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Cooper SE, Dunsmoor JE. Fear conditioning and extinction in obsessive-compulsive disorder: A systematic review. Neurosci Biobehav Rev 2021; 129:75-94. [PMID: 34314751 PMCID: PMC8429207 DOI: 10.1016/j.neubiorev.2021.07.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/04/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022]
Abstract
Laboratory experiments using fear conditioning and extinction protocols help lay the groundwork for designing, testing, and optimizing innovative treatments for anxiety-related disorders. Yet, there is limited basic research on fear conditioning and extinction in obsessive-compulsive disorder (OCD). This is surprising because exposure-based treatments based on associative learning principles are among the most popular and effective treatment options for OCD. Here, we systematically review and critically assess existing aversive conditioning and extinction studies of OCD. Across 12 studies, there was moderate evidence that OCD is associated with abnormal acquisition of conditioned responses that differ from comparison groups. There was relatively stronger evidence of OCD's association with impaired extinction processes. This included multiple studies finding elevated conditioned responses during extinction learning and poorer threat/safety discrimination during recall, although a minority of studies yielded results inconsistent with this conclusion. Overall, the conditioning model holds value for OCD research, but more work is necessary to clarify emerging patterns of results and increase clinical translational utility to the level seen in other anxiety-related disorders. We detail limitations in the literature and suggest next steps, including modeling OCD with more complex conditioning methodology (e.g., semantic/conceptual generalization, avoidance) and improving individual-differences assessment with dimensional techniques.
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Affiliation(s)
- Samuel E Cooper
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, 78712, USA.
| | - Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, 78712, USA.
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2
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Nisticò V, De Angelis A, Erro R, Demartini B, Ricciardi L. Obsessive-Compulsive Disorder and Decision Making under Ambiguity: A Systematic Review with Meta-Analysis. Brain Sci 2021; 11:brainsci11020143. [PMID: 33499211 PMCID: PMC7912249 DOI: 10.3390/brainsci11020143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
In the last decade, decision-making has been proposed to have a central role in obsessive-compulsive disorder (OCD) aetiology, since patients show pathological doubt and an apparent inability to make decisions. Here, we aimed to comprehensively review decision making under ambiguity, as measured by the Iowa Gambling Task (IGT), in OCD, using a meta-analytic approach. According to PRISMA Guidelines, we selected 26 studies for a systematic review and, amongst them, 16 studies were included in a meta-analysis, comprising a total of 846 OCD patients and 763 healthy controls (HC). Our results show that OCD patients perform significantly lower than HC at the IGT, pointing towards the direction of a decision making impairment. In particular, this deficit seems to emerge mainly in the last three blocks of the IGT. IGT scores in OCD patients under the age of 18 were still significantly lower than in HC. Finally, no difference emerged between medicated and unmedicated patients, since they both scored significantly lower at the IGT compared to HC. In conclusion, our results are in line with the hypothesis according to which decision making impairment might represent a potential endophenotype lying between the clinical manifestation of OCD and its neurobiological aetiology.
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Affiliation(s)
- Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milano, Italy; (V.N.); (B.D.)
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, 20142 Milano, Italy
| | - Andrea De Angelis
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK;
- Department of Neuropsychiatry, St George’s Hospital, South West London and St George’s Mental Health NHS Trust, London SW17 0RE, UK
| | - Roberto Erro
- Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana”, Università di Salerno, 84018 Baronissi, Salerno, Italy;
| | - Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milano, Italy; (V.N.); (B.D.)
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, 20142 Milano, Italy
- Unità di Psichiatria II, Presidio San Paolo, ASST Santi Paolo e Carlo, 20142 Milano, Italy
| | - Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK;
- Correspondence:
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3
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Soshi T, Nagamine M, Fukuda E, Takeuchi A. Pre-specified Anxiety Predicts Future Decision-Making Performances Under Different Temporally Constrained Conditions. Front Psychol 2019; 10:1544. [PMID: 31354572 PMCID: PMC6634256 DOI: 10.3389/fpsyg.2019.01544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/18/2019] [Indexed: 12/29/2022] Open
Abstract
In real-life circumstances, people occasionally require making forced decisions when encountering unpredictable events and situations that yield socially and privately unfavorable consequences. In order to prevent future negative consequences, it is beneficial to successfully predict future decision-making behaviors based on various types of information, including behavioral traits and/or psychological states. For this prospective purpose, the present study used the Iowa Gambling Task, which simulates multiple aspects of real-life decision-making processes, such as choice preference, selection and evaluation of output feedback, and investigated how anxiety profiles predict decision-making performances under conditions with different temporal pressures on task execution. To conduct a temporally causal analysis, we assessed the trait and state anxiety profiles of 33 young participants prior to the task and analyzed their subsequent decision-making performances. We separated two disadvantageous card decks with high rewards and losses into high- and middle-risk decks, and calculated local performance indexes for decision-making immediately after salient penalty events for the high-risk deck in addition to traditional global performance indexes concerning overall trial outcomes such as final winnings and net scores. For global decision-making, higher trait anxiety predicted more risky choices solely in the self-paced condition without temporal pressure. For local decision-making, state anxiety predicted risk-taking performances differently in the self- and forced-paced conditions. In the self-paced condition, higher state anxiety predicted higher risk-avoidance. In the forced-paced condition, higher state anxiety predicted more frequent choices of the middle-risk deck. These findings suggest not only that pre-specified anxiety profiles can effectively predict future decision-making behaviors under different temporal pressures, but also newly indicate that behavioral mechanisms for moderate risk-taking under an emergent condition should be focused on to effectively prevent future unfavorable consequences when actually encountering negative events.
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Affiliation(s)
- Takahiro Soshi
- Graduate School of Frontier Biosciences, Osaka University, Osaka, Japan
| | - Mitsue Nagamine
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
| | - Emiko Fukuda
- Department of Industrial Engineering and Economics, School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Ai Takeuchi
- College of Economics, Ritsumeikan University, Kyoto, Japan
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4
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Liew J, Grisham JR, Hayes BK. Inductive and deductive reasoning in obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2018; 59:79-86. [PMID: 29247958 DOI: 10.1016/j.jbtep.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/04/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES This study examined the hypothesis that participants diagnosed with obsessive-compulsive disorder (OCD) show a selective deficit in inductive reasoning but are equivalent to controls in deductive reasoning. METHODS Twenty-five participants with OCD and 25 non-clinical controls made inductive and deductive judgments about a common set of arguments that varied in logical validity and the amount of positive evidence provided (premise sample size). A second inductive reasoning task required participants to make forced-choice decisions and rate the usefulness of diverse evidence or non-diverse evidence for evaluating arguments. RESULTS No differences in deductive reasoning were found between participants diagnosed with OCD and control participants. Both groups saw that the amount of positive evidence supporting a conclusion was an important guide for evaluating inductive arguments. However, those with OCD showed less sensitivity to premise diversity in inductive reasoning than controls. The findings were similar for both emotionally neutral and OCD-relevant stimuli. LIMITATIONS The absence of a clinical control group means that it is difficult to know whether the deficit in diversity-based reasoning is specific to those with OCD. CONCLUSIONS People with OCD are impaired in some forms of inductive reasoning (using diverse evidence) but not others (use of sample size). Deductive reasoning appears intact in those with OCD. Difficulties using evidence diversity when reasoning inductively may maintain OCD symptoms through reduced generalization of learned safety information.
