The exploitation-exploration (EE) trade-off describes how, when making a decision, an organism must often choose between a safe alternative with a known pay-off, and one or more riskier alternatives with uncertain pay-offs. Recently, the concept of the EE trade-off has been extended to the examination of how organisms distribute limited attentional resources between several stimuli. This work suggests that when the rules governing the environment are certain, participants learn to "exploit" by attending preferentially to cues that provide the most information about upcoming events. However, when the rules are uncertain, people "explore" by increasing their attention to all cues that may provide information to help in predicting upcoming events. In the current study, we examine how uncertainty affects the EE trade-off in attention using a contextual two-armed bandit task, where participants explore with both their attention and their choice behavior. We find evidence for an influence of uncertainty on the EE trade-off in both choice and attention. These findings provide support for the idea of an EE trade-off in attention, and that uncertainty is a primary motivator for exploration in both choice and attentional allocation.
Objective: To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. Methods: We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 individuals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. Results: People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26; 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17; 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90; 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions; while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. Conclusion: Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis; (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.
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