Overactive performance monitoring in obsessive-compulsive disorder: ERP evidence from correct and erroneous reactions

Obsessive-compulsive disorder (OCD) has repeatedly been associated with hyperactivity in fronto-striatal brain regions and regions related to performance monitoring. The aim of the current study was to further investigate electrophysiological correlates of performance monitoring. Specifically, we intended to replicate previous results revealing enhanced error-related negativity (ERN) amplitudes in OCD patients. Furthermore, we examined whether OCD patients also showed alterations regarding the correct-related negativity (CRN), the error positivity (Pe) and behavioural correlates of performance monitoring. Event-related brain potentials (ERPs) were recorded from a group of 20 OCD patients and 20 healthy control participants during a modified flanker task. Force sensitive response buttons were utilized to separate correct trials from incorrect trials with full and partial response activation. Both groups displayed substantial ERN and Pe amplitudes for full and partial errors. On error trials OCD patients showed enhanced ERN amplitudes, but group differences were not significant for the Pe and for behavioural adjustment. Further, the OCD group also exhibited enhanced CRN amplitudes and a correlation of frontal CRN amplitudes with symptom severity. These data provide further support for the view that performance monitoring is overactive in OCD. Further, since the amplitude enhancement is not specific to error processing, but is also observed for correct reactions, a response monitoring or evaluation process that contributes to both ERP components might be overactive in OCD. This is in line with fMRI results that revealed higher error- and conflict-related activity in the medial frontal cortex in OCD patients.     

Action‐Monitoring Alterations as Indicators of Predictive Deficits in Schizophrenia

A flexible and dynamically adjustable behavior is crucial to adapt to a continuously changing environment. In order to optimally adapt, we need to learn from the consequences of our behavior. We usually learn through different kinds of prediction errors, which occur when we experience unexpected situations due to false predictions. With this literature review, we intended to contribute to current etiological models that ascribe various positive symptoms (particularly delusions and hallucinations) in patients with schizophrenia to false prediction errors and deficient predictive learning. We discuss alterations in the electrophysiological measure of the error‐related negativity/error negativity (ERN/Ne) as a global deficit and a trait in schizophrenia, as they have been observed in different samples of patients with schizophrenia, in individuals at high‐risk and individuals with subclinical schizotypal traits. As the ERN/Ne can itself be considered the result of predictive processes (evaluation of current action outcomes as worse than expected), we propose that the reported alterations indicate that patients suffering from schizophrenic illnesses fail to adequately classify the outcomes of their actions as better or worse than expected due to a deficit in self‐monitoring. Furthermore, we discuss results in further action‐monitoring components, such as the correct response negativity (CRN)—a smaller negativity elicited by correct responses; and error positivity (Pe)—a later positivity assumed to reflect conscious error processing. The reported results show normal Pe amplitudes and normal post‐error adjustments (adaptations after committed error to improve performance), indicating an intact later and conscious processing. From the results of diminished differences between ERN/Ne and CRN amplitudes, we conclude a general predictive deficit in early aspects of self‐monitoring associated with positive symptoms in patients with schizophrenia.     

ERP correlates of conscious error recognition: aware and unaware errors in an antisaccade task

Event-related potential (ERP) studies identified the error-related negativity (Ne/ERN) and the error positivity (Pe) to be associated with performance errors. However, the functional significance of these components is not yet resolved. With the present study we intended to further investigate to what extent these components are related to error awareness. ERPs were recorded during an antisaccade task, and error awareness was obtained from accuracy ratings on each trial. In accordance with earlier findings, aware and unaware errors did not differ in Ne/ERN amplitude. Whereas the late Pe (400-600 ms) shows an increased parietal positivity for aware compared with unaware errors, the early Pe (200-300 ms) shows no dissociation between aware and unaware errors. These data lend further support to the view that the Ne/ERN and the (late) Pe reflect different processes in performance monitoring. In fact the present results provide a clear replication of [S. Nieuwenhuis et al. (2001) Psychophysiology, 38, 752-760], showing that the Pe is associated with error awareness and remedial action. Furthermore, it has been shown that this is only true for the late Pe, whereas the early Pe like the Ne/ERN is not modulated by error awareness.     

