Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Schizophrenia | Research

Decision making under ambiguity and risk in adolescent-onset schizophrenia

Authors: Dandan Li, Fengyan Zhang, Lu Wang, Yifan Zhang, Tingting Yang, Kai Wang, Chunyan Zhu

Published in: BMC Psychiatry | Issue 1/2021

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.

Available only for authorised users

Kennedy EKA, Datta SS. Antipsychotic medication for childhood-onset schizophrenia. Cochrane Database Syst Rev. 2007;3(3):CD004027.

Young CMFR. Pharmacologic treatment of adolescent and child schizophrenia. Expert Rev Neurother. 2004;4(1):53–60. https://doi.org/10.1586/14737175.4.1.53.CrossRefPubMed

Armenteros JL, Davies M. Antipsychotics in early onset schizophrenia: systematic review and meta-analysis. Eur Child Adolesc Psychiatry. 2006;15(3):141–8. https://doi.org/10.1007/s00787-005-0515-2.CrossRefPubMed

Pagsberg AK, Tarp S, Glintborg D, Stenstrom AD, Fink-Jensen A, Correll CU, et al. Acute antipsychotic treatment of children and adolescents with schizophrenia-Spectrum disorders: a systematic review and network meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56(3):191–202. https://doi.org/10.1016/j.jaac.2016.12.013.CrossRefPubMed

Madaan V. Dvir, Y., & Wilson, D. R.: child and adolescent schizophrenia: pharmacological approaches. Expert Opin Pharmacother. 2008;9(12):2053–68. https://doi.org/10.1517/14656566.9.12.2053.CrossRefPubMed

Paus T, Keshavan M, Giedd JN. Why do many psychiatric disorders emerge during adolescence? Nat Rev Neurosci. 2008;9(12):947–57. https://doi.org/10.1038/nrn2513.CrossRefPubMedPubMedCentral

Dienel SJ, Lewis DA. Alterations in cortical interneurons and cognitive function in schizophrenia. Neurobiol Dis. 2019;131:104208.CrossRef

Howes OD, Murray RM. Schizophrenia: an integrated sociodevelopmental-cognitive model. Lancet. 2014;383(9929):1677–87. https://doi.org/10.1016/S0140-6736(13)62036-X.CrossRefPubMed

Garcia RR, Aliste F, Soto G. Social cognition in schizophrenia: cognitive and neurobiological aspects. Revista colombiana de psiquiatria. 2018;47(3):170–6. https://doi.org/10.1016/j.rcpeng.2018.06.004.CrossRefPubMed

10.

Schneider C, Papachristou E, Wimberley T, Gasse C, Dima D, MacCabe JH, et al. Clozapine use in childhood and adolescent schizophrenia: a nationwide population-based study. Eur Neuropsychopharmacol. 2015;25(6):857–63. https://doi.org/10.1016/j.euroneuro.2015.02.003.CrossRefPubMed

11.

Sanchez-Gistau V, Baeza I, Arango C, Gonzalez-Pinto A, de la Serna E, Parellada M, et al. Predictors of suicide attempt in early-onset, first-episode psychoses: a longitudinal 24-month follow-up study. J Clin Psychiatry. 2013;74(1):59–66. https://doi.org/10.4088/JCP.12m07632.CrossRefPubMed

12.

Heinz A, Deserno L, Reininghaus U. Urbanicity, social adversity and psychosis. World Psychiatry. 2013;12:187–97.CrossRef

13.

Kriegler J, Wegener S, Richter F, Scherbaum N, Brand M, Wegmann E. DM of individuals with heroin addiction receiving opioid maintenance treatment compared to early abstinent users. Drug Alcohol Depend. 2019;205:107593. https://doi.org/10.1016/j.drugalcdep.2019.107593.CrossRefPubMed

14.

Lejuez CW, Aklin WM, Zvolensky MJ, Pedulla CM. Evaluation of the balloon analogue risk task (BART) as a predictor of adolescent real-world risk-taking behaviours. J Adolesc. 2003;26(4):475–9. https://doi.org/10.1016/S0140-1971(03)00036-8.CrossRefPubMed

15.

Heekeren HR, Marrett S, Ungerleider LG. The neural systems that mediate human perceptual DM. Nat Rev Neurosci. 2008;9(6):467–79. https://doi.org/10.1038/nrn2374.CrossRefPubMed

16.

Sterzer P. Moving forward in perceptual DM. Proc Natl Acad Sci. 2016;113(21):5771–3. https://doi.org/10.1073/pnas.1605619113.CrossRefPubMed

17.

