Weakness of will, akrasia, and the neuropsychiatry of decision making: an interdisciplinary perspective

Clinical Assessment of Judgment in Adults and the Elderly: Development and Validation of the Three Domains of Judgment Test-Clinical Version (3DJT-CV)

(1) Background: This article discusses the first two phases of development and validation of the Three Domains of Judgment Test (3DJT). This computer-based tool, co-constructed with users and capable of being administered remotely, aims to assess the three main domains of judgment (practical, moral, and social) and learn from the psychometric weaknesses of tests currently used in clinical practice. (2) Method: First, we presented the 3DJT to experts in cognition, who evaluated the tool as a whole as well as the content validity, relevance, and acceptability of 72 scenarios. Second, an improved version was administered to 70 subjects without cognitive impairment to select scenarios with the best psychometric properties in order to build a future clinically short version of the test. (3) Results: Fifty-six scenarios were retained following expert evaluation. Results support the idea that the improved version has good internal consistency, and the concurrent validity primer shows that 3DJT is a good measure of judgment. Furthermore, the improved version was found to have a significant number of scenarios with good psychometric properties to prepare a clinical version of the test. (4) Conclusion: The 3DJT is an interesting alternative tool for assessing judgment. However, more studies are needed for its implementation in a clinical context.

A multi-pronged investigation of option generation using depression, PET and modafinil

Option generation is a critical process in decision making, but previous studies have largely focused on choices between options given by a researcher. Consequently, how we self-generate options for behaviour remain poorly understood. Here, we investigated option generation in major depressive disorder and how dopamine might modulate this process, as well as the effects of modafinil (a putative cognitive enhancer) on option generation in healthy individuals. We first compared differences in self-generated options between healthy non-depressed adults [n = 44, age = 26.3 years (SD 5.9)] and patients with major depressive disorder [n = 54, age = 24.8 years (SD 7.4)]. In the second study, a subset of depressed individuals [n = 22, age = 25.6 years (SD 7.8)] underwent PET scans with 11C-raclopride to examine the relationships between dopamine D2/D3 receptor availability and individual differences in option generation. Finally, a randomized, double-blind, placebo-controlled, three-way crossover study of modafinil (100 mg and 200 mg), was conducted in an independent sample of healthy people [n = 19, age = 23.2 years (SD 4.8)] to compare option generation under different doses of this drug. The first study revealed that patients with major depressive disorder produced significantly fewer options [t(96) = 2.68, P = 0.009, Cohen's d = 0.54], albeit with greater uniqueness [t(96) = -2.54, P = 0.01, Cohen's d = 0.52], on the option generation task compared to healthy controls. In the second study, we found that 11C-raclopride binding potential in the putamen was negatively correlated with fluency (r = -0.69, P = 0.001) but positively associated with uniqueness (r = 0.59, P = 0.007). Hence, depressed individuals with higher densities of unoccupied putamen D2/D3 receptors in the putamen generated fewer but more unique options, whereas patients with lower D2/D3 receptor availability were likely to produce a larger number of similar options. Finally, healthy participants were less unique [F(2,36) = 3.32, P = 0.048, partial η2 = 0.16] and diverse [F(2,36) = 4.31, P = 0.021, partial η2 = 0.19] after taking 200 mg versus 100 mg and 0 mg of modafinil, while fluency increased linearly with dosage at a trend level [F(1,18) = 4.11, P = 0.058, partial η2 = 0.19]. Our results show, for the first time, that option generation is affected in clinical depression and that dopaminergic activity in the putamen of patients with major depressive disorder may play a key role in the self-generation of options. Modafinil was also found to influence option generation in healthy people by reducing the creativity of options produced.

Added value of functional neuroimaging to assess decision-making capacity of older adults with neurocognitive disorders: protocol for a prospective, monocentric, single-arm study (IMAGISION)

INTRODUCTION

Assessment of decision-making capacity (DMC) is essential in daily life as well as for defining a person-centred care plan. Nevertheless, in ageing, especially if signs of dementia appear, it becomes difficult to assess decision-making ability and raises ethical questions. Currently, the assessment of DMC is based on the clinician's evaluation, completed by neuropsychological tests. Functional MRI (fMRI) could bring added value to the diagnosis of DMC in difficult situations.

