1
|
Farrar DC, Killiany RJ, Moss MB, Fink B, Budson AE. Event-related Potentials Corresponding to Decision-making Under Uncertain Conditions. Cogn Behav Neurol 2023; 36:166-177. [PMID: 37404132 DOI: 10.1097/wnn.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/17/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Decision-making is essential to human functioning, and resolving uncertainty is an essential part of decision-making. Impaired decision-making is present in many pathological conditions, and identifying markers of decision-making under uncertainty will provide a measure of clinical impact in future studies of therapeutic intervention for impaired decision-making. OBJECTIVE To describe EEG event-related potentials (ERPs) correlating with decision-making under uncertain conditions when compared with certain conditions. METHOD We used a novel card-matching task based on the Wisconsin Card Sorting Test to describe the neural correlates of uncertainty, as measured by EEG, in a group of 27 neurotypical individuals. We evaluated 500-ms intervals in the 2 seconds after card presentation to identify ERPs that are associated with maximal uncertainty compared with maximal certainty. RESULTS After correcting for multiple comparisons, we identified an ERP in the 500-1000-ms time frame (certain > uncertain, max amplitude 12.73 µV, latency 914 ms) in the left posterior inferior region of the scalp. We also found a P300-like ERP in the left frontal and parietal regions in the 0-500-ms time frame when the individuals received correct versus incorrect feedback (incorrect feedback > correct feedback, max amplitude 1.625 µV, latency 339 ms). CONCLUSION We identified an ERP in the 500-1000-ms time frame (certain > uncertain) that may reflect the resolution of uncertainty, as well as a P300-like ERP when feedback is presented (incorrect feedback > correct feedback). These findings can be used in future studies to improve decision-making and resolve uncertainty on the described markers.
Collapse
Affiliation(s)
- Danielle C Farrar
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Ronald J Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Mark B Moss
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Brandi Fink
- Department of Psychiatry and Behavioral Sciences, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew E Budson
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
2
|
Xu M, Lee WK, Ko CH, Chiu YC, Lin CH. The Prominent Deck B Phenomenon in Schizophrenia: An Empirical Study on Iowa Gambling Task. Front Psychol 2021; 12:619855. [PMID: 34539474 PMCID: PMC8446202 DOI: 10.3389/fpsyg.2021.619855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Iowa Gambling Task (IGT) was established to evaluate emotion-based decision-making ability under uncertain circumstances in clinical populations, including schizophrenia (Sz). However, there remains a lack of stable behavioral measures regarding discrimination for decision-making performance in IGT between schizophrenic cases and healthy participants. None of the Sz-IGT studies has specifically verified the prominent deck B (PDB) phenomenon gradually revealed in other populations. Here, we provided a global review and empirical study to verify these Sz-IGT issues. Methods: Seeking reliable and valid behavioral measures, we reviewed 38 studies using IGT to investigate decision-making behavior in Sz groups. The IGT, the Wisconsin Card Sorting Test (WCST), and clinical symptoms evaluations were administered to 61 schizophrenia or schizoaffective cases diagnosed by psychiatrists and 62 demographically matched healthy participants. Results: There were no valid behavioral measures in IGT that could significantly identify the decision-making dysfunction of Sz. However, Sz cases, on average, made more choices from disadvantageous deck B relative to other decks, particularly in the later learning process (block 3-5). Compared to the control group, the Sz group was more impaired on the WCST. The high-gain frequency decks B and D showed significant correlations with WCST but no correlation between clinical symptoms and IGT/WCST. Conclusions: Gain-loss frequency (GLF) has a dominant and stable impact on the decision-making process in both Sz and control groups. PDB phenomenon is essentially challenging to be observed on the ground of the expected value (EV) viewpoint approach on the IGT in both populations. Consequently, caution should be exercised when launching the IGT to assess the decision-making ability of Sz under a clinical scenario.
