Disruption of consciousness depends on insight in OCD and on positive symptoms in schizophrenia

Disruption of conscious access contributes to the advent of psychotic symptoms in schizophrenia but could also explain lack of insight in other psychiatric disorders. In this study, we explored how insight and psychotic symptoms related to disruption of consciousness. We explored consciousness in patients with schizophrenia, patients with obsessive-compulsive disorder (OCD) with good vs. poor insight and matched controls. Participants underwent clinical assessments and performed a visual masking task allowing us to measure individual consciousness threshold. We used a principal component analysis to reduce symptom dimensionality and explored how consciousness measures related to symptomatology. We found that clinical dimensions could be well summarized by a restricted set of principal components which also correlated with the extent of consciousness disruption. More specifically, positive symptoms were associated with impaired conscious access in patients with schizophrenia whereas the level of insight delineated two subtypes of OCD patients, those with poor insight who had consciousness impairments similar to patients with schizophrenia, and those with good insight who resemble healthy controls. Our study provides new insights about consciousness disruption in psychiatric disorders, showing that it relates to positive symptoms in schizophrenia and with insight in OCD. In OCD, it revealed a distinct subgroup sharing neuropathological features with schizophrenia. Our findings refine the mapping between symptoms and cognition, paving the way for a better treatment selection.

A study of doubt in obsessive-compulsive disorder

BACKGROUND AND OBJECTIVES

Obsessive-compulsive disorder (OCD) has been referred to as the "doubting disease," yet there has been little foundational research on its phenomenology and characteristics. Studies of doubt have relied on researchers' idiosyncratic conceptualizations of the construct, resulting in varied assessment methods and different prevalence rates (11-75%). We examined the nature and characteristics of doubt in people with clinical and subclinical OCD so as to identify its nature and characteristics, and factors that may be unique to OCD.

METHODS

A semi-structured interview about doubt was administered to people with OCD (N = 44) and with subclinical OCD (N = 21).

RESULTS

Doubt was highly prevalent and manifested as a form of obsession, uncertainty about whether a task was done properly, and/or lack of confidence in memory and perceptions. All participants took action to resolve doubt and/or proactively pre-empt or reduce future doubt. Doubt was deeply connected to negative core beliefs about the self. The groups did not differ on their experience of doubt, except that greater symptom severity was associated with greater interference from doubt, less ability to resist it, and less success of proactive, but not reactive, strategies to manage it.

LIMITATIONS

We relied on retrospective report, and the subclinical group was relatively small.

CONCLUSIONS

In subclinical and clinical OCD, doubt is pervasive, manifests in three domains, is connected to negative core beliefs, and is highly aversive. Continued empirical study of doubt is essential to proper assessment and to development of theories and treatment of OCD.

Just let me check: The role of individual differences in self-reported anxiety and obsessive-compulsive features on subjective, behavioural, and physiological indices during a checking task

Checking behaviour has been described as a form of preventative behaviour used by an individual to establish control over the environment and avoid future misfortune. However, when compulsive, checking behaviours can become disabling and distressing and have been linked to the maintenance of anxiety and obsessive-compulsive disorders. Despite this, there is limited literature across the field that has assessed the impact of dimensional measures of anxiety and obsessive-compulsive features (i.e., negative affect, uncertainty, and perfectionism) in driving checking behaviour. As such, the present study examined the impact of individual differences in self-reported anxiety and obsessive-compulsive features on subjective, behavioural, and physiological indices during a visual discrimination and checking task (n = 87). Higher self-reported anxiety and obsessive-compulsive features were associated with higher subjective ratings of unpleasantness and the urge to check during the task. Moreover, higher self-reported anxiety and obsessive-compulsive features related to general negative affect, uncertainty, and perfectionism were associated with greater checking frequency during the task. Lastly, stronger obsessional beliefs about perfectionism and the need for certainty were found to predict poorer accuracy, slower reaction times, and higher engagement of the corrugator supercilii during the task. In sum, these findings demonstrate how different anxiety and obsessive-compulsive features, in particular perfectionism and the need for certainty, may relate to and maintain checking behaviour in low threat contexts, which likely has implications for models of excessive and persistent checking in anxiety and obsessive-compulsive disorders.