Error processing and impulsiveness in normals: evidence from event-related potentials

Electrophysiological correlates of impulsiveness were investigated in thirty-two healthy subjects using event-related potentials (ERP). Impulsiveness was determined by calculating individual reaction times (as a function of general response speed) in order to split the entire group into two subgroups with a more controlled (n = 16) and less controlled (n = 16) response style. Participants performed a Go/Nogo task while a 64 channel EEG was recorded. Artifact-free EEG segments were used to compute ERPs on correct Go trials and incorrect Nogo trials, separately. Three ERP components were of special interest: the error-related negativity (ERN)/error negativity (Ne) and the "early" error positivity (Pe) reflecting automatic error processing and the "late" error positivity (Pe) which is thought to mirror the awareness of erroneous responses. Subjects with higher impulsiveness showed smaller amplitudes than subjects with lower impulsiveness for the ERN/Ne component and the "early" Pe component. With regard to the "late" Pe groups did not differ. Hence, ERP measures appear suitable for detailed analyses of impulsiveness in healthy participants. Moreover, present results argue for the necessity of careful control of impulsiveness when including normal comparison groups in the context of clinical studies.     

Neuropsychological correlates of error negativity and positivity in schizophrenia patients

The purpose of the present paper was to determine error-monitoring ability and its relationship with executive function in patients with schizophrenia. In order to evaluate error-monitoring ability, the error negativity (Ne) and error positivity (Pe) were measured using the Stroop task. The correct-related negativity (CRN) and positivity (Pc) were also measured. In addition, neuropsychological tests were administered in order to evaluate executive function. The patients with schizophrenia had significantly reduced Ne and augmented CRN amplitudes, but the Pe and Pc amplitudes of the patients were comparable to those of the controls. In addition, the Ne amplitude, measured at Fcz was positively correlated with the Trail Making Test (TMT), part B response time, and the categories achieved on the Wisconsin Card Sorting Test (WCST) in patients with schizophrenia. No significant correlations were found between Ne amplitude and performance on the neuropsychological tests in the controls. And no associations were detected between CRN, Pe, Pc amplitudes and neuropsychological performance, in either the patients with schizophrenia or the controls. Reduced Ne amplitudes and augmented CRN amplitudes in patients with schizophrenia suggest the dysfunctional behavior-monitoring system in these patients. The functional significances of Ne and Pe are discussed.     

Disrupted action monitoring in recent-onset psychosis patients with schizophrenia and bipolar disorder

Schizophrenia patients experience cognitive control disturbances, manifest in altered neural signatures during action monitoring. It remains unclear whether error- and conflict-monitoring disturbances co-occur, and whether they are observed in recent-onset psychosis patients with schizophrenia or bipolar disorder. We tested electrophysiological measures of action monitoring in these patients. Seventy-three schizophrenia patients (SZ), 26 bipolar disorder type I patients (BP), each within one year of psychosis onset, and 54 healthy control subjects (HC) underwent EEG during Stroop task performance. In the trial-averaged EEG at three midline scalp electrodes, the error-related negativity (ERN), error positivity (Pe) and conflict-related N450 were measured. Compared to HC (1) SZ exhibited an attenuated ERN and N450, and Pe unchanged and (2) BP exhibited an attenuated ERN but normal Pe and N450. Between patient groups, SZ showed an attenuated N450; ERN and Pe were not significantly different. A small (n=10) SZ subgroup that was not receiving antipsychotic medication showed normal ERPs. Altered error- and conflict-monitoring occur together in the first-episode schizophrenia patients, and these measures are comparable in patients with the first-episode bipolar disorder. Antipsychotic medication may be associated with altered measures of error-monitoring in schizophrenia.     

