[Show abstract][Hide abstract] ABSTRACT: Our earlier study found patients with depression to show a preference for larger reward as measured by the Iowa Gambling Task (IGT). In this IGT version, larger rewards were associated with even larger consequent losses. In the light of the clinical markers defining depressive disorder, this finding might appear controversial at first. Performance of depressed patients on various decision-making (DM) tasks is typically found to be impaired. Evidence points toward reduced reward learning, as well as the difficulty to shift strategy and integrate environmental changes into DM contingencies. This results in an impaired ability to modulate behavior as a function of reward, or punishment, respectively. Clinical symptoms of the disorder, the genetic profile, as well as personality traits might also influence DM strategies. More severe depression increased sensitivity to immediate large punishment, thus predicting future decisions, and was also associated with higher harm avoidance. Anhedonic features diminished reward learning abilities to a greater extent, even predicting clinical outcome. Several questions about how these aspects relate remain to be clarified. Is there a genetic predisposition for the DM impairment preceding mood symptoms? Is it the consequence of clinical signs or even learned behavior serving as a coping strategy? Are patients prone to develop an aversion of loss or are they unable to sense or deal with reward or the preference of reward? Does the DM deficit normalize or is a persisting impairment predictor for clinical outcome or relapse risk? To what extent is it influenced by medication effects? How does a long-lasting DM deficit affect daily life and social interactions? Strikingly, research evidence indicates that depressed patients tend to behave less deceptive and more self-focused, resulting in impaired social DM. The difficulty in daily interpersonal interactions might contribute to social isolation, further intensifying depressive symptoms.
Frontiers in Psychology 01/2013; 4:732. · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: High relapse rate and extreme difficulty to maintain abstinence are core characteristics of alcohol dependence (AD). Previous studies have demonstrated a persistent decision-making (DM) deficit in AD. We aimed to reveal specific personality features and stress-coping mechanisms presumed to compensate for ineffective DM skills.
Eighty-eight unmedicated patients with AD were enrolled. Intact general cognitive status was assured by IQ above 90. Forty-three patients had an average abstinence period of 12 weeks and were currently in an inpatient treatment program (short-term abstinence group, STA) and 45 patients were abstinent for at least 3 years (long-term abstinence group, LTA). The two groups were assessed using an integrative approach combining domains of DM, temperament and character dimensions and stress-coping measures.
Both groups performed at chance level with no linear improvement tendency on the gambling task assessing DM adequacy. The LTA group scored significantly higher on scales of self-directedness and cooperativeness. In contrast, levels of harm avoidance, emotion-oriented coping and perceived stress were significantly higher in the STA group.
Our findings provide new evidence for a persistent DM deficit with no learning effect in AD. Despite the deficit, alcohol-dependent patients can achieve LTA. STA patients perceive higher levels of stress and use non-adaptive coping strategies. We propose that the more adaptive personality profile of LTA patients contributes to the compensation of the trait-like DM deficit in alcoholism. These compensatory features represent promising new targets for preventive measures and therapeutic interventions in AD.
Alcohol and Alcoholism 01/2012; 47(1):18-24. · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Psychotic, cognitive and affective symptoms defining schizophrenia may, though much less severe, manifest themselves in up to 10 to 20% of the general population. What explains the fact that in certain cases the symptoms require even constant medical supervision, while others are capable of living a normal life within social conventions? Which factors lead to the transition of mild, subclinical manifestations and vulnerability indicators towards the outburst of one of the most severe and depriving mental disorders? Genetic susceptibility is undoubtedly crucial. More recent research findings emphasize the modifying effect of specific environmental factors on gene expression. The gene-environment interplay may induce so-called epigenetic alterations which may manifest themselves over several generations. Future integrative, multi-dimensional and flexible schizophrenia research approaches focusing on the identification of neurobiological and cognitive outcomes are much needed to understand disease vulnerability, susceptibility mechanisms, periods and interactions. Research methods may differ, but our aim is common - establishing more effective diagnostic and therapeutic interventions.