Perceptual Decision Impairments Linked to Obsessive-Compulsive Symptoms are Substantially Driven by State-Based Effects

Computational models of decision making have identified a relationship between obsessive-compulsive symptoms (OCS), both in the general population and in patients, and impairments in perceptual evidence accumulation. Some studies have interpreted these deficits to reflect global disease traits which give rise to clusters of OCS. Such assumptions are not uncommon, even if implicit, in computational psychiatry more broadly. However, it is well established that state- and trait-symptom scores are often correlated (e.g., state and trait anxiety), and the extent to which perceptual deficits are actually explained by state-based symptoms is unclear. State-based symptoms may give rise to information processing differences in a number of ways, including the mechanistically less interesting possibility of tying up working memory and attentional resources for off-task processing. In a general population sample (N = 150), we investigated the extent to which previously identified impairments in perceptual evidence accumulation were related to trait vs stated-based OCS. In addition, we tested whether differences in working memory capacity moderated state-based impairments, such that impairments were worse in individuals with lower working memory capacity. We replicated previous work demonstrating a negative relationship between the rate of evidence accumulation and trait-based OCS when state-based symptoms were unaccounted for. When state-based effects were included in the model, they captured a significant degree of impairment while trait-based effects were attenuated, although they did not disappear completely. We did not find evidence that working memory capacity moderated the state-based effects. Our work suggests that investigating the relationship between information processing and state-based symptoms may be important more generally in computational psychiatry beyond this specific context.

Inverse Association Between Resting-State Putamen Activity and Iowa Gambling Task Performance in Patients With Obsessive-Compulsive Disorder and Control Subjects

BACKGROUND

Symptoms of obsessive-compulsive disorder (OCD) have been conceptualized as manifestations of decision-making deficits. Patients with OCD exhibit impairment during the decision-making process, as assessed by the Iowa Gambling Task (IGT). This impairment is independent of clinical severity and disease progression. However, the association between the decision-making deficit and resting-state brain activity of patients with OCD has not been examined.

METHODS

Fifty unmedicated patients with OCD and 55 matched control subjects completed IGT. Resting-state brain activity was examined using the fractional amplitude of low-frequency fluctuations (fALFFs). fALFF analysis focused on the slow-4 and 5 bands. Group comparisons were performed to determine the association between IGT performance and fALFFs.

RESULTS

There was a significant group difference in the association between the IGT total net score and slow-4 fALFFs in the left putamen (voxel height threshold of p < 0.001; cluster size threshold of p < 0.05; family wise error-corrected). Higher putamen slow-4 fALFFs were correlated with lower IGT scores for OCD patients (r = -0.485; p < 0.0005) and higher IGT scores for control subjects (r = 0.402; p < 0.005). There was no group difference in the association between the IGT total net score and slow-5 fALFFs.

CONCLUSIONS

These findings in unmedicated patients demonstrate the importance of resting-state putamen activity for decision-making deficit associated with OCD, as measured by IGT. The inverse correlation may be explained by the hypersensitive response of the putamen in patients with OCD.

Obsessive-Compulsive Disorder and Decision Making under Ambiguity: A Systematic Review with Meta-Analysis

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.

Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions

Neuropsychological functions in obsessive-compulsive disorder (OCD) have been extensively investigated. Despite some common findings across studies indicating deficient test performance across cognitive domains with small to medium effect sizes, results remain inconsistent and heterogeneous. However, multiple past attempts to identify moderators that may account for such variability have been unrewarding. Typical moderators including symptom severity, age at onset, medication status, and comorbid conditions failed to provide sufficient explanatory power. It has then been posited that these inconsistencies may be attributed to the inherent heterogeneous nature of the disorder (i.e., symptom dimensions), or to the natural fluctuation in symptom severity. However, recent meta-analyses suggest that these factors may not account for the persistent unexplained variability. Other potential factors-some of which are unique to neuropsychological testing-received scarce research attention, including definition of cognitive impairments, specificity and selection of test and outcome measures, and their limited ecological validity. Other moderators, particularly motivational aspects, and metacognitive factors (e.g., self-efficacy) were not previously addressed despite their potential association to OCD, and their documented impact on cognitive function. The aim of the present mini-review is to provide an updated succinct overview of the current status of the neuropsychological literature in OCD and expanding upon oft-neglected potential moderators and their putative impact on neuropsychological findings in OCD. Our goal is to highlight important avenues for further research and provide a road map for investigators in order to advance our understanding of cognitive functions in OCD that has been stagnant in the past decade.

