Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision-making

Impact of ADHD symptoms on clinical and cognitive aspects of problem gambling

BACKGROUND

Problem gambling is common across cultures, and has been conceptualized in terms of impulsivity. While elevated rates of attention deficit hyperactivity disorder (ADHD) have been observed in problem gamblers, the relationship between these two conditions, and other dissociable forms of impulsivity, has received little research attention.

METHODS

N=126 non-treatment seeking young adults with problem gambling were recruited from the community, and were grouped according to the presence or absence of probable current ADHD. Clinical and cognitive measures pertaining to impulsivity were collected via detailed psychiatric assessment, questionnaires, and computerized neuropsychological tests. These variables were compared between groups.

RESULTS

Probable current ADHD was identified in 21.4% of the sample, and was associated with earlier age at onset of gambling behaviors, higher Barratt impulsivity scores (all three subscales), greater caffeine intake, worse response inhibition (Stop-Signal Test), and impaired decision-making (greater proportion of points gambled, Cambridge Gamble Test). Problem gamblers with and without ADHD did not differ on demographic characteristics or the rate of other psychiatric disorders, depression scores, nicotine and alcohol consumption, and body mass index. No significant group differences were found for general response speed, working memory, or executive planning.

CONCLUSIONS

ADHD is common in young adults with dysfunctional gambling behaviors and is associated with elevated questionnaire and cognitive based measures of impulsivity, along with heightened caffeine use. Future work should study the causal nature between these factors and the treatment implications of these findings.

Economic risk coding by single neurons in the orbitofrontal cortex

Risk is a ubiquitous feature of the environment for all organisms. Very few things in life are achieved with absolute certainty. Therefore, it is essential that organisms process risky information efficiently to promote adaptive behaviour and enhance survival. Here we outline a clear definition of economic risk derived from economic theory and focus on two experiments in which we have shown subpopulations of single neurons in the orbitofrontal cortex of rhesus macaques that code either economic risk per se or an error-related risk signal, namely a risk prediction error. These biological risk signals are essential for processing and updating risky information in the environment to contribute to efficient decision making and adaptive behaviour.

Punishment and psychopathy: a case-control functional MRI investigation of reinforcement learning in violent antisocial personality disordered men

BACKGROUND

Men with antisocial personality disorder show lifelong abnormalities in adaptive decision making guided by the weighing up of reward and punishment information. Among men with antisocial personality disorder, modification of the behaviour of those with additional diagnoses of psychopathy seems particularly resistant to punishment.

METHODS

We did a case-control functional MRI (fMRI) study in 50 men, of whom 12 were violent offenders with antisocial personality disorder and psychopathy, 20 were violent offenders with antisocial personality disorder but not psychopathy, and 18 were healthy non-offenders. We used fMRI to measure brain activation associated with the representation of punishment or reward information during an event-related probabilistic response-reversal task, assessed with standard general linear-model-based analysis.

FINDINGS

Offenders with antisocial personality disorder and psychopathy displayed discrete regions of increased activation in the posterior cingulate cortex and anterior insula in response to punished errors during the task reversal phase, and decreased activation to all correct rewarded responses in the superior temporal cortex. This finding was in contrast to results for offenders without psychopathy and healthy non-offenders.

INTERPRETATION

Punishment prediction error signalling in offenders with antisocial personality disorder and psychopathy was highly atypical. This finding challenges the widely held view that such men are simply characterised by diminished neural sensitivity to punishment. Instead, this finding indicates altered organisation of the information-processing system responsible for reinforcement learning and appropriate decision making. This difference between violent offenders with antisocial personality disorder with and without psychopathy has implications for the causes of these disorders and for treatment approaches.

FUNDING

National Forensic Mental Health Research and Development Programme, UK Ministry of Justice, Psychiatry Research Trust, NIHR Biomedical Research Centre.

Reward processing in neurodegenerative disease

Representation of reward value involves a distributed network including cortical and subcortical structures. Because neurodegenerative illnesses target specific anatomic networks that partially overlap with the reward circuit, they would be predicted to have distinct impairments in reward processing. This review presents the existing evidence of reward processing changes in neurodegenerative diseases including mild cognitive impairment (MCI), Alzheimer's disease, frontotemporal dementia, amyotrophic lateral sclerosis (ALS), Parkinson's disease, and Huntington's disease, as well as in healthy aging. Carefully distinguishing the different aspects of reward processing (primary rewards, secondary rewards, reward-based learning, and reward-based decision-making) and using tasks that differentiate the stages of processing reward will lead to improved understanding of this fundamental process and clarify a contributing cause of behavioral change in these illnesses.

Anterior insula responds to temporally unpredictable aversiveness: an fMRI study

A heightened sensitivity to unpredictable aversiveness is a key component of several anxiety disorders. Neuroimaging studies of unpredictable aversiveness have shown that the anterior region of the insula cortex (AIC) plays a central role in the anticipation of unpredictable aversiveness. The present study extended these findings by examining the role of the AIC in temporal unpredictability (i.e. not knowing when the stimulus will occur), a particularly critical aspect of unpredictability as it increases contextual anxiety and vigilance, given that the danger could happen 'at any time'. Nineteen healthy participants underwent functional MRI while anticipating either temporally unpredictable or predictable aversive (or neutral) images. Participants showed greater right AIC activation while anticipating unpredictable relative to predictable aversive images. In addition, activation in this region was correlated positively with self-reported individual differences in a key facet of intolerance of uncertainty (inhibitory behavior). Taken together, the present study suggests that the AIC plays an important role in the anticipation of temporally unpredictable aversiveness and may mediate key deficits in anxiety disorders.