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Affiliation(s)
- Janice Liew
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
| | - Brett K Hayes
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
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5
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Carlisi CO, Norman L, Murphy CM, Christakou A, Chantiluke K, Giampietro V, Simmons A, Brammer M, Murphy DG, Mataix-Cols D, Rubia K. Shared and Disorder-Specific Neurocomputational Mechanisms of Decision-Making in Autism Spectrum Disorder and Obsessive-Compulsive Disorder. Cereb Cortex 2017; 27:5804-5816. [PMID: 29045575 PMCID: PMC6919268 DOI: 10.1093/cercor/bhx265] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) often share phenotypes of repetitive behaviors, possibly underpinned by abnormal decision-making. To compare neural correlates underlying decision-making between these disorders, brain activation of boys with ASD (N = 24), OCD (N = 20) and typically developing controls (N = 20) during gambling was compared, and computational modeling compared performance. Patients were unimpaired on number of risky decisions, but modeling showed that both patient groups had lower choice consistency and relied less on reinforcement learning compared to controls. ASD individuals had disorder-specific choice perseverance abnormalities compared to OCD individuals. Neurofunctionally, ASD and OCD boys shared dorsolateral/inferior frontal underactivation compared to controls during decision-making. During outcome anticipation, patients shared underactivation compared to controls in lateral inferior/orbitofrontal cortex and ventral striatum. During reward receipt, ASD boys had disorder-specific enhanced activation in inferior frontal/insular regions relative to OCD boys and controls. Results showed that ASD and OCD individuals shared decision-making strategies that differed from controls to achieve comparable performance to controls. Patients showed shared abnormalities in lateral-(orbito)fronto-striatal reward circuitry, but ASD boys had disorder-specific lateral inferior frontal/insular overactivation, suggesting that shared and disorder-specific mechanisms underpin decision-making in these disorders. Findings provide evidence for shared neurobiological substrates that could serve as possible future biomarkers.
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Affiliation(s)
- Christina O Carlisi
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Luke Norman
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Clodagh M Murphy
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, UK
| | - Anastasia Christakou
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Kaylita Chantiluke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Andrew Simmons
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Michael Brammer
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Declan G Murphy
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, UK
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Pushkarskaya H, Tolin D, Ruderman L, Henick D, Kelly JM, Pittenger C, Levy I. Value-based decision making under uncertainty in hoarding and obsessive- compulsive disorders. Psychiatry Res 2017; 258:305-315. [PMID: 28864119 PMCID: PMC5741294 DOI: 10.1016/j.psychres.2017.08.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/20/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Abstract
Difficulties in decision making are a core impairment in a range of disease states. For instance, both obsessive- compulsive disorder (OCD) and hoarding disorder (HD) are associated with indecisiveness, inefficient planning, and enhanced uncertainty intolerance, even in contexts unrelated to their core symptomology. We examined decision-making patterns in 19 individuals with OCD, 19 individuals with HD, 19 individuals with comorbid OCD and HD, and 57 individuals from the general population, using a well-validated choice task grounded in behavioral economic theory. Our results suggest that difficulties in decision making in individuals with OCD (with or without comorbid HD) are linked to reduced fidelity of value-based decision making (i.e. increase in inconsistent choices). In contrast, we find that performance of individuals with HD on our laboratory task is largely intact. Overall, these results support our hypothesis that decision-making impairments in OCD and HD, which can appear quite similar clinically, have importantly different underpinnings. Systematic investigation of different aspects of decision making, under varying conditions, may shed new light on commonalities between and distinctions among clinical syndromes.
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Affiliation(s)
- Helen Pushkarskaya
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - David Tolin
- Department of Psychology, Yale University, New Haven, CT 06510, USA,Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT 06114, USA
| | - Lital Ruderman
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Daniel Henick
- Department of Psychology, Yale University, New Haven, CT 06510, USA
| | - J. MacLaren Kelly
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Christopher Pittenger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA,Department of Psychology, Yale University, New Haven, CT 06510, USA,Child Study Center, Yale School of Medicine, New Haven, CT 06510, USA
| | - Ifat Levy
- Section of Comparative Medicine, Yale School of Medicine, New Haven, CT 06510, USA,Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, USA
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7
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Zhang C, Chen Y, Tian S, Wang T, Xie Y, Jin H, Lin G, Gong H, Zeljic K, Sun B, Yang T, Zhan S. Effects of Anterior Capsulotomy on Decision Making in Patients with Refractory Obsessive-Compulsive Disorder. Front Psychol 2017; 8:1814. [PMID: 29089909 PMCID: PMC5651033 DOI: 10.3389/fpsyg.2017.01814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/29/2017] [Indexed: 12/05/2022] Open
Abstract
Despite various lines of evidence implicating impaired decision-making ability in individuals with obsessive–compulsive disorder (OCD), neuropsychological investigation has generated inconsistent findings. Although the cortico-striato-thalamo-cortical (CSTC) circuitry has been suggested, the involvement of the cortex has not yet been fully demonstrated. Moreover, it is unknown whether surgical intervention on the CSTC circuitry results in a predicted improvement of decision-making ability of OCD. Here we present a study of decision making based on the Iowa Gambling Task (IGT) to investigate decision making in a large sample of individuals with treatment-resistant OCD with and without anterior capsulotomy (AC). Task performance was evaluated in healthy subjects, individuals with OCD that had not undergone surgery, and postsurgical OCD patients with AC. The latter group was further divided into a short-term postsurgical group and a long-term postsurgical group. We found that the OCD patients without surgery performed significantly worse than the healthy controls on the IGT. There were no significant differences in decision-making between the presurgical OCD patients and those at the short-term postsurgical follow-up. Decision-making ability of the long-term postsurgical OCD patients was improved to the level comparable to that of healthy controls. All clinical symptoms (OCD, depression, and anxiety) assessed by psychiatric rating scales were significantly alleviated post-surgically, but exhibited no correlation with their IGT task performance. Our findings provide strong evidence that OCD is linked to impairments in decision-making ability; that impaired CSTC circuitry function is directly involved in the manifestation of OCD; and that AC related improvements in cognitive functions are caused by long-term plasticity in the brain circuitry.
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Affiliation(s)
- Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yilin Chen
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Shuaiwei Tian
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yile Xie
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guozhen Lin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hengfen Gong
- Department of Psychiatry, Pudong District Mental Health Center, Shanghai, China
| | - Kristina Zeljic
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianming Yang
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Shikun Zhan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Individuals with high obsessive-compulsive tendencies or undermined confidence rely more on external proxies to access their internal states. J Behav Ther Exp Psychiatry 2017; 54:263-269. [PMID: 27710870 DOI: 10.1016/j.jbtep.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 05/27/2016] [Accepted: 09/20/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES The Seeking Proxies for Internal States (SPIS) hypothesis predicts that obsessive-compulsive disorder (OCD) is associated with a deficit in subjective convictions, which may lead to a reliance on external substitutes for the perceptions of an individual's internal states. Two well-designed studies were performed for the present work that adopted a false bio-feedback procedure in a muscle tension task to examine the SPIS hypothesis. METHODS The false bio-feedback paradigm was used to investigate our hypothesis. NeXus-10 Mark II hardware and V2011 BioTrace + software (Mind Media B.V., Herten, Netherlands) were utilized to measure the muscle tension of the flexor carpiulnaris muscle, which characterized the target's internal state. In addition, false EMG changes were recorded and displayed on a computer monitor and were considered external proxies. RESULTS Study 1 demonstrated that the participants with high obsessive-compulsive (OC) tendencies were more affected by the false bio-feedback and exhibited lower confidence in their judgments regarding their muscle tension compared with the participants with low OC tendencies. These findings indicate that subjects with high OC tendencies were more influenced by self-perception effects. In contrast, the subjects in the undermined confidence group in Study 2 were more easily influenced by the false bio-feedback compared with the control group, which suggests that the subjects in the undermined confidence group were more affected by self-perception effects. LIMITATIONS We did not combine the undermined confidence with OC tendencies or OCD symptoms in our paradigm to investigate their joint effects on self-perception. CONCLUSIONS Our findings provide further evidence that supports the SPIS hypothesis, which indicates that OC tendencies and the confidence in an individual's recognition of internal states appear to have similar effects on the assessment of internal states and reliance on proxies.
