizophrenia
Sonnenschein, S. F., Gomes, F. V., & Grace, A. A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00613 · Cited by 138
From Gene to Behavior: L-Type Calcium Channel Mechanisms Underlying Neuropsychiatric Symptoms
Kabir, Z. D., Martínez-Rivera, A., & Rajadhyaksha, A. M. (2017) · Neurotherapeutics · doi:10.1007/s13311-017-0532-0 · Cited by 128
Heinz, A., Murray, G. K., Schlagenhauf, F., Sterzer, P., Grace, A. A., & Waltz, J. A. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby154 · Cited by 123
Self-citationCognitive flexibility: Impact on entrepreneurial intentions
Dheer, R. J. S., & Lenartowicz, T. (2019) · Journal of Vocational Behavior · doi:10.1016/j.jvb.2019.103339 · Cited by 94
Simulated visual hallucinations in virtual reality enhance cognitive flexibility
Rastelli, C., Greco, A., Kenett, Y. N., Finocchiaro, C., & Pisapia, N. D. (2022) · Scientific Reports · doi:10.1038/s41598-022-08047-w · Cited by 76
Psychedelic therapy's transdiagnostic effects: A research domain criteria (RDoC) perspective
Kelly, J. R., Gillan, C. M., Prenderville, J., Kelly, C., Harkin, A., Clarke, G., & O'Keane, V. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.800072 · Cited by 69
Everything is connected: Inference and attractors in delusions
Adams, R. A., Vincent, P., Benrimoh, D. A., Friston, K. J., & Parr, T. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2021.07.032 · Cited by 60
“In general, sequential belief updating tasks have found that people with a diagnosis of schizophrenia (PSz) tend to make bigger belief updates than controls to unexpected information, which can also manifest as increased ‘switching’ (from one response to another) in bandit-type tasks (Fear and Healy, 1997; Garety et a…”
BackgroundInfluentialImpaired cognitive flexibility across psychiatric disorders
Grant, J. E., & Chamberlain, S. R. (2023) · CNS Spectrums · doi:10.1017/s1092852923002237 · Cited by 67
“Many psychiatric disorders are characterized by repetitive compulsive behaviors (including, for example, alcohol and substance use disorders, schizophrenia, autism spectrum disorders, eating disorders, gambling disorder, trichotillomania, and skin-picking disorder).(1-7) Obsessivecompulsive disorder (OCD) may reflect…”
BackgroundExplaining Delusions: Reducing Uncertainty Through Basic and Computational Neuroscience
Feeney, E. J., Groman, S. M., Taylor, J. R., & Corlett, P. R. (2016) · Schizophrenia Bulletin · doi:10.1093/schbul/sbw194 · Cited by 51
Belief Updating and Paranoia in Individuals With Schizophrenia
Sheffield, J. M., Suthaharan, P., Leptourgos, P., & Corlett, P. R. (2022) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2022.03.013 · Cited by 57
Dopamine depletion effects on cognitive flexibility as modulated by tDCS of the dlPFC
Borwick, C., Lal, R., Lim, L. W., Stagg, C. J., & Aquili, L. (2019) · Brain stimulation · doi:10.1016/j.brs.2019.08.016 · Cited by 50
Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination
Wong, S. M. Y., Chen, E. Y. H., Lee, M. C. Y., Suen, Y. N., & Hui, C. L. M. (2023) · Brain Sciences · doi:10.3390/brainsci13071041 · Cited by 48
Activity-dependent isomerization of Kv4.2 by Pin1 regulates cognitive flexibility
Hu, J., Malloy, C., Tabor, G. T., Gutzmann, J. J., Liu, Y., Abebe, D. T., Karlsson, R., Durell, S. R., Cameron, H. A., & Hoffman, D. A. (2020) · Nature Communications · doi:10.1038/s41467-020-15390-x · Cited by 47
Jantzie, L. L., Oppong, A. Y., Conteh, F. S., Yellowhair, T. R., Kim, J., Fink, G., Wolin, A., Northington, F. J., & Robinson, S. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00233 · Cited by 46
“Serotonin signaling is also integral to cognitive flexibility (107).”