Relationship of γ-aminobutyric acid and glutamate+glutamine concentrations in the perigenual anterior cingulate cortex with performance of Cambridge Gambling Task

The anterior cingulate cortex (ACC), consisting of the perigenual ACC (pgACC) and mid-ACC (i.e., affective and cognitive areas, respectively), plays a significant role in the performance of gambling tasks, which are used to measure decision-making behavior under conditions of risk. Although recent neuroimaging studies have suggested that the γ-aminobutyric acid (GABA) concentration in the pgACC is associated with decision-making behavior, knowledge regarding the relationship of GABA concentrations in subdivisions of the ACC with gambling task performance is still limited. The aim of our magnetic resonance spectroscopy study is to investigate in 20 healthy males the relationship of concentrations of GABA and glutamate+glutamine (Glx) in the pgACC, mid-ACC, and occipital cortex (OC) with multiple indexes of decision-making behavior under conditions of risk, using the Cambridge Gambling Task (CGT). The GABA/creatine (Cr) ratio in the pgACC negatively correlated with delay aversion score, which corresponds to the impulsivity index. The Glx/Cr ratio in the pgACC negatively correlated with risk adjustment score, which is reported to reflect the ability to change the amount of the bet depending on the probability of winning or losing. The scores of CGT did not significantly correlate with the GABA/Cr or Glx/Cr ratio in the mid-ACC or OC. Results of this study suggest that in the pgACC, but not in the mid-ACC or OC, GABA and Glx concentrations play a distinct role in regulating impulsiveness and risk probability during decision-making behavior under conditions of risk, respectively.

Impaired executive functioning after left anterior insular stroke: a case report

Given the insular's anatomic complexity and functional interconnectivity, acute lesions may result in varied clinical presentations, including autonomic, somatosensory, perceptual, motor, affective, and cognitive deficits. Although functional neuroimaging studies have demonstrated its role in executive functions, no clinical manifestations have been reported to date. We present the case of a woman with an acute left anterior insular infarction leading to executive (i.e., word and design fluency, mental flexibility, sustained attention, inhibitory control), but not language, visuoperceptual, or memory impairment. This case confirms the left anterior insula's involvement in executive functioning and suggests that an infarction may result in executive impairment.

Risk-sensitive decision-making in patients with posterior parietal and ventromedial prefrontal cortex injury

Successful choice under risk requires the integration of information about outcome probabilities and values and implicates a brain network including the ventromedial prefrontal cortex (vmPFC) and posterior parietal cortex (pPAR). Damage to the vmPFC is linked to poor decision-making and increased risk-taking. Electrophysiological and neuroimaging data implicate the pPAR in the processing of reward probability during choice, but the causal contribution of this area has not been established. We compared patients with lesions to the pPAR (n = 13), vmPFC (n = 13), and healthy volunteers (n = 22) on the Roulette Betting Task, a measure of risk-sensitive decision-making. Both lesion groups were impaired in adjusting their bets to the probability of winning. This impairment was correlated with the extent of pPAR, but not vmPFC, damage. In addition, the vmPFC group chose higher bets than healthy controls overall, an effect that correlated with lesion volume in the medial orbitofrontal cortex. Both lesion groups earned fewer points than healthy controls. The groups did not differ on 2 tasks assessing probabilistic reasoning outside of a risk-reward context. Our results demonstrate the causal involvement of both the pPAR and vmPFC in risk-sensitive choice and indicate distinguishable roles of these areas in probability processing and risk appetite.

Decision making in young people at familial risk of depression

BACKGROUND

Major depression is associated with abnormalities in reward processing at neural and behavioural levels. Neural abnormalities in reward have been described in young people at familial risk of depression but behavioural changes in reward-based decision making have been less studied in this group.

METHOD

We studied 63 young people (mean age 18.9 years) with a parent with a diagnosis of major depression but who had never been depressed themselves, that is with a positive family history of depression (the FH+ group). Participants performed the Cambridge Gambling Task (CGT), which provides several measures of decision making including deliberation time, quality of decision making, risk taking, risk adjustment and delay aversion. A control group of 49 age- and gender-matched young people with no history of mood disorder in a first-degree relative undertook the same task.

RESULTS

Both FH+ participants and controls had low and equivalent scores on anxiety and depression self-rating scales. Compared to controls, the FH+ participants showed overall lower risk taking, although like controls they made more risky choices as the odds of a favourable outcome increased. No other measures of decision making differed between the two groups.

CONCLUSIONS

Young people at increased familial risk of depression have altered risk taking that is not accounted for by current affective symptomatology. Lowered risk taking might represent an impairment in reward seeking, which is one of several changes in reward-based behaviours seen in acutely depressed patients; however, our findings suggest that decreased reward seeking could be part of a risk endophenotype for depression.

Suicidality in non-treatment seeking young adults with subsyndromal gambling disorder

Gambling Disorder is associated with elevated rates of suicidal thoughts and acts. However, virtually nothing is known about suicidality in people with subsyndromal forms of gambling disorder. A total of 174 non-treatment seeking subjects were recruited for a study of impulsivity and met criteria for a subsyndromal form of DSM-5 gambling disorder (31.0 % females; mean age = 21.7 ± 3.61 years). Subjects were categorized as being 'at risk of suicide' or 'no suicide risk' based on the Mini-International Neuropsychiatric Interview (MINI). Those with and without suicidality were compared on clinical and cognitive measures. 32 (18.4 %) met MINI criteria for suicidality. Suicidality was significantly associated with mood and anxiety disorders, greater rates of nicotine consumption, and relative impairments in decision-making and cognitive flexibility. These findings suggest that decision-making impairments may be implicated in the development of both gambling problems and suicidality. Future work should address causality, neural correlates, and tailored suicide prevention strategies for people with, or at risk for, disordered forms of gambling.

Impaired decision-making and selective cortical frontal thinning in Cushing's syndrome

CONTEXT AND OBJECTIVE

Cushing's syndrome (CS) is caused by a glucocorticoid excess. This hypercortisolism can damage the prefrontal cortex, known to be important in decision-making. Our aim was to evaluate decision-making in CS and to explore cortical thickness.

SUBJECTS AND METHODS

Thirty-five patients with CS (27 cured, eight medically treated) and thirty-five matched controls were evaluated using Iowa gambling task (IGT) and 3 Tesla magnetic resonance imaging (MRI) to assess cortical thickness. The IGT evaluates decision-making, including strategy and learning during the test. Cortical thickness was determined on MRI using freesurfer software tools, including a whole-brain analysis.