Collapse
Affiliation(s)
- Mei Xu
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - We-Kang Lee
- Sleep Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Psychology, Soochow University, Taipei, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.,College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Chu Chiu
- Department of Psychology, Soochow University, Taipei, Taiwan
| | - Ching-Hung Lin
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Non-linear Analysis and Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
3
|
Li D, Zhang F, Wang L, Zhang Y, Yang T, Wang K, Zhu C. Decision making under ambiguity and risk in adolescent-onset schizophrenia. BMC Psychiatry 2021; 21:230. [PMID: 33947364 PMCID: PMC8094464 DOI: 10.1186/s12888-021-03230-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Numerous studies have identified impaired decision making (DM) under both ambiguity and risk in adult patients with schizophrenia. However, the assessment of DM in patients with adolescent-onset schizophrenia (AOS) has been challenging as a result of the instability and heterogeneity of manifestations. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT), which are frequently used to evaluate DM respectively under ambiguity and risk, are sensitive to adolescents and neuropsychiatric patients. Our research intended to examine the performance of DM in a relatively large sample of patients with AOS using the above-mentioned two tasks. We also aimed to take a closer look at the relationship between DM and symptom severity of schizophrenia. METHODS We compared the performance of DM in 71 patients with AOS and 53 well-matched healthy controls using IGT for DM under ambiguity and GDT for DM under risk through net scores, total scores and feedback ration. Neuropsychological tests were conducted in all participants. Clinical symptoms were evaluated by using Positive and Negative Syndrome Scale (PANSS) in 71 patients with AOS. Pearson's correlation revealed the relationship among total score of DM and clinical and neuropsychological data. RESULTS Compared to healthy controls, patients with AOS failed to show learning effect and had a significant difference on the 5th block in IGT and conducted more disadvantageous choices as well as exhibited worse negative feedback rate in GDT. Apart from DM impairment under risk, diminished DM abilities under ambiguity were found related to poor executive function in AOS in the present study. CONCLUSIONS Our findings unveiled the abnormal pattern of DM in AOS, mainly reflected under the risky condition, extending the knowledge on the performance of DM under ambiguity and risk in AOS. Inefficient DM under risk may account for the lagging impulse control and the combined effects of developmental disease. In addition, our study demonstrated that the performance on IGT was related to executive function in AOS.
Collapse
Affiliation(s)
- Dandan Li
- grid.412679.f0000 0004 1771 3402Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China ,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022 China ,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230022 China ,grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022 China
| | - Fengyan Zhang
- grid.33199.310000 0004 0368 7223Children’s Rehabilitation Department, Wuhan Mental Health Center, Wuhan, 430012 China
| | - Lu Wang
- grid.412679.f0000 0004 1771 3402Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Yifan Zhang
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022 China
| | - Tingting Yang
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022 China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China. .,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China. .,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230022, China. .,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China. .,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230022, China.
| | - Chunyan Zhu
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China. .,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230022, China. .,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China.
| |
Collapse
|
4
|
Lee WK, Lin CJ, Liu LH, Lin CH, Chiu YC. Recollecting Cross-Cultural Evidences: Are Decision Makers Really Foresighted in Iowa Gambling Task? Front Psychol 2021; 11:537219. [PMID: 33408659 PMCID: PMC7779794 DOI: 10.3389/fpsyg.2020.537219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
The Iowa Gambling Task (IGT) has become a remarkable experimental paradigm of dynamic emotion decision making. In recent years, research has emphasized the "prominent deck B (PDB) phenomenon" among normal (control group) participants, in which they favor "bad" deck B with its high-frequency gain structure-a finding that is incongruent with the original IGT hypothesis concerning foresightedness. Some studies have attributed such performance inconsistencies to cultural differences. In the present review, 86 studies featuring data on individual deck selections were drawn from an initial sample of 958 IGT-related studies published from 1994 to 2017 for further investigation. The PDB phenomenon was found in 67.44% of the studies (58 of 86), and most participants were recorded as having adopted the "gain-stay loss-randomize" strategy to cope with uncertainty. Notably, participants in our sample of studies originated from 16 areas across North America, South America, Europe, Oceania, and Asia, and the findings suggest that the PDB phenomenon may be cross-cultural.
