Toward an Understanding of Decision Making in Severe Mental Illness

Abstract

A commonality of patients with major psychiatric disorders is their propensity to make poor decisions, which is intimately related to poor real-life outcomes. The authors reviewed the literature on decision making as applied to severe psychiatric disorders, with particular focus on advances in cognitive neuroscience. Deficits in reward sensitivity, avoidance learning, and temporal discounting are reported in depression. Besides abnormalities in hedonic capacity, other cognitive distortions required for flexible control of behavior occur in patients with bipolar disorder and schizophrenia. A conceptual framework of abnormal decision making in mental illness could generate targeted interventions to improve quality of life and clinical outcomes.

Tobacco demand, delay discounting, and smoking topography among smokers with and without psychopathology

“…Inconsistencies in this literature may be related to method variance (e.g., self-reported versus diagnostic assessment of psychopathology). More research in smokers is warranted to better understand how psychopathology may impact DD, given evidence of steeper (impulsive) DD in various forms of psychopathology (Cáceda et al, 2014; Story et al, 2016). Alternative forms of discounting (e.g., excessive probability discounting) should also be explored to better understand the nature of immediate tobacco preference despite known long-term consequences.…”

“…The undervaluation of future rewards (steeper DD) is a key characteristic of problematic health behaviors (Amlung et al, 2017, 2016), including cigarette smoking (Amlung et al, 2017). Additionally, steeper DD has been observed in various psychological disorders, including those characterized by impulsivity (hypomania/mania, attention deficit-hyperactivity disorder), disorders of cognitive or executive dysfunction (e.g., schizophrenia), disorders involving future-focused uncertainty/fear (e.g., posttraumatic stress disorder, anxiety disorders, borderline personality disorder; Cáceda et al, 2014; Story et al, 2016). Despite the clear documented link between psychological disorders and DD, limited work has examined the nature of DD among smokers with psychological disorders.…”

An eye-tracking investigation of intentional motion perception in patients with schizophrenia

“…Impairments in decision making have been extensively reported in individuals with schizophrenia on numerous different tasks. 32 The decreased cognitive sensitivity remained significantly different between groups once differences in terms of visual exploration and general cognitive abilities were taken into ac count, thus suggesting that difficulties at the high level and explicit cognitive stage of processing remain the most robust impairment underlying the chasing detection deficit in indi viduals with schizophrenia.…”

How Situational Diagnosis Helps Disentangle Ethical and Psychological Features of Complex Cases

“…Severe mental illness, such as major depression, bipolar disorder, or schizophrenia, has been found to be associated with poor decision making [6]. And decision-making capacity can fluctuate in patients with bipolar disorder, being impaired when the patient is in a manic episode but returning with the patient's recuperation [7].…”