METHODS AND ANALYSIS

IMAGISION is a prospective, monocentric, single-arm study evaluating fMRI compared with clinical assessment of DMC. The study will begin during Fall 2021 and should be completed by Spring 2023. Participants will be recruited from a memory clinic where they will come for an assessment of their cognitive abilities due to decision-making needs to support ageing in place. They will be older people over 70 years of age, living at home, presenting with a diagnosis of mild dementia, and no exclusion criteria of MRI. They will be clinically assessed by a geriatrician on their DMC, based on the neuropsychological tests usually performed. Participants will then perform a behavioural task in fMRI (Balloon Analogue Risk Task) to analyse the activation areas. Additional semistructured interviews will be conducted to explore real life implications. The main analysis will study concordance/discordance between the clinical classification and the activation of fMRI regions of interest. Reclassification as 'capable', based on fMRI, of patients for whom clinical diagnosis is 'questionable' will be considered as a diagnostic gain.

ETHICS AND DISSEMINATION

IMAGISION has been authorised by a research ethics board (Comité de Protection des Personnes, Bordeaux, II) in France, in accordance with French legislation on interventional biomedical research, under the reference IDRCB number 2019-A00863-54, since 30 September 2020. Participants will sign an informed consent form. The results of the study will be presented in international peer-reviewed scientific journals, international scientific conferences and public lectures.

TRIAL REGISTRATION NUMBER

NCT03931148.

Neural Activation in Risky Decision-Making Tasks in Healthy Older Adults: A Meta-Analysis of fMRI Data

Decision making is a complex cognitive phenomenon commonly used in everyday life. Studies have shown differences in behavioral strategies in risky decision-making tasks over the course of aging. The development of functional neuroimaging has gradually allowed the exploration of the neurofunctional bases of these behaviors. The purpose of our study was to carry out a meta-analysis on the neural networks underlying risky decision making in healthy older adults. Following the PRISMA guidelines, we systematically searched for fMRI studies of decision making in older adults using risky decision-making tasks. To perform the quantitative meta-analysis, we used the revised version of the activation likelihood estimation (ALE) algorithm. A total of 620 references were selected for initial screening. Among these, five studies with a total of 98 cognitively normal older participants (mean age: 69.5 years) were included. The meta-analysis yielded two clusters. Main activations were found in the right insula, bilateral dorsolateral prefrontal cortex (dlPFC) and left orbitofrontal cortex (OFC). Despite the limited number of studies included, our meta-analysis highlights the crucial involvement of circuits associated with both emotion regulation and the decision to act. However, in contrast to the literature on young adults, our results indicate a different pattern of hemispheric lateralization in older participants. These activations can be used as a minimum pattern of activation in the risky decision-making tasks of healthy older subjects.

The insanity defence without mental illness? Some considerations

In this paper we aim to offer a balanced argument to motivate (re)thinking about the mental illness clause within the insanity defence. This is the clause that states that mental illness should have a relevant causal or explanatory role for the presence of the incapacities or limited capacities that are covered by this defence. We offer three main considerations showing the important legal and epistemological roles that the mental illness clause plays in the evaluation of legal responsibility. Although we acknowledge that these advantages could be preserved without having this clause explicitly stated in the law, we resist proposals that deny the importance of mental illness in exculpation. We argue, thus, that any attempt at removing the mental illness clause from legal formulations of the insanity defence should offer alternative ways of keeping in place these advantages.

The Meat Paradox, Omnivore's Akrasia, and Animal Ethics

Western cultures have witnessed an intriguing phenomenon in recent years: People are both more concerned for animal wellbeing and consume more animal products than ever before. This contradiction has been explored in psychology under the term "meat paradox". However, what has been omitted from the explorations is the age-old philosophical notion of "akrasia", within which one both knows "the good" and acts against it. The paper seeks to address this omission by comparing psychological research on the meat paradox with philosophy of akrasia. Applying Plato, Aristotle, Descartes, and Spinoza, I investigate the underlying factors of and solutions to what is here called "omnivore's akrasia". Whilst contemporary research on the meat paradox focuses on various descriptive cognitive errors (such as cognitive dissonance), philosophy of akrasia has tended to focus more prescriptively on moral reason and virtue. After discussing "nudging" as an implication of the descriptive approach, the paper supports the prescriptive perspective and "the cultivation argument". The claim is that contemporary research on the contradictions concerning attitudes toward other animals would greatly benefit from paying more attention to the value-laden mental factors underlying moral agency.