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Disrupted latent decision processes in medication-free pediatric OCD patients. J Affect Disord 2017; 207:32-37. [PMID: 27690351 DOI: 10.1016/j.jad.2016.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/14/2016] [Accepted: 09/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Decision-making in Obsessive Compulsive Disorder has typically been investigated in the adult population. Computational approaches have recently started to get integrated into these studies. However, decision-making research in pediatric OCD populations is scarce. METHODS We investigated latent decision processes in 21 medication-free pediatric OCD patients and 23 healthy control participants. We hypothesized that OCD patients would be more cautious and less efficient in evidence accumulation than controls in a two alternative forced choice (2AFC) task. RESULTS Pediatric OCD patients were less efficient than controls in accumulating perceptual evidence and showed a tendency to be more cautious. In comparison to post-correct decisions, OCD patients increased decision thresholds after erroneous decisions, whereas healthy controls decreased decision thresholds. These changes were coupled with weaker evidence accumulation after errors in both groups. LIMITATIONS The small sample size limited the power of the study. CONCLUSIONS Our results demonstrate poorer decision-making performance in pediatric OCD patients at the level of latent processes, specifically in terms of evidence accumulation.
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10
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Erhan C, Balcı F. Obsessive compulsive features predict cautious decision strategies. Q J Exp Psychol (Hove) 2017; 70:179-190. [DOI: 10.1080/17470218.2015.1130070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Obsessive compulsive disorder (OCD) is occasionally characterized by decision-making deficits. Compared to the isolated analysis of the choice and response times, characterizing decision outputs at the level of latent processes can be a more powerful approach in revealing differences, even in subclinical cases. We hypothesized that participants with higher obsessive compulsive (OC) features would set their decision thresholds higher and thus make more cautious decisions. Method: We used a perceptual two-alternative forced-choice (2AFC) task (dot motion discrimination) to test this hypothesis in a non-clinical sample ( N = 74). We fitted the data with the diffusion model and evaluated the optimality of decision outputs. We also conducted exploratory analyses to reveal which subscales best predicted the differences at the level of latent decision processes. Results: Higher OC total scores in Maudsley and Padua scales significantly predicted higher threshold settings (cautiousness). The follow-up exploratory analyses with subscale scores showed that checking and rumination tendencies predicted higher threshold settings whereas washing tendency predicted faster non-decision times. Conclusions: Our primary results showed that participants with higher degrees of OC features exhibit more cautious decision making. Our exploratory analyses also revealed distinctions based on different types of OC features in both controlled (cautiousness in decision making) and automatic (faster non-decision times) elements of the decision process.
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Affiliation(s)
- Ceyla Erhan
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Fuat Balcı
- Department of Psychology, Koç University, Istanbul, Turkey
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11
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Abstract
Obsessive-compulsive disorder (OCD) is a mental disorder featuring obsessions (intrusive thoughts) and compulsions (repetitive behaviors performed in the context of rigid rituals). There is strong evidence for a neurobiological basis of this disorder, involving limbic cortical regions and related basal ganglion areas. However, more research is needed to lift the veil on the precise nature of that involvement and the way it drives the clinical expression of OCD. Altered cognitive functions may underlie the symptoms and thus draw a link between the clinical expression of the disorder and its neurobiological etiology. Our extensive review demonstrates that OCD patients do present a broad range of neuropsychological dysfunctions across all cognitive domains (memory, attention, flexibility, inhibition, verbal fluency, planning, decision-making), but some methodological issues temper this observation. Thus, future research should have a more integrative approach to cognitive functioning, gathering contributions of both experimental psychology and more fundamental neurosciences.
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Affiliation(s)
- Nabil Benzina
- "Behaviour, Emotion, and Basal Ganglia" Team, Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France.
| | - Luc Mallet
- "Behaviour, Emotion, and Basal Ganglia" Team, Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
- AP-HP, Service de Psychiatrie, DHU PePsy, Hôpital Henri Mondor, Université Paris-Est Créteil, INSERM U955, Fondation FondaMental, Créteil, France
| | - Eric Burguière
- "Behaviour, Emotion, and Basal Ganglia" Team, Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - Karim N'Diaye
- "Behaviour, Emotion, and Basal Ganglia" Team, Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - Antoine Pelissolo
- AP-HP, Service de Psychiatrie, DHU PePsy, Hôpital Henri Mondor, Université Paris-Est Créteil, INSERM U955, Fondation FondaMental, Créteil, France
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12
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Pick a Card, Any Card: The Relationship Between Anxiety, Obsessive-Compulsive Symptoms and Decision-Making. BEHAVIOUR CHANGE 2016. [DOI: 10.1017/bec.2016.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Specific deficits in decision-making have been demonstrated in patients with obsessive-compulsive disorder (OCD). The experience of anxious arousal in obsessive-compulsive (OC) patients has been posited to be responsible for disrupting the cognitive processes that lead to efficacious decision-making (Sachdev & Malhi, 2005). In spite of this, research has neglected to examine explicitly the effect of anxiety on the relationship between decision-making and OCD. The current study investigates whether decision-making differences on the Iowa Gambling Task (IGT) occur as a function of OC symptomatology in a non-clinical sample (n = 110). Participants were randomly allocated to either an anxiety condition (n = 58) or control condition (n = 52). Anxious arousal was induced in the anxiety condition via an experimental manipulation prior to commencing the IGT. Participants in the anxiety condition performed significantly worse than those in the control group on the IGT. However, OC symptomatology did not significantly predict IGT performance. The experience of anxiety did not significantly moderate the relationship between OC symptomatology and IGT performance. These findings indicate that decision-making differences do not occur as a function of OC symptomatology in a non-clinical sample; however, they do suggest that the experience of anxiety significantly impairs decision-making performance. The theoretical and practical applications of the findings are discussed.
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Martoni RM, Brombin C, Nonis A, Salgari GC, Buongiorno A, Cavallini MC, Galimberti E, Bellodi L. Evaluating effect of symptoms heterogeneity on decision-making ability in obsessive-compulsive disorder. Psychiatry Clin Neurosci 2015; 69:402-10. [PMID: 25522816 DOI: 10.1111/pcn.12264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/25/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022]
Abstract
AIMS Despite having a univocal definition, obsessive-compulsive disorder (OCD) shows a remarkably phenotypic heterogeneity. The published reports show impaired decision-making in OCD patients, using tasks such as the Iowa Gambling Task (IGT). We wanted to verify the hypothesis of an IGT worse performance in a large sample of OCD patients and healthy control (HC) subjects and to examine the relation between neuropsychological performance in IGT and the OCD symptoms heterogeneity. METHODS Binary data from the Yale-Brown Obsessive Compulsive Scale collected on a large sample of OCD patients were analyzed using a multidimensional item response theory model to explore the underlying structure of data, thus revealing latent factors. Factor scores were categorized into quartiles. Then, for each factor, we identified patients respectively with the highest versus lowest score. We evaluated whether symptom dimensions affect the probability of a correct answer over time generalized, during IGT performance, fitting a generalized linear mixed model. RESULTS We found a general deficit in ambiguous decision-making in OCD compared to HC. Moreover, our findings suggested that OCD symptoms heterogeneity affects decision-making learning abilities during IGT. In fact, while 'Symmetry' and 'Washing' patients showed a learning curve during the task, other subgroups did not. CONCLUSIONS Our study confirmed previous findings suggesting that OCD is characterized by a deficit in decision-making under uncertainty. Moreover, our study gave evidence about biological specificity for each symptom dimension in OCD. Data were discussed in the context of the somatic marker hypothesis, which was hypothesized to be reduced in OCD patients.
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Affiliation(s)
- Riccardo Maria Martoni
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy.,Decision Theory in Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Brombin
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,CUSSB, University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Nonis
- CUSSB, University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Angela Buongiorno
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy
| | | | - Elisa Galimberti
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Bellodi
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy.,Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
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14
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Kim HW, Kang JI, Namkoong K, Jhung K, Ha RY, Kim SJ. Further evidence of a dissociation between decision-making under ambiguity and decision-making under risk in obsessive-compulsive disorder. J Affect Disord 2015; 176:118-24. [PMID: 25704564 DOI: 10.1016/j.jad.2015.01.060] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deficits in decision-making have been suggested as a key concept in understanding the symptoms of obsessive-compulsive disorder (OCD). However, evidence in the extant literature remains inconclusive on whether patients with OCD show inferior performance on laboratory decision-making tasks. The aims of the present study were therefore to (1) assess decision-making under ambiguity and under risk in patients with OCD and (2) study the influence of neuropsychological and clinical variables on decision-making in OCD. METHODS The sample consisted of 65 patients with OCD and 58 controls. The Iowa gambling task (IGT) and the game of dice task (GDT) were used to examine decision-making under ambiguity and decision-making under risk, respectively. In addition, reversal learning and executive function were assessed in terms of their relationship with decision-making tasks. RESULTS Patients with OCD showed impairment in the IGT, but not in the GDT. Reversal learning was neither impaired nor correlated with IGT performance. Among the clinical variables, illness severity and depression were associated with IGT scores. Executive function was impaired, but no significant relationship was found between executive function and GDT performance in OCD patients. LIMITATIONS Almost all OCD patients were on medication when they performed decision-making tasks. CONCLUSIONS Patients with OCD are impaired in decision-making under ambiguity, but not under risk. These findings demonstrate that decision-making processes are dissociated in OCD.
