Relationships between executive function, working memory, and decision-making on the Iowa Gambling Task: Evidence from ventromedial patients, dorsolateral patients, and normal subjects

The neurological effects of acute physical exhaustion on inhibitory function

OBJECTIVE

We aimed to investigate the neural mechanisms underlying the inhibitory function performance of maritime Search and Rescue (SAR) personnel in states of physical exhaustion.

BACKGROUND

SAR missions pose serious challenges to the cognitive function of SAR personnel, especially in extreme environments and physical exhaustion. It is important to understand SAR personnel's cognitive performance and neural activity under exhaustion to improve the efficiency of task execution and ensure work safety.

METHOD

Twenty-six maritime SAR personnel were recruited to simulate boat operations until they reached a self-imposed state of exhaustion. The exhaustion state was monitored by maximum heart rate and subjective fatigue scale. Two event-related potentials, N200 and P300, were measured during a Go-Nogo task before and after a session of acute exhaustive tasks.

RESULTS

After exhaustion, a marked reduction in accuracy, a notable increase in N200 amplitude, and a substantial decline in P300 amplitude under the Nogo condition were observed compared to the baseline phase. Pre- and post-exhaustion comparisons using standardized low-resolution brain electromagnetic tomography revealed reduced activations in the right middle temporal gyrus's N200 component after exhaustion in SAR personnel during the Nogo condition.

CONCLUSION

The results suggest that acute physical exhaustion significantly impacts the inhibition ability of SAR personnel, prolonging the conflict monitoring phase and weakening the response inhibition phase. These findings provide valuable insights into how physical exhaustion affects cognitive functions critical to the safety and effectiveness of SAR operations, and can inform strategies to improve training and equipment to enhance performance under extreme conditions.

Transcranial direct current stimulation combined with cognitive training improves decision making and executive functions in opioid use disorder: a triple-blind sham-controlled pilot study

Opioid use disorder (OUD) is a chronic disorder with a considerable amount of morbidity and mortality. Despite remarkable improvement achieved by maintenance programs, an array of treatment goals were still unmet. Mounting evidence suggests that transcranial Direct Current Stimulation (tDCS) improves decision making and cognitive functions in addictive disorders. tDCS paired with a decision making task was depicted to diminish impulsivity as well.

The present study aimed to assess the effect of tDCS combined with cognitive training (CT) in OUD for the first time.

In this triple-blind randomized sham-controlled pilot study, 38 individuals with OUD from the Buprenorphine-Naloxone Maintenance Therapy program were administered 20-minutes of 2 mA active/sham tDCS over the dorsolateral prefrontal cortex with concomitant cognitive training. A selected test battery evaluating decision making under risk and ambiguity as well as executive functions, verbal fluency and working memory was utilized before and after the intervention.

Greater improvements were observed in decision making under ambiguity (p = 0.016), set shifting ability and alternating fluency while no improvements were observed in decision making under risk in the active group, compared to sham.

Deficits of decision making and executive functions have a pivotal role in the perpetuation and the relapse of the OUD. Alleviation of these impairments brought tDCS/CT forth as an expedient neuroscientifically-grounded treatment option that merits further exploration in OUD, Trial registration: NCT05568251.

Endorsement of psychotic-like experiences and problematic cannabis use associated with worse executive functioning performance in undergraduates

BACKGROUND

Emerging adults who endorse more positive psychotic-like experiences (PLEs; bizarre experiences, delusional ideations) may experience greater cannabis-related impairments in executive function. Negative and depressive PLEs are also associated with cannabis use, however, less is known about their relation to executive functioning. Here, we hypothesize that high positive PLEs and cannabis use are associated with worse performance on computerized versions of the Iowa Gambling Task (IGT) and the Card Sorting Task (CST); exploratory analyses are conducted with negative and depressive PLEs.

METHODS

We recruited university students (N = 543) who completed an online study consisting of self-report measures of problematic cannabis use (Cannabis Use Disorder Identification Test; CUDIT-R) and PLEs (Community Assessment of Psychotic Experiences; CAPE). Of these, n=270 completed the CST and n=251 completed the IGT.