BackgroundWießner, I., Olivieri, R., Falchi-Carvalho, M., Palhano-Fontes, F., Maia, L. O., Feilding, A., de Araújo, D. B., Ribeiro, S. T. G., & Tófoli, L. F. (2022) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2022.01.114 · Cited by 41
Distinct roles of striatal direct and indirect pathways in value-based decision making
Kwak, S., & Jung, M. W. (2019) · eLife · doi:10.7554/elife.46050 · Cited by 41
“There also exists a large body of literature indicating a role for D2R in reversal learning, although D1R has also been implicated in this process (Izquierdo et al., 2017; Klanker et al., 2013; Waltz, 2017).”
BackgroundStress, associative learning, and decision-making
Giovanniello, J. R., Bravo-Rivera, C., Rosenkranz, J. A., & Lattal, K. M. (2023) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2023.107812 · Cited by 39
“For example, a deficit in cognitive flexibility is an endophenotype of numerous psychiatric conditions, including PTSD (Qureshi et al., 2011), anxiety (Ansari et al., 2008; Park & Moghaddam, 2017), obsessive–compulsive disorder (Gruner & Pittenger, 2017), and schizophrenia (Waltz, 2017).”
Satterfield, B. C., Hinson, J. M., Whitney, P. J., Schmidt, M. A., Wisor, J. P., & Dongen, H. P. A. V. (2017) · Cortex · doi:10.1016/j.cortex.2017.11.012 · Cited by 37
Shepard, R. M., Heslin, K. A., Hagerdorn, P. L., & Coutellier, L. D. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0436-3 · Cited by 39
Orexin deficiency modulates cognitive flexibility in a sex‐dependent manner
Durairaja, A., & Fendt, M. (2020) · Genes Brain & Behavior · doi:10.1111/gbb.12707 · Cited by 41
“Neuropsychiatric disorders are often associated with learning impairments especially in learning tasks that demand cognitive flexibility.(1,2) Cognitive flexibility is the ability to perform reversals or to transfer attention within the same perceptual dimension (IDS: intra-”
BackgroundKraft, D., Rademacher, L., Eckart, C., & Fiebach, C. J. (2020) · Journal of Cognition · doi:10.5334/joc.120 · Cited by 35
A generative framework for the study of delusions
Erdmann, T., & Mathys, C. D. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2020.11.048 · Cited by 32
“For the study of delusional belief dynamics, popular experiments in computational psychiatry such as reversal learning tasks (Schlagenhauf et al., 2014; Waltz, 2017) or the beads task (Adams et al., 2018; Baker et al., 2019) are too restricted in the range of behaviour they allow.”
BackgroundConcepts, Frames and Cascades in Semantics, Cognition and Ontology
Löbner, S., Gamerschlag, T., Kalenscher, T., Schrenk, M., & Zeevat, H. (2021) · Language, cognition and mind · doi:10.1007/978-3-030-50200-3 · Cited by 32
Doss, M. K., Samaha, J., Barrett, F. S., Griffiths, R. R., de Wit, H., Gallo, D. A., & Koen, J. D. (2023) · Psychological Review · doi:10.1037/rev0000455 · Cited by 33
Modeling subjective relevance in schizophrenia and its relation to aberrant salience
Katthagen, T., Mathys, C., Deserno, L., Walter, H., Kathmann, N., Heinz, A., & Schlagenhauf, F. (2018) · PLOS Computational Biology · doi:10.1371/journal.pcbi.1006319 · Cited by 29
Cleal, M., Fontana, B. D., Double, M., Mezabrovschi, R., Parcell, L., Redhead, E. S., & Parker, M. O. (2021) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2021.02.005 · Cited by 28
Tanaka, M., Kunugi, A., Suzuki, A., Suzuki, N., Suzuki, M., & Kimura, H. (2019) · Pharmacology Research & Perspectives · doi:10.1002/prp2.479 · Cited by 24
Hassani, S. A., Neumann, A. R., Russell, J. K., Jones, C. K., & Womelsdorf, T. (2023) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2216792120 · Cited by 21
Mental flexibility: An MEG investigation in typically developing children