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Affiliation(s)
- Hae Won Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee In Kang
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Kee Namkoong
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyungun Jhung
- Department of Adolescent Psychiatry, National Center for Child and Adolescent Psychiatry, Seoul National Hospital, Seoul, South Korea
| | - Ra Yeon Ha
- Department of Psychiatry, Seoul Bukbu Hospital, Seoul, South Korea
| | - Se Joo Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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15
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Reward-based decision making in pathological gambling: The roles of risk and delay. Neurosci Res 2015; 90:3-14. [DOI: 10.1016/j.neures.2014.09.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 01/27/2023]
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Abstract
Obsessive compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are two of the most common neuropsychiatric diseases in paediatric populations. The high comorbidity of ADHD and OCD with each other, especially of ADHD in paediatric OCD, is well described. OCD and ADHD often follow a chronic course with persistent rates of at least 40–50 %. Family studies showed high heritability in ADHD and OCD, and some genetic findings showed similar variants for both disorders of the same pathogenetic mechanisms, whereas other genetic findings may differentiate between ADHD and OCD. Neuropsychological and neuroimaging studies suggest that partly similar executive functions are affected in both disorders. The deficits in the corresponding brain networks may be responsible for the perseverative, compulsive symptoms in OCD but also for the disinhibited and impulsive symptoms characterizing ADHD. This article reviews the current literature of neuroimaging, neurochemical circuitry, neuropsychological and genetic findings considering similarities as well as differences between OCD and ADHD.
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17
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Morein-Zamir S, Papmeyer M, Pertusa A, Chamberlain SR, Fineberg NA, Sahakian BJ, Mataix-Cols D, Robbins TW. The profile of executive function in OCD hoarders and hoarding disorder. Psychiatry Res 2014; 215:659-67. [PMID: 24467873 PMCID: PMC3988927 DOI: 10.1016/j.psychres.2013.12.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 12/07/2013] [Accepted: 12/12/2013] [Indexed: 12/17/2022]
Abstract
Hoarding disorder is a new mental disorder in DSM-5. It is classified alongside OCD and other presumably related disorders in the Obsessive-Compulsive and Related Disorders chapter. We examined cognitive performance in two distinct groups comprising individuals with both OCD and severe hoarding, and individuals with hoarding disorder without comorbid OCD. Participants completed executive function tasks assessing inhibitory control, cognitive flexibility, spatial planning, probabilistic learning and reversal and decision making. Compared to a matched healthy control group, OCD hoarders showed significantly worse performance on measures of response inhibition, set shifting, spatial planning, probabilistic learning and reversal, with intact decision making. Despite having a strikingly different clinical presentation, individuals with only hoarding disorder did not differ significantly from OCD hoarders on any cognitive measure suggesting the two hoarding groups have a similar pattern of cognitive difficulties. Tests of cognitive flexibility were least similar across the groups, but differences were small and potentially reflected subtle variation in underlying brain pathology together with psychometric limitations. These results highlight both commonalities and potential differences between OCD and hoarding disorder, and together with other lines of evidence, support the inclusion of the new disorder within the new Obsessive-Compulsive and Related Disorders chapter in DSM-5.
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Affiliation(s)
- Sharon Morein-Zamir
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of Psychology, University of Cambridge, Cambridge, UK.
| | - Martina Papmeyer
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychology, University of Cambridge, Cambridge, UK
| | - Alberto Pertusa
- Departments of Psychology and Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | - Samuel R. Chamberlain
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Naomi A. Fineberg
- Mental Health Unit, QEII Hospital, Welwyn Garden City, Hertfordshire, UK
| | - Barbara J. Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David Mataix-Cols
- Department of Psychology, University of Cambridge, Cambridge, UK,Departments of Psychology and Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychology, University of Cambridge, Cambridge, UK
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18
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New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectr 2014; 19:69-89. [PMID: 24512640 PMCID: PMC4113335 DOI: 10.1017/s1092852913000801] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Impulsivity and compulsivity represent useful conceptualizations that involve dissociable cognitive functions, which are mediated by neuroanatomically and neurochemically distinct components of cortico-subcortical circuitry. The constructs were historically viewed as diametrically opposed, with impulsivity being associated with risk-seeking and compulsivity with harm-avoidance. However, they are increasingly recognized to be linked by shared neuropsychological mechanisms involving dysfunctional inhibition of thoughts and behaviors. In this article, we selectively review new developments in the investigation of the neurocognition of impulsivity and compulsivity in humans, in order to advance our understanding of the pathophysiology of impulsive, compulsive, and addictive disorders and indicate new directions for research.
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19
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Olfactory identification deficits and associated response inhibition in obsessive-compulsive disorder: on the scent of the orbitofronto-striatal model. Psychiatry Res 2013; 210:208-14. [PMID: 23870490 DOI: 10.1016/j.psychres.2013.05.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 02/16/2013] [Accepted: 05/22/2013] [Indexed: 11/20/2022]
Abstract
Olfactory identification ability implicates the integrity of the orbitofrontal cortex (OFC). The fronto-striatal circuits including the OFC have been involved in the neuropathology of Obsessive Compulsive Disorder (OCD). However, only a few studies have examined olfactory function in patients with OCD. The Brief Smell Identification Test (B-SIT) and tests from the Cambridge Neuropsychological Automated Battery (CANTAB) were administered to 25 patients with OCD and to 21 healthy matched controls. OCD patients showed a significant impairment in olfactory identification ability as well as widely distributed cognitive deficits in visual memory, executive functions, attention, and response inhibition. The degree of behavioural impairment on motor impulsivity (prolonged response inhibition Stop-Signal Reaction Time) strongly correlated with the B-SIT score. Our study is the first to indicate a shared OFC pathological neural substrate underlying olfactory identification impairment, impulsivity, and OCD. Deficits in visual memory, executive functions and attention further indicate that regions outside of the orbitofronto-striatal loop may be involved in this disorder. Such results may help delineate the clinical complexity of OCD and support more targeted investigations and interventions. In this regard, research on the potential diagnostic utility of olfactory identification deficits in the assessment of OCD would certainly be useful.
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20
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Boisseau CL, Thompson-Brenner H, Pratt EM, Farchione TJ, Barlow DH. The relationship between decision-making and perfectionism in obsessive-compulsive disorder and eating disorders. J Behav Ther Exp Psychiatry 2013; 44:316-21. [PMID: 23454627 DOI: 10.1016/j.jbtep.2013.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 01/24/2013] [Accepted: 01/29/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Obsessive-compulsive disorder (OCD) and eating disorders (EDs) show phenotypic similarities and have been independently associated with deficits in decision-making and maladaptive perfectionism. However, research directly comparing the two disorders is sparse and the significance of observed similarities remains in question. Therefore, the present study compared decision-making in OCD and EDs in relationship to perfectionistic personality traits. METHODS Sixty-one women were enrolled in the study comprising 3 mutually exclusive groups: 19 with OCD, 17 with EDs, and 21 healthy controls. Decision-making performance on the Iowa Gambling Task under two conditions, ambiguity and risk, was examined in relationship to perfectionistic traits. RESULTS Behavioral results indicated that EDs participants, relative to both OCD and control participants, were impaired in decision-making under conditions of risk. Heightened perfectionism was associated with less risky decision-making in OCD, but more risky decision-making in EDs. LIMITATIONS Sample size was small and all participants were women, which may limit generalizability. CONCLUSION Results support decision-making deficits in EDs, which may be related to a dysfunctional determination of risk versus reward. This study is the first to suggest that the relationship between perfectionism and risk taking may manifest differently in these phenotypically similar disorders.