RESULTS

Problematic cannabis use and high endorsement of positive PLEs related to significantly worse performance on the IGT and greater perseverative errors on the CST. In addition, people who endorsed high levels of positive PLEs were also significantly more likely to complete the IGT with less money relative to those who endorsed fewer PLEs, regardless of cannabis use. Further analyses based on negative PLEs revealed a similar pattern for perseverative errors on the CST; depressive PLEs were not related to task performance.

CONCLUSION

Findings highlight that problematic cannabis use and more frequent and distressing positive PLEs are associated with poorer executive functioning. Thus, executive functioning may have implications for intervention among those high on both attributes, who are at high risk of onset of psychosis.

Not all bad decisions are alike: approach and avoidant bad decisions are associated with distinct network organization

Introduction

Decisions under ambiguity occurs daily for everyone. Subsequently, we all deliberate upon options to initiate an action most appropriate for current goal demands. Researchers has attempted to identify factors which contribute to risk taking, alongside the neurocircuitry underpinning it. Empirically, uncertain decision making is frequently assessed using the Iowa Gambling Task (IGT). Research have reliably identified varying regions implicating two broader circuits known as the reward and salience networks. However, considerable work has focused on contrasting "good" versus "bad" decisions.

Methods

The present investigation attempted a unique approach to analyzing the modified IGT acquired during fMRI (n = 24) and focused on active and passive bad decisions to identify potential internetwork connectivity, dissociable connectivity patterns between approach and avoidant bad decisions, and their relationship with personality traits, which can be linked with behavioral approach styles.

Results

Network cluster analyses revealed general internetwork connectivity when passing (avoiding) good decks; however, the OFC was functionally disconnected from the rest of the selected brain regions when playing (approaching) bad decks. Decreased reward responsiveness was linked to increased functional connectivity between the lateral OFC and aSMG, while drive was associated with increased functional connectivity between dACC and aINS.

Discussion

We report evidence that approach and avoidant bad decisions are associated with distinct neural communication patterns. Avoidant decisions were marked by substantial network integration and coherence, contrasted with the general scarcity of internetwork communication observed for approach decisions. Furthermore, the present investigation observed preliminary evidence of personality traits linked with neural communication between salience and reward evaluative networks.

The Effect of Multi-Session Prefrontal Cortical Stimulation on Aggression: A Randomized, Double-Blind, Parallel-Group Trial

Findings from brain imaging studies investigating the neural underpinnings of antisocial behavior have implicated the prefrontal cortex in the regulation of aggressive reactions. However, relatively few studies have examined the role of the prefrontal cortex on aggression in an experimental way. This study examines whether upregulating the prefrontal cortex using repeated transcranial direct current stimulation (tDCS) reduces aggressive behavior. In a double-blind, parallel-group, randomized controlled trial, 88 healthy adults (42 males, 46 females) were assigned to one session of anodal tDCS over the ventromedial prefrontal cortex (n = 47) or sham stimulation (n = 41) per day for three consecutive days and assessed using a behavioral measure of aggression. Levels of aggressive responses post-intervention did not significantly differ between the active and sham stimulation groups. However, a significant interaction effect between the stimulation group and gender was observed, whereby males, but not females, exhibited reduced aggression after prefrontal stimulation. To the authors' knowledge, this is the first study to examine the effect of multi-session prefrontal tDCS on aggressive behavior in healthy adults. Results highlight that there are differences in responsivity to tDCS in modifying aggressive behavior.