Collapse
Affiliation(s)
- We-Kang Lee
- Department of Psychology, Soochow University, Taipei, Taiwan.,Shin Kong Wu Ho-Su Memorial Hospital Sleep Center, Taipei, Taiwan
| | - Ching-Jen Lin
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Nonlinear Analysis and Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Hua Liu
- Department of Psychology, Soochow University, Taipei, Taiwan
| | - Ching-Hung Lin
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Nonlinear Analysis and Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Chu Chiu
- Department of Psychology, Soochow University, Taipei, Taiwan
| |
Collapse
|
5
|
Yang CC, Mauer L, Völlm B, Khalifa N. The Effects of Non-invasive Brain Stimulation on Impulsivity in People with Mental Disorders: a Systematic Review and Explanatory Meta-Analysis. Neuropsychol Rev 2020; 30:499-520. [PMID: 33009976 DOI: 10.1007/s11065-020-09456-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/20/2020] [Indexed: 01/03/2023]
Abstract
Impulsivity is a multi-faceted construct that underpins various mental health disorders. Impulsive behavior exacts a substantial health and economic burden, hence the importance of developing specific interventions to target impulsivity. Two forms of non-invasive brain stimulation, namely transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), have been used to modulate impulsivity. To date, no reviews have systematically examined their effects on modulating impulsivity in people with mental health disorders. We conducted a systematic review and meta-analysis of the literature from AMED, Embase, Medline and PsycINFO databases on the use of rTMS and tDCS to modulate impulsivity in people with mental health disorders. Results from 11 tDCS and 18 rTMS studies indicate that tDCS has a significant, albeit small, effect on modulating impulsivity (g = 0.29; 95% CI, 0.09 to 0.48; p = .004) whereas rTMS has no significant effect on impulsivity (g = -0.08; 95% Cl, -0.35 to 0.19; p = .550). Subgroup analyses identified the key parameters required to enhance the effects of tDCS and rTMS on impulsivity. Gender and stimulation intensity acted as significant moderators for effects of rTMS on impulsivity. There is insufficient evidence to support the use of tDCS or rTMS in clinical practice to reduce impulsivity in people with mental health disorders. The use of standardized non-invasive brain stimulation protocols and outcome measures in patients with the same diagnosis is advised to minimize methodological heterogeneity.
Collapse
Affiliation(s)
- Cheng-Chang Yang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, No 291 ZhongZheng Road, Zhonghe District, New Taipei City, Taiwan. .,Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Laura Mauer
- Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Dresden, Germany
| | - Birgit Völlm
- Klinik und Poliklinik für Forensische Psychiatrie, Universitat Rostock, Rostock, Germany
| | - Najat Khalifa
- Division of Forensic Psychiatry, Department of Psychiatry, School of Medicine, Queen's University, Kingston, Canada
| |
Collapse
|
6
|
Karyadi KA, Nitch SR, Kinney DI, Britt WG. Decision making of forensic psychiatric inpatients deemed incompetent to stand trial. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:66-76. [PMID: 31957489 DOI: 10.1080/23279095.2019.1709847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined decision making and its correlates among forensic psychiatric inpatients deemed incompetent to stand trial (IST). This study utilized archival data (n = 41; Mean Age = 44.27, SD = 15.89, 79.1% Male; 34.1% Caucasian). Decision making was measured using the Iowa Gambling Task (IGT), which is purported to simulate real-life decision making. Correlates included cognitive functioning, psychiatric symptom severity, and impulsivity. Participants selected more frequently from disadvantageous decks, which yield larger immediate monetary gains with a larger long-term monetary losses (Mean NET = -9.51, SD = 26.70), but avoided decks yielding frequent monetary losses (Mean GLF = 10.10, SD = 26.70). Consistently, participants selected most frequently from a deck yielding the most immediate monetary gains and the least frequent monetary losses compared to other decks (ps < 0.05). Based upon their selections, participants lost a significant amount of money (M = -$1,493.22, SD = $1,182.26). IGT outcomes were differentially associated with cognitive functioning (rs = -0.26 to 0.47), psychiatric symptom severity (rs = -0.41 to 0.37), and impulsivity (rs = -0.47 to 0.28; all ps = 0.003-0.98). Findings can guide future research, as well as guide competency restoration and decision-making interventions, for this population.