Decision Inertia in Critical Incidents

Abstract. When presented with competing options, critical incident decision makers often struggle to commit to a choice (in particular when all options appear to yield negative consequences). Despite being motivated to take action in disasters, terrorism, major investigations, and complex political interventions, decision makers can become inert, looping between phases of situation assessment, option generation, and option evaluation. This “looping” is functionally redundant when it persists until they have lost the opportunity to take action. We define this as “decision inertia”: the result of a process of (redundant) deliberation over possible options and in the absence of any further useful information. In the context of critical incidents (political, security, military, law enforcement) we have discovered that rather than disengaging and avoiding difficult choices, decision makers are acutely aware of the negative consequences that might arise if they failed to decide (i.e., the incident would escalate). The sensitization to possible future outcomes leads to intense deliberation over possible choices and their consequences and, ultimately, can result in a failure to take any action in time (or at all). We (i) discuss decision inertia as a novel psychological process of redundant deliberation during crises; (ii) define the concept and discuss the emerging studies in support of our tentative hypotheses regarding how the cognitively active process of deliberation can result in complete behavioral inactivity; and (iii) suggest recommendations and interventions for combatting inertia.

The Cognitive Underpinnings of Option Generation in Everyday Life Decision-Making: A Latent Variable Analysis

The ability to generate options for action is crucial for everyday life decision-making. In this article, we propose and test a model of the cognitive underpinnings of option generation in everyday life situations. We carried out a laboratory study using measures of a wide range of cognitive functions and asked participants (N = 157) to generate options for actions for different everyday life decision-making scenarios. The results of a latent variable analysis show that the cognitive underpinnings of option generation are consistent across different everyday life situations and, hence, option generation can be conceptualized as a general construct. Moreover, the results of a confirmatory factor analysis reveal that, when controlling for the shared variance among the cognitive processes assessed, verbal fluency, working memory capacity, ideation fluency, and processing speed predicted option generation. These findings suggest that option generation in everyday life situations can be distinguished from other cognitive constructs, such as divergent thinking (in terms of ideas' originality) and long-term memory.

Dopamine Modulates Option Generation for Behavior

Animals make innumerable decisions every day, each of which involves evaluating potential options for action. But how are options generated? Although much is now known about decision making when a fixed set of potential options is provided, surprisingly little progress has been made on self-generated options. Some researchers have proposed that such abilities might be modulated by dopamine. Here, we used a new measure of option generation that is quantitative, objective, and culture fair to investigate how humans generate different behavioral options. Participants were asked to draw as many different paths (options) as they could between two points within a fixed time. Healthy individuals (n = 96) exhibited a trade-off between uniqueness (how individually different their options were) and fluency (number of options), generating either many similar or few unique options. To assess influence of dopamine, we first examined patients with Parkinson's disease (n = 35) ON and OFF their dopaminergic medication and compared them to elderly healthy controls (n = 34). Then we conducted a double-blind, placebo-controlled crossover study of the D2 agonist cabergoline in healthy older people (n = 29). Across both studies, dopamine increased fluency but diminished overall uniqueness of options generated, due to the effect of fluency trading off with uniqueness. Crucially, however, when this trade-off was corrected for, dopamine was found to increase uniqueness for any given fluency. Three carefully designed control studies showed that performance on our option-generation task was not related to executing movements, planning actions, or selecting between generated options. These findings show that dopamine plays an important role in modulating option generation.

Effects of Process and Outcome Accountability on Idea Generation

Previous research on the effects of outcome and process accountability on decision making has neglected the preceding phase of idea generation. We conducted a 2 (outcome accountability: yes vs. no) × 2 (process accountability: yes vs. no) experiment (N = 147) to test the effects of accountability on quantity and quality of generated ideas in a product design task. Furthermore, we examined potential negative side effects of accountability (i.e., stress and lengthened decision making). We found that (a) outcome accountability had a negative effect on quantity of ideas and (b) process accountability extended the idea generation process. Furthermore, any type of accountability (c) had a negative effect on uniqueness of ideas, (d) did not affect the quality of the idea that was selected, and (e) increased stress. Moreover, the negative effect of accountability on uniqueness of ideas was mediated by stress.

Evaluating Decision-Making: Validation and Regression-Based Normative Data of the Judgment Assessment Tool

OBJECTIVE

This study presents the results of the development and validation of the Judgment Assessment Tool (JAT). The JAT measures two core aspects of judgment, namely generation of solutions (G) and assessment of options (A), the two first stages of decision-making process.

METHOD

During the test development phase (study 1), a preliminary version of the JAT was evaluated by 14 experts and tested on 30 healthy controls (HC). One hundred and twenty HC (20-84 years old) and 24 participants with mild Alzheimer's disease (AD) were subsequently tested on the final version of the JAT (study 2). HC participants aged 60 and over and AD participants underwent a neuropsychological evaluation.