The COMT gene modulates the relationship between bilingual adaptation in executive function and decision-making: an EEG study

Bilingual adaptive control mechanisms appear to be linked to congenital genetic factors such as dopamine (DA) genes. However, it is unclear as to whether acquired cognitive exercise can vanquish innate influences that allow bilingual executive advantages to be shown in other cognitive areas. In the present study, we examine the relationship between gene-dependent executive control and decision-making by targeting the enzyme catecholamine-O-methyltransferase (COMT) and employing electroencephalography (EEG). Chinese-English bilinguals (N = 101) participated in a language switching task and the Iowa Gambling Task (IGT). The findings showed that COMT Val158Met polymorphism played a complex role in decision-making and bilingual executive control processing: Bilinguals with Valine (Val) homozygotes had poorer performance in the IGT, while Methionine (Met) carriers had larger switch costs in the language switching task. Second, the cross-task relationships varied among bilinguals with different COMT genotypes: Bilinguals with Met allele genotypes showed larger switch costs and better performance on the IGT. These findings suggest that bilinguals who carry Met allele are equipped with more efficient adaptive mechanisms of executive functions that are generalized to other cognitive domains.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-022-09867-2.

Tools for the Assessment of Risk-Taking Behavior in Older Adults with Mild Dementia: A Cross-Sectional Clinical Study

Diseases such as Alzheimer's cause an alteration of cognitive functions, which can lead to increased daily risk-taking in older adults living at home. The assessment of decision-making abilities is primarily based on clinicians' global analysis. Usual neuropsychological tests such as the MoCA (Montreal Cognitive Assessment) cover most of the cognitive domains and include mental flexibility tasks. Specific behavioral tasks for risk-taking, such as the Balloon Analogue Risk Task (BART) or the Iowa Gambling Task (IGT), have been developed to assess risk-taking behavior, particularly in the field of addictology. Our cross-sectional study aims to determine whether the MoCA global cognitive assessment could be used as a substitute for behavioral tasks in the assessment of risky behavior. In the current study, 24 patients (age: 82.1 ± 5.9) diagnosed with mild dementia completed the cognitive assessment (MoCA and executive function assessment) and two behavioral risk-taking tasks (BART, simplified version of the IGT). Results revealed no relationship between scores obtained in the MoCA and behavioral decision-making tasks. However, the two tasks assessing risk-taking behavior resulted in concordant risk profiles. In addition, patients with a high risk-taking behavior profile on the BART had better Trail Making Test (TMT) scores and thus retained mental flexibility. These findings suggest that MoCA scores are not representative of risk-taking behavioral inclinations. Thus, additional clinical tests should be used to assess risk-taking behavior in geriatric settings. Executive function measures, such as the TMT, and behavioral laboratory measures, such as the BART, are recommended for this purpose.

High-Definition Transcranial Direct Current Stimulation Improves Decision-Making Ability: A Study Based on EEG

High-definition transcranial direct current stimulation (HD-tDCS) has been shown to modulate decision-making; however, the neurophysiological mechanisms underlying this effect remain unclear. To further explore the neurophysiological processes of decision-making modulated by HD-tDCS, health participants underwent ten anodal (n = 16)/sham (n = 17) HD-tDCS sessions targeting the left DLPFC. Iowa gambling task was performed simultaneously with electroencephalography (EEG) before and after HD-tDCS. Iowa gambling task performance, the P300 amplitude, and the power of theta oscillation as an index of decision-making were compared. Behavioral changes were found that showed anodal HD-tDCS could improve the decision-making function, in which participants could make more advantageous choices. The electrophysiological results showed that the P300 amplitude significantly increased in CZ, CPZ electrode placement site and theta oscillation power significantly activated in FCZ, CZ electrode placement site after anodal HD-tDCS. Significant positive correlations were observed between the changes in the percent use of negative feedback and the changes in theta oscillation power before and after anodal HD-tDCS. This study showed that HD-tDCS is a promising technology in improving decision-making and theta oscillation induced by may be a predictor of improved decision-making.

Altered social decision making in patients with chronic pain

BACKGROUND

Chronic pain affects up to 20% of the population, impairs quality of life and reduces social participation. Previous research reported that pain-related perceived injustice covaries with these negative consequences. The current study probed whether chronic pain patients responded more strongly to disadvantageous social inequity than healthy individuals.

METHODS

We administered the Ultimatum Game, a neuroeconomic social exchange game, where a sum of money is split between two players to a large sample of patients with chronic pain disorder with somatic and psychological factors (n = 102) and healthy controls (n = 101). Anonymised, and in truth experimentally controlled, co-players proposed a split, and our participants either accepted or rejected these offers.