Collapse
Affiliation(s)
- Kenny A Karyadi
- Department of Psychology, Patton State Hospital, Patton, CA, USA.,Behavioral Health Institute, Loma Linda University, Redlands, CA, USA
| | - Stephen R Nitch
- Department of Psychology, Patton State Hospital, Patton, CA, USA
| | | | - William G Britt
- Department of Psychology, Patton State Hospital, Patton, CA, USA.,Behavioral Health Institute, Loma Linda University, Redlands, CA, USA
| |
Collapse
|
7
|
Saperia S, Da Silva S, Siddiqui I, Agid O, Daskalakis ZJ, Ravindran A, Voineskos AN, Zakzanis KK, Remington G, Foussias G. Reward-driven decision-making impairments in schizophrenia. Schizophr Res 2019; 206:277-283. [PMID: 30442476 DOI: 10.1016/j.schres.2018.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 11/25/2022]
Abstract
The ability to use feedback to guide optimal decision-making is essential for goal-directed behaviour. While impairments in feedback-driven decision-making have been associated with schizophrenia and depression, this has been examined primarily in the context of binary probabilistic choice paradigms. In real-world decision-making, however, individuals must make choices when there are more than two competing options that vary in the frequency and magnitude of potential rewards and losses. Thus, the current study examined win-stay/lose-shift (WSLS) behaviour on the Iowa Gambling Task (IGT) in order to evaluate the influence of immediate rewards and losses in guiding real-world decision-making in patients with schizophrenia and major depressive disorder. Fifty-one patients with schizophrenia, 43 patients with major depressive disorder, and 51 healthy controls completed the IGT, as well as a series of clinical and cognitive measures. WSLS was assessed by quantifying trial-by-trial behaviour following rewards and losses on the IGT. Multivariate analyses of variance revealed that patients with schizophrenia demonstrated intact lose-shift behaviour, but significantly reduced win-stay rates compared to healthy controls. In contrast, no WSLS impairments emerged in the depressed group. Win-stay impairments in the schizophrenia group were significantly related to deficits in motivation and cognition. Patients with schizophrenia exhibit impaired reward-driven decision-making in the context of multiple choices with concurrent rewards and losses, and this appears to be driven by a reduced propensity for advantageous win-stay behaviour. With the importance of reward learning and decision-making in generating goal-directed behaviour, these findings suggest a potential mechanism contributing to the motivation deficits seen in schizophrenia.
Collapse
Affiliation(s)
- Sarah Saperia
- Centre for Addiction and Mental Health, Toronto, Canada.
| | - Susana Da Silva
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ishraq Siddiqui
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Z Jeff Daskalakis
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Arun Ravindran
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Gary Remington
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Kim SJ, Hong YJ, Kim MW, Jung YH, Min SR, Kim JJ. Inflexible eye fixation pattern in schizophrenia affecting decision-making on daily life. Psychiatry Res 2019; 274:414-420. [PMID: 30870671 DOI: 10.1016/j.psychres.2019.02.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 02/05/2023]
Abstract
Patients with schizophrenia have difficulties in real life due to impairment in ability to make decisions. The purpose of this study was to elucidate the relationship between impaired decision-making processes with real life stimuli and abnormal eye gaze patterns in patients with schizophrenia. Each of 23 patients with schizophrenia and 23 healthy controls performed an apparel purchase decision task including the influencing factors such as preference, fit, and price, during which the eye gaze was traced. Fixation time and fixation time ratio on areas of interest, which were set for participant faces and clothing, were compared between the two groups. Compared with controls, patients made purchase decisions at a higher rate and showed significantly shorter fixation time on clothing in the preference, fit, and price phases and on faces in the purchase phase. Fixation time ratio of face over clothing did not change over purchase decisions in patients, whereas controls showed significantly higher fixation time ratio in not-to-buy decisions than in to-buy decisions. These results suggest that aberrant decision-making behaviors in patients with schizophrenia are closely related to inflexible visual information gathering patterns because they apportion the same amount of attention to objects regardless of purchase intention.
