Shurman B, Horan WP, Nuechterlein KH. Schizophrenia patients demonstrate a distinctive pattern of decision-making impairment on the Iowa Gambling Task. Schizophr Res 72: 215-224

University of California Los Angeles, Neuropsychiatric Institute 300 UCLA Medical Plaza, Los Angeles, CA 90095-6968, USA.
Schizophrenia Research (Impact Factor: 3.92). 02/2005; 72(2-3):215-24. DOI: 10.1016/j.schres.2004.03.020
Source: PubMed


Although dorsolateral prefrontal cortex (DLPFC) abnormalities in schizophrenia are well established, several lines of evidence suggest the orbitofrontal cortex (OFC) may also be dysfunctional in this disorder. We examined the performance of schizophrenia patients and nonpatient controls on the Iowa Gambling Task [Cognition 50 (1994) 7], a decision-making task sensitive to OFC damage that involves a series of selections from four decks of cards that vary in their reward/punishment profiles. Patients also completed neuropsychological tests assessing DLPFC functions and clinical symptom assessments. The schizophrenic patients demonstrated a pattern of impaired performance that differed both from healthy controls and from the "non-conservative" pattern typically found in patients with OFC lesions. The patients selected from the two card decks that had low frequency and high magnitude punishments significantly more often than the decks with high frequency and low magnitude punishments. Performance on the task was not strongly related to tests sensitive to DLPFC dysfunction but was correlated with negative symptoms. Results suggest that individuals with schizophrenia display a pattern of compromised decision-making that is somewhat distinct from that found in OFC lesion patients and that may be linked to certain clinical symptoms.

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Available from: Keith H Nuechterlein, Feb 15, 2015
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    • "The performance of entrepreneurially experienced individuals, in terms of the frequency of selections from the 'good' decks and the magnitude of final losses, is in a similar range as the typical performance of patients with lesions in the VMPFC and the bilateral amygdala (Bechara et al., 1999), schizophrenic patients (e.g., Shurman et al., 2005), and patients suffering from substance abuse (Barry & Petry, 2008). Does the behavioral similarity of entrepreneurially experienced people and patients imply that both groups suffer from similar problems? "
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    • "The IGT has been administered in numerous studies of DM and reinforcement learning in schizophrenia (Kester et al. 2006; Kim et al. 2009, 2012; Lee et al. 2007; Ritter et al. 2004; Sevy et al. 2007; Shurman et al. 2005; Wilder et al. 1998), with mixed results. While SZ patients do not show the dramatic insensitivity to punishments observed in OFC lesion patients in the early studies of Bechara et al. (1994), SZ patients often show a reduced ability to learn to choose good decks more frequently over time (Kester et al. 2006; Shurman et al. 2005). However, genuine insensitivity to punishments—which may be characteristic of some patient groups, such as those with bipolar affective disorder (Brambilla et al. 2013; Burdick et al. 2014) or orbitofrontal lesions (Bechara et al. 1994, 1999)—does not appear to be the best explanation of poor IGT performance in SZ patients. "
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    ABSTRACT: Motivational deficits (avolition and anhedonia ) have historically been considered important negative symptoms of schizophrenia (SZ). Numerous studies have attempted to identify the neural substrates of avolition and anhedonia in schizophrenia , but these studies have not produced much agreement. Deficits in various aspects of reinforcement processing have been observed in individuals with schizophrenia, but it is not exactly clear which of these deficits actually engender motivational impairments in SZ. The purpose of this chapter is to examine how various reinforcement-related behavioral and neural signals could contribute to motivational impairments in both schizophrenia and psychiatric illness, in general. In particular, we describe different aspects of the concept of expected value (EV) , such as the distinction between the EV of stimuli and the expected value of actions, the acquisition of value versus the estimation of value, and the discounting of value as a consequence of time or effort required. We conclude that avolition and anhedonia in SZ are most commonly tied to aberrant signals for expected value, in the context of learning. We discuss implications for further research on the neural substrates of motivational impairments in psychiatric illness.
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    • "This is an open access article under the CC BY license ( average, show an IGT performance style that is similar to that seen in patients with OFC lesions (Shurman et al., 2005; Nakamura et al., 2008). Another possible reason for the relationship between OFC volume and CPTp responsiveness is that reduced OFC volume relates to higher impulsivity in schizophrenia patients, a personality characteristic suggestive of lower cognitive flexibility (Kumari et al., 2009a; Schiffer et al., 2010). "
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    ABSTRACT: Grey matter volume (GMV) in the orbitofrontal cortex (OFC) may relate to better response to cognitive behavioural therapy for psychosis (CBTp) because of the region's role in emotional decision-making and cognitive flexibility. This study aimed to determine the relation between pre-therapy OFC GMV or asymmetry and CBTp responsiveness and emotional decision-making as measured by the Iowa Gambling Task (IGT). Thirty patients received CBTp+standard care (CBTp+SC; 25 completers) for 6–8 months. All patients (before receiving CBTp) and 25 healthy participants underwent structural magnetic resonance imaging and performed the IGT. Patients’ symptoms were assessed before and after therapy. Pre-therapy OFC GMV, measured using a region-of-interest approach, and IGT performance, measured as overall learning, attention to reward, memory for past outcomes and choice consistency, were comparable between patient and healthy groups. In the CBTp+SC group, greater OFC GMV was correlated with positive symptom improvement, specifically hallucinations and persecution. Greater rightward OFC asymmetry correlated with improvement in several negative and general psychopathology symptoms. Greater left OFC GMV was associated with lower IGT attention to reward. The findings suggest that greater OFC volume and rightward asymmetry, which maintain the OFC's function in emotional decision-making and cognitive flexibility, are beneficial for CBTp responsiveness.
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