Decision-making about intrusive thoughts: Relationships to attitudes towards them

BACKGROUND AND OBJECTIVES

The present study investigated decision-making strategies about and evaluations of intrusive thoughts in OCD presented in hypothetical targets in vignettes in a non-clinical population. It was expected participants would be hastier in their decisions for violent and sexual thoughts than checking and contamination thoughts and find those thoughts more credible. In addition, it was expected that hastier decision-making would be related to poorer evaluation of the targets. It was further expected that higher OC traits would be related to collecting fewer data.

METHODS

Participants (N = 84) read four vignettes, two detailing a target with taboo intrusive thoughts and two detailing a target with non-taboo intrusive thoughts. Participants engaged in decision-making tasks about the targets before making decisions about the validity of the fears and rating their thoughts about the target.

RESULTS

There was a relationship between data gathering and evaluations of the targets, but only for targets with taboo thoughts - requesting fewer data was associated with believing that the violent and sexual thoughts were true and evaluating them more negatively. Participants with higher OC traits gathered fewer data before deciding on three of the four tasks.

LIMITATIONS

The sample was non-clinical and homogenous; stimuli may have been unbalanced across vignettes.

CONCLUSIONS

Reasoning about and attitudes about taboo intrusive thoughts appear to be considerably related.

Why check? A meta-analysis of checking in obsessive-compulsive disorder: Threat vs. distrust of senses

Compulsive checking is the most common ritual among individuals with obsessive-compulsive disorder (OCD). Yet, other than uncertainty, the variables prompting checking are not fully understood. Laboratory studies suggest that task conditions - whether threatening (anxiety-relevant) or neutral, and task type - whether requiring perceptual or reasoning decision-making - may be influential. The purpose of our meta-analysis was to compare OCD participants and healthy controls on experimental tasks involving uncertainty in which a behavioral measure of checking was obtained. Four databases were searched. Twenty-two studies met the inclusion criteria, including 43 conditions comparing 663 OCD participants to 614 healthy controls. Due to the dependent structure of the data a robust variance estimation analysis approach was used. Overall effects were similar for neutral and threatening conditions. However, OCD participants responded with greater checking compared to controls on perceptual tasks, but not on reasoning tasks. Results support previous reports suggesting that OCD checking can be observed in neutral conditions, possibly posing as a risk factor for a checking vicious cycle. In addition, our results support OCD models which focus on checking as stemming from interference with automatic processes and distrust of sensory modalities.

Inductive and deductive reasoning in obsessive-compulsive disorder

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.

"What I believe is true": Belief-confirming reasoning bias in social anxiety disorder

BACKGROUND AND OBJECTIVES

Research shows that people tend to consider believable conclusions as valid and unbelievable conclusions as invalid (belief bias). When applied to anxiogenic beliefs, this belief bias could well hinder the correction of dysfunctional convictions. Previous work has shown that high socially anxious students indeed display such fear-confirming, belief biased, reasoning. A critical next question is whether these findings translate to a clinical population of people with social anxiety disorder (SAD). We test whether (i) patients with SAD show belief bias with regard to SAD-relevant themes, (ii) this belief bias is specific for SAD patients or can also be found in panic disorder (PD) patients, (iii) differential belief bias effects in SAD are restricted to social anxiety concerns or are also evident in the context of reasoning with neutral themes.

METHOD

45 SAD patients, 24 PD patients, and 45 non-symptomatic controls (NSCs) completed a syllogistic belief bias task with SAD-relevant and neutral content.