Collapse
Affiliation(s)
- Soo-Jeong Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeon-Ju Hong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Woo Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sa-Rang Min
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
9
|
Betz LT, Brambilla P, Ilankovic A, Premkumar P, Kim MS, Raffard S, Bayard S, Hori H, Lee KU, Lee SJ, Koutsouleris N, Kambeitz J. Deciphering reward-based decision-making in schizophrenia: A meta-analysis and behavioral modeling of the Iowa Gambling Task. Schizophr Res 2019; 204:7-15. [PMID: 30262254 DOI: 10.1016/j.schres.2018.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 08/26/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with schizophrenia (SZP) have been reported to exhibit impairments in reward-based decision-making, but results are heterogeneous with multiple potential confounds such as age, intelligence level, clinical symptoms or medication, making it difficult to evaluate the robustness of these impairments. METHODS We conducted a meta-analysis of studies comparing the performance of SZP and healthy controls (HC) in the Iowa Gambling Task (IGT) as well as comprehensive analyses based on subject-level data (n = 303 SZP, n = 188 HC) to investigate reward-based decision-making in SZP. To quantify differences in the influence of individual deck features (immediate gain, gain frequency, net loss) between SZP and HC, we additionally employed a least-squares model. RESULTS SZP showed statistically significant suboptimal decisions as indicated by disadvantageous deck choices (d from 0.51 to −0.62) and lower net scores (d from −0.35 to −1.03) in a meta-analysis of k = 29 samples (n = 1127 SZP, n = 1149 HC) and these results were confirmed in a complementary subject-level analysis. Moreover, decision-making in SZP was characterized by a relative overweighting of immediate gain and net losses and an underweighting of gain frequency. Moderator analyses revealed that in part, decision-making in the IGT was moderated by intelligence level, medication and general symptom scores. CONCLUSION Our results indicate robust impairments in reward-based decision-making in SZP and suggest that decreased cognitive resources, such as working memory, may contribute to these alterations.
Collapse
Affiliation(s)
- Linda T Betz
- Department of Psychiatry, Ludwig-Maximilian-University Munich, Munich, Germany.
| | - Paolo Brambilla
- Scientific Institute IRCCS "E. Medea", Bosisio Parini, Lecco, Italy.
| | - Andrej Ilankovic
- Psychiatry Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Preethi Premkumar
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK.
| | - Myung-Sun Kim
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea.
| | - Stéphane Raffard
- University Department of Adult Psychiatry, La Colombière Hospital, CHRU Montpellier, Montpellier, France; Laboratoire Epsylon, EA 4556, Université Paul Valéry Montpellier 3, Montpellier, France.
| | - Sophie Bayard
- Laboratoire Epsylon, EA 4556, Université Paul Valéry Montpellier 3, Montpellier, France.
| | - Hikaru Hori
- Department of Psychiatry, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 8078555, Japan.
| | - Kyoung-Uk Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, Republic of Korea.
| | - Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | | | - Joseph Kambeitz
- Department of Psychiatry, Ludwig-Maximilian-University Munich, Munich, Germany.
| |
Collapse
|
10
|
Woodrow A, Sparks S, Bobrovskaia V, Paterson C, Murphy P, Hutton P. Decision-making ability in psychosis: a systematic review and meta-analysis of the magnitude, specificity and correlates of impaired performance on the Iowa and Cambridge Gambling Tasks. Psychol Med 2019; 49:32-48. [PMID: 30246669 DOI: 10.1017/s0033291718002660] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To identify factors which may help or hinder decision-making ability in people with psychosis, we did a systematic review and meta-analysis of their performance on the Iowa and Cambridge Gambling Tasks. Analysis of 47 samples found they had moderately poorer performance than healthy individuals (N = 4264, g = -0.57, 95% confidence interval (CI) -0.66 to -0.48). Few studies (k = 8) used non-psychotic clinical comparator groups, although very low-quality evidence (k = 3) found people with bipolar disorder may perform better. Negative symptoms (k = 13, N = 648, r = -0.17, 95% CI -0.26 to -0.07) and lower IQ (k = 11, N = 525, r = 0.20, 95% CI 0.29-0.10), but not positive symptoms (k = 10, N = 512, r = -0.01, 95% CI -0.11 to 0.08), each had small-moderate associations with poorer decision-making. Lower quality evidence suggested general symptoms, working memory, social functioning, awareness of emotional responses to information, and attentional bias towards gain are associated with decision-making, but not education, executive functioning or overall symptoms. Meta-regression suggested an inverse association between decision-making and depression severity (k = 6, Q = 6.41, R2 100%, p = 0.01). Those taking first-generation (k = 6, N = 305, g = -0.17, 95% CI -0.40 to 0.06, p = 0.147) or low-dose antipsychotics (k = 5, N = 442, g = -0.19, 95% CI -0.44 to 0.06, p = 0.139) had unimpaired decision-making. Although meta-regression found no linear association between dose and performance, non-reporting of the dose was common and associated with larger impairments (k = 46, Q = 4.71, R2 14%, p = 0.03). Those supporting people with psychosis to make decisions, including treatment decisions, should consider the potential effect of these factors. Interventionist-causal trials are required to test whether reducing antipsychotic dose and treating anxiety and depression can improve decision-making in this group.