RESULTS

Chronic pain patients were hypersensitive to disadvantageous inequity and punished their co-players for proposed unequal splits more often than healthy controls. Furthermore, this systematic shift in social decision making was independent of patients' performance on tests of executive functions and risk-sensitive (non-social) decision making .

CONCLUSIONS

Our findings indicate that chronic pain is associated with anomalies in social decision making (compared to healthy controls) and hypersensitivity to social inequity that is likely to negatively impact social partaking and thereby the quality of life.

Risk Decision Making and Executive Function among Adolescents and Young Adults

The dual theory establishes that the decision-making process relies on two different systems, the affective system and the executive function (EF), developed during adolescence. This study analyzes the relationship between the decision-making and EF processes in a group of early adolescents (mean age = 12.51 years, SD = 0.61), where more affective impulse processes are developed, and in young adults (mean age = 19.38 years, SD = 1.97), where cognitive control processes have already matured. For this purpose, 140 participants in Spain completed the Iowa Gambling Task (IGT) to measure their risky decisions and the Wisconsin Card Sorting Task (WCST) to measure their EF. Performance on the IGT improves over blocks; however, adolescents received lower mean scores than young adults. However, controlling for age, perseverative errors were negatively associated with the mean net score on the risky blocks of IGT; thus, those who committed more perseverative errors in the WCST were more likely to take cards from the disadvantageous decks on the last blocks of the IGT. The current study shows that adolescents and adults solve ambiguous decisions by trial and error; however, adolescents are more likely to make risky decisions without attending to the long-term consequences. Following the dual theory hypothesis, the maturation of EF with age partly accounts for this difference in risky decision-making between adolescents and adults.

The impact of childhood trauma on thalamic functional connectivity in patients with obsessive-compulsive disorder

BACKGROUND

Childhood trauma is a vulnerability factor for the development of obsessive-compulsive disorder (OCD). Empirical findings suggest that trauma-related alterations in brain networks, especially in thalamus-related regions, have been observed in OCD patients. However, the relationship between childhood trauma and thalamic connectivity in patients with OCD remains unclear. The present study aimed to examine the impact of childhood trauma on thalamic functional connectivity in OCD patients.

METHODS

Magnetic resonance imaging resting-state scans were acquired in 79 patients with OCD, including 22 patients with a high level of childhood trauma (OCD_HCT), 57 patients with a low level of childhood trauma (OCD_LCT) and 47 healthy controls. Seven thalamic subdivisions were chosen as regions of interest (ROIs) to examine the group difference in thalamic ROIs and whole-brain resting-state functional connectivity (rsFC).

RESULTS

We found significantly decreased caudate-thalamic rsFC in OCD patients as a whole group and also in OCD_LCT patients, compared with healthy controls. However, OCD_HCT patients exhibited increased thalamic rsFC with the prefrontal cortex when compared with both OCD_LCT patients and healthy controls.

CONCLUSIONS

Taken together, OCD patients with high and low levels of childhood trauma exhibit different pathological alterations in thalamic rsFC, suggesting that childhood trauma may be a predisposing factor for some OCD patients.

Uncovering the effects of bilingual language control on rational decisions: An ERP study

A growing body of research suggests that the language in which bilinguals make decisions affects the rationality of such decisions. Furthermore, bilinguals constantly confront cross-language interference that requires complex language control processes to resolve this competition. However, the relationship between language control and decision-making is unclear. In the current study, we analyze electrophysiological and behavior data elicited from two groups of Chinese-English bilinguals. One group was trained in intensive language switching and then completed the Iowa Gambling Task (IGT) and the other group completed the two tasks in the reverse order. We found that bilinguals who first received language switching training significantly scored higher on the IGT, with the score positively correlating with L1 and L2 switch costs. More importantly, training with language switching first led to an N2 component for L1 switching costs that negatively correlated with both loss feedback-related negativity and the P3 component. These effects did not emerge among the group of bilinguals who performed the IGT first. Taken together, the findings suggest that bilinguals are assisted in making rational decisions by language control on feedback evaluation.