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Affiliation(s)
- Christina L Boisseau
- Department of Psychiatry and Human Behavior, Brown University Medical School and Butler Hospital, Providence, RI 02906, USA.
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21
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Dittrich WH, Johansen T. Cognitive deficits of executive functions and decision-making in obsessive-compulsive disorder. Scand J Psychol 2013; 54:393-400. [PMID: 23841985 DOI: 10.1111/sjop.12066] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 05/09/2013] [Indexed: 11/30/2022]
Abstract
The nature of cognitive deficits in obsessive-compulsive disorder (OCD) is characterized by contradictory findings in terms of specific neuropsychological deficits. Selective impairments have been suggested to involve visuospatial memory, set shifting, decision-making and response inhibition. The aim of this study was to investigate cognitive deficits in decision-making and executive functioning in OCD. It was hypothesized that the OCD patients would be less accurate in their responses compared to the healthy controls in rational decision-making on a version of the Cambridge gambling task (CGT) and on the color-word interference test and on a version of the Tower of Hanoi test (tower test) of executive functioning. Thirteen participants with OCD were compared to a group of healthy controls (n = 13) matched for age, gender, education and verbal IQ. Results revealed significant differences between the OCD group and the healthy control group on quality of decision-making on the CGT and for achievement score on the tower test. On these two tasks the OCD group performed worse than the healthy control group. The symptom-dimension analysis revealed performance differences where safety checking patients were impaired on the tower test compared to contamination patients. Results are discussed in the framework of cognition and emotion processing and findings implicate that OCD models should address, specifically, the interaction between cognition and emotion. Here the emotional disruption hypothesis is forwarded to account for the dysfunctional behaviors in OCD. Further implications regarding methodological and inhibitory factors affecting cognitive information processing are highlighted.
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Affiliation(s)
- Winand H Dittrich
- Research Center for Behavioral Economics, FOM Hochschule, Frankfurt am Main, Germany.
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22
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Lin CH, Song TJ, Chen YY, Lee WK, Chiu YC. Reexamining the validity and reliability of the clinical version of the iowa gambling task: evidence from a normal subject group. Front Psychol 2013; 4:220. [PMID: 23755026 PMCID: PMC3665927 DOI: 10.3389/fpsyg.2013.00220] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 04/10/2013] [Indexed: 11/21/2022] Open
Abstract
Over past decade, the Iowa gambling task (IGT) has been utilized to test various decision deficits induced by neurological damage or psychiatric disorders. The IGT has recently been standardized for identifying 13 different neuropsychological disorders. Neuropsychological patients choose bad decks frequently, and normal subjects prefer good expected value (EV) decks. However, the IGT has several validity and reliability problems. Some research groups have pointed out that the validity of IGT is influenced by the personality and emotional state of subjects. Additionally, several other studies have proposed that the “prominent deck B phenomenon” (PDB phenomenon) – that is, normal subjects preferring bad deck B – may be the most serious problem confronting IGT validity. Specifically, deck B offers a high frequency of gains but negative EV. In the standard IGT administration, choice behavior can be understood with reference to gain-loss frequency (GLF) rather than inferred future consequences (EV, the basic assumption of IGT). Furthermore, using two different criteria (basic assumption vs. professional norm) results in significantly different classification results. Therefore, we recruited 72 normal subjects to test the validity and reliability of IGT. Each subject performed three runs of the computer-based clinical IGT version. The PDB phenomenon has been observed to a significant degree in the first and second stages of the clinical IGT version. Obviously, validity, reliability, and the practice effect were unstable between two given stages. The present form of the clinical IGT version has only one stage, so its use should be reconsidered for examining normal decision makers; results from patient groups must also be interpreted with great care. GLF could be the main factor to be considered in establishing the constructional validity and reliability of the clinical IGT version.
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Affiliation(s)
- Ching-Hung Lin
- Department of Psychology, Soochow University Taipei, Taiwan ; Brain Research Center, National Yang-Ming University Taipei, Taiwan ; Biomedical Electronics Translational Research Center, National Chiao Tung University Hsinchu, Taiwan ; Biomedical Engineering R&D Center, China Medical University Taichung, Taiwan
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23
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Lorian CN, Mahoney A, Grisham JR. Playing it safe: an examination of risk-avoidance in an anxious treatment-seeking sample. J Affect Disord 2012; 141:63-71. [PMID: 22425431 DOI: 10.1016/j.jad.2012.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 02/14/2012] [Accepted: 02/14/2012] [Indexed: 11/30/2022]
Abstract
It has been argued that individuals who are anxious are less likely and willing to take perceived risks across multiple behavioral domains (e.g., social, recreational, financial etc.), and that this bias is likely implicated in the etiology of pathological anxiety. While evidence is accumulating, there has been minimal research investigating the characteristics of risk-avoidance across anxiety disorders and across the specific risk-taking domains. The current study investigated risk-avoidance across domains in an anxious treatment-seeking sample. We hypothesized that: (i) individuals with anxiety would be more risk averse across domains relative to healthy controls; and, (ii) risk-avoidance would predict unique variance in anxiety symptoms, above and beyond other vulnerability factors (e.g., neuroticism). Individuals diagnosed with one or more anxiety disorders (n=67) completed measures of risk-taking, anxiety and depression symptoms, personality, and psychological distress. Healthy controls (n=58) completed measures of risk-taking and psychological distress. Results partially confirmed our hypotheses, demonstrating that anxious individuals were significantly more risk averse relative to controls across most domains, even after controlling for age and psychological distress. Furthermore, specific domains were found to account for unique variance in specific anxiety symptoms, as well as symptoms of depression. The results of this study provide novel evidence to suggest that risk-aversion is a possible transdiagnostic factor contributing to anxiety pathology.
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Affiliation(s)
- Carolyn N Lorian
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
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24
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Kodaira M, Iwadare Y, Ushijima H, Oiji A, Kato M, Sugiyama N, Sasayama D, Usami M, Watanabe K, Saito K. Poor performance on the Iowa gambling task in children with obsessive-compulsive disorder. Ann Gen Psychiatry 2012; 11:25. [PMID: 23062199 PMCID: PMC3508952 DOI: 10.1186/1744-859x-11-25] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 10/08/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Several lines of evidence implicate orbitofrontal cortex dysfunction in the pathophysiology of obsessive-compulsive disorder (OCD). The purpose of this study was to investigate neuropsychological dysfunction of the orbitofrontal cortex in children with OCD. METHODS The Iowa Gambling Task (IGT), which reflects orbitofrontal cortex function, and the Wisconsin Card Sorting Test (WCST), which is associated with functioning of the dorsolateral prefrontal cortex, were administered to 22 children with OCD and 22 healthy controls matched for gender, age, and intelligence. RESULTS OCD patients displayed poor performance on the IGT. In contrast, performance on the WCST was not impaired in OCD patients compared to controls. CONCLUSIONS These findings are in line with previous studies demonstrating that OCD in childhood is associated with a dysfunction of orbitofrontal-striatal-thalamic circuitry.
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Affiliation(s)
- Masaki Kodaira
- Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-0836, Japan.