Collapse
Affiliation(s)
- Amanda Woodrow
- School of Health and Social Care, Edinburgh Napier University,Edinburgh,UK
| | - Sarah Sparks
- School of Health in Social Science, University of Edinburgh,Edinburgh,UK
| | | | - Charlotte Paterson
- School of Health and Social Care, Edinburgh Napier University,Edinburgh,UK
| | - Philip Murphy
- School of Health and Social Care, Edinburgh Napier University,Edinburgh,UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University,Edinburgh,UK
| |
Collapse
|
11
|
Yang CC, Khalifa N, Völlm B. Excitatory repetitive transcranial magnetic stimulation applied to the right inferior frontal gyrus has no effect on motor or cognitive impulsivity in healthy adults. Behav Brain Res 2018; 347:1-7. [DOI: 10.1016/j.bbr.2018.02.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
|
12
|
Yang CC, Völlm B, Khalifa N. The Effects of rTMS on Impulsivity in Normal Adults: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2018; 28:377-392. [DOI: 10.1007/s11065-018-9376-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/18/2018] [Indexed: 02/08/2023]
|
13
|
Cotrena C, Branco LD, Fonseca RP. Adaptation and validation of the Melbourne Decision Making Questionnaire to Brazilian Portuguese. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 40:29-37. [DOI: 10.1590/2237-6089-2017-0062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022]
Abstract
Abstract Introduction: Decision making (DM) is among the most important abilities for everyday functioning. However, the most widely used measures of DM come from behavioral paradigms, whose ecological validity and standalone use has been criticized in the literature. Though these issues could be addressed by the use of DM questionnaires as a complementary assessment method, no such instruments have been validated for use in Brazilian Portuguese. Therefore, the aim of this study was to conduct the translation and validation of the Melbourne Decision Making Questionnaire (MDMQ) for use in a Brazilian population. Methods: The adaptation of the MDMQ involved the following steps: translation, back-translation, expert review and pilot study. These steps were followed by factor analysis and internal consistency measurements, which led to the exclusion of 4 items from the scale. The 18-item version of the MDMQ was then administered to a validation sample consisting of healthy adults, as well as patients with bipolar disorder (BD) and major depressive disorder (MDD). Results: The instrument displayed good internal consistency, with the hypervigilance subscale showing the lowest, though still acceptable, Cronbach's alpha value. Its factor structure was comparable to that of the original MDMQ according to confirmatory factor analysis. Nevertheless, the MDMQ was sensitive to both depression severity and the presence of MDD and BD, both of which are known to have an impact on DM ability. Conclusion: The version of the MDMQ produced in the present study may be an important addition to neuropsychological assessment batteries with a focus on DM and related abilities
Collapse
Affiliation(s)
- Charles Cotrena
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | | |
Collapse
|
14
|
Farrar DC, Mian AZ, Budson AE, Moss MB, Killiany RJ. Functional brain networks involved in decision-making under certain and uncertain conditions. Neuroradiology 2017; 60:61-69. [PMID: 29164280 DOI: 10.1007/s00234-017-1949-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/09/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to describe imaging markers of decision-making under uncertain conditions in normal individuals, in order to provide baseline activity to compare to impaired decision-making in pathological states. METHODS In this cross-sectional study, 19 healthy subjects ages 18-35 completed a novel decision-making card-matching task using a Phillips T3 Scanner and a 32-channel head coil. Functional data were collected in six functional runs. In one condition of the task, the participant was certain of the rule to apply to match the cards; in the other condition, the participant was uncertain. We performed cluster-based comparison of the two conditions using FSL fMRI Expert Analysis Tool and network-based analysis using MATLAB. RESULTS The uncertain > certain comparison yielded three clusters-a midline cluster that extended through the midbrain, the thalamus, bilateral prefrontal cortex, the striatum, and bilateral parietal/occipital clusters. The certain > uncertain comparison yielded bilateral clusters in the insula, parietal and temporal lobe, as well as a medial frontal cluster. A larger, more connected functional network was found in the uncertain condition. CONCLUSION The involvement of the insula, parietal cortex, temporal cortex, ventromedial prefrontal cortex, and orbitofrontal cortex of the certain condition reinforces the notion that certainty is inherently rewarding. For the uncertain condition, the involvement of the prefrontal cortex, parietal cortex, striatum, thalamus, amygdala, and hippocampal involvement was expected, as these are areas involved in resolving uncertainty and rule updating. The involvement of occipital cortical involvement and midbrain involvement may be attributed to increased visual attention and increased motor control.