Hidden biases in clinical decision-making: potential solutions, challenges, and perspectives

Every day, we must make decisions that range from simple and risk-free to difficult and risky. Our cognitive sources' limitations, as well as the need for speed, can frequently impair the quality and accuracy of our reasoning processes. Indeed, cognitive shortcuts lead us to solutions that are sufficiently satisfying to allow us to make quick decisions. Unfortunately, heuristics frequently misguide us, and we fall victim to biases and systematic distortions of our perceptions and judgments. Because suboptimal diagnostic reasoning processes can have dramatic consequences, the clinical setting is an ideal setting for developing targeted interventions to reduce the rates and magnitude of biases. There are several approaches to bias mitigation, some of which may be impractical. Furthermore, advances in information technology have given us powerful tools for addressing and preventing errors in health care. Recognizing and accepting the role of biases is only the first and unavoidable step toward any effective intervention proposal. As a result, our narrative review aims to present some insights on this contentious topic based on both medical and psychological literature.

“Hot” executive functions are comparable across monolingual and bilingual elementary school children: Results from a study with the Iowa Gambling Task

Past research found performance differences between monolingual and bilingual children in the domain of executive functions (EF). Furthermore, recent studies have reported advantages in processing efficiency or mental effort in bilingual adults and children. These studies mostly focused on the investigation of “cold” EF tasks. Studies including measures of “hot” EF, i.e., tasks operating in an emotionally significant setting, are limited and hence results are inconclusive. In the present study, we extend previous research by investigating performance in a task of the “hot” EF domain by both behavioral data and mental effort via pupillary changes during task performance. Seventy-three monolingual and bilingual school children (mean age = 107.23 months, SD = 10.26) solved the Iowa Gambling Task in two different conditions. In the standard task, characterized by constant gains and occasional losses, children did not learn to improve their decision-making behavior. In a reversed task version, characterized by constant losses and occasional gains, both monolinguals and bilinguals learned to improve their decision-making behavior over the course of the task. In both versions of the task, children switched choices more often after losses than after gains. Bilinguals switched their choices less often than monolinguals in the reversed task, indicating a slightly more mature decision-making strategy. Mental effort did not differ between monolinguals and bilinguals. Conclusions of these findings for the bilingual advantage assumption will be discussed.

Need for cognition moderates the impairment of decision making caused by nightshift work in nurses

The current study explores the effect of nightshift work on the decision-making competence and performance of the Iowa Gambling Task (IGT) and analyzes whether individual differences in the need for cognition (NFC) can moderate this effect. A total of 107 female nurses were recruited to complete the decision-making competence scale and IGT at two times, after a night shift and after a day shift. The results revealed that the IGT scores and decision-making competence of nurses after nightshift work significantly declined, and also that the decrease in decision-making competence was related to the nurses’ performance of the IGT. Additionally, the decreasing degree of IGT and decision-making competence scores of the high-NFC group were significantly lower than those of the low-NFC group after nightshift work. In can be concluded that the decrease in decision-making competence which was related with poor decision-making due to nightshift work. NFC moderated the effect of nightshift work on decision-making.

Decision making in Parkinson's disease: An analysis of the studies using the Iowa Gambling Task

In Parkinson's disease (PD) impairments in decision making can occur, in particular because of the tendency toward risky and rewarding options. The Iowa Gambling Task has been widely used to investigate decision processes involving these options. The task assesses the ability to manage risk and to learn from feedback. The present paper aims at critically examining those studies in which this task has been administered to PD patients, in order to understand possible anomalies in patients' decision processes and which variables are responsible for that. A meta‐analysis has been conducted as well. Features of the task, sociodemographic and clinical aspects (including daily drugs intake), cognitive conditions and emotional disorders of the patients have been taken into account. Neural correlates of decision‐making competences were considered. It emerged that PD patients show a trend of preference toward risky choices, probably due to an impairment in anticipating the unrewarding consequences or to an insensitiveness to punishment. The possible role played by dopamine medications in decision making under uncertain conditions, affecting basal ganglia and structures involved in the limbic loop, was discussed. Attention has been focused on some aspects that need to be investigated in further research, in order to delve into this issue and promote patients' quality of life.