Bechara A. The role of emotion in decision-making: evidence from neurological patients with orbitofrontal damage. Brain Cogn. 2004;55(1):30–40. https://doi.org/10.1016/j.bandc.2003.04.001.CrossRefPubMed

18.

Brand M, Labudda K, Markowitsch HJ. Neuropsychological correlates of decision-making in ambiguous and risky situations. Neural Netw. 2006;19(8):1266–76. https://doi.org/10.1016/j.neunet.2006.03.001.CrossRefPubMed

19.

Bechara A, Damasio AR, Damasio H, Anderson SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition. 1994;5:7–15.CrossRef

20.

Fujiwara E, Borsutzky S, Kalbe E, Kessler J, Markowitsch H. J: decision-making defificits of Korsakoff patients in a new gambling task with explicit rules: associations with executive functions. Neuropsychology. 2005;12:276–7.

21.

Zhang L, Dong Y, Ji Y, Zhu C, Yu F, Ma H, et al. Dissociation of DM under ambiguity and DM under risk: a neurocognitive endophenotype candidate for obsessive–compulsive disorder. Prog Neuro-Psychopharmacol Biol Psychiatry. 2015;57:60–8. https://doi.org/10.1016/j.pnpbp.2014.09.005.CrossRef

22.

Sun TXT, Wang J, Zhang L, Tian Y, Wang K, Yu X, et al. Decision-making under ambiguity or risk in individuals with Alzheimer's disease and mild cognitive impairment. Front Psychiatry. 2020;8(11):218.

23.

Biars JW, Johnson NL, Nespeca M, Busch RM, Kubu CS, Floden DP. Iowa gambling task performance in Parkinson disease patients with impulse control disorders. Archiv Clin Neuropsychol. 2019;34(3):310–8. https://doi.org/10.1093/arclin/acy036.CrossRef

24.

Lee Y, Kim Y-T, Seo E, Park O, Jeong S-H, Kim SH, et al. Dissociation of emotional decision-making from cognitive decision-making in chronic schizophrenia. Psychiatry Res. 2007;152(2–3):113–20. https://doi.org/10.1016/j.psychres.2006.02.001.CrossRefPubMed

25.

Runyon M, Buelow MT. Risky decision-making and delusion proneness: an initial examination. Heliyon. 2019;5(11):e02767. https://doi.org/10.1016/j.heliyon.2019.e02767.CrossRefPubMedPubMedCentral

26.

Pedersen A, Goder R, Tomczyk S, Ohrmann P. Risky decision-making under risk in schizophrenia: a deliberate choice? J Behav Ther Exp Psychiatry. 2017;56:57–64. https://doi.org/10.1016/j.jbtep.2016.08.004.CrossRefPubMed

27.

Brown EC, Hack SM, Gold JM, Carpenter WT Jr, Fischer BA, Prentice KP, et al. Integrating frequency and magnitude information in decision-making in schizophrenia: an account of patient performance on the Iowa gambling task. J Psychiatr Res. 2015;66-67:16–23. https://doi.org/10.1016/j.jpsychires.2015.04.007.CrossRefPubMed

28.

Hori H, Yoshimura R, Katsuki A, Atake K, Nakamura J. Relationships between brain-derived neurotrophic factor, clinical symptoms, and decision-making in chronic schizophrenia: data from the Iowa gambling task. Front Behav Neurosci. 2014;8:417.CrossRef

29.

Collins AG, Brown JK, Gold JM, Waltz JA, Frank MJ. Working memory contributions to reinforcement learning impairments in schizophrenia. J Neurosci. 2014;34(41):13747–56. https://doi.org/10.1523/JNEUROSCI.0989-14.2014.CrossRefPubMedPubMedCentral

30.

Saperia S, Da Silva S, Siddiqui I, Agid O, Daskalakis ZJ, Ravindran A, et al. Reward-driven decision-making impairments in schizophrenia. Schizophr Res. 2019;206:277–83. https://doi.org/10.1016/j.schres.2018.11.004.CrossRefPubMed

31.

Gold JM, Waltz JA, Prentice KJ, Morris SE, Heerey EA. Reward processing in schizophrenia: a deficit in the representation of value. Schizophr Bull. 2008;34(5):835–47. https://doi.org/10.1093/schbul/sbn068.CrossRefPubMedPubMedCentral

32.

Fond G, Bayard S, Capdevielle D, Del-Monte J, Mimoun N, Macgregor A, et al. A further evaluation of decision-making under risk and under ambiguity in schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2013;263(3):249–57. https://doi.org/10.1007/s00406-012-0330-y.CrossRefPubMed

33.