RESULTS

There were no differences between medically treated and cured CS patients. They presented an altered decision-making strategy compared to controls, choosing a lower number of the safer cards (P < 0·05). They showed more difficulties than controls to learn the correct profiles of wins and losses for each card group (P < 0·05). In whole-brain analysis, patients with CS showed decreased cortical thickness in the left superior frontal cortex, left precentral cortex, left insular cortex, left and right rostral anterior cingulate cortex, and right caudal middle frontal cortex compared to controls (P < 0·001).

CONCLUSIONS

Patients with CS failed to learn advantageous strategies and their behaviour was driven by short-term reward and long-term punishment, indicating learning problems because they did not use previous experience as a feedback factor to regulate their choices. These alterations in decision-making and the decreased cortical thickness in frontal areas suggest that chronic hypercortisolism promotes brain changes which are not completely reversible after endocrine remission.

Displaced aggression predicts switching deficits in people with temporal lobe epilepsy

This study examined the relationship between task-switching abilities and displaced aggression in people with temporal lobe epilepsy (PWE). Participants (35 PWE and 35 healthy controls) performed emotion and gender classification switching tasks. People with temporal lobe epilepsy showed larger switch costs than controls. This result reflected task-switching deficits in PWE. People with temporal lobe epilepsy reported higher anger rumination, revenge planning, and behavioral displaced aggression compared with controls. Displaced aggression was a significant predictor of the task switch costs. It is suggested that displaced aggression is a significant marker of task-switching deficits.

The neural bases for valuing social equality

The neural basis of how humans value and pursue social equality has become a major topic in social neuroscience research. Although recent studies have identified a set of brain regions and possible mechanisms that are involved in the neural processing of equality of outcome between individuals, how the human brain processes equality of opportunity remains unknown. In this review article, first we describe the importance of the distinction between equality of outcome and equality of opportunity, which has been emphasized in philosophy and economics. Next, we discuss possible approaches for empirical characterization of human valuation of equality of opportunity vs. equality of outcome. Understanding how these two concepts are distinct and interact with each other may provide a better explanation of complex human behaviors concerning fairness and social equality.

A longitudinal high-risk study of adolescent anxiety, depression and parent-severity on the developmental course of risk-adjustment

BACKGROUND

Adolescence is associated with developments in the reward system and increased rates of emotional disorders. Familial risk for depression may be associated with disruptions in the reward system. However, it is unclear how symptoms of depression and anxiety influence the development of reward-processing over adolescence and whether variation in the severity of parental depression is associated with hyposensitivity to reward in a high-risk sample.

METHODS

We focused on risk-adjustment (adjusting decisions about reward according to the probability of obtaining reward) as this was hypothesized to improve over adolescence. In a one-year longitudinal sample (N = 197) of adolescent offspring of depressed parents, we examined how symptoms of depression and anxiety (generalized anxiety and social anxiety) influenced the development of risk-adjustment. We also examined how parental depression severity influenced adolescent risk-adjustment.

RESULTS

Risk-adjustment improved over the course of the study indicating improved adjustment of reward-seeking to shifting contingencies. Depressive symptoms were associated with decreases in risk-adjustment over time while social anxiety symptoms were associated with increases in risk-adjustment over time. Specifically, depression was associated with reductions in reward-seeking at favourable reward probabilities only, whereas social anxiety (but not generalized anxiety) led to reductions in reward-seeking at low reward probabilities only. Parent depression severity was associated with lowered risk-adjustment in offspring and also influenced the longitudinal relationship between risk-adjustment and offspring depression.

CONCLUSIONS

Anxiety and depression distinctly alter the pattern of longitudinal change in reward-processing. Severity of parent depression was associated with alterations in adolescent offspring reward-processing in a high-risk sample.

Transient inactivation of the medial prefrontal cortex impairs performance on a working memory-dependent conditional discrimination task

The rodent medial prefrontal cortex (mPFC) has been implicated in working memory function; lesions and inactivation of this region have been shown to result in impairments in spatial working memory (WM) tasks. Our laboratory has developed a tactile-visual conditional discrimination (CD) task, which uses floor insert cues to signal the correct goal-arm choice in a T maze. This task can be manipulated by altering the floor insert cues to be present throughout the trial (CDSTANDARD) or to be present only at the beginning of the trial (CDWM), thus making the task either WM-independent or WM-dependent, respectively. This ability to manipulate the working memory demand of the task while holding all other task features constant allows us to rule out the possibility that confounding performance variables contribute to the observed impairment. A previous study from our lab showed that mPFC inactivation did not impair performance on CDSTANDARD, confirming that mPFC inactivation does not induce sensorimotor or motivational deficits that could impact task performance. To examine whether mPFC inactivation impairs CDWM, the current study transiently inactivated the mPFC with bilateral microinfusions of muscimol immediately prior to testing on the CDWM task. As predicted, CDWM task performance was significantly impaired during the muscimol-infusion session compared with the control saline-infusion sessions. Together with our previous demonstration that the mPFC in not required for CDSTANDARD, these results not only confirm that the mPFC is crucial for working memory, but also set the stage for using the task-comparison approach to investigate corticolimbic interactions during working memory.

Neural mechanisms underlying context-dependent shifts in risk preferences

Studies of risky decision-making have demonstrated that humans typically prefer risky options after incurring a financial loss, while generally preferring safer options after a monetary gain. Here, we examined the neural processes underlying these inconsistent risk preferences by investigating the evaluation of gains and losses, and demonstrating how these responses can impact subsequent preference for either risky or safe choice options. Participants performed a task while undergoing fMRI in which they experienced both gains and losses. Immediately following a gain or loss, participants decided to either play or pass on a "double-or-quits" gamble. The outcome of the gamble could either double or eliminate their initial gain (from the time-estimation task) or redeem or double their initial loss. If they chose not to play this gamble, they retained the initial gain or loss. We demonstrate a shift in risk-taking preferences for identical sets of gambles as a function of previous gains or losses, with participants showing a greater preference towards riskier decisions in the context of a prior loss. An interaction between evaluating gain/loss contexts and subsequent behavioral risk pattern revealed an increased BOLD response in the ventromedial prefrontal cortex (vmPFC), with stronger responses for both gambling in a loss context and safety in a gain context. This suggests that the vmPFC is responsible for integrating these contextual effects, with these processes impacting on subsequent risky choice.