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25
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Nakazato T. Dual modes of extracellular serotonin changes in the rat ventral striatum modulate adaptation to a social stress environment, studied with wireless voltammetry. Exp Brain Res 2012; 230:583-96. [DOI: 10.1007/s00221-012-3168-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 06/25/2012] [Indexed: 02/03/2023]
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26
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Lorian CN, Titov N, Grisham JR. Changes in risk-taking over the course of an internet-delivered cognitive behavioral therapy treatment for generalized anxiety disorder. J Anxiety Disord 2012; 26:140-9. [PMID: 22079215 DOI: 10.1016/j.janxdis.2011.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 10/03/2011] [Accepted: 10/09/2011] [Indexed: 10/16/2022]
Abstract
It has been proposed that a persistent and pervasive tendency to avoid risks is involved in the development and maintenance of clinically significant anxiety. Few studies, however, have examined the clinical implications of risk-aversion, and particularly the association between risk-aversion and treatment outcome. The current study investigated how risk-aversion in specific domains (Social and Recreational) related to treatment outcome in a clinical sample of patients with generalized anxiety disorder (GAD) undergoing internet-delivered cognitive-behavioral therapy (CBT). We hypothesized that: (i) risk-taking would increase as a result of treatment and (ii) risk-taking would mediate changes in symptom severity and impairment as a result of treatment. Individuals recruited online (N=44) meeting diagnostic criteria for GAD were randomized to the treatment (n=24) or control group (n=20). Participants completed measures of symptom severity, impairment and risk-taking before and after treatment. Results partially confirmed our hypotheses, demonstrating that participants in the treatment group significantly increased social and recreational risk-taking scores relative to the control group and risk-taking mediated treatment outcome for depression, but not for anxiety symptoms. The results of this study suggest that social and recreational risk-avoidance decreases following CBT treatment, and this change may mediate treatment outcome for depression. Clinical implications of these findings are discussed.
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Affiliation(s)
- Carolyn N Lorian
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
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27
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Krishna R, Udupa S, George CM, Kumar KJ, Viswanath B, Kandavel T, Venkatasubramanian G, Reddy YCJ. Neuropsychological performance in OCD: a study in medication-naïve patients. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1969-76. [PMID: 21967733 DOI: 10.1016/j.pnpbp.2011.09.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/02/2011] [Accepted: 09/16/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is associated with impairments in multiple neuropsychological domains but the findings are rather inconsistent across studies. One potential reason for poor replication is the confounding influence of medications. There is limited research on neuropsychological performance in medication-naïve, never treated OCD patients. METHODS In this study, we assessed 31 medication-naïve, never-treated, DSM-IV OCD patients free of comorbid major depression and 31 healthy controls individually matched for age, gender and years of education, with tests of attention, executive function, memory reasoning and visuo-spatial function. RESULTS Medication-naïve OCD patients did not significantly differ from healthy controls on most neuropsychological tests. Patients performed somewhat poorly only on the highest goal hierarchy of the Tower of London (TOL) test (p=0.001, effect size=0.68). CONCLUSIONS It is intriguing to find that symptomatic, drug-naïve OCD patients did not significantly differ from healthy controls on most neuropsychological tests. Our finding of medium effect size on TOL highest goal hierarchy test suggests that brain regions outside the affective orbitofrontal loop may also be perhaps involved in OCD. This finding however needs replication because of modest effect size. Future studies should focus on studying medication-naïve, co-morbidity-free patients and relatives using symptom dimensions for consistent and robust findings.
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Affiliation(s)
- Rakhee Krishna
- National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
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28
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Del Casale A, Kotzalidis GD, Rapinesi C, Serata D, Ambrosi E, Simonetti A, Pompili M, Ferracuti S, Tatarelli R, Girardi P. Functional neuroimaging in obsessive-compulsive disorder. Neuropsychobiology 2011; 64:61-85. [PMID: 21701225 DOI: 10.1159/000325223] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 01/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Obsessive-compulsive disorder (OCD) is a severe, highly prevalent and chronically disabling psychiatric disorder that usually emerges during childhood or adolescence. This paper aims to review the literature on functional neuroimaging in OCD, analysing the reported dysfunctional connectivity in the corticostriatothalamocortical circuitry. METHOD This study included papers published in peer-reviewed journals dealing with functional imaging in OCD. RESULTS Striatal dysfunction, mainly of the caudate nucleus, leads to inefficient thalamic gating, resulting in hyperactivity within the orbitofrontal cortex (intrusive thoughts) and the anterior cingulate cortex (non-specific anxiety). Compulsions consist of ritualistic behaviours performed to recruit the inefficient striatum and neutralise unwanted thoughts and anxiety. Functional neuroimaging findings are discussed against the background of specific cognitive impairments, mainly regarding visuospatial processing, executive functioning and motor speed. Cognitive deficits are partial and specific, matching imaging data. CONCLUSIONS Several studies have targeted brain regions hypothesised to be involved in the pathogenesis of OCD, showing the existence of dysfunctional connectivity in the corticostriatothalamocortical circuitry. Improvements in spatial resolution of neuroimaging techniques may contribute to a better understanding of the neurocircuitry of OCD and other anxiety disorders.
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Affiliation(s)
- A Del Casale
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University and Sant'Andrea Hospital, Rome, Italy.
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29
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Rocha FFD, Alvarenga NB, Malloy-Diniz L, Corrêa H. Decision-making impairment in obsessive-compulsive disorder as measured by the Iowa Gambling Task. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:642-7. [DOI: 10.1590/s0004-282x2011000500013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 03/28/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: This study aims to evaluate the process of decision-making in patients with obsessive-compulsive disorder (OCD) using the Iowa Gambling Task (IGT). In addition, we intend to expand the understanding of clinical and demographic characteristics that influence decision-making. METHOD: Our sample consisted of 214 subjects (107 diagnosed with OCD and 107 healthy controls) who were evaluated on their clinical, demographic and neuropsychological features. Moreover, the Iowa Gambling Task (IGT), a task that detects and measures decision-making impairments, was used. RESULTS: We found that OCD patients performed significantly worse on the IGT. Furthermore, features such as symptoms of anxiety did not influence IGT performance. CONCLUSION: Impaired decision-making seems to be a key feature of OCD. Given that OCD is a complex heterogeneous disorder, homogeneous groups are necessary for an accurate characterization of our findings.
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da Rocha FF, Malloy-Diniz L, Lage NV, Corrêa H. The relationship between the Met allele of the BDNF Val66Met polymorphism and impairments in decision making under ambiguity in patients with obsessive-compulsive disorder. GENES BRAIN AND BEHAVIOR 2011; 10:523-9. [DOI: 10.1111/j.1601-183x.2011.00687.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Orhan Murat Koçak, Nalçacı E, Halise Devrimci Özgüven, Emel Güneş Nalçacı, Ergenç I. Evaluation of cognitive slowing in OCD by means of creating incongruence between lexicon and prosody. Psychiatry Res 2010; 179:306-11. [PMID: 20488555 DOI: 10.1016/j.psychres.2009.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 02/15/2009] [Accepted: 04/22/2009] [Indexed: 10/19/2022]
Abstract
Studies indicate that patients with obsessive-compulsive disorder (OCD) have slowing in cognitive processing, especially in the presence of a conflict. This study aimed to determine whether decision and motor times in OCD patients were affected by manipulating the congruence/incongruence of lexical and prosodic aspects of commands. An experimental paradigm was designed to simulate a situation that can trigger anxiety and obsessions in OCD patients. Commands with or without a conflict, that is, an incongruence between lexical and prosodic aspects, were given to the participants. Decision time, motor time and errors were the main parameters of the experiment. The control group had significantly faster decision times than the OCD group in response to both conflicting and non-conflicting commands. The OCD patients demonstrated higher trait anxiety, while Stroop interference and state anxiety were not significantly different between the groups. These results suggest that OCD patients experience slowing in their response times, regardless of whether the stimuli are conflicting or not.
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Affiliation(s)
- Orhan Murat Koçak
- Kırıkkale University, Department of Psychiatry, Süleyman Demirel Research and Education Hospital, Kırıkkale, 71100, Turkey.
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Abstract
Obsessive-compulsive disorder is a common debilitating condition affecting individuals from childhood through adult life. There is good evidence of genetic contribution to its etiology, but environmental risk factors also are likely to be involved. The condition probably has a complex pattern of inheritance. Molecular studies have identified several potentially relevant genes, but much additional research is needed to establish definitive causes of the condition.