Neuropsychopharmacologia Hungarica: a Magyar Pszichofarmakológiai Egyesület lapja = official journal of the Hungarian Association of Psychopharmacology 12/2011; 13(4):211-7.
[Show abstract][Hide abstract] ABSTRACT: Pharmacological treatment of major psychiatric conditions (eg, schizophrenia, bipolar disorder) is exceptionally difficult during pregnancy. Despite all efforts, medication-resistant life-threatening mental deterioration can emerge with the urgent need for rapid and effective intervention. In these cases, electroconvulsive therapy (ECT) may represent the only valid and safe therapeutic option. Here, we present the challenging medical case of a 31-year-old primigravida with a general medical history of obesity and hypertension, previously diagnosed with bipolar affective disorder, now presenting with severe, therapy-resistant manic agitation. Full symptomatic remission was achieved and preserved with ECT given between the 7th and 22nd gestational weeks, the pregnancy reached full term, and a healthy child was born by cesarean delivery performed because of preeclampsia. Although it is unusual to start ECT this early in pregnancy, with the thorough assessment of potential risk factors and preventive measures taken, it can be the most effective and presumably the least risky treatment approach. By delineating key aspects of both the psychiatric and anesthetic management of this case, we aim to highlight the importance of a close cooperation between all medical fields involved in clinical practice.
The journal of ECT 06/2011; 27(4):328-30. · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with major depressive disorder (MDD) show neuropsychological impairments, including deficient executive functions and suboptimal decision-making strategies, which are mediated by several brain regions. In the development of these symptoms the pathology of the prefrontal cortex (PFC), including the dorsolateral, ventromedial and orbitofrontal regions, may also play an important role. Neuropsychological assessment is a useful tool in detecting and measuring these deficiencies, showing that patients with MDD exhibit altered sensitivity to reward and punishment. However, impairment of emotional decision-making strategies in MDD is influenced by genetic variations (5-HTTLPR polymorphism) and personality traits, which seem to have a higher predictive value on decision making performance than the clinical symptoms.
[Show abstract][Hide abstract] ABSTRACT: Patients with major depressive disorder (MDD) show suboptimal decision-making strategy in experimental game situations. The influence of personality traits and genetic variations on decision-making is not known.
Contingency learning based on the cumulative effect of reward and punishment was assessed in 124 patients with unipolar MDD using the ABCD (reward sensitivity) and EFGH (punishment sensitivity) versions of the Iowa Gambling Test. All patients were genotyped for serotonin transporter promoter polymorphism (5-HTTLPR) and received the Temperament and Character Inventory (TCI).
Patients with the ll genotype achieved higher persistence scores and used more optimal decision-making strategy on the ABCD task compared with patients with the ss genotype. Higher persistence was associated with better performance on the ABCD task, and higher harm-avoidance was associated with worse performance on the EFGH task.
Healthy control volunteers were not included. Personality traits and decision-making were not assessed with multiple questionnaires and tasks. Type I errors cannot be excluded.
Decision-making strategy is influenced by personality traits and genetic variations in patients with MDD. Patients carrying the ss variant of the 5-HTTLPR show less persistence and tend to be influenced by high immediate reward.
Journal of Affective Disorders 12/2007; 103(1-3):273-6. · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with major depressive disorder (MDD) show neuropsychological impairments, including deficient executive functions and altered sensitivity to reward and punishment.
Executive functions (Wisconsin Card Sorting Test, WCST) and contingency learning based on the cumulative effect of reward and punishment (Iowa Gambling Test, IGT) were assessed in 30 medicated patients with unipolar MDD and in 20 healthy control volunteers. In the classic ABCD version of the IGT, advantageous decks are characterized by immediate small reward but even smaller future punishment. In the modified EFGH version, advantageous decks are characterized by immediate large punishment but even larger future reward.
Patients with MDD were impaired in the WCST and in the ABCD version of the IGT but showed normal performances on the EFGH task. Depression, but not executive dysfunctions, significantly predicted performances on the EFGH task: less severe depressive symptoms were associated with better performances on the EFGH task.