Cognitive control in the self-regulation of physical activity and sedentary behavior

Cognitive control of physical activity and sedentary behavior is receiving increased attention in the neuroscientific and behavioral medicine literature as a means of better understanding and improving the self-regulation of physical activity. Enhancing individuals' cognitive control capacities may provide a means to increase physical activity and reduce sedentary behavior. First, this paper reviews emerging evidence of the antecedence of cognitive control abilities in successful self-regulation of physical activity, and in precipitating self-regulation failure that predisposes to sedentary behavior. We then highlight the brain networks that may underpin the cognitive control and self-regulation of physical activity, including the default mode network, prefrontal cortical networks and brain regions and pathways associated with reward. We then discuss research on cognitive training interventions that document improved cognitive control and that suggest promise of influencing physical activity regulation. Key cognitive training components likely to be the most effective at improving self-regulation are also highlighted. The review concludes with suggestions for future research.

Ventromedial prefrontal cortex lesions alter neural and physiological correlates of anticipation

Uncertainty is a ubiquitous feature of our daily lives. Although previous studies have identified a number of neural and peripheral physiological changes associated with uncertainty, there are limited data on the causal mechanisms underlying these responses in humans. In this study, we address this empirical gap through a novel application of fMRI in neurosurgical patients with focal, bilateral ventromedial prefrontal cortex (vmPFC) damage. The fMRI task involved cued anticipation of aversive and neutral picture stimuli; "certain" cues unambiguously indicated the upcoming picture valence, whereas "ambiguous" cues could precede either picture type. Healthy subjects exhibited robust bilateral insula responses to ambiguous cues, and this cue-related insula activity significantly correlated with heart rate variability during the task. By contrast, the vmPFC lesion patients exhibited altered cue-related insula activity and reduced heart rate variability. These findings suggest a role for vmPFC in coordinating neural and physiological responses during anticipation.

Human brain structure predicts individual differences in preconscious evaluation of facial dominance and trustworthiness

Social cues conveyed by the human face, such as eye gaze direction, are evaluated even before they are consciously perceived. While there is substantial individual variability in such evaluation, its neural basis is unknown. Here we asked whether individual differences in preconscious evaluation of social face traits were associated with local variability in brain structure. Adult human participants (n = 36) monocularly viewed faces varying in dominance and trustworthiness, which were suppressed from awareness by a dynamic noise pattern shown to the other eye. The time taken for faces to emerge from suppression and become visible (t2e) was used as a measure of potency in competing for visual awareness. Both dominant and untrustworthy faces resulted in slower t2e than neutral faces, with substantial individual variability in these effects. Individual differences in t2e were correlated with gray matter volume in right insula for dominant faces, and with gray matter volume in medial prefrontal cortex, right temporoparietal junction and bilateral fusiform face area for untrustworthy faces. Thus, individual differences in preconscious social processing can be predicted from local brain structure, and separable correlates for facial dominance and untrustworthiness suggest distinct mechanisms of preconscious processing.

Insights into human behavior from lesions to the prefrontal cortex

The prefrontal cortex (PFC), a cortical region that was once thought to be functionally insignificant, is now known to play an essential role in the organization and control of goal-directed thought and behavior. Neuroimaging, neurophysiological, and modeling techniques have led to tremendous advances in our understanding of PFC functions over the last few decades. It should be noted, however, that neurological, neuropathological, and neuropsychological studies have contributed some of the most essential, historical, and often prescient conclusions regarding the functions of this region. Importantly, examination of patients with brain damage allows one to draw conclusions about whether a brain area is necessary for a particular function. Here, we provide a broad overview of PFC functions based on behavioral and neural changes resulting from damage to PFC in both human patients and nonhuman primates.

Retrait de consentement et chirurgie éveillée : illustration et enjeux éthiques

Contexte

Le développement au cours des deniers années des interventions neurochirurgicales sous anesthésie locale, en particulier dans le champ neuro-oncologique, rend possible la question d’une éventuelle révocation per opératoire du consentement du patient à la procédure chirurgicale.

Observation

Les auteurs décrivent la révocation de son consentement par un patient au cours de l’exérèse chirurgicale d’un gliome de bas grade fronto-temporo-insulaire droit.

Discussion

Les aspects spécifiques aux conditions de révocation du consentement dans le contexte particulier de la chirurgie sous anesthésie locale sont discutés. La possibilité d’un pacte d’Ulysse est proposée et discutée.

Conclusions

Les interventions chirurgicales en condition éveillée créent un contexte particulier en ce qu’une révocation du consentement per opératoire devient possible. Dans ces conditions, l’information préopératoire pourrait aussi aborder avec le malade la question de la conduite à tenir au cas où il serait amené à solliciter un retrait de consentement lors de son réveil per opératoire.

Age of second language acquisition affects nonverbal conflict processing in children: an fMRI study

BACKGROUND

In their daily communication, bilinguals switch between two languages, a process that involves the selection of a target language and minimization of interference from a nontarget language. Previous studies have uncovered the neural structure in bilinguals and the activation patterns associated with performing verbal conflict tasks. One question that remains, however is whether this extra verbal switching affects brain function during nonverbal conflict tasks.

METHODS

In this study, we have used fMRI to investigate the impact of bilingualism in children performing two nonverbal tasks involving stimulus-stimulus and stimulus-response conflicts. Three groups of 8-11-year-old children--bilinguals from birth (2L1), second language learners (L2L), and a control group of monolinguals (1L1)--were scanned while performing a color Simon and a numerical Stroop task. Reaction times and accuracy were logged.