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Affiliation(s)
- Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Hospital, Meyer 113, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| | - Marco Grados
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - J F Samuels
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
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Starcke K, Tuschen-Caffier B, Markowitsch HJ, Brand M. Dissociation of decisions in ambiguous and risky situations in obsessive-compulsive disorder. Psychiatry Res 2010; 175:114-20. [PMID: 20004479 DOI: 10.1016/j.psychres.2008.10.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 02/29/2008] [Accepted: 10/23/2008] [Indexed: 10/20/2022]
Abstract
Patients with obsessive-compulsive disorder (OCD) often show deficits in everyday decision-making, a phenomenon which is leading to a growing research interest in neuropsychological aspects of decision-making in OCD. Previous investigations of OCD patients demonstrated deficits in the Iowa Gambling Task (IGT), a decision-making task with implicit rules. Results were interpreted as reflecting orbitofrontal cortex dysfunctions observed in OCD. The aim of the present study is to investigate OCD patients' performance on the Game of Dice Task (GDT), a decision-making task with explicit and stable rules. For this purpose, 23 patients with OCD and 22 healthy comparison subjects were examined with the GDT and the IGT as well as with tests of executive functioning. While patients performed worse than comparison subjects on the IGT, they were unimpaired on the GDT and executive functioning tasks. Results further emphasize dysfunctions of the orbitofrontal cortex, but indicate intact functioning of the dorsolateral prefrontal cortex in patients with OCD.
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Affiliation(s)
- Katrin Starcke
- Department of Physiological Psychology, University of Bielefeld, P.O. Box 100131, 33501 Bielefeld, Germany.
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Bedard MJ, Joyal CC, Godbout L, Chantal S. Executive Functions and the Obsessive-Compulsive Disorder: On the Importance of Subclinical Symptoms and Other Concomitant Factors. Arch Clin Neuropsychol 2009; 24:585-98. [DOI: 10.1093/arclin/acp052] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Starcke K, Tuschen-Caffier B, Markowitsch HJ, Brand M. Skin conductance responses during decisions in ambiguous and risky situations in obsessive-compulsive disorder. Cogn Neuropsychiatry 2009; 14:199-216. [PMID: 19499386 DOI: 10.1080/13546800902996831] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Patients with obsessive-compulsive disorder (OCD) often have difficulties in everyday decision making. In addition, recent research suggests that patients have reduced performance on the Iowa Gambling Task, a laboratory decision-making task with implicit rules that taps emotional feedback processing. Disadvantageous decision making is accompanied by reduced skin conductance responses (SCRs) generated during task performance. METHODS The current study investigates behavioural and SCR data during the Iowa Gambling Task (IGT) and additionally the Game of Dice Task (GDT), a decision-making task with explicit and stable rules. We examined 14 patients with OCD and 15 comparison subjects performing the two decision-making tasks while recording accompanying SCR. RESULTS Patients showed difficulties on the Iowa Gambling Task but not the Game of Dice Task. This was also confirmed by the SCR results. In the Iowa Gambling Task differences in SCR patterns for patients and comparison subjects were observed, whereas SCRs during the Game of Dice Task did not differ between groups. CONCLUSIONS Behavioural and SCR data indicate that patients with OCD have difficulties in decisions under implicit but not under explicit risk conditions.
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Affiliation(s)
- Katrin Starcke
- Department of Physiological Psychology, University of Bielefeld, PO Box 100131, Bielefeld 33501, Germany.
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Olley A, Malhi G, Sachdev P. Memory and executive functioning in obsessive-compulsive disorder: a selective review. J Affect Disord 2007; 104:15-23. [PMID: 17442402 DOI: 10.1016/j.jad.2007.02.023] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 02/28/2007] [Accepted: 02/28/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND The neurocognitive deficits that underlie the unique features of obsessive-compulsive disorder (OCD) are not yet completely understood. This paper reviews the main neuropsychological findings in memory and executive functioning in this disorder, and examines a number of challenges facing this area of research. METHOD A selective review of the neuropsychological literature on OCD was conducted using MEDLINE and drawing on literature known to the authors. RESULTS The neuropsychological profile of OCD appears to be one of primary executive dysfunction. Although memory functioning may be affected, these deficits appear secondary to an executive failure of organizational strategies during encoding. On tasks of executive functioning patients with OCD demonstrate increased response latencies, perseveration of responses, and difficulties utilizing feedback to adapt to change. LIMITATIONS A statistical meta-analysis was not performed and only the cognitive domains of memory and executive functioning were examined. CONCLUSIONS Given the prominence of chronic doubt and indecision in clinical settings, it is surprising that decision making as a cognitive construct as related to OCD has not received greater attention in the neuropsychological literature. On the basis of emerging literature we suggest that it is a potential area of dysfunction and one that warrants further investigation as it may assist in enhancing our understanding of the pathophysiology of OCD.
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Affiliation(s)
- Amanda Olley
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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Abstract
Decision-making consists of selecting an action from a set of available options. This results in an outcome that changes the state of the decision-maker. Therefore, decision-making is part of a homeostatic process. Individuals with psychiatric disorders show altered decision-making. They select options that are either non-optimal or nonhomeostatic. These dysfunctional patterns of decision-making in individuals with psychiatric disorders may fundamentally relate to problems with homeostatic regulation. These may manifest themselves in (i) how the length of time between decisions and their outcomes influences subsequent decision-making, (ii) how gain and loss feedback are integrated to determine the optimal decision, (iii) how individuals adapt their decision strategies to match the specific context, or (iv) how seemingly maladaptive responses result from an attempt to establish an unstable homeostatic balance.
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Affiliation(s)
- Martin P Paulus
- Department of Psychiatry, University of California at San Diego, 8950 Villa La Jolla Drive, La Jolla, CA 92037-0985, USA.
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Menzies L, Chamberlain SR, Laird AR, Thelen SM, Sahakian BJ, Bullmore ET. Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev 2007; 32:525-49. [PMID: 18061263 PMCID: PMC2889493 DOI: 10.1016/j.neubiorev.2007.09.005] [Citation(s) in RCA: 819] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 09/24/2007] [Accepted: 09/28/2007] [Indexed: 12/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a common, heritable and disabling neuropsychiatric disorder. Theoretical models suggest that OCD is underpinned by functional and structural abnormalities in orbitofronto-striatal circuits. Evidence from cognitive and neuroimaging studies (functional and structural magnetic resonance imaging (MRI) and positron emission tomography (PET)) have generally been taken to be supportive of these theoretical models; however, results from these studies have not been entirely congruent with each other. With the advent of whole brain-based structural imaging techniques, such as voxel-based morphometry and multivoxel analyses, we consider it timely to assess neuroimaging findings to date, and to examine their compatibility with cognitive studies and orbitofronto-striatal models. As part of this assessment, we performed a quantitative, voxel-level meta-analysis of functional MRI findings, which revealed consistent abnormalities in orbitofronto-striatal and other additional areas in OCD. This review also considers the evidence for involvement of other brain areas outside orbitofronto-striatal regions in OCD, the limitations of current imaging techniques, and how future developments in imaging may aid our understanding of OCD.
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Affiliation(s)
- Lara Menzies
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
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Glicksohn J, Naor-Ziv R, Leshem R. Impulsive decision-making: Learning to gamble wisely? Cognition 2007; 105:195-205. [PMID: 17007830 DOI: 10.1016/j.cognition.2006.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Revised: 07/20/2006] [Accepted: 08/10/2006] [Indexed: 11/22/2022]
Abstract
A decade ago, Bechara et al. [Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 7-15] published a paper in Cognition, introducing a Gambling Task which was designed to mimic everyday decision-making. Since then, the task has been computerized, its decision-making components have been scrutinized, and it has been employed in various patient groups, such as pathological gamblers, substance abusers, and so forth. Time and again it has been shown that while normal controls perform well on the task, it is the various target populations under scrutiny who exhibit poor performance. Yet, as we show in this paper, a total of 46% of normal individuals exhibited poor performance on the task, indicating a lack of learning. We argue that while so much importance has been placed on contrasting patients with controls, perhaps the real emphasis should lie in distinguishing among different individual profiles of performance on the task, irrespective of clinical classification. Our basic recommendation is to look at the individual data, pool when you can, and only then to contrast groups.
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Affiliation(s)
- Joseph Glicksohn
- Department of Criminology, The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan 52100, Israel.