Mogadam, A., Keller, A. E., Taylor, M. J., Lerch, J. P., Anagnostou, E. A., & Pang, E. W. (2017) · Brain and Cognition · doi:10.1016/j.bandc.2017.10.001 · Cited by 22
“…mental illnesses (Airaksinen, Larsson, Lundberg, & Forsell, 2004; Cavedini, Zorzi, Piccinni, Cavallini, & Bellodi, 2010; Tchanturia et al., 2012; Waltz, 2016) and developmental disorders (Anderson, 2002; Dajani & Uddin, 2015; Ozonoff& Jensen, 1999; Shin et al., 2008), expanding our knowledge of…”
Quantitative prediction of individual cognitive flexibility using structural MRI
Zhu, J., Zhu, D., Zhang, C., Wang, Y., Yang, Y., & Yu, Y. (2018) · Brain Imaging and Behavior · doi:10.1007/s11682-018-9905-1 · Cited by 21
Thonnard, D., Dreesen, E., Callaerts‐Vegh, Z., & D’Hooge, R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.12.003 · Cited by 21
“…have been associated with deficits in cognitive flexibility, such as Parkinson's disease, Alzheimer's disease, schizophrenia, autism, ADHD and depression (El Haj et al., 2015; Halleland et al., 2012; Martínez-Martínez et al., 2017; McDermott and Ebmeier, 2009; Waltz, 2017; Westwood et al., 2016).”
Nijmeijer, S. E., van Tol, M., Aleman, A., & Keijzer, M. C. J. (2021) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.550180 · Cited by 20
“Although out of scope of the current study, other age groups might also benefit from the improvement in cognitive flexibility resulting from learning a new language and it could be applied in rehabilitation in other disorders where cognitive flexibility is compromised, such as in schizophrenia (Waltz, 2017), traumatic…”
BackgroundGarcía‐Mieres, H., Usall, J., Feixas, G., & Ochoa, S. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.594840 · Cited by 19
“Patients with more dichotomous interpersonal thinking had an earlier age at onset, higher self-certainty, lower estimation of their cognitive reserve (vocabulary subtest ofWAIS), lower abilities for abstract thinking (similarities subtest of WAIS), poorer executive functioning (number of categories completed and perse…”
BackgroundMethodInfluentialFrameworking memory and serotonergic markers
Meneses, A. (2017) · Reviews in the Neurosciences · doi:10.1515/revneuro-2016-0079 · Cited by 19
GABA Supplementation Negatively Affects Cognitive Flexibility Independent of Tyrosine
Lim, L. W., & Aquili, L. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10091807 · Cited by 18
Livingston, N. R., Hawkins, P. C., Gilleen, J., Ye, R., Valdearenas, L., Shergill, S. S., & Mehta, M. A. (2021) · Journal of Psychopharmacology · doi:10.1177/02698811211000778 · Cited by 17
“This task has been validated in lesion studies (Dias et al., 1996) and neuroimaging studies (Hampshire and Owen, 2006), is sensitive to pharmacological modulation (Tait et al., 2014), and has been extensively used to examine set-shifting deficits in schizophrenia (Waltz, 2017).”
BackgroundWang, Y., Hu, X., & Li, Y. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1069036 · Cited by 18
“Schizophrenia is a mental disorder with deficits in cognitive flexibility (1, 3).”
BackgroundCognitive flexibility: Development, disease and treatment
Powell, E. M., & Ragozzino, M. E. (2016) · Neuroscience · doi:10.1016/j.neuroscience.2016.12.023 · Cited by 17
Reversal learning impairments in the maternal immune activation rat model of schizophrenia.
Kleinmans, M., & Bilkey, D. K. (2018) · Behavioral Neuroscience · doi:10.1037/bne0000275 · Cited by 17
Ruiz-Castañeda, P., Molina, E. S., Aguirre-Loaiza, H., & Daza, M. T. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.571271 · Cited by 19
“Regarding the ability to change or alternate the mental set, the difficulties in this aspect, have been related to perseveration problems, and with the difficulty that patients have to disengage attention (Waltz, 2017).”
