Risky decision-making under risk in schizophrenia: A deliberate choice?

Pedersen, Anya; Göder, Robert; Tomczyk, Samuel; Ohrmann, Patricia

doi:10.1016/j.jbtep.2016.08.004

Cited by 34 publications

(32 citation statements)

References 49 publications

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“…Some mental illnesses also involve altered sensitivity to reward (e.g., hypersensitive in bipolar vs. hyposensitive in depression) ( Alloy, Olino, Freed, & Nusslock, 2016 ), which likely influences motivation to engage in high-reward behaviors such as gambling. Experimental gambling paradigms have found that people with schizophrenia or BPD make riskier choices and are less likely to change their behavior in response to negative feedback ( Pedersen, Goder, Tomczyk, & Ohrmann, 2017 ; Schuermann, Kathmann, Stiglmayr, Renneberg, & Endrass, 2011 ). The result of these potentially converging factors is that when engaging in an activity with high potential rewards, such as gambling, patients may make impulsive or poorly reasoned decisions and continue to gamble despite increasing losses ( Grant & Chamberlain, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

Problem gambling and substance use in patients attending community mental health services

et al. 2017

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Background and aimsRelatively little is known about co-occurring gambling problems and their overlap with other addictive behaviors among individuals attending mental health services. We aimed to determine rates of gambling and substance use problems in patients accessing mental health services in Victoria, Australia.MethodsA total of 837 adult patients were surveyed about their gambling and administered standardized screening tools for problem gambling and harmful tobacco, alcohol, and drug use. Prevalence of gambling problems was estimated and regression models used to determine predictors of problem gambling.ResultsThe gambling participation rate was 41.6% [95% CI = 38.2–44.9]. The Problem Gambling Severity Index identified 19.7% [CI = 17.0–22.4] as “non-problem gamblers,” 7.2% [CI = 5.4–8.9] as “low-risk” gamblers, 8.4% [CI = 6.5–10.2] as “moderate-risk” gamblers, and 6.3% [CI = 4.7–8.0] as “problem gamblers.” One-fifth (21.9%) of the sample and 52.6% of all gamblers were identified as either low-risk, moderate-risk, or problem gamblers (PGs). Patients classified as problem and moderate-risk gamblers had significantly elevated rates of nicotine and illicit drug dependence (p < .001) according to short screening tools. Current diagnosis of drug use (OR = 4.31 [CI = 1.98–9.37]), borderline personality (OR = 2.59 [CI = 1.13–5.94]), bipolar affective (OR = 2.01 [CI = 1.07–3.80]), and psychotic (OR = 1.83 [CI = 1.03–3.25]) disorders were significant predictors of problem gambling.Discussion and conclusionsPatients were less likely to gamble, but eight times as likely to be classified as PG, relative to Victoria’s adult general population. Elevated rates of harmful substance use among moderate-risk and PG suggest overlapping vulnerability to addictive behaviors. These findings suggest mental health services should embed routine screening into clinical practice, and train clinicians in the management of problem gambling.

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Section: Discussionmentioning

confidence: 99%

Problem gambling and substance use in patients attending community mental health services

et al. 2017

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“…We also noted that neurocognition deficits are well-established in schizophrenia and have a close relationship with social cognition, including ToM [26, 27]. Furthermore, specific aspects of neurocognition, such as working memory and executive function, are closely related to decision-making behaviors [28, 29]. Therefore, in the present study, in addition to the focus on the role of ToM in social decision-making, we also explored the mediation effect of neurocognition on social decision-making.…”

Section: Introductionmentioning

confidence: 99%

Theory of mind deficits partly mediate impaired social decision-making in schizophrenia

Yang

Mao

et al. 2017

BMC Psychiatry

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BackgroundUsing paradigms from game theory, researchers have reported abnormal decision-making in social context in patients with schizophrenia. However, less is known about the underpinnings of the impairment. This study aimed to test whether theory of mind (ToM) deficits and/or neurocognitive dysfunctions mediate impaired social decision-making in patients with schizophrenia.MethodsWe compared thirty-five patients with schizophrenia to thirty-eight matched healthy controls with regard to social decision-making using the mini Ultimatum Game (mini UG), a paradigm from game theory. Additionally, we assessed ToM using the Theory of Mind Picture Stories Task, a mental state attribution task, and assessed neurocognition using the Brief Assessment of Cognition in Schizophrenia. Mediation analyses were performed on the data.ResultsIn contrast to the behavioral pattern of healthy controls in the mini UG, the patients with schizophrenia significantly accepted more disadvantageous offers and rejected more advantageous offers, and showed reduced sensitivity to the fairness-related context changes in the mini UG. Impaired ToM and neurocognition were also found in the patients. Mediation analyses indicated that ToM but not neurocognition partially mediated the group differences on the disadvantageous and advantageous offers in the mini UG.ConclusionsPatients with schizophrenia exhibited impaired social decision-making. This impairment can be partly explained by their ToM deficits rather than neurocognitive deficits. However, the exact nature of the ToM deficits that mediate impaired social decision-making needs to be identified in future.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1313-3) contains supplementary material, which is available to authorized users.

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“…With regard to patients with SCZ, most previous studies have found an increased preference for the disadvantageous decks relative to healthy controls (HCs; E. C. Brown et al, ; Nestor et al, ; Pedersen, Göder, Tomczyk, & Ohrmann, ; Saperia et al, ). However, the results in patients with MDD were inconsistent.…”

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confidence: 99%

A transdiagnostic comparison of affective decision‐making in patients with schizophrenia, major depressive disorder, or bipolar disorder

Zhou

Ye³

et al. 2020

PsyCh Journal

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Deficit in decision-making has been found in patients with schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD), respectively, while the common and distinct characteristics of this deficit among these patients are still unclear. The present study aimed to make a transdiagnostic comparison of the affective decision-making ability in patients with SCZ, MDD, and BD. In this study, 33 patients with SCZ, 23 patients with MDD, 29 patients with BD, and 34 healthy controls (HCs) were recruited and the Iowa Gambling Task (IGT) was used to assess the affective decision-making ability. The results showed that all three diagnostic groups tended to select the disadvantageous decks but not advantageous decks compared to HCs. For patients with SCZ, an excessive preference for the disadvantageous decks with larger-magnitude less frequent punishments (deck B) may be the main reason of the deficit in affective decision-making, while that in patients with MDD was a significantly decreased ability to choose advantageous decks on the whole but with larger-magnitude less frequent punishments (deck D). As regards patients with BD, the concurrence of more choices of deck B and fewer choices of deck D was the characteristic of the deficit in affective decision-making. Our findings suggest a common affective decision-making impairment in the context of multiple choices in patients with SCZ, MDD, and BD, while the underlying mechanisms of the impairment among these patients may be slightly different.

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Risky decision-making under risk in schizophrenia: A deliberate choice?

Cited by 34 publications

References 49 publications

Problem gambling and substance use in patients attending community mental health services

Problem gambling and substance use in patients attending community mental health services

Theory of mind deficits partly mediate impaired social decision-making in schizophrenia

A transdiagnostic comparison of affective decision‐making in patients with schizophrenia, major depressive disorder, or bipolar disorder

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