RESULTS

SAD patients displayed belief bias for social anxiety related materials, while the PD group and the NSC group did not. Yet, the difference between SAD and PD was not significant. All groups showed similar belief bias effects for neutral content.

LIMITATIONS

Content of the belief bias task was not tailored to idiosyncratic beliefs. The study lacked power to detect medium or small differences.

CONCLUSIONS

SAD patients showed concern-congruent belief biased interference effects when judging the logical validity of social anxiety relevant syllogisms. Such concern-relevant belief bias may contribute to the persistence of anxiogenic beliefs.

Patients With Obsessive-Compulsive Disorder Check Excessively in Response to Mild Uncertainty

Patients with obsessive-compulsive disorder (OCD) not only respond to obsessions with perseverative checking, but also engage in more general checking, irrespective of their obsessive concerns. This study investigated whether general checking is specific to OCD and exacerbated when only mild uncertainty is induced. Thirty-one patients with OCD, 26 anxiety- and 31 healthy controls performed a visual search task with eye-tracking and indicated in 50 search displays whether a target was "present" or "absent". Target-present trials were unambiguous, whereas target-absent trials induced mild uncertainty, because participants had to rely on not overlooking the target. Checking behavior was measured by assessing search time and the number of fixations, measured with an eye-tracker. Results showed that in both target-present and target-absent trials patients with OCD searched longer and made more fixations than healthy and anxiety controls. However, the difference in checking behavior between patients with OCD and the control groups was larger in target-absent trials (where mild uncertainty was induced). Anxiety and healthy controls did not differ in checking behavior. Thus, mild uncertainty appears to specifically promote checking in patients with OCD, which has implications for treatment.

Altered cognitive response to serotonin challenge as a candidate endophenotype for obsessive-compulsive disorder

RATIONALE

Obsessive-compulsive disorder (OCD) implicates dysfunction of orbitofrontal and insula-related circuitry and of the serotonin system. There is an on-going search in psychiatry for intermediate biological markers, termed 'endophenotypes', that exist not only in patients with a given disorder but also in their clinically unaffected first-degree relatives.

OBJECTIVE

Pharmacological challenge is recognized as a means of eliciting an endophenotype, but this strategy has yet to be used in OCD.

METHODS

Twenty-three OCD patients without comorbidities (12 [52.2 %] female), 13 clinically asymptomatic first-degree relatives of OCD patients (11 [84.6 %] female) and 27 healthy controls (16 [59.3 %] female) received single-dose escitalopram (20 mg) and placebo in a randomized double-blind crossover design. Effects of treatment on decision-making were quantified using the Cambridge Gamble Task (CGT) in conjunction with a mixed model analysis of covariance (ANCOVA).

RESULTS

There was a significant interaction between serotonergic challenge and group for risk adjustment on the CGT (F = 4.1406; p = 0.02). Only controls showed a significant placebo-drug change in risk adjustment (p = 0.02; versus p > 0.10). Numerically, escitalopram was associated with increase in risk adjustment in controls and reductions in the other groups. Change in risk adjustment was similar in OCD patients and relatives (p = 0.806) and differed significantly from controls (p = 0.007; p = 0.041, respectively).

CONCLUSIONS

Individuals with OCD, and first-degree relatives, showed an altered cognitive response to serotonin challenge. This is the first demonstration of a candidate pharmacological challenge endophenotype for the disorder. Future work should confirm these findings in a larger sample size and ideally extend them to other cognitive paradigms, utilizing functional neuroimaging.

Cognitive neuroscience of obsessive-compulsive disorder

Cognitive neuroscience investigates neural responses to cognitive and emotional probes, an approach that has yielded critical insights into the neurobiological mechanisms of psychiatric disorders. This article reviews some of the major findings from neuroimaging studies using a cognitive neuroscience approach to investigate obsessive-compulsive disorder (OCD). It evaluates the consistency of results and interprets findings within the context of OCD symptoms, and proposes a model of OCD involving inflexibility of internally focused cognition. Although further research is needed, this body of work probing cognitive-emotional processes in OCD has already shed considerable light on the underlying mechanisms of the disorder.