Early and late components of error monitoring in violent offenders with psychopathy

BACKGROUND: One of the most recognizable features of psychopathy is the reduced ability to successfully learn and adapt overt behavior. This might be due to deficient processing of error information indicating the need to adapt controlled behavior. METHODS: Event-related potentials (ERPs) and behavioral components of error-monitoring processes were investigated in 16 individuals with psychopathy and in 18 healthy subjects. A letter version of the Eriksen flanker task was used in two conditions. The first condition (normal condition) required participants to press one of two buttons depending on the identity of the target stimulus. The second condition (signaling condition) required them to signal each time they had committed an error by making a second press on a signaling button. Early stages of error monitoring were investigated by using the error-related negativity (ERN/Ne) and post-error slowing as indexes. Later stages were explored by examining the error positivity (Pe) and signaling rates. RESULTS: Both groups showed similar ERN amplitudes and amounts of post-error slowing. The psychopathic group exhibited both reduced Pe amplitudes and diminished error-signaling rates compared with the control group. CONCLUSIONS: Individuals with psychopathy show intact early error processing and automatic behavioral adaptation but have deficits in later stages of error processing and controlled behavioral adaptation. This is an indication that individuals with psychopathy are unable to effectively use error information to change their behavior adequately.     

Error-related negativity abnormalities in generalized anxiety disorder and obsessive-compulsive disorder

Enhanced error-related negativity (ERN) has been associated with anxiety among both non-clinical and clinical populations. However, whether it is abnormal among adult patients with generalized anxiety disorder (GAD) is still unknown. The present study investigated it across GAD and obsessive-compulsive disorder (OCD). Event related brain potentials (ERPs) were recorded from a group of 27 GAD patients, 25 OCD patients and 27 healthy control participants during a modified Erikson Flankers task. ERP difference waveforms were obtained by subtracting ERP to correct response (CRN) from ERP to error response (ERN). The Ne component of ERPs at medial frontal electrodes were analyzed and reported. The Ne component of ERP difference waveform was enhanced only in OCD patients, but not in GAD patients, as compared to the healthy controls. An exploratory analysis also revealed higher Ne amplitude of error trial waveforms in both GAD and OCD patients than in healthy controls, and an insignificant group difference in Ne component of correct trial waveforms. The Ne amplitude of error trial waveforms also correlated with Hamilton Anxiety Rating Scale (HAMA) scores and with Hamilton Depression Rating Scale (HAMD) scores across the three subject groups. The main findings of the present study suggest that error processing is altered in OCD but not in GAD, and that ERN abnormalities in GAD are possibly associated with an overactive response checking process or excessive response monitoring.     

Reduced error monitoring in children with autism spectrum disorder: an ERP study

This study investigated self-monitoring in children with autism spectrum disorder (ASD) with event-related potentials looking at both the error-related negativity (ERN) and error-related positivity (Pe). The ERN is related to early error/conflict detection, and the Pe has been associated with conscious error evaluation or attention allocation. In addition, post-error slowing in reaction times (RTs) was measured. Children with ASD and age- and IQ- matched controls were administered an easy and a hard version of an auditory decision task. Results showed that the ERN was smaller in children with ASD but localized in the anterior cingulate cortex (ACC) in both groups. In addition we found a negativity on correct trials (CRN) that did not differ between the groups. Furthermore, a reduced Pe and a lack of post-error slowing in RTs were found in children with ASD. The reduced ERN in children with ASD, in the presence of an intact CRN, might suggest a specific insensitivity to detect situations in which the chance of making errors is enhanced. This might in turn lead to reduced error awareness/attention allocation to the erroneous event (reduced Pe) and eventually in a failure in change of strategy to deal with a situation, as becomes evident from the lack of post-error slowing in the ASD group. This relates well to the perseverative behaviour that is seen in children with ASD. We discuss these results in terms of a general deficit in self-monitoring, underlying social disturbance in ASD and the involvement of the ACC.     

State dependent changes in error monitoring in schizophrenia

The aim of this study was to determine if error negativity/error-related negativity (N(e)/ERN), error positivity (P(e)), correct response negativity (CRN) or correct response positivity (P(c)) amplitude are influenced by state changes in schizophrenia. Event-related potentials (ERPs) were recorded from nine schizophrenic patients while they performed a simple go/no-go task during the early stages of an acute episode and again following 6 weeks of treatment with antipsychotics. ERPs were also recorded from nine healthy participants while they performed the same task. Response-locked potentials were computed for errors of commission and for correct responses. Scores for reality distortion syndrome, psychomotor poverty syndrome and disorganization syndrome were determined for the schizophrenic participants before and after treatment using the Signs and Symptoms of Psychotic Illness (SSPI) Scale. N(e)/ERN amplitude was significantly reduced, compared with that in healthy participants, in the schizophrenic patients when acutely ill, and increased significantly following treatment. N(e)/ERN amplitude remained significantly larger in the healthy group than in the patients with schizophrenia after treatment. This study suggests that N(e)/ERN and CRN amplitude are modulated by clinical state in schizophrenia and provides further support to findings that decreased N(e)/ERN amplitude is a potentially useful trait marker for schizophrenia, while P(c) and P(e) amplitude are not abnormal.     

