The Prominent Deck B Phenomenon in Schizophrenia: An Empirical Study on Iowa Gambling Task

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.

Relationship between coping styles and affective decision- making process among schizophrenia patients and healthy controls

“…Despite extensive investigation of risky decision-making, there is no consensus as to whether SZ disorders are associated with impaired performance on the IGT. [32] concluded that show impaired IGT performance because a decreased ability to perceive risk-relevant information and to discriminate between "safe" and dangerous options [16,17,19] but not others [18,20,21,22,33]. In accordance with previous studies [34,35], SZ patients have decreased coping skills.…”

“…Schizophrenia (SZ) is a chronic neurodevelopmental disorder with de cits in affective processing [15]. In fact, in some studies, patients with SZ showed poor IGT performance compared to healthy controls (HC) [16,17,18,19]. However, other group of authors failed to nd differences between patients with SZ and HC [20,21,22].…”

Reanalyzing the Maia and McClelland (2004) Empirical Data: How Do Participants Really Behave in the Iowa Gambling Task?

“…Consequently, this means that gain-loss frequency might be the most dominant guiding factor in decision behavior under uncertainty (2) and that the final outcome/expected value might be a secondary factor. Furthermore, an increasing number of IGT clinical studies compared the selection strategies of neurological/psychiatric patients and control groups found that the control group participants chose Deck B significantly more often than Deck A (24,(27)(28)(29)(30)(31). The number of clinical cases exhibiting the PDB phenomenon during IGT has yet to be established.…”