Impaired Perception of Unintentional Transgression of Social Norms after Prefrontal Cortex Damage: Relationship to Decision Making, Emotion Recognition, and Executive Functions

OBJECTIVE

Patients with prefrontal cortex damage often transgress social rules and show lower accuracy in identifying and explaining inappropriate social behavior. The objective of this study was to examine the relationship between the ability to perceive other unintentional transgressions of social norms and both decision making and emotion recognition as these abilities are critical for appropriate social behavior.

METHOD

We examined a group of patients with focal prefrontal cortex damage (N = 28) and a group of matched control participants (N = 28) for their abilities to detect unintentional transgression of social norms using the "Faux-Pas" task of theory of mind, to make advantageous decisions on the Iowa gambling task, and to recognize basic emotions on the Ekman facial affect test.

RESULTS

The group of patients with frontal lobe damage was impaired in all of these tasks compared with control participants. Moreover, all the "Faux-Pas", Iowa gambling, and emotion recognition tasks were significantly associated and predicted by executive measures of inhibition, flexibility, or planning. However, only measures from the Iowa gambling task were associated and predicted performance on the "Faux-Pas" task. These tasks were not associated with performance in recognition of basic emotions. These findings suggest that theory of mind, executive functions, and decision-making abilities act in an interdependent way for appropriate social behavior. However, theory of mind and emotion recognition seem to have distinct but additive effects upon social behavior. Results from VLSM analysis also corroborate these data by showing a partially overlapped prefrontal circuitry underlying these cognitive domains.

The role of the medial prefrontal cortex in cognition, ageing and dementia

Humans require a plethora of higher cognitive skills to perform executive functions, such as reasoning, planning, language and social interactions, which are regulated predominantly by the prefrontal cortex. The prefrontal cortex comprises the lateral, medial and orbitofrontal regions. In higher primates, the lateral prefrontal cortex is further separated into the respective dorsal and ventral subregions. However, all these regions have variably been implicated in several fronto-subcortical circuits. Dysfunction of these circuits has been highlighted in vascular and other neurocognitive disorders. Recent advances suggest the medial prefrontal cortex plays an important regulatory role in numerous cognitive functions, including attention, inhibitory control, habit formation and working, spatial or long-term memory. The medial prefrontal cortex appears highly interconnected with subcortical regions (thalamus, amygdala and hippocampus) and exerts top-down executive control over various cognitive domains and stimuli. Much of our knowledge comes from rodent models using precise lesions and electrophysiology readouts from specific medial prefrontal cortex locations. Although, anatomical disparities of the rodent medial prefrontal cortex compared to the primate homologue are apparent, current rodent models have effectively implicated the medial prefrontal cortex as a neural substrate of cognitive decline within ageing and dementia. Human brain connectivity-based neuroimaging has demonstrated that large-scale medial prefrontal cortex networks, such as the default mode network, are equally important for cognition. However, there is little consensus on how medial prefrontal cortex functional connectivity specifically changes during brain pathological states. In context with previous work in rodents and non-human primates, we attempt to convey a consensus on the current understanding of the role of predominantly the medial prefrontal cortex and its functional connectivity measured by resting-state functional MRI in ageing associated disorders, including prodromal dementia states, Alzheimer's disease, post-ischaemic stroke, Parkinsonism and frontotemporal dementia. Previous cross-sectional studies suggest that medial prefrontal cortex functional connectivity abnormalities are consistently found in the default mode network across both ageing and neurocognitive disorders such as Alzheimer's disease and vascular cognitive impairment. Distinct disease-specific patterns of medial prefrontal cortex functional connectivity alterations within specific large-scale networks appear to consistently feature in the default mode network, whilst detrimental connectivity alterations are associated with cognitive impairments independently from structural pathological aberrations, such as grey matter atrophy. These disease-specific patterns of medial prefrontal cortex functional connectivity also precede structural pathological changes and may be driven by ageing-related vascular mechanisms. The default mode network supports utility as a potential biomarker and therapeutic target for dementia-associated conditions. Yet, these associations still require validation in longitudinal studies using larger sample sizes.