How is the Beads Task related to intolerance of uncertainty in anxiety disorders?

Intolerance of uncertainty (IU) is a cognitive bias associated with anxiety disorders that has only been reliably measured using self-report instruments. The current study investigated relationships between a probabilistic inference task - the Beads Task - and self-report IU. Individuals with anxiety disorders (ANX) and non-anxious controls (NAC) completed self-report measures as well as the Beads Task at three levels of difficulty. The Beads Task successfully induced task-related uncertainty as the decision became more difficult. While the two groups did not differ on the observable performance related measures, the ANX group was significantly more distressed during the task than were the NACs. Moreover, among the ANX group, self-reported IU was correlated with draws to decision and distress during the task. The Beads Task appears to provoke distress associated with uncertainty for anxious individuals, rather than altering their behavioral responses; thus, clinical implications and avenues for future research are discussed.

Cognitive deficits of executive functions and decision-making in obsessive-compulsive disorder

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.

Neuropsychological functioning in obsessive-compulsive disorder: are executive functions the key deficit?

OBJECTIVE

Although several studies have examined neuropsychological functions in obsessive-compulsive disorder (OCD), findings are not conclusive, predominantly due to small samples and assessment of limited domains. We aim to map the neuropsychological profile of OCD in a large sample with a comprehensive battery of tests.

METHOD

Neuropsychological functions were tested in 150 subjects with DSM-IV OCD and 205 healthy control subjects.

RESULTS

Subjects with OCD performed significantly worse than healthy control subjects on Colour Trails 1 time, Tower of Hanoi 3-disk time, Wisconsin Card Sorting Test categories completed, Iowa Gambling Task, Complex Figure Test immediate and delayed recall (p<0.001).

CONCLUSIONS

Subjects with OCD evince deficits in scanning, planning time, concept formation, decision making and encoding of non-verbal memory after controlling for the effects of age, gender and education. The profile is suggestive of a predominantly executive dysfunction, with difficulties in strategizing and organizing stimuli and cognitive resources for maximum efficiency. The findings implicate dorsolateral prefrontal, superior medial prefrontal and anterior cingulate cortices, suggesting that OCD might not be a purely orbitofronto-striatal disorder as previously conceptualized.

Obsessive-compulsive tendencies are related to indecisiveness and reliance on feedback in a neutral color judgment task

BACKGROUND AND OBJECTIVES

The present study was designed to test whether OC tendencies are associated with indecisiveness and increased need for objective feedback in vague decision situations. This hypothesis was tested using a neutral color judgment task that places minimal demands on working memory.

METHODS

Sixty-one participants completed several measures of OC symptoms and tendencies. Indecisiveness was tested on a novel computerized task in which participants can move along a continuum marked by two colors at the extreme ends and are instructed to choose the color they judge to be the exact mid-point on the continuum.

RESULTS

OC scores were positively correlated with indecisiveness on the task, as assessed by the amount of time it took participants to complete the task and the extent of their search through the color continuum. This association was most pronounced when feedback for performance was not routinely provided. Requests for feedback were also positively correlated with OC scores. OC scores were not associated with actual performance on the task (accuracy levels) or with confidence ratings.

LIMITATIONS

The study relies on non-clinical participants and the extent to which these results would extend to OCD patients in unknown. Some effects may be confounded by the fixed order in which the task phases were administered.

CONCLUSIONS

The findings support the hypothesis that OC tendencies are associated with general indecisiveness and reliance on external feedback.

Reasoning bias and belief conviction in obsessive-compulsive disorder and delusions: jumping to conclusions across disorders?

OBJECTIVES

This study investigated whether a reasoning bias ('jumping to conclusions'; JTC) found to be associated with higher levels of conviction in delusions is also associated with high-conviction beliefs in obsessive-compulsive disorder (OCD).

DESIGN

The experimental design was mixed-effects, with one between-subjects factor of group and one within-subjects factor of task.

