Decision making under ambiguity and risk in adolescent-onset schizophrenia

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.

Decision-making under risk and its correlates in schizophrenia

“…While both groups selected more cards when loss probability was lower, the degree of this adjustment was significantly larger in non-SSD participants. Our findings were largely consistent with past studies regarding altered risk adjustment in schizophrenia (Heerey et al, 2008;Hutton et al, 2002;Li et al, 2021;Martin et al, 2015;Pedersen et al, 2017). Notedly, when comparing risk-taking separately during 1-loss-card and 3-loss-card conditions, we observed no group differences in either risk-taking or deviation from optimal decision.…”

“…For instance, in one study, individuals with both chronic and first-episode psychosis adjusted their bets to a lesser extent in response to changing probability compared to controls (Hutton et al, 2002). Another study found that individuals with adolescent-onset schizophrenia made fewer optimal choices and adjusted their behavior less according to negative outcomes on the previous decision (Li et al, 2021). Despite this work, much remains unknown about risky decision-making in schizophrenia.…”

The effect of increased reward sensitivity on risk decision making in adolescents with non-suicidal self-injury

“…MoCA < 26 indicates mild cognitive impairment. The Chinese version used in this study has been widely used in a sample of Chinese adolescents [41].…”