RESULTS

Compared to monolingual controls, bilingual children showed higher behavioral congruency effect of these tasks, which is matched by the recruitment of brain regions that are generally used in general cognitive control, language processing or to solve language conflict situations in bilinguals (caudate nucleus, posterior cingulate gyrus, STG, precuneus). Further, the activation of these areas was found to be higher in 2L1 compared to L2L.

CONCLUSION

The coupling of longer reaction times to the recruitment of extra language-related brain areas supports the hypothesis that when dealing with language conflicts the specialization of bilinguals hampers the way they can process with nonverbal conflicts, at least at early stages in life.

Opioid system in the medial prefrontal cortex mediates binge-like eating

Binge eating disorder is an addiction-like disorder characterized by excessive food consumption within discrete periods of time. This study was aimed at understanding the role of the opioid system within the medial prefrontal cortex (mPFC) in the consummatory and motivational aspects of binge-like eating. For this purpose, we trained male rats to obtain either a sugary, highly palatable diet (Palatable rats) or a chow diet (Chow rats) for 1 hour/day. We then evaluated the effects of the opioid receptor antagonist, naltrexone, given either systemically or site-specifically into the nucleus accumbens (NAcc) or the mPFC on a fixed ratio 1 (FR1) and a progressive ratio schedule of reinforcement for food. Finally, we assessed the expression of the genes proopiomelanocortin (POMC), pro-dynorphin (PDyn) and pro-enkephalin (PEnk), coding for the opioids peptides in the NAcc and the mPFC in both groups. Palatable rats rapidly escalated their intake by four times. Naltrexone, when administered systemically and into the NAcc, reduced FR1 responding for food and motivation to eat under a progressive ratio in both Chow and Palatable rats; conversely, when administered into the mPFC, the effects were highly selective for binge eating rats. Furthermore, we found a twofold increase in POMC and a ∼50% reduction in PDyn gene expression in the mPFC of Palatable rats, when compared to control rats; however, no changes were observed in the NAcc. Our data suggest that neuroadaptations of the opioid system in the mPFC occur following intermittent access to highly palatable food, which may be responsible for the development of binge-like eating.

Brain signatures of moral sensitivity in adolescents with early social deprivation

The present study examined neural responses associated with moral sensitivity in adolescents with a background of early social deprivation. Using high-density electroencephalography (hdEEG), brain activity was measured during an intentional inference task, which assesses rapid moral decision-making regarding intentional or unintentional harm to people and objects. We compared the responses to this task in a socially deprived group (DG) with that of a control group (CG). The event-related potentials (ERPs) results showed atypical early and late frontal cortical markers associated with attribution of intentionality during moral decision-making in DG (especially regarding intentional harm to people). The source space of the hdEEG showed reduced activity for DG compared with CG in the right prefrontal cortex, bilaterally in the ventromedial prefrontal cortex (vmPFC), and right insula. Moreover, the reduced response in vmPFC for DG was predicted by higher rates of externalizing problems. These findings demonstrate the importance of the social environment in early moral development, supporting a prefrontal maturation model of social deprivation.

The role of dopamine in risk taking: a specific look at Parkinson's disease and gambling

An influential model suggests that dopamine signals the difference between predicted and experienced reward. In this way, dopamine can act as a learning signal that can shape behaviors to maximize rewards and avoid punishments. Dopamine is also thought to invigorate reward seeking behavior. Loss of dopamine signaling is the major abnormality in Parkinson’s disease. Dopamine agonists have been implicated in the occurrence of impulse control disorders in Parkinson’s disease patients, the most common being pathological gambling, compulsive sexual behavior, and compulsive buying. Recently, a number of functional imaging studies investigating impulse control disorders in Parkinson’s disease have been published. Here we review this literature, and attempt to place it within a decision-making framework in which potential gains and losses are evaluated to arrive at optimum choices. We also provide a hypothetical but still incomplete model on the effect of dopamine agonist treatment on these value and risk assessments. Two of the main brain structures thought to be involved in computing aspects of reward and loss are the ventral striatum (VStr) and the insula, both dopamine projection sites. Both structures are consistently implicated in functional brain imaging studies of pathological gambling in Parkinson’s disease.

The neural bases underlying social risk perception in purchase decisions

Social considerations significantly influence daily purchase decisions, and the perception of social risk (i.e., the anticipated disapproval of others) is crucial in dissuading consumers from making purchases. However, the neural basis for consumers' perception of social risk remains undiscovered, and this novel study clarifies the relevant neural processes. A total of 26 volunteers were scanned while they evaluated purchase intention of products (purchase intention task) and their anticipation of others' disapproval for possessing a product (social risk task), using functional magnetic resonance imaging (fMRI). The fMRI data from the purchase intention task was used to identify the brain region associated with perception of social risk during purchase decision making by using subjective social risk ratings for a parametric modulation analysis. Furthermore, we aimed to explore if there was a difference between participants' purchase decisions and their explicit evaluations of social risk, with reference to the neural activity associated with social risk perception. For this, subjective social risk ratings were used for a parametric modulation analysis on fMRI data from the social risk task. Analysis of the purchase intention task revealed a significant positive correlation between ratings of social risk and activity in the anterior insula, an area of the brain that is known as part of the emotion-related network. Analysis of the social risk task revealed a significant positive correlation between ratings of social risk and activity in the temporal parietal junction and the medial prefrontal cortex, which are known as theory-of-mind regions. Our results suggest that the anterior insula processes consumers' social risk implicitly to prompt consumers not to buy socially unacceptable products, whereas ToM-related regions process such risk explicitly in considering the anticipated disapproval of others. These findings may prove helpful in understanding the mental processes involved in purchase decisions.