Zhang L, Tang J, Dong Y, Ji Y, Tao R, Liang Z, et al. Similarities and differences in decision-making impairments between autism Spectrum disorder and schizophrenia. Front Behav Neurosci. 2015;9:259.PubMedPubMedCentral

34.

Brand M, Recknor EC, Grabenhorst F, Bechara A. Decisions under ambiguity and decisions under risk: correlations with executive functions and comparisons of two different gambling tasks with implicit and explicit rules. J Clin Exp Neuropsychol. 2007;29(1):86–99. https://doi.org/10.1080/13803390500507196.CrossRefPubMed

35.

Smith DG, Xiao L, Bechara A. DM in children and adolescents: impaired Iowa gambling task performance in early adolescence. Dev Psychol. 2012;48(4):1180–7. https://doi.org/10.1037/a0026342.CrossRefPubMed

36.

Donati MA, Panno A, Chiesi F, Primi C. A mediation model to explain DM under conditions of risk among adolescents: the role of fluid intelligence and probabilistic reasoning. J Clin Exp Neuropsychol. 2014;36(6):588–95. https://doi.org/10.1080/13803395.2014.918091.CrossRefPubMed

37.

Donati MA, Frosini A, Izzo VA, Primi C. The effectiveness of the game of dice task in predicting at-risk and problem gambling among adolescents: the contribution of the neural networks. J Gambl Stud. 2018;35(1):1–14.CrossRef

38.

Kester HM, Sevy S, Yechiam E, Burdick KE, Cervellione KL, Kumra S. Decision-making impairments in adolescents with early-onset schizophrenia. Schizophr Res. 2006;85(1–3):113–23. https://doi.org/10.1016/j.schres.2006.02.028.CrossRefPubMed

39.

Bin Xuan PL, Aiqing Z, Liping Y. Decision-making in adolescents with profound hearing loss. J Deaf Stud Deaf Educ. 2018;23(3):219-27.

40.

Paiva ML, Rzezak P, Santos B, Lima EM, Moschetta SP, Vincentiis S, et al. Dissociation between DM under ambiguity and risk in patients with juvenile myoclonic epilepsy. Epilepsy Behav. 2019;101(Pt A):106548.CrossRef

41.

APA. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Press; 2000.

42.

Nie K, Zhang Y, Wang L, Zhao J, Huang Z, Gan R, et al. A pilot study of psychometric properties of the Beijing version of Montreal cognitive assessment in patients with idiopathic Parkinson’s disease in China. J Clin Neurosci. 2012;19(11):1497–500. https://doi.org/10.1016/j.jocn.2011.11.039.CrossRefPubMed

43.

HAMILTON. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50–5. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x.CrossRefPubMed

44.

HAMILTON. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56–62. https://doi.org/10.1136/jnnp.23.1.56.CrossRefPubMedPubMedCentral

45.

Stanley R, Kay AF, Lewis A. Opler the positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261–76.CrossRef

46.

D. W. Wechsler Memory Scale—revised. San Antonio: The Psychological Corporation; 1987.

47.

Spreen O. SEne: a compendium of neuropsychological tests. New York: Oxford University Press; 1998.

48.

Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971;9(1):97–113. https://doi.org/10.1016/0028-3932(71)90067-4.CrossRefPubMed

49.

Matsuzawa D, Shirayama Y, Niitsu T, Hashimoto K, Iyo M. Deficits in emotion based decision-making in schizophrenia; a new insight based on the Iowa gambling task. Prog Neuro-Psychopharmacol Biol Psychiatry. 2015;57:52–9. https://doi.org/10.1016/j.pnpbp.2014.10.007.CrossRef

50.

Blakemore S-J, Robbins TW. Decision-making in the adolescent brain. Nat Neurosci. 2012;15(9):1184–91. https://doi.org/10.1038/nn.3177.CrossRefPubMed

51.

Chang WC, Waltz JA, Gold JM, Chan TCW, Chen EYH. Mild reinforcement learning deficits in patients with first-episode psychosis. Schizophr Bull. 2016;42(6):1476–85. https://doi.org/10.1093/schbul/sbw060.CrossRefPubMedPubMedCentral

52.

Papanastasiou E, Mouchlianitis E, Joyce DW, McGuire P, Banaschewski T, Bokde ALW, et al. Examination of the neural basis of Psychoticlike experiences in adolescence during reward processing. JAMA Psychiatry. 2018;75(10):1043–51. https://doi.org/10.1001/jamapsychiatry.2018.1973.CrossRefPubMedPubMedCentral

53.