Collapse
Affiliation(s)
- Danielle C Farrar
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 650 Albany St, Basement, Boston, MA, 02118, USA.
| | - Asim Z Mian
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Mark B Moss
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 650 Albany St, Basement, Boston, MA, 02118, USA
| | - Ronald J Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 650 Albany St, Basement, Boston, MA, 02118, USA
| |
Collapse
|
15
|
van der Staay FJ, van Zutphen JA, de Ridder MM, Nordquist RE. Effects of environmental enrichment on decision-making behavior in pigs. Appl Anim Behav Sci 2017. [DOI: 10.1016/j.applanim.2017.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Matsumoto J, Hirano Y, Hashimoto K, Ishima T, Kanahara N, Niitsu T, Shiina A, Hashimoto T, Sato Y, Yokote K, Murano S, Kimura H, Hosoda Y, Shimizu E, Iyo M, Nakazato M. Altered serum level of matrix metalloproteinase-9 and its association with decision-making in eating disorders. Psychiatry Clin Neurosci 2017; 71:124-134. [PMID: 27891714 DOI: 10.1111/pcn.12490] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/13/2016] [Accepted: 11/16/2016] [Indexed: 12/11/2022]
Abstract
AIM The aims of this study were to determine whether the serum levels of precursor brain-derived neurotrophic factor (proBDNF), mature BDNF (mBDNF), and matrix metalloproteinase-9 (MMP-9) are altered in patients with eating disorders (ED), including anorexia nervosa (AN) and bulimia nervosa (BN), and to explore whether those levels are associated with decision-making abilities. METHODS Nineteen women with AN, 28 women with BN, and 22 age-matched healthy control women (HC) were enrolled in the current study. All participants had their decision-making abilities assessed using the Iowa Gambling Task (IGT). Their eating-related pathophysiology and depressive/anxiety symptoms were also evaluated. RESULTS The MMP-9 level in AN was significantly lower than that in either BN or HC, but the serum levels of proBDNF and mBDNF did not differ among the three groups. Investigation of the serum levels of proBDNF and MMP-9 in patients with ED and controls revealed a significant correlation between them. In the BN, there were positive correlations between mBDNF level and IGT performance and also between MMP-9 level and IGT performance, but these correlations did not occur in AN. The MMP-9 level was positively associated with the Symptom Scale, one of the subscales of the Bulimic Investigatory Test, Edinburgh, only in AN. CONCLUSION These results suggest that the serum level of MMP-9 plays a role in the pathophysiology of AN, and both the serum levels of mBDNF and MMP-9 may be associated with decision-making abilities in patients with BN.