Damage to insula abolishes cognitive distortions during simulated gambling

Gambling is a naturalistic example of risky decision-making. During gambling, players typically display an array of cognitive biases that create a distorted expectancy of winning. This study investigated brain regions underpinning gambling-related cognitive distortions, contrasting patients with focal brain lesions to the ventromedial prefrontal cortex (vmPFC), insula, or amygdala ("target patients") against healthy comparison participants and lesion comparison patients (i.e., with lesions that spare the target regions). A slot machine task was used to deliver near-miss outcomes (i.e., nonwins that fall spatially close to a jackpot), and a roulette game was used to examine the gambler's fallacy (color decisions following outcome runs). Comparison groups displayed a heightened motivation to play following near misses (compared with full misses), and manifested a classic gambler's fallacy effect. Both effects were also observed in patients with vmPFC and amygdala damage, but were absent in patients with insula damage. Our findings indicate that the distorted cognitive processing of near-miss outcomes and event sequences may be ordinarily supported by the recruitment of the insula. Interventions to reduce insula reactivity could show promise in the treatment of disordered gambling.

The insula: a critical neural substrate for craving and drug seeking under conflict and risk

Drug addiction is characterized by the inability to control drug use when it results in negative consequences or conflicts with more adaptive goals. Our previous work showed that damage to the insula disrupted addiction to cigarette smoking-the first time that the insula was shown to be a critical neural substrate for addiction. Here, we review those findings, as well as more recent studies that corroborate and extend them, demonstrating the role of the insula in (1) incentive motivational processes that drive addictive behavior, (2) control processes that moderate or inhibit addictive behavior, and (3) interoceptive processes that represent bodily states associated with drug use. We then describe a theoretical framework that attempts to integrate these seemingly disparate findings. In this framework, the insula functions in the recall of interoceptive drug effects during craving and drug seeking under specific conditions where drug taking is perceived as risky and/or where there is conflict between drug taking and more adaptive goals. We describe this framework in an evolutionary context and discuss its implications for understanding the mechanisms of behavior change in addiction treatments.

Emotion-based learning: insights from the Iowa Gambling Task

Interest in the cognitive and/or emotional basis of complex decision-making, and the related phenomenon of emotion-based learning, has been heavily influenced by the Iowa Gambling Task. A number of psychological variables have been investigated as potentially important in understanding emotion-based learning. This paper reviews the extent to which humans are explicitly aware of how we make such decisions; the biasing influence of pre-existing emotional labels; and the extent to which emotion-based systems are anatomically and functionally independent of episodic memory. Review of literature suggests that (i) an aspect of conscious awareness does appear to be readily achieved during the IGT, but as a relatively unfocused emotion-based "gut-feeling," akin to intuition; (ii) Several studies have manipulated the affective pre-loading of IGT tasks, and make it clear that such labeling has a substantial influence on performance, an experimental manipulation similar to the phenomenon of prejudice. (iii) Finally, it appears that complex emotion-based learning can remain intact despite profound amnesia, at least in some neurological patients, a finding with a range of potentially important clinical implications: in the management of dementia; in explaining infantile amnesia; and in understanding of the possible mechanisms of psychotherapy.

Dissecting impulsivity and its relationships to drug addictions

Addictions are often characterized as forms of impulsive behavior. That said, it is often noted that impulsivity is a multidimensional construct, spanning several psychological domains. This review describes the relationship between varieties of impulsivity and addiction-related behaviors, the nature of the causal relationship between the two, and the underlying neurobiological mechanisms that promote impulsive behaviors. We conclude that the available data strongly support the notion that impulsivity is both a risk factor for, and a consequence of, drug and alcohol consumption. While the evidence indicating that subtypes of impulsive behavior are uniquely informative--either biologically or with respect to their relationships to addictions--is convincing, multiple lines of study link distinct subtypes of impulsivity to low dopamine D2 receptor function and perturbed serotonergic transmission, revealing shared mechanisms between the subtypes. Therefore, a common biological framework involving monoaminergic transmitters in key frontostriatal circuits may link multiple forms of impulsivity to drug self-administration and addiction-related behaviors. Further dissection of these relationships is needed before the next phase of genetic and genomic discovery will be able to reveal the biological sources of the vulnerability for addiction indexed by impulsivity.

A rodent version of the Iowa Gambling Task: 7 years of progress

In the Iowa Gambling Task (IGT) subjects need to find a way to earn money in a context of variable wins and losses, conflicting short-term and long-term pay-off, and uncertainty of outcomes. In 2006, we published the first rodent version of the IGT (r-IGT; Behavior Research Methods 38, 470–478). Here, we discuss emerging ideas on the involvement of different prefrontal-striatal networks in task-progression in the r-IGT, as revealed by our studies thus far. The emotional system, encompassing, among others, the orbitofrontal cortex, infralimbic cortex and nucleus accumbens (shell and core area), may be involved in assessing and anticipating the value of different options in the early stages of the task, i.e., as animals explore and learn task contingencies. The cognitive control system, encompassing, among others, the prelimbic cortex and dorsomedial striatum, may be involved in instrumental goal-directed behavior in later stages of the task, i.e., as behavior toward long-term options is strengthened (reinforced) and behavior toward long-term poor options is weakened (punished). In addition, we suggest two directions for future research: (1) the role of the internal state of the subject in decision-making, and (2) studying differences in task-related costs. Overall, our studies have contributed to understanding the interaction between the emotional system and cognitive control system as crucial to navigating human and non-human animals alike through a world of variable wins and losses, conflicting short-term and long-term pay-offs, and uncertainty of outcomes.

Adolescents' risky decision-making activates neural networks related to social cognition and cognitive control processes

This study examines by means of functional magnetic resonance imaging the neural mechanisms underlying adolescents’ risk decision-making in social contexts. We hypothesize that the social context could engage brain regions associated with social cognition processes and developmental changes are also expected. Sixty participants (adolescents: 17–18, and young adults: 21–22 years old) read narratives describing typical situations of decision-making in the presence of peers. They were asked to make choices in risky situations (e.g., taking or refusing a drug) or ambiguous situations (e.g., eating a hamburger or a hotdog). Risky as compared to ambiguous scenarios activated bilateral temporoparietal junction (TPJ), bilateral middle temporal gyrus (MTG), right medial prefrontal cortex, and the precuneus bilaterally; i.e., brain regions related to social cognition processes, such as self-reflection and theory of mind (ToM). In addition, brain structures related to cognitive control were active [right anterior cingulate cortex (ACC), bilateral dorsolateral prefrontal cortex (DLPFC), bilateral orbitofrontal cortex], whereas no significant clusters were obtained in the reward system (ventral striatum). Choosing the dangerous option involved a further activation of control areas (ACC) and emotional and social cognition areas (temporal pole). Adolescents employed more neural resources than young adults in the right DLPFC and the right TPJ in risk situations. When choosing the dangerous option, young adults showed a further engagement in ToM related regions (bilateral MTG) and in motor control regions related to the planning of actions (pre-supplementary motor area). Finally, the right insula and the right superior temporal gyrus were more activated in women than in men, suggesting more emotional involvement and more intensive modeling of the others’ perspective in the risky conditions. These findings call for more comprehensive developmental accounts of decision-making in social contexts that incorporate the role of emotional and social cognition processes.