The sample size was small and only few neuropsychological tests were used. Unmedicated patients were not assessed. Individual personality style, response strategies, and behavioral impulsivity were not investigated.
Medicated patients with MDD show altered sensitivity to reward and punishment: immediate large reward enhanced related response patterns even when the strategy was disadvantageous and immediate large punishment did not prohibit related response patterns. Impairments in emotional decision-making were not a pure consequence of executive dysfunctions.
Journal of Affective Disorders 03/2006; 90(2-3):209-15. · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The "dorsal-stream vulnerability" hypothesis claims that motion-sensitive areas in the dorsal occipito-parietal visual system are vulnerable to genetic and environmental factors which affect brain maturation and development. The aim of this study was to investigate the possibility that developmental anomalies of directional motion perception can be detected in children of mothers with schizophrenia and bipolar disorder. Motion and form coherence thresholds were measured in 36 children of mothers with schizophrenia, 28 children of mothers with bipolar disorder, and 30 children with negative family history at 7, 8-9, and 10-11 years of age. These tasks require the detection of direction of coherently moving dots embedded among randomly oscillating dots (motion task) and the detection of tangentially oriented line-segments embedded among randomly oriented segments (form task). Results revealed that the rate of development in the motion task was less pronounced in children of mothers with schizophrenia than that in children of mothers with bipolar disorder and in age-matched controls. The development of form perception was spared. Children of mothers with bipolar disorder showed an intact development in both motion and form perception tasks. These results suggest that the progressive developmental abnormality of motion-sensitive visual areas may be a characteristic feature of schizophrenia-vulnerability.
Schizophrenia Research 03/2006; 82(1):9-14. · 4.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The pathology of the prefrontal cortex (PFC) may play an important role in the development of the symptoms of major depressive disorder. In this study, the authors used the Wisconsin Card Sorting Test (WCST) and the Iowa Gambling Test (IGT) to investigate PFC functions in depression. The WCST investigates cognitive set-shifting abilities, whereas the IGT is sensitive for the cumulative effect of reward and punishment on decision-making. Participants were 20 patients with DSM-IV major depressive disorder and 20 age-, gender-, and education-matched healthy control subjects. The depressed patients showed significant impairment in both tests, but the WCST and IGT scores did not correlate. There was no significant correlation between the test results and the severity of depressive and anxiety symptoms. Our results suggest a global impairment of the PFC in depression, which includes the dorsolateral and ventromedial regions.
Psychiatria Hungarica: A Magyar Pszichiatriai Tarsasag tudomanyos folyoirata 02/2005; 20(6):412-6.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the possibility that 'theory of mind' (ToM) impairments are associated with schizophrenia liability.
Forty healthy control subjects and 79 first-degree biological relatives of schizophrenia patients (32 siblings and 47 parents) received the Eyes Test, during which subjects are asked to choose the word best describes the mental state of a person whose eyes are depicted on a photograph.
The affected relatives (n = 14) performed worse on the Eyes Test compared with the controls (P = 0.0001), whereas the unaffected relatives (n = 65) showed intact performances (P = 0.4). The Eyes Test values did not correlate with age and IQ. There was no significant difference between male and female participants.
ToM deficits, as measured by the Eyes Test, are not associated with schizophrenia liability.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate lateral connectivity in early visual cortex of schizophrenia patients. Contrast thresholds were measured for centrally presented Gabor patches which were surrounded by two collinear or orthogonal flankers. The healthy subjects (n = 15) showed lower contrast thresholds for central Gabor patches when collinear flankers were presented. This effect was significantly reduced in unmedicated highly functioning schizophrenia patients (n = 20) who performed normally on the continuous performance test. The performance of the patients did not correlate with the positive and negative symptoms. The facilitation effect of collinear flankers is believed to reflect lateral interactions between feature-specific units in early visual cortex (V1). Our results therefore suggest abnormal lateral interactions in early visual cortex of schizophrenia patients.