Collapse
Affiliation(s)
- Junko Matsumoto
- Department of Regional Disaster Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | | | | | | | - Tomihisa Niitsu
- Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Tasuku Hashimoto
- Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasunori Sato
- Global Clinical Research, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koutaro Yokote
- Clinical Cell Biology and Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunichi Murano
- Department of Regional Disaster Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Kimura
- Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yutaka Hosoda
- Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiji Shimizu
- Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaomi Iyo
- Center for Forensic Mental Health, Chiba, Japan.,Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michiko Nakazato
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
17
|
Nishinaka H, Nakane J, Nagata T, Imai A, Kuroki N, Sakikawa N, Omori M, Kuroda O, Hirabayashi N, Igarashi Y, Hashimoto K. Neuropsychological Impairment and Its Association with Violence Risk in Japanese Forensic Psychiatric Patients: A Case-Control Study. PLoS One 2016; 11:e0148354. [PMID: 26824701 PMCID: PMC4732612 DOI: 10.1371/journal.pone.0148354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/15/2016] [Indexed: 12/16/2022] Open
Abstract
Background In Japan, the legislation directing treatment of offenders with psychiatric disorders was enacted in 2005. Neuropsychological impairment is highly related to functional outcomes in patients with psychiatric disorders, and several studies have suggested an association between neuropsychological impairment and violent behaviors. However, there have been no studies of neuropsychological impairment in forensic patients covered by the Japanese legislation. This study is designed to examine the neuropsychological characteristics of forensic patients in comparison to healthy controls and to assess the relationship between neuropsychological impairment and violence risk. Methods Seventy-one forensic patients with psychiatric disorders and 54 healthy controls (matched by age, gender, and education) were enrolled. The CogState Battery (CSB) consisting of eight cognitive domains, the Iowa Gambling Task (IGT) to test emotion-based decision making, and psychological measures of violence risk including psychopathy were used. Results Forensic patients exhibited poorer performances on all CSB subtests and the IGT than controls. For each group, partial correlational analyses indicated that poor IGT performance was related to psychopathy, especially antisocial behavior. In forensic patients, the CSB composite score was associated with risk factors for future violent behavior, including stress and noncompliance with remediation attempts. Conclusion Forensic patients with psychiatric disorders exhibit a wide range of neuropsychological impairments, and these findings suggest that neuropsychological impairment may increase the risk of violent behavior. Therefore, the treatment of neuropsychological impairment in forensic patients with psychiatric disorders is necessary to improve functional outcomes as well as to prevent violence.
Collapse
Affiliation(s)
- Hirofumi Nishinaka
- Division of Clinical Neuroscience, Center for Forensic Mental Health, Chiba University, Chiba, Japan
| | - Jun Nakane
- National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Takako Nagata
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Atsushi Imai
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Noriomi Kuroki
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Noriko Sakikawa
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Mayu Omori
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Osamu Kuroda
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Naotsugu Hirabayashi
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshito Igarashi
- Division of Law and Psychiatry, Center for Forensic Mental Health, Chiba University, Chiba, Japan
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Center for Forensic Mental Health, Chiba University, Chiba, Japan
- * E-mail:
| |
Collapse
|
18
|
Edwards CJ, Cella M, Tarrier N, Wykes T. Investigating the empirical support for therapeutic targets proposed by the temporal experience of pleasure model in schizophrenia: A systematic review. Schizophr Res 2015; 168:120-44. [PMID: 26342966 DOI: 10.1016/j.schres.2015.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anhedonia and amotivation are substantial predictors of poor functional outcomes in people with schizophrenia and often present a formidable barrier to returning to work or building relationships. The Temporal Experience of Pleasure Model proposes constructs which should be considered therapeutic targets for these symptoms in schizophrenia e.g. anticipatory pleasure, memory, executive functions, motivation and behaviours related to the activity. Recent reviews have highlighted the need for a clear evidence base to drive the development of targeted interventions. OBJECTIVE To review systematically the empirical evidence for each TEP model component and propose evidence-based therapeutic targets for anhedonia and amotivation in schizophrenia. METHOD Following PRISMA guidelines, PubMed and PsycInfo were searched using the terms "schizophrenia" and "anhedonia". Studies were included if they measured anhedonia and participants had a diagnosis of schizophrenia. The methodology, measures and main findings from each study were extracted and critically summarised for each TEP model construct. RESULTS 80 independent studies were reviewed and executive functions, emotional memory and the translation of motivation into actions are highlighted as key deficits with a strong evidence base in people with schizophrenia. However, there are many relationships that are unclear because the empirical work is limited by over-general tasks and measures. CONCLUSIONS Promising methods for research which have more ecological validity include experience sampling and behavioural tasks assessing motivation. Specific adaptations to Cognitive Remediation Therapy, Cognitive Behavioural Therapy and the utilisation of mobile technology to enhance representations and emotional memory are recommended for future development.
Collapse
Affiliation(s)
- Clementine J Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.
| | - Nicholas Tarrier
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.
| |
Collapse
|