Regional brain changes occurring during disobedience to "experts" in financial decision-making

It is well recognized that individuals follow "Expert" advice, even when flawed and offers no advantage, and sometimes leads to disadvantages. The neurobiology underlying this is uncertain, and in particular there is an incomplete understanding of which brain regions are most involved when individuals chose to disobey an expert. To study this we examined functional magnetic resonance imaging (fMRI) differences during an investment game where subjects received differentially credible investment advice. Participants (n = 42; 32 males) played an investment game, in which they could Buy or Not Buy a sequence of stocks. The better they did, the more money they made. Participants received either "Expert" advice or "Peer" advice. Those receiving Expert advice were told the advice came from a certified financial "Expert". Those receiving Peer Advice were told the advice was that of the student administering the scans, who deliberately dressed and acted casually. Both streams of advice were predetermined and identical. The advice was scripted to be helpful initially, but progressively worse as the task continued, becoming 100% wrong by the end of the task. Subjects receiving Expert Advice followed the advice significantly longer on average, even though this was progressively worse advice. Thus, following Expert advice had poorer consequences for individuals, but this did not dissuade them from continuing to follow the advice. In contrast, when subjects disobeyed Expert advice they exhibited significant anterior cingulate cortex (ACC) and superior frontal gyrus activation relative to those disobeying Peer advice. These findings may suggest that in subjects who defy authority, or believe they are doing so (in this case by disobeying an "Expert") there is increased activation of these two brain regions. This may have relevance to several areas of behavior, and the potential role of these two brain regions in regard to disobedience behavior requires further study.

Neural basis of emotional decision making in trait anxiety

Although trait anxiety has been associated with risk decision making, whether it is related to risk per se or to the feeling of the risk, as well as the underlying neurocognitive mechanisms, remains unclear. Using a decision-making task with a manipulation of frame (i.e., written description of options as a potential gain or loss) and functional magnetic resonance imaging, we investigated the neurocognitive relationship between trait anxiety and decision making. The classic framing effect was observed: participants chose the safe option when it was described as a potential gain, but they avoided the same option when it was described as a potential loss. Most importantly, trait anxiety was positively correlated with this behavioral bias. Trait anxiety was also positively correlated with amygdala-based "emotional" system activation and its coupling with the ventromedial prefrontal cortex (vmPFC) when decisions were consistent with the framing effect, but negatively correlated with the dorsal anterior cingulate cortex (dACC)-based "analytic" system activation and its connectivity to the vmPFC when decisions ran counter to the framing effect. Our findings suggest that trait anxiety is not associated with subjective risk preference but an evaluative bias of emotional information in decision making, underpinned by a hyperactive emotional system and a hypoactive analytic system in the brain.

Addiction science: Uncovering neurobiological complexity

Until very recently addiction-research was limited by existing tools and strategies that were inadequate for studying the inherent complexity at each of the different phenomenological levels. However, powerful new tools (e.g., optogenetics and designer drug receptors) and high throughput protocols are starting to give researchers the potential to systematically interrogate "all" genes, epigenetic marks, and neuronal circuits. These advances, combined with imaging technologies (both for preclinical and clinical studies) and a paradigm shift toward open access have spurred an unlimited growth of datasets transforming the way we investigate the neurobiology of substance use disorders (SUD) and the factors that modulate risk and resilience. This article is part of a Special Issue entitled 'NIDA 40th Anniversary Issue'.

Posttraumatic stress disorder: a theoretical model of the hyperarousal subtype

Posttraumatic stress disorder (PTSD) is a frequent and distressing mental disorder, about which much remains to be learned. It is a heterogeneous disorder; the hyperarousal subtype (about 70% of occurrences and simply termed PTSD in this paper) is the topic of this article, but the dissociative subtype (about 30% of occurrences and likely involving quite different brain mechanisms) is outside its scope. A theoretical model is presented that integrates neuroscience data on diverse brain regions known to be involved in PTSD, and extensive psychiatric findings on the disorder. Specifically, the amygdala is a multifunctional brain region that is crucial to PTSD, and processes peritraumatic hyperarousal on grounded cognition principles to produce hyperarousal symptoms. Amygdala activity also modulates hippocampal function, which is supported by a large body of evidence, and likewise amygdala activity modulates several brainstem regions, visual cortex, rostral anterior cingulate cortex (rACC), and medial orbitofrontal cortex (mOFC), to produce diverse startle, visual, memory, numbing, anger, and recklessness symptoms. Additional brain regions process other aspects of peritraumatic responses to produce further symptoms. These contentions are supported by neuroimaging, neuropsychological, neuroanatomical, physiological, cognitive, and behavioral evidence. Collectively, the model offers an account of how responses at the time of trauma are transformed into an extensive array of the 20 PTSD symptoms that are specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. It elucidates the neural mechanisms of a specific form of psychopathology, and accords with the Research Domain Criteria framework.

Association between tobacco smoking and cognitive functioning in young adults

BACKGROUND

Tobacco smoking represents a considerable public health burden globally. Smoking in older adults is associated with cognitive impairment and more rapid age-associated cognitive decline, but there is a paucity of studies in younger people.