METHODS

Participants were 16 people with high-conviction OCD (≥ 50%), 16 people with low-conviction OCD (< 50%), 16 people with delusions (≥ 50% conviction), and 16 non-clinical controls. JTC was assessed using a neutral probabilistic reasoning task (beads task) and a version involving words of differing emotional salience (words task).

RESULTS

There was no statistically significant difference in draws to decision on the beads task between the high-conviction OCD group, the low-conviction OCD group, and the non-clinical controls. The delusions group made significantly fewer draws to decision compared to the non-clinical controls on the words task but not the beads task and significantly fewer draws on both tasks compared with the combined OCD group. Emotionally salient material (words task) did not affect draws to decision in any group.

CONCLUSIONS

JTC is associated with delusions but not high-conviction beliefs in OCD. The cognitive processes associated with high-conviction beliefs in OCD and psychosis may not be trans-diagnostic. This is consistent with the view that high-conviction OCD should not be classified as a psychotic disorder.

Moral reasoning in obsessive-compulsive disorder

An inflated sense of responsibility often characterizes patients with obsessive-compulsive disorder (OCD). In this study, we asked OCD patients (n=20) and control participants (n=18) to resolve a series of moral dilemmas embedded in hypothetical scenarios. Each scenario required participants to choose one of two undesirable courses of action, both involving loss of life. The utilitarian option required them to act, thereby causing the death of one person, but indirectly saving the lives of others whose death would otherwise have occurred. The other option involved no action on their part, but their failure to act resulted in the deaths of people. The groups did not differ significantly in the options chosen, or in their latencies to resolve moral dilemmas. However, within the OCD group, the higher patients' scores on the Responsibility Attitude Scale, the less likely they were to act to kill one person to save the lives of others. In summary, these data imply a stronger association between moral reasoning patterns and responsibility attitudes than to OCD per se.

Skin conductance responses during decisions in ambiguous and risky situations in obsessive-compulsive disorder

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.

A behavior-analytic account of cognitive bias in clinical populations

Cognitive bias refers to a well-established finding that individuals who suffer from certain clinical problems (e.g., depression, anxiety, posttraumatic stress disorder, substance abuse, etc.) selectively attend to, remember, and interpret events relevant to their condition. Although a body of literature exists that has tried to examine this phenomenon, most existing explanations are mentalistic and mediational. In this paper we offer a behavior-analytic account of cognitive bias, its development, and how it may contribute to maintenance of clinical problems. This account is based on establishing operations or motivating events, verbal processes, and relational responding. Clinical and future research implications are also discussed.

Memory and executive functioning in obsessive-compulsive disorder: a selective review

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.

An fMRI examination of developmental differences in the neural correlates of uncertainty and decision-making

BACKGROUND

Maturation of prefrontal circuits during adolescence contributes to the development of cognitive processes such as decision-making. Recent theories suggest that these neural changes also play a role in the shift from generalized anxiety disorder (GAD) to depression that often occurs during this developmental period. Cognitive models of the development of GAD highlight the role of intolerance of uncertainty (IU), which can be characterized behaviorally by impairments in decision-making. The present study examines potential developmental differences in frontal regions associated with uncertain decision-making, and tests the impact of IU on these circuits.

METHODS

Twelve healthy adults (ages 19-36) and 12 healthy adolescents (ages 13-17) completed a decision-making task with conditions of varied uncertainty while fMRI scans were acquired. They also completed measures of worry and IU, and a questionnaire about their levels of anxiety and certainty during the task.

RESULTS

Combined group analyses demonstrated significant linear effects of uncertainty on activity within anterior cingulate cortex (ACC). Region of interest (ROI)-based analysis found a significant interaction of group and IU ratings in ACC. Increased IU was associated with robust linear increases in ACC activity only in adolescents. An ROI analysis of feedback-related processing found that adolescents demonstrated greater activation during incorrect trials relative to correct trials, while the adults showed no difference in neural activity associated with incorrect and correct feedback.

CONCLUSIONS

This decision-making task was shown to be effective at eliciting uncertainty-related ACC activity in adults and adolescents. Further, IU impacts ACC activity in adolescents during uncertain decision-making, providing preliminary support for a developmental model of GAD.