BackgroundZhao, X., Tran, H., DeRosa, H., Roderick, R. C., & Kentner, A. C. (2021) · Genes Brain & Behavior · doi:10.1111/gbb.12755 · Cited by 17
The abiding relevance of mouse models of rare mutations to psychiatric neuroscience and therapeutics
Gogos, J. A., Crabtree, G. W., & Diamantopoulou, A. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.03.018 · Cited by 15
“In support of this, it has been shown that severity of cognitive impairment correlates with risk and perseverance of psychosis in schizophrenia (Lam et al., 2018; Olivier et al., 2017; Waltz, 2017).”
BackgroundParanormal belief, cognitive-perceptual factors, and well-being: A network analysis
Dagnall, N., Denovan, A., & Drinkwater, K. G. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.967823 · Cited by 15
“This relationship is explained by characteristics such as hypersensitivity, reduced latent inhibition (Carson, 2011), and lower cognitive flexibility (Peters et al., 1999), which are features of psychosis (see Williams et al., 1998; Waltz, 2017; Calvo et al., 2021).”
BackgroundAnderson, E. M., Demis, S., D’Acquisto, H., Engelhardt, A., & Hearing, M. C. (2021) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2021.621751 · Cited by 14
“, stress), reduce emotional control, and promote the development of maladaptive behaviors that can disrupt the capacity of individuals to engage in their lives effectively (Lange et al., 2017; Waltz, 2017; Gabrys et al., 2018).”
BackgroundNeurostimulation to improve cognitive flexibility
Sachse, E. M., & Widge, A. S. (2025) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2025.101484 · Cited by 15
Young, M. K., Conn, K., Das, J., Zou, S., Alexander, S., Burne, T. H. J., & Kesby, J. P. (2022) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2022.08.005 · Cited by 13
“Impairments in cognitive fl exibility have been observed in a range of neuro-psychiatric disorders including schizophrenia, Parkinson ’ s disease, obsessive-compulsive disorder, and substance abuse (1 – 4).”
BackgroundStandke, I., Trempler, I., Dannlowski, U., Schubotz, R. I., & Lencer, R. (2021) · NeuroImage: Clinical · doi:10.1016/j.nicl.2021.102855 · Cited by 11
“Deficits in cognitive flexibility in schizophrenia spectrum disorders have previously been associated with confounding factors such as disease state and medication (Waltz 2017).”
BackgroundBortolon, C., Chen, S., & Bonanno, G. A. (2022) · British Journal of Clinical Psychology · doi:10.1111/bjc.12395 · Cited by 14
Dagnall, N., Denovan, A., & Drinkwater, K. G. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1094701 · Cited by 11
“…that transliminality embodies features such as lower cognitive flexibility (Peters et al., 1999) and heightened sensory information flow (i.e. reduced latent inhibition and hypersensitivity) (Carson, 2011), which are present in more extreme forms within psychosis (Waltz, 2017; Calvo et al., 2021).”
BackgroundKarunakaran, K. B., Jain, S., Brahmachari, S. K., Balakrishnan, N., & Ganapathiraju, M. (2024) · Schizophrenia · doi:10.1038/s41537-024-00439-3 · Cited by 9
Munarriz‐Cuezva, E., & Meana, J. J. (2024) · Journal of Neurochemistry · doi:10.1111/jnc.16212 · Cited by 10
“These data suggest deficits in adaptation when the environmental con - ditions changed, as observed in schizophrenia patients (Sampedro et al., 2019 ; Waltz, 2017).”
Predictive processing accounts of psychosis: bottom-up or top-down disruptions
Goodwin, I., Diederen, K. M. J., Hird, E., Weilnhammer, V. A., Garrido, M. I., & Knolle, F. (2026) · Nature Mental Health · doi:10.1038/s44220-025-00558-5 · Cited by 9
“Participants with schizophrenia also show reduced activity in the striatum during reward anticipation 89–92 and this is associated with the severity of negative symptoms 89,90,92–94 .”