Elevated fatty acid amide hydrolase in the prefrontal cortex of borderline personality disorder: a [11C]CURB positron emission tomography study

Amygdala-prefrontal cortex (PFC) functional impairments have been linked to emotion dysregulation and aggression in borderline personality disorder (BPD). Fatty acid amide hydrolase (FAAH), the major catabolic enzyme for the endocannabinoid anandamide, has been proposed as a key regulator of the amygdala-PFC circuit that subserves emotion regulation. We tested the hypothesis that FAAH levels measured with [¹¹C]CURB positron emission tomography in amygdala and PFC would be elevated in BPD and would relate to hostility and aggression. Twenty BPD patients and 20 healthy controls underwent FAAH genotyping (rs324420) and scanning with [¹¹C]CURB. BPD patients were medication-free and were not experiencing a current major depressive episode. Regional differences in [¹¹C]CURB binding were assessed using multivariate analysis of covariance with PFC and amygdala [¹¹C]CURB binding as dependent variables, diagnosis as a fixed factor, and sex and genotype as covariates. [¹¹C]CURB binding was marginally elevated across the PFC and amygdala in BPD (p = 0.08). In a priori selected PFC, but not amygdala, [¹¹C]CURB binding was significantly higher in BPD (11.0%, p = 0.035 versus 10.6%, p = 0.29). PFC and amygdala [¹¹C]CURB binding was positively correlated with measures of hostility in BPD (r > 0.4; p < 0.04). This study is the first to provide preliminary evidence of elevated PFC FAAH binding in any psychiatric condition. Findings are consistent with the model that lower endocannabinoid tone could perturb PFC circuitry that regulates emotion and aggression. Replication of these findings could encourage testing of FAAH inhibitors as innovative treatments for BPD.

Amygdala Circuitry During Neurofeedback Training and Symptoms' Change in Adolescents With Varying Depression

Typical adolescents have increased limbic engagement unchecked by regulatory medial prefrontal cortex (PFC) activity as well as heightened self-focus. The resulting emotion dysregulation and self-focused rumination make adolescents more susceptible to depression and suicide attempts. Heightened self-focus converges with mental illness among depressed adolescents, who deploy exaggerated attention to negative self-relevant stimuli and neglect positive ones as part of depression's phenomenology. This results in rigid negative self-representations during an identity formative period with potential lifetime repercussions. Current empirically supported treatments fail to allay recurrent depression. Evidence-based interventions for illnesses linked to suicide ideation and attempts (e.g., depression) underperform across the lifespan. This could be because current treatments are not successful in altering pervasive negative self-representations and affect dysregulation, which is known to be a risk factor of chronic depression. This study departs from the premise that increasing positive self-processing might be protective against chronic depression particularly during adolescence. The present research is a novel investigation of neurofeedback as a potential treatment alternative for adolescent depression. To enhance positive self-processing, we used the happy self-face as a cue to initiate neurofeedback from the bilateral amygdala and hippocampus and adolescents attempted to upregulate that limbic activity through the recall of positive autobiographical memories. We identified limbic functional circuitry engaged during neurofeedback and links to short-term symptoms' change in depression and rumination. We found that depressed youth showed greater right amygdala to right frontocortical connectivity and lower left amygdala to right frontocortical connectivity compared to healthy controls during neurofeedback vs. control conditions. Depressed youth also showed significant symptom reduction. Connectivity between the right amygdala and frontocortical regions was positively correlated with rumination and depression change, but connectivity between frontocortical regions and the left amygdala was negatively correlated with depression change. The results suggest that depressed youth might engage implicit emotion regulation circuitry while healthy youth recruit explicit emotion regulation circuits during neurofeedback. Our findings support a compensatory approach (i.e., target the right amygdala) during future neurofeedback interventions in depressed youth. Future work ought to include a placebo condition or group.

Decision making of forensic psychiatric inpatients deemed incompetent to stand trial

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.