METHOD

Adults aged 18-29 years were recruited from a longitudinal study investigating impulsivity in young people. Exclusion criteria were presence of any axis-I morbidity or cannabis use. Subjects undertook neurocognitive assessment using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Demographic, clinical, and cognitive differences between smokers (N = 37) and nonsmokers (N = 177) were characterized.

RESULTS

Groups were well matched in terms of age, education, income, and gender. In comparison to nonsmokers, nicotine users showed significant cognitive impairments on sustained attention (target detection: p= .005), spatial working memory (errors: p= .023, strategy use: p= .004), executive planning (p= .002), and did not appropriately adjust behavior as a function of risk (Gamble task risk adjustment: p= .004). Smokers were intact on general response speeds and response inhibition.

CONCLUSIONS

These data, using objective translational paradigms, support an association between tobacco smoking and cognitive problems in young people, with implications for such individuals and for society. Future studies should extend these results longitudinally to explore causality, and evaluate effects of nicotinic agents (including anti-smoking medications) on cognition.

Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective

Uncertainty about a possible future threat disrupts our ability to avoid it or to mitigate its negative impact and thus results in anxiety. Here, we focus the broad literature on the neurobiology of anxiety through the lens of uncertainty. We identify five processes that are essential for adaptive anticipatory responses to future threat uncertainty and propose that alterations in the neural instantiation of these processes result in maladaptive responses to uncertainty in pathological anxiety. This framework has the potential to advance the classification, diagnosis and treatment of clinical anxiety.

Neural correlates of impulsivity in healthy males and females with family histories of alcoholism

Individuals family-history positive (FHP) for alcoholism have increased risk for the disorder, which may be mediated by intermediate behavioral traits such as impulsivity. Given the sex differences in the risk for and clinical presentation of addictive disorders, risk for addiction may be differentially mediated by impulsivity within FHP males and females. FHP (N=28) and family-history negative (FHN, N=31) healthy, non-substance-abusing adults completed an fMRI Go/No-Go task and were assessed on impulsivity and alcohol use. Effects of family history and sex were investigated as were associations between neural correlates of impulse control and out-of-scanner measures of impulsivity and alcohol use. FHP individuals showed greater activation in the left anterior insula and inferior frontal gyrus during successful inhibitions, an effect that was driven primarily by FHP males. Higher self-reported impulsivity and behavioral discounting impulsivity, but not alcohol use measures, were associated with greater BOLD signal in the region that differentiated the FHP and FHN groups. Impulsivity factors were associated with alcohol use measures across the FHP and FHN groups. These findings are consistent with increased risk for addiction among FHP individuals being conferred through disrupted function within neural systems important for impulse control.

Decreased insular and increased midbrain activations during decision-making under risk in adolescents with excess weight

OBJECTIVE

Functional magnetic resonance imaging (fMRI) was used to explore the brain substrates of decisions under risk in excess weight adolescents. Decreased activations of the brain regions signaling risk (orbitofrontal cortex [OFC], insula) were expected during anticipation of higher rewards and increased activations of the brain regions involved in reward processing (OFC, striatum) were expected after reward receipt in excess weight adolescents compared to normal weight controls.

DESIGN AND METHODS

Fifty-two adolescents (age range 12-17), classified in three groups as a function of BMI: obese (n = 21), overweight (n = 15), or normal weight (n = 16) performed the Risky-Gains task as described by Paulus et al. in the fMRI scanner.

RESULTS

Excess weight adolescents, compared to normal weight controls, showed decreased left insular and increased midbrain activations during anticipation of risky choices. In addition, excess weight adolescents showed increased activations of the inferior frontal gyrus, parahippocampus, thalamus, and posterior brain regions after reward receipt.

CONCLUSIONS

Adolescents with excess weight showed reduced activations in brain regions signaling risk and increased activations in regions signaling reward during anticipation of decisions involving risk and reward. In addition, post-decision reward outcomes produced increased activations of regions involved in emotional salience in excess weight adolescents versus controls.

Functional connectivity networks associated with chronic musculoskeletal pain in old age

OBJECTIVE

Musculoskeletal disorders are common and often lead to chronic pain in older adults. Because the efficacy of interventions varies with the duration of pain, the identification of early biomarkers for chronic pain would have important public health consequences. Imaging of functional connectivity differences between brain regions might identify some of the earliest functional consequences of a disease process. We tested the hypothesis that chronic musculoskeletal pain in older persons is associated with changes in functional brain connectivity.

METHOD

We used resting-state functional magnetic resonance imaging and a spherical seed-based region of interest approach to assess functional connectivity of brain regions on a sample of 128 (64 who reported chronic musculoskeletal pain and 64 demographically matched, pain free) nondemented older adults from the Memory and Aging Project, a clinical-pathological cohort study of aging and dementia.

RESULTS

Older adults with chronic pain showed greater functional connectivity between the posterior cingulate and left insula, left superior temporal gyrus, and left cerebellum.

CONCLUSION

Chronic musculoskeletal pain is associated with a specific pattern of functional connectivity between brain regions among older adults.

Increased firing to cues that predict low-value reward in the medial orbitofrontal cortex

Anatomical, imaging, and lesion work have suggested that medial and lateral aspects of orbitofrontal cortex (OFC) play different roles in reward-guided decision-making, yet few single-neuron recording studies have examined activity in more medial parts of the OFC (mOFC) making it difficult to fully assess its involvement in motivated behavior. Previously, we have shown that neurons in lateral parts of the OFC (lOFC) selectively fire for rewards of different values. In that study, we trained rats to respond to different fluid wells for rewards of different sizes or delivered at different delays. Rats preferred large over small reward, and rewards delivered after short compared with long delays. Here, we recorded from single neurons in rat rostral mOFC as they performed the same task. Similar to the lOFC, activity was attenuated for rewards that were delivered after long delays and was enhanced for delivery of larger rewards. However, unlike lOFC, odor-responsive neurons in the mOFC were more active when cues predicted low-value outcomes. These data suggest that odor-responsive mOFC neurons signal the association between environmental cues and unfavorable outcomes during decision making.