Negrón-Oyarzo, I., Dib, T., Chacana-Véliz, L., Quilodrán, N. L., & Urrutia-Piñones, J. (2024) · Frontiers in Neural Circuits · doi:10.3389/fncir.2024.1286111 · Cited by 7
“…behavioral responses, a feature observed in several situations that compromise well-being and mental health, including cognitive decline during aging (Richard’s et al., 2021), mood disorders (Kashdan and Rottenberg, 2010) and schizophrenia (Waltz, 2017), among others (Diamond, 2013; Uddin, 2021).”
BackgroundRiedel, P., Domachowska, I., Lee, Y., Neukam, P. T., Tönges, L., Li, S., Goschke, T., & Smolka, M. N. (2022) · Psychopharmacology · doi:10.1007/s00213-022-06077-w · Cited by 9
“2017; Waltz 2017; Arnsten et al.”
BackgroundKristensen, T. D., Ambrosen, K., Raghava, J., Syeda, W., Dhollander, T., Lemvigh, C., Bojesen, K., Barber, A. D., Nielsen, M. O., Rostrup, E., et al. (2024) · Schizophrenia · doi:10.1038/s41537-024-00487-9 · Cited by 6
“Cognitive fl exibility is consistently found to be disrupted in patients with schizophrenia 72 , and in fl uenced by illness state, clinical pro fi le 73 , and antipsychotic medication 74 .”
BackgroundSyn3 Gene Knockout Negatively Impacts Aspects of Reversal Learning Performance
Moore, A. C., Linden, J., & Jentsch, D. (2021) · eNeuro · doi:10.1523/eneuro.0251-21.2021 · Cited by 8
“001 654 Waltz, J. A. (2017). The neural underpinnings of cognitive flexibility and their disruption in psychotic 655 illness. Neuroscience, 345, 203–217. https://doi.org/10.1016/j.neuroscience.2016.06.005 656 Waltz, J. A., & Gold, J. M. (2007). Probabilistic Reversal Learning Impairment in Schizophrenia.”
BackgroundInfluentialSagheddu, C., Cancedda, E., Bagheri, F., Kalaba, P., Muntoni, A. L., Lubec, J., Lübec, G., Sanna, F., & Pistis, M. (2023) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyad056 · Cited by 7
“…flexibility, 2 dopamine-related executive functions that are altered in several psychopathological conditions, from psychosis to drug abuse (Waltz, 2017; Potvin et al., 2018), and whose alteration represents a classical sign of hypofrontality (i.e., a condition characterized by…”
BackgroundMethodOlfactory capacity in anorexia nervosa: correlations with set-shifting ability
Karavia, A., Kapsali, F., Gonidakis, F., Koliou, A., Tsigkaropoulou, E., Papageorgiou, C., & Michopoulos, I. (2021) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-021-01188-3 · Cited by 7
Giusti, L., Bianchini, V., Aggio, A., Mammarella, S., Salza, A., Necozione, S., Alunno, A., Ferri, C., Casacchia, M., & Roncone, R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.903759 · Cited by 6
“This unhealthy lifestyle and non-adherence to treatment over time could be ascribed to a low level of selfregulatory behaviors (39), cognitive flexibility (40, 41), and low levels of self-esteem (42).”
BackgroundHaddon, J. E., Titherage, D., Heckenast, J. R., Carter, J., Owen, M. J., Hall, J., Wilkinson, L. S., & Jones, M. W. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02969-x · Cited by 6
Knížková, K., Siroňová, A., Večeřová, M., Keřková, B., Šustová, P., Jonáš, J., Hrubý, A., & Rodríguez, M. (2023) · Applied Neuropsychology Adult · doi:10.1080/23279095.2023.2230508 · Cited by 6
“In schizophrenia, an evaluation of CF — often reported under the umbrella of executive functioning — seems to be one of the important markers in neuropsychological assessments (Waltz, 2017).”
Chang, Y.-C., Li, W., Lee, L. J., & Lee, L. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21228518 · Cited by 8
“The choice and switching of coping strategies require proper cognitive flexibility; unfortunately, cognitive flexibility is diminished in patients with schizophrenia [55].”