The impact of perfectionism and anxiety traits on action monitoring in major depressive disorder

Perfectionism and anxiety features are involved in the clinical presentation and neurobiology of major depressive disorder (MDD). In MDD, cognitive control mechanisms such as action monitoring can adequately be investigated applying electrophysiological registrations of the error-related negativity (ERN) and error positivity (Pe). It is also known that traits of perfectionism and anxiety influence ERN amplitudes in healthy subjects. The current study explores the impact of perfectionism and anxiety traits on action monitoring in MDD. A total of 39 MDD patients performed a flankers task during an event-related potential (ERP) session and completed the multidimensional perfectionism scale (MPS) with its concern over mistakes (CM) and doubt about actions (DA) subscales and the trait form of the State Trait Anxiety Inventory. Multiple regression analyses with stepwise backward elimination revealed MPS-DA to be a significant predictor (R ²:0.22) for the ERN outcomes, and overall MPS (R ²:0.13) and MPS-CM scores (R ²:0.18) to have significant predictive value for the Pe amplitudes. Anxiety traits did not have a predictive capacity for the ERPs. MPS-DA clearly affected the ERN, and overall MPS and MPS-CM influenced the Pe, whereas no predictive capacity was found for anxiety traits. The manifest impact of perfectionism on patients’ error-related ERPs may contribute to our understanding of the action-monitoring process and the functional significance of the Pe in MDD. The divergent findings for perfectionism and anxiety features also indicate that the wide range of various affective personality styles might exert a different effect on action monitoring in MDD, awaiting further investigation.     

Neural correlates of performance monitoring in adult patients with attention deficit hyperactivity disorder (ADHD)

Introduction. In this study, the neural correlates of error processing in adult patients with attention deficit hyperactivity disorder (ADHD) are to be investigated for the first time. Recent studies in children with ADHD suggested, with some inconsistencies, deficits in error processing. Based on an analogue study with students, we hypothesized that ADHD patients show reduced amplitudes in the event-related potential (ERP) of the Pe (error positivity) but normal amplitudes of the ERN (error-related negativity) after incorrect responses. Method. In this study we investigated 34 adult ADHD patients and 34 healthy controls with a modified version of the Eriksen flanker task while recording the neural activity with 26 scalp EEG electrodes. Patients discontinued all medication at least 3 days prior to investigation. Age was included as a control variable for the statistical analyses. Results and conclusion. As hypothesized, we found reduced Pe amplitudes, but also reduced ERN values, in ADHD patients. Importantly, theses differences as well as the deficits in behavioural performance were mainly detectable in the younger subsample, but not in the elderly subsample. Our results indicate that adult ADHD patients are characterized by deficits in error processing, which vanish with age.     

Parametric modulation of error-related ERP components by the magnitude of visuo-motor mismatch

Errors generate typical brain responses, characterized by two successive event-related potentials (ERP) following incorrect action: the error-related negativity (ERN) and the positivity error (Pe). However, it is unclear whether these error-related responses are sensitive to the magnitude of the error, or instead show all-or-none effects. We studied error-monitoring with ERPs while healthy adult participants performed ballistic pointing movements towards a visual target with or without optical prisms, in alternating runs. This allowed us to record variable pointing errors, ranging from slight to large deviations relative to the visual target. Behavioural results demonstrated a classic effect of prisms on pointing (i.e. initial shifts away from targets, with rapidly improving performance), as well as robust prismatic after-effects (i.e. deviations in the opposite direction when removing the prisms after successful adaptation). Critically, the amplitude of both ERN and Pe were strongly influenced by the magnitude of errors. Error-related ERPs were observed for large deviations, but their amplitudes decreased monotonically when pointing accuracy increased, revealing a parametric modulation of monitoring systems as a function of the severity of errors. These results indicate that early error detection mechanisms do not represent failures in an all-or-none manner, but rather encode the degree of mismatch between the actual and expected motor outcome, providing a flexible cognitive control process that can discriminate between different degrees of mismatch between intentions and outcomes.     

