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.

Download full-text


Available from: Keith H Nuechterlein, Feb 15, 2015
  • Source
    • "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? "
    [Show abstract] [Hide abstract]
    ABSTRACT: We introduce ‘exploratory perseverance’ as a novel construct that captures perseverant behavior in settings in which several alternatives can be explored and evaluated. We suggest that entrepreneurs display exploratory perseverance reflected by a tendency to keep exploring broader sets of alternatives, to adopt a parallel rather than sequential approach to trial-and-error learning, and, after negative experiences with some alternatives, to be more inclined to give them a second chance. The results from an experimental study of 449 individuals participating in the Iowa Gambling Task indicate that more entrepreneurially experienced individuals display greater exploratory perseverance than those with little to no entrepreneurial experience.
    Full-text · Article · Dec 2016 · Entrepreneurship: Theory and Practice
    • "pharmacological reduction of medial PFC (mPFC) GABA A -receptor transmission has been shown to produce a host of symptoms reminiscent of schizophrenia, including disrupted attention (Paine et al., 2011; Pehrson et al., 2013), set-shifting ability (Enomoto et al., 2011), spatial reference and working memory (Auger and Floresco, 2014), and appropriate salience attribution during aversive conditioning (Piantadosi and Floresco, 2014). Recently, Paine et al. (2014) illustrated that antagonism of GABA A -receptors in the rat mPFC impairs decision-making on a task similar to the Iowa Gambling Task, a task which assesses probabilistic or " risky " decisionmaking and is consistently impaired in schizophrenia (Kim et al., 2009; Shurman et al., 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The prefrontal cortex (PFC) is critical for higher-order cognitive functions, including decision-making. In psychiatric conditions such as schizophrenia, prefrontal dysfunction co-occurs with pronounced alterations in decision-making ability. These alterations include a diminished ability to utilize probabilistic reinforcement in guiding future choice, and a reduced willingness to expend effort to receive reward. Among the neurochemical abnormalities observed in the PFC of individuals with schizophrenia are alterations in the production and function of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). To probe how PFC GABA hypofunction may contribute to alterations in cost/benefit decision-making, we assessed the effects GABAA-receptor antagonist bicuculline (BIC; 50 ng in 0.5 μl saline/hemisphere) infusion in the medial PFC of rats during performance on a series of well-validated cost/benefit decision-making tasks. Intra-PFC BIC reduced risky choice and reward sensitivity during probabilistic discounting and decreased the preference for larger rewards associated with a greater effort cost, similar to the behavioral sequelae observed in schizophrenia. Additional experiments revealed that these treatments did not alter instrumental responding on a progressive ratio schedule, nor did they impair the ability to discriminate between reward and no reward. However, BIC induced a subtle but consistent impairment in preference for larger vs. smaller rewards of equal cost. BIC infusion also increased decision latencies and impaired the ability to "stay on task" as indexed by reduced rates of instrumental responding. Collectively, these results implicate prefrontal GABAergic dysfunction as a key contributing factor to abnormal decision-making observed in schizophrenia and other neuropsychiatric conditions with similar neurobiological and behavioral alterations.
    No preview · Article · Oct 2015 · Neuropharmacology
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jan 2015 · Psychiatry Research: Neuroimaging
Show more