BackgroundWang, A., Chao, O. Y.-H., Nikolaus, S., Lamounier‐Zepter, V., Hollenberg, C. P., Lübec, G., Trossbach, S. V., Korth, C., & Huston, J. P. (2022) · Neuroscience · doi:10.1016/j.neuroscience.2022.04.013 · Cited by 6
Warsi, N. M., Wong, S. M., Germann, J., Boutet, A., Arski, O. N., Anderson, R., Erdman, L., Yan, H., Suresh, H., Gouveia, F. V., et al. (2023) · Neural Networks · doi:10.1016/j.neunet.2023.07.019 · Cited by 6
Savolainen, K., Ihalainen, J. A., Hämäläinen, E., Tanila, H., & Forsberg, M. (2020) · Behavioural Brain Research · doi:10.1016/j.bbr.2020.113057 · Cited by 6
The role of affective states in computational psychiatry
Benrimoh, D. A., Smith, R. S., Diaconescu, A. O., Friesen, T., Jalali, S., Mikuš, N., Gschwandtner, L. P., Gandhi, J., Horga, G., & Powers, A. R. (2025) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyaf049 · Cited by 7
“145,146 The longer this process persists, the stronger these priors become, and the less viable the alternative models of the w orld—resulting in the development of (negatively valenced) crystallized false beliefs.”
Unilateral Striatal Deep Brain Stimulation Improves Cognitive Control
Sachse, E. M., Rijn, E. M. D.-V., Bennek, J. P., Buccini, M. C., Mensinger, M. E., Iacobucci, F. A., Reimer, A. E., & Widge, A. S. (2026) · Journal of Neuroscience · doi:10.1523/jneurosci.1925-25.2026 · Cited by 5
The neural basis for uncertainty processing in hierarchical decision making
Wang, M. B., Lynch, N., & Halassa, M. M. (2025) · Nature Communications · doi:10.1038/s41467-025-63994-y · Cited by 9
Mahmoud, G. S., Hosny, G., & Sayed, S. A. (2021) · PubMed Central · Cited by 5
Peeters, L. D., Wills, L. J., Cuozzo, A. M., Ivanich, K. L., & Brown, R. W. (2023) · Psychopharmacology · doi:10.1007/s00213-023-06379-7 · Cited by 4
“Deficits in cognitive flexibility in psychosis manifest in persistent delusions and are often attributed to hypofrontality (Waltz 2017; García-Mieres et al.”
BackgroundMantonakis, L., Stefanatou, P., Tsionis, A., Konstantakopoulos, G., Xenaki, L., Ntigrintaki, A.-A., Ralli, I., Dimitrakopoulos, S., Kollias, K., & Stefanis, N. C. (2024) · Brain Sciences · doi:10.3390/brainsci14020162 · Cited by 6
“…between CF-related structures and negative symptoms, emphasizing the interconnected nature of brain structures in cognitive and symptomatic domains, with consistent involvement of DLPFC, MOFC, right superior, and inferior frontal gyri in both patients with deficit syndrome (DS) and CF [83–85].”
Background¿Cuál es la relación entre Funciones Ejecutivas y Mentalización?
López‐Silva, P., & Bustos, P. (2017) · Universitas Psychologica · doi:10.11144/javeriana.upsy16-4.crmd · Cited by 8
“Además, esta idea es consistente con los bajos niveles de flexibilidad cognitiva que muestran los pacientes psicóticos (Waltz, 2016), por lo que la relación entre alteraciones en FE y formación de síntomas psicóticos estaría bien fundamentada desde un punto de vista empírico, pero también…”
BackgroundRiggs, L. M., Aronson, S., Mou, T.-C. M., Pereira, E. F. R., Thompson, S. M., & Gould, T. D. (2025) · Cell Reports · doi:10.1016/j.celrep.2025.115743 · Cited by 4
Christensen, M. J., Vernal, D. L., Jeppesen, U. N., Hjorthøj, C. R., Mainz, J., Pinkham, A. E., Austin, S. F., Veling, W., Ward, T., Nordentoft, M., et al. (2026) · Psychological Medicine · doi:10.1017/s0033291726103870 · Cited by 3
“…a stronger cognitive foundation, including greater cognitive flexibility, better insight, and lower conviction in their beliefs, which may facilitate engagement with the cognitive demands of CBTp (Brabban et al., 2009; Garety et al., 1997; Jenner et al., 2024; Naeem et al., 2008; Waltz, 2017).”