Processing of Positive and Negative Feedback in Patients with Cerebellar Lesions

It is well accepted that the cerebellum plays a crucial role in the prediction of the sensory consequences of movements. Recent findings of altered error processing in patients with selective cerebellar lesions led to the hypothesis that feedback processing and feedback-based learning might be affected by cerebellar damage as well. Thus, the present study investigated learning from and processing of positive and negative feedback in 12 patients with selective cerebellar lesions and healthy control subjects. Participants performed a monetary feedback learning task. The processing of positive and negative feedback was assessed by means of event-related potentials (ERPs) during the learning task and during a separate task in which the frequencies of positive and negative feedback were balanced. Patients did not show a general learning deficit compared to controls. Relative to the control group, however, patients with cerebellar lesions showed significantly higher ERP difference wave amplitudes (rewards–losses) in a time window between 250 and 450 ms after feedback presentation, possibly indicating impaired outcome prediction. The analysis of the original waveforms suggested that patients and controls primarily differed in their pattern of feedback-related negativity and P300 amplitudes. Our results add to recent findings on altered performance monitoring associated with cerebellar damage and demonstrate, for the first time, alterations of feedback processing in patients with cerebellar damage. Unaffected learning performance appears to suggest that chronic cerebellar lesions can be compensated in behaviour.     

Unavoidable errors: a spatio-temporal analysis of time-course and neural sources of evoked potentials associated with error processing in a speeded task

The detection of errors is known to be associated with two successive neurophysiological components in EEG, with an early time-course following motor execution: the error-related negativity (ERN/Ne) and late positivity (Pe). The exact cognitive and physiological processes contributing to these two EEG components, as well as their functional independence, are still partly unclear. Furthermore, these components are typically obtained in conditions where errors are rare events relative to correct trials, and thus presumably implicate other cognitive and motivational processes besides error monitoring. Here, we investigated error processing using high-density scalp ERPs and advanced topographical analyses in healthy participants, during a new Go/noGo task that led to many errors within a relatively short period of time, yet without generating frustration or insufficient motivation. ERP results showed the presence of two distinct electrophysiological markers of error monitoring (ERN/Ne and Pe) during this task, even though errors were practically as frequent as correct responses. Topographic mapping analyses showed for the first time that both the ERN/Ne and Pe elicited a specific distribution of electrical activity relative to correct responses (not just a change in the amplitude of electric signals), suggesting the activation of a distinct configuration of intracranial generators during error detection. This was confirmed by additional analyses using dipole source localization, showing generators in anterior cingulate cortex contributing to the ERN/Ne, but in more posterior cingulate regions for Pe. Moreover, we found that, across all participants, the magnitude of the ERN/Ne correlated with the level of state anxiety, even in the subclinical range, whereas the Pe was correlated negatively with the total number of errors and positively with the improvement of response speed on correct trials. By contrast, no significant relation was found between error monitoring ERPs and individual measures of impulsivity. Taken together, these data suggest that these two successive EEG components associated with errors reflect different monitoring processes, with distinct neural substrates in cingulate cortex. While ERN/Ne processes in anterior cingulate might primarily mediate error detection, Pe processes in posterior cingulate might be more directly related to behavioral adjustment based on the outcome of current actions.     