Galvan A, Hare TA, Parra CE, Penn J, Voss H, Glover G, et al. Earlier development of the accumbens relative to orbitofrontal cortex might underlie risk-taking behavior in adolescents. J Neurosci. 2006;26(25):6885–92. https://doi.org/10.1523/JNEUROSCI.1062-06.2006.CrossRefPubMedPubMedCentral

54.

Vijayakumar N, Op de Macks Z, Shirtcliff EA, Pfeifer JH. Puberty and the human brain: insights into adolescent development. Neurosci Biobehav Rev. 2018;92:417–36. https://doi.org/10.1016/j.neubiorev.2018.06.004.CrossRefPubMedPubMedCentral

55.

Santangelo PS, Koenig J, Funke V, Parzer P, Resch F, Ebner-Priemer UW, et al. Ecological momentary assessment of affective and interpersonal instability in adolescent non-suicidal self-injury. J Abnorm Child Psychol. 2017;45(7):1429–38. https://doi.org/10.1007/s10802-016-0249-2.CrossRefPubMed

56.

Grootens-Wiegers P, Hein IM, van den Broek JM, de Vries MC. Medical decision-making in children and adolescents: developmental and neuroscientific aspects. 2017;17(1):120.

57.

Pacheco-Colon I, Hawes SW, Duperrouzel JC, Lopez-Quintero C, Gonzalez R. Decision-making as a latent construct and its measurement invariance in a large sample of adolescent Cannabis users. J Int Neuropsychol Soc. 2019;25(7):661–7. https://doi.org/10.1017/S1355617719000341.CrossRefPubMedPubMedCentral

58.

Farrar DC, Mian AZ, Budson AE, Moss MB, Killiany RJ. Functional brain networks involved in decision-making under certain and uncertain conditions. Neuroradiology. 2018;60(1):61–9. https://doi.org/10.1007/s00234-017-1949-1.CrossRefPubMed

59.

AKaPD Z. Development of “hot” executive function: the children gambling task. Brain Cogn. 2004;55(1):148–57. https://doi.org/10.1016/S0278-2626(03)00275-6.CrossRef

60.

MacKenzie LE, Patterson VC, Zwicker A, Drobinin V, Fisher HL, Abidi S, et al. Hot and cold executive functions in youth with psychotic symptoms. Psychol Med. 2017;47(16):2844–53. https://doi.org/10.1017/S0033291717001374.CrossRefPubMed

61.

Tripathi R, Kumar K, Bharath S, P M, Rawat VS, Varghese M. Indian older adults and the digit span a preliminary report. Dementia Neuropsychologia. 2019;13(1):111–5. https://doi.org/10.1590/1980-57642018dn13-010013.CrossRefPubMedPubMedCentral

62.

Holfelder B, Klotzbier TJ, Eisele M, Schott N. Hot and cool executive function in elite- and amateur- adolescent athletes from open and closed skills sports. Front Psychol. 2020;11:694. https://doi.org/10.3389/fpsyg.2020.00694.CrossRefPubMedPubMedCentral

63.

James M, Gold JAW, Matveeva TM. Negative symptoms and the failure to represent the expected reward value of actions: behavioral and computational modeling evidence. Arch Gen Psychiatry. 2012;69(2):129.CrossRef

64.

Moran EKCA, Barch DM. Supplemental material for ecological momentary assessment of negative symptoms in schizophrenia: relationships to effort-based DM and reinforcement learning. J Abnorm Psychol. 2017;126(1):96–105. https://doi.org/10.1037/abn0000240.CrossRefPubMed

Title: Decision making under ambiguity and risk in adolescent-onset schizophrenia
Authors: Dandan Li
Fengyan Zhang
Lu Wang
Yifan Zhang
Tingting Yang
Kai Wang
Chunyan Zhu
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Schizophrenia
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03230-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Decision making under ambiguity and risk in adolescent-onset schizophrenia

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Benign ethnic neutropenia: an analysis of prevalence, timing and identification accuracy in two large inner-city NHS hospitals

ADHD overdiagnosis and the role of patient gender among Iranian psychiatrists

Reducing worry and rumination in young adults via a mobile phone app: study protocol of the ECoWeB (Emotional Competence for Well-Being in Young Adults) randomised controlled trial focused on repetitive negative thinking

Military and demographic predictors of mental ill-health and socioeconomic hardship among UK veterans

Genetic susceptibility of opioid receptor genes polymorphism to drug addiction: A candidate-gene association study

Longitudinal influence of COVID-19-related stress on sexual compulsivity symptoms in Chinese undergraduates