Hawkins, P. C. T., Schwarz, A. J., Stone, J. M., Pepper, F., Gilleen, J., Gijsen, S. C. J., Mazibuko, N., Arkilo, D., Yin, W., Wu, J., et al. (2025) · Psychopharmacology · doi:10.1007/s00213-025-06884-x · Cited by 3
“This does not pre-clude the potential for an improvement of specific domains of function within subgroups of this heterogenous illness with chronic dosing (Waltz 2017), but we were unable to test that hypothesis in this study.”
Thalamic regulation of reinforcement learning strategies across prefrontal-striatal networks
Wang, B., Wang, M. B., Lam, N. H., Liu, M., Li, S., Wimmer, R. D., Paz‐Alonso, P. M., Halassa, M. M., & Pleger, B. (2025) · Nature Communications · doi:10.1038/s41467-025-63995-x · Cited by 5
A mentális rugalmasság idegtudománya
Janka, Z. (2017) · Orvosi Hetilap · doi:10.1556/650.2017.30906 · Cited by 4
Anderson, Z. G., Gupta, T., Revelle, W., Haase, C. M., & Mittal, V. A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.755027 · Cited by 5
Zhao, X., Tran, H., DeRosa, H., Roderick, R. C., & Kentner, A. C. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.02.15.431275 · Cited by 3
Chu, M.-Y., Li, S.-B., Zhang, Y., Wang, L.-L., Lv, Q.-Y., Lui, S. S. Y., Wang, Z., Yi, Z.-H., Wang, Y., & Chan, R. C. K. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf220 · Cited by 2
MORRIS, B. J. (2026) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2026.111628 · Cited by 2
“…cognitive domains all involve recruitment of PFC and/or OFC (Ortiz-Gil et al., 2011; Potkin et al., 2009; Ritter et al., 2004; Senkowski and Gallinat, 2015; Waltz, 2017; Zeeb and Winstanley, 2013), suggesting some overlap with the circuitry implicated in negative, and positive, symptomology (Fig.”
Nami, M., Wang, D. O., Panel, M.-N., Abel, T. G., Banerjee, S., Bredy, T. W., Chaudhury, D., Frankland, P. W., Hayashi, Y., Hirase, H., et al. (2026) · Molecular Brain · doi:10.1186/s13041-026-01281-7 · Cited by 2
“Thus, targeting resting-state aberrance may present a novel angle for disease intervention [83].”
Park, A. J. (2023) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.1091082 · Cited by 3
“The ability to cope with novel situations is critical for everyday life, and this cognitive flexibility is impaired in patients with neuropsychiatric disorders including autism and schizophrenia (Geurts et al., 2009; Waltz, 2017).”
BackgroundClarificando el rol de la mentalización en el desarrollo de las funciones ejecutivas
López‐Silva, P., & Bustos, P. (2017) · Redalyc (Universidad Autónoma del Estado de México) · Cited by 2
Matthews, S. C., Greco, A., Rastelli, C., & Nia, A. B. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1448043 · Cited by 1
“CF is a central aspect of cognition, permitting adaptation to changing environmental demands, and is markedly decreased in both depression and addiction (30, 31).”
Başkaya, E. (2025) · Western Journal of Nursing Research · doi:10.1177/01939459251400481 · Cited by 1
“37 In a study conducted by Laere et al, it was reported that cognitive processing speed and flexibility were impaired in patients with schizophrenia.”
Wolfe, T., Gassel, A., Calvert, M. L., Isaac, L., James, G. A., Koscik, T. R., & Kilts, C. (2026) · eNeuro · doi:10.1523/eneuro.0179-25.2025 · Cited by 1
“Both these association types go hand-in-hand with cognitive performance (Park and Moghaddam, 2017; Waltz, 2017; Berry et al., 2018).”