Error processing in the adolescent brain: Age-related differences in electrophysiology,behavioral adaptation,and brain morphology

Detecting errors and adjusting behaviour appropriately are fundamental cognitive abilities that are known to improve through adolescence. The cognitive and neural processes underlying this development, however, are still poorly understood. To address this knowledge gap, we performed a thorough investigation of error processing in a Flanker task in a cross-sectional sample of participants 8 to 19 years of age (n = 98). We examined age-related differences in event-related potentials known to be associated with error processing, namely the error-related negativity (ERN) and the error positivity (Pe), as well as their relationships with task performance, post-error adjustments and regional cingulate cortex thickness and surface area. We found that ERN amplitude increased with age, while Pe amplitude remained constant. A more negative ERN was associated with higher task accuracy and faster reaction times, while a more positive Pe was associated with higher accuracy, independently of age. When estimating post-error adjustments from trials following both incongruent and congruent trials, post-error slowing and post-error improvement in accuracy both increased with age, but this was only found for post-error slowing when analysing trials following incongruent trials. There were no age-independent associations between either ERN or Pe amplitude and cingulate cortex thickness or area measures.     

Developmental changes in error monitoring: an event-related potential study

The aim of the study was to investigate the developmental trajectory of error monitoring. For this purpose, children (age 7-8), young adolescents (age 13-14) and adults (age 23-24) performed a Go/No-Go task and were compared on overt reaction time (RT) performance and on event-related potentials (ERPs), thought to reflect error detection (error-related negativity: ERN) and conscious evaluation (error positivity: Pe) of the error. RT on correct trials, variability of responding and percentage of errors decreased with age. The latencies of incorrect responses, compared to correct responses, were shorter in children and adolescents than in adults, indicative of developmental changes in impulsive response style. Groups did not differ in the ability to adjust response strategies after making an error (post-error slowing). The ERN amplitude increased with age, the Pe amplitude did not change with age. Possible explanations for the developmental changes in ERN are discussed.     

Age-related changes in error processing in young children: A school-based investigation

Growth in executive functioning (EF) skills play a role children's academic success, and the transition to elementary school is an important time for the development of these abilities. Despite this, evidence concerning the development of the ERP components linked to EF, including the error-related negativity (ERN) and the error positivity (Pe), over this period is inconclusive. Data were recorded in a school setting from 3- to 7-year-old children (N = 96, mean age = 5 years 11 months) as they performed a Go/No-Go task. Results revealed the presence of the ERN and Pe on error relative to correct trials at all age levels. Older children showed increased response inhibition as evidenced by faster, more accurate responses. Although developmental changes in the ERN were not identified, the Pe increased with age. In addition, girls made fewer mistakes and showed elevated Pe amplitudes relative to boys. Based on a representative school-based sample, findings indicate that the ERN is present in children as young as 3, and that development can be seen in the Pe between ages 3 and 7. Results varied as a function of gender, providing insight into the range of factors associated with developmental changes in the complex relations between behavioral and electrophysiological measures of error processing.     

Early math and reading achievement are associated with the error positivity

Executive functioning (EF) and motivation are associated with academic achievement and error-related ERPs. The present study explores whether early academic skills predict variability in the error-related negativity (ERN) and error positivity (Pe). Data from 113 three- to seven-year-old children in a Go/No-Go task revealed that stronger early reading and math skills predicted a larger Pe. Closer examination revealed that this relation was quadratic and significant for children performing at or near grade level, but not significant for above-average achievers. Early academics did not predict the ERN. These findings suggest that the Pe – which reflects individual differences in motivational processes as well as attention – may be associated with early academic achievement.     

Altered error-related brain activity in youth with major depression

Depression is associated with impairments in cognitive control including action monitoring processes, which involve the detection and processing of erroneous responses in order to adjust behavior. Although numerous studies have reported altered error-related brain activity in depressed adults, relatively little is known about age-related changes in error-related brain activity in depressed youth. This study focuses on the error-related negativity (ERN), a negative deflection in the event-related potential (ERP) that is maximal approximately 50ms following errors. High-density ERPs were examined following responses on a flanker task in 24 youth diagnosed with MDD and 14 low-risk healthy controls (HC). Results indicate that compared to HC, MDD youth had significantly smaller ERN amplitudes and did not exhibit the normative increases in ERN amplitudes as a function of age. Also, ERN amplitudes were similar in depressed youth with and without comorbid anxiety. These results suggest that depressed youth exhibit different age-related changes in brain activity associated with action monitoring processes. Findings are discussed in terms of existing work on the neural correlates of action monitoring and depression and the need for longitudinal research studies investigating the development of neural systems underlying action monitoring in youth diagnosed with and at risk for depression.