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Abstract
Zusammenfassung: In diesem Übersichts-Artikel wird eine Taxonomie exekutiver Funktionen auf der Basis neuropsychologischer Modelle vorgestellt, an der sich eine klinische Diagnostik orientieren kann. Unterschieden werden vier Regulationsebenen, kognitive Regulation, Aktivitätsregulation, emotionale Regulation und soziale Regulation, denen sich klinisch beobachtbare Phänomene bei Störungen exekutiver Funktionen zuordnen lassen. Schließlich werden die besonderen Probleme thematisiert, die sich bei der Diagnostik exekutiver Funktionen hinsichtlich ökologischer Validität, Konstruktvalidität, Reliabilität und anderer methodischer Kriterien stellen.
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Chamberlain SR, Fineberg NA, Blackwell AD, Clark L, Robbins TW, Sahakian BJ. A neuropsychological comparison of obsessive–compulsive disorder and trichotillomania. Neuropsychologia 2007; 45:654-62. [PMID: 17005210 DOI: 10.1016/j.neuropsychologia.2006.07.016] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 07/21/2006] [Accepted: 07/23/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) and trichotillomania (compulsive hair-pulling) share overlapping co-morbidity, familial transmission, and phenomenology. However, the extent to which these disorders share a common cognitive phenotype has yet to be elucidated using patients without confounding co-morbidities. AIM To compare neurocognitive functioning in co-morbidity-free patients with OCD and trichotillomania, focusing on domains of learning and memory, executive function, affective processing, reflection-impulsivity and decision-making. METHOD Twenty patients with OCD, 20 patients with trichotillomania, and 20 matched controls undertook neuropsychological assessment after meeting stringent inclusion criteria. RESULTS Groups were matched for age, education, verbal IQ, and gender. The OCD and trichotillomania groups were impaired on spatial working memory. Only OCD patients showed additional impairments on executive planning and visual pattern recognition memory, and missed more responses to sad target words than other groups on an affective go/no-go task. Furthermore, OCD patients failed to modulate their behaviour between conditions on the reflection-impulsivity test, suggestive of cognitive inflexibility. Both clinical groups showed intact decision-making and probabilistic reversal learning. CONCLUSIONS OCD and trichotillomania shared overlapping spatial working memory problems, but neuropsychological dysfunction in OCD spanned additional domains that were intact in trichotillomania. Findings are discussed in relation to likely fronto-striatal neural substrates and future research directions.
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Affiliation(s)
- Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK.
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Lawrence NS, Wooderson S, Mataix-Cols D, David R, Speckens A, Phillips ML. Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder. Neuropsychology 2006; 20:409-19. [PMID: 16846259 DOI: 10.1037/0894-4105.20.4.409] [Citation(s) in RCA: 216] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is clinically heterogeneous. The authors examined how specific OCD symptom dimensions were related to neuropsychological functions using multiple regression analyses. A total of 39 OCD patients and 40 controls completed the Iowa Gambling Task (IGT; A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994), which is a test of decision making, and the Wisconsin Card Sorting Test (R. K. Heaton, 1981), which is a test of set shifting. OCD patients and controls showed comparable decision making. However, patients with prominent hoarding symptoms showed impaired decision making on the IGT as well as reduced skin conductance responses. OCD patients had poorer set shifting abilities than controls, and symmetry/ordering symptoms were negatively associated with set shifting. These results help explain previous inconsistent findings in neuropsychological research in OCD and support recent neuroimaging data showing dissociable neural mechanisms involved in mediating the different OCD symptom dimensions.
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Affiliation(s)
- Natalia S Lawrence
- Section of Neuroscience and Emotion, Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, London, England.
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Cavedini P, Gorini A, Bellodi L. Understanding Obsessive–Compulsive Disorder: Focus on Decision Making. Neuropsychol Rev 2006; 16:3-15. [PMID: 16708289 DOI: 10.1007/s11065-006-9001-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.
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Affiliation(s)
- Paolo Cavedini
- San Raffaele Scientific Institute, Department of Neuropsychiatric Sciences, Universitá Vita-Salute San Raffaele, Faculty of Psychology, 20 Via Stamir D'Aneona, 20127 Milan, Italy.
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Roh KS, Shin MS, Kim MS, Ha TH, Shin YW, Lee KJ, Kwon JS. Persistent cognitive dysfunction in patients with obsessive-compulsive disorder: a naturalistic study. Psychiatry Clin Neurosci 2005; 59:539-45. [PMID: 16194255 DOI: 10.1111/j.1440-1819.2005.01411.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of the present study was to investigate the changes in the cognitive dysfunctions of patients with obsessive-compulsive disorder (OCD) over a 1-year period of pharmacological treatment. Twenty-one OCD patients and 20 normal subjects underwent neuropsychological tests and clinical evaluations on three separate occasions (baseline, 4 months, and 1 year after the start of medications). OCD patients continued to show significant impairments in the following cognitive measures compared with the normal controls: accuracy of immediate and delayed recall on the Rey-Osterrieth complex figure tests, the numbers of responses on the category fluency test, the response time on the trail making test--part A, and the number of perseverative response and perseverative errors on the Wisconsin card sorting test. The findings in this study suggested that impaired performance on cognitive domains, such as visuospatial memory and verbal fluency may underline the pathology of OCD.
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Affiliation(s)
- Kyu Sik Roh
- Neuroscience Institute, SNU-MRC, and Department of Psychiatry, Seoul National University, Seoul, Korea
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Chamberlain SR, Blackwell AD, Fineberg NA, Robbins TW, Sahakian BJ. The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neurosci Biobehav Rev 2005; 29:399-419. [PMID: 15820546 DOI: 10.1016/j.neubiorev.2004.11.006] [Citation(s) in RCA: 549] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2004] [Revised: 11/12/2004] [Accepted: 11/19/2004] [Indexed: 01/11/2023]
Abstract
Obsessive compulsive disorder (OCD) is a highly debilitating neuropsychiatric condition with estimated lifetime prevalence of 2-3%, more than twice that of schizophrenia. However, in contrast to other neuropsychiatric conditions of a comparable or lesser prevalence, relatively little is understood about the aetiology, neural substrates and cognitive profile of OCD. Despite strong evidence for OCD being familial, with risk to first-degree relatives much greater than for the background population, its genetic underpinnings have not yet been adequately delineated. Although cognitive dysfunction is evident in the everyday behaviour of OCD sufferers and is central to contemporary psychological models, theory-based studies of neurocognitive function have yet to reveal a reliable cognitive signature, and interpretation has often been confounded by failures to control for co-morbidities. The neuroimaging findings in OCD are amongst the most robust reported in the psychiatric literature, with structural and functional abnormalities frequently reported in orbitofrontal cortex, anterior cingulate cortex, and caudate nucleus. In spite of this, our relative lack of understanding of OCD neurochemical processes continues to impede progress in the development of novel pharmacological treatment approaches. Integrating the neurobiological, cognitive, and clinical findings, we propose that OCD might usefully be conceptualised in terms of lateral orbitofrontal loop dysfunction, and that failures in cognitive and behavioural inhibitory processes appear to underlie many of the symptoms and neurocognitive findings. We highlight existing limitations in the literature, and the potential utility of endophenotypes in overcoming these limitations. We propose that neurocognitive indices of inhibitory functions may represent a useful heuristic in the search for endophenotypes in OCD. This has direct implications not only for OCD but also for putative obsessive-compulsive spectrum conditions including attention deficit hyperactivity disorder, Tourette's syndrome, and trichotillomania (compulsive hair pulling).
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Affiliation(s)
- S R Chamberlain
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, P.O. Box 189, Cambridge CB2 2QQ, UK.
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Nitschke JB, Heller W. Distinguishing neural substrates of heterogeneity among anxiety disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2005; 67:1-42. [PMID: 16291018 DOI: 10.1016/s0074-7742(05)67001-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jack B Nitschke
- Waisman Laboratory for Brain Imaging and Behavior, Departments of Psychiatry and Psychology, University of Wisconsin, Madison, Wisconsin 53705, USA
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