The role of cue transparency in task switching: an SDM-PSI meta-analysis in healthy adults
Zheng1, X., Qiu, Y., Lin, S. T., Deng, W., Jiang, Z., Wang, B. A., & Huang, R. (2026) · Brain Imaging and Behavior · doi:10.1007/s11682-026-01080-7 · Cited by 1
“…flexibility refers to an individual’s ability to adapt their thoughts and behaviors in response to changing external environments, shifting internal states, and evolving goals (Dajani & Uddin, 2015 ; Diamond, 2013; Geurts et al., 2009 ; Prado et al., 2017 ; Spellman et al., 2021 ; Waltz, 2017 ).”
Examining clinical relevance of interpretation inflexibility in social contexts
Deng, W., Zabag, R., Narain, S., Cannon, T. D., & Joormann, J. (2026) · Annals of General Psychiatry · doi:10.1186/s12991-026-00683-0 · Cited by 1
“Early measures of interpretation inflexibility were developed by psychosis researchers to evaluate cognitive rigidity [35], a factor underlying several psychotic symptoms such as persecutory beliefs and paranoia [36].”
Le, G. H., Wong, S., Luch, S. D. D., Orsini, D. K., Vasudeva, S., Agarwal, S. M., Llach, C.-D., Rosenblat, J. D., & McIntyre, R. S. (2026) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.70143 · Cited by 1
Escitalopram Restores Reversal Learning Impairments in Rats with Lesions of Orbital Frontal Cortex
Tait, D. S., Bowman, E. E., Miller, S., Dovlatyan, M., Sánchez, C., & Brown, V. J. (2021) · Language, cognition and mind · doi:10.1007/978-3-030-50200-3_18 · Cited by 1
“…is an additional potential benefit, in that it enables the refinement of ‘animalmodels’ of human psychiatric disorders, such as schizophrenia or depression, in which cognitive flexibility is impaired (Murray et al. 2008; Kehagia et al. 2010; Murphy et al. 2012; Gilmour et al. 2013; Waltz 2017).”
BackgroundCuesta, M. J., Gil‐Berrozpe, G. J., Sánchez-Torres, A. M., Lorente-Omeñaca, R., Moreno-Izco, L., & Peralta, V. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2021.09.008 · Cited by 1
The MAM Model to Study the Role of Dopamine in Schizophrenia
Zhu, X., Uliana, D. L., & Grace, A. A. (2022) · Neuromethods · doi:10.1007/978-1-0716-2799-0_10 · Cited by 1
Chu, M., Wang, L., Lui, S. S. Y., & Chan, R. C. K. (2024) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2023.11.001 · Cited by 1
“Waltz (2) reviewed previous studies that used probabilistic reversal learning tasks in patients with SCZ and found a vast heterogeneity of fi ndings across studies.”
BackgroundResultInfluential
Metadata
- Authors
- Waltz, J. A.
- Affiliations
- University of Maryland, Baltimore (US)
- Corresponding author
- Waltz, James A.
- ORCID
- Waltz, James A.
- Venue
- Neuroscience
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 345
- Pages
- 203-217
- ISSN
- 0306-4522 (ISSN-L)
- PMC
- PMC5143214
- OpenAlex
- W2411740764
- Cited by
- 122
- References
- 159
- Citations by year
- 2026: 17 · 2025: 14 · 2024: 7 · 2023: 14 · 2022: 13 · 2021: 22 · 2020: 10 · 2019: 7 · 2018: 7 · 2017: 9
- FWCI
- 1.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K12 RR023250, R01 MH094460, R01 MH080066)
- NIDA-IRP
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- cognitive flexibility, schizophrenia, probabilistic reversal learning, set-shifting, interindividual variability, neural correlates, neuromodulation, antipsychotic drugs, cognitive impairment
- MeSH terms
- Animals, Brain, Cognition, Humans, Neural Pathways, Psychotic Disorders, Reversal Learning, Schizophrenia, Schizophrenic Psychology, Executive Function
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