RESULTS

The internal consistency of the final version of the JAT assessed by Cronbach's a was 0.71 for the HC group and 0.85 for the AD group. Performance on the JAT was normally distributed both in the HC and AD groups. The test correlated with abstract reasoning, verbal fluency, and working memory. Results revealed adequate test-retest reliability and excellent interrater reliability (k coefficient was 0.92 for the G section and 0.93 for the A section). Demographically adjusted normative data were generated based on a regression analysis and results showed that AD participants performed worse than HC with a large effect size (Cohen's d = 1.79).

CONCLUSION

Overall, these results provide evidence of the reliability and strong construct validity of the JAT to evaluate judgment.

Cognitive and Affective Aspects of Creative Option Generation in Everyday Life Situations

Which factors influence a human being’s ability to develop new perspectives and be creative? This ability is pivotal for any context in which new cognitions are required, such as innovative endeavors in science and art, or psychotherapeutic settings. In this article, we seek to bring together two research programs investigating the generation of creative options: On the one hand, research on option generation in the decision-making literature and, on the other hand, cognitive and clinical creativity research. Previous decision-making research has largely neglected the topic of generating creative options. Experiments typically provided participants with a clear set of options to choose from, but everyday life situations are less structured and allow countless ways to react. Before choosing an option, agents have to self-generate a set of options to choose from. Such option generation processes have only recently moved to the center of attention. The present study examines the creative quality of self-generated options in daily life situations. A student sample (N = 48) generated options for action in 70 briefly described everyday life scenarios. We rated the quality of the options on three dimensions of creativity- originality, feasibility, and divergence -and linked these qualities to option generation fluency (speed and number of generated options), situational features like the familiarity and the affective valence of the situation in which the options were generated, and trait measures of cognitive performance. We found that when situations were familiar to the participant, greater negative affective valence of the situation was associated with more originality and divergence of generated options. We also found that a higher option generation fluency was associated with a greater maximal originality of options. We complete our article with a joint research agenda for researchers in the decision-making field focusing on option generation and, on the other hand, researchers working on the cognitive and clinical aspects of creativity.

Attributions of Responsibility and Blame for Procrastination Behavior

The present study examined the relationship between procrastination, delay, blameworthiness, and moral responsibility. Undergraduate students (N = 240) were provided two scenarios in which the reason for inaction (procrastination, delay), the target (self, other), and the outcome (positive, negative) were manipulated, and students were asked to rate the moral responsibility and blameworthiness of the agent. Results indicated that individuals who procrastinated were seen as more morally responsible and blameworthy than those who experienced delay. More specifically, after a negative outcome, procrastination was associated with more moral responsibility, whereas delay was associated with less moral responsibility. After a positive outcome, individuals perceived procrastination as deserving of less moral responsibility, and delays as associated with more moral responsibility. Finally, a three-way interaction showed that participants rated procrastination that resulted in failure as deserving of responsibility when engaged in by others as opposed to oneself.

Mental disorder and legal responsibility: the relevance of stages of decision making

The paper discusses the relevance of decision-making models for evaluating the impact of mental disorder on legal responsibility. A three-stage model is presented that analyzes decision making in terms of behavioral control. We argue that understanding dysfunctions in each of the three stages of decision making could provide important insights in the relation between mental disorder and legal responsibility. In particular, it is argued that generating options for action constitutes an important but largely ignored stage of the decision-making process, and that dysfunctions in this early stage might undermine the whole process of making decisions (and thus behavioral control) more strongly than dysfunctions in later stages. Lastly, we show how the presented framework could be relevant to the actual psychiatric assessment of a defendant's decision making within the context of an insanity defense.

The effects of caffeine on option generation and subsequent choice

RATIONALE

Although the effects of caffeine on basic cognitive functions are well-known, its effects on more complex decision making, particularly on option generation, is yet to be explored.

OBJECTIVE

We examined the effects of caffeine on option generation in decision making using everyday life decisional situations.

METHODS

In a double-blind placebo-controlled experiment, participants (N = 47) either received 300 mg of caffeine or a placebo. Participants had to generate choice options (things they could do) for a series of high and low familiar real-world scenarios and, subsequently, to decide among these options.

RESULTS

Analyses revealed that participants in the caffeine condition generated significantly fewer options than participants in the placebo condition. Moreover, caffeine significantly reduced the option generation onset time, that is, participants in the caffeine condition generated their first option significantly faster than participants in the placebo condition. Regarding subsequent choice, we found evidence supporting the "take-the-first" heuristic, that is, the tendency to select the first generated option. This tendency was neither affected by caffeine nor by the familiarity of the scenarios.

CONCLUSIONS

Caffeine results in fewer options generated in unconstrained real-life decision-making situations and decreases generation onset times.

The cognitive and neural basis of option generation and subsequent choice

Decision-making research has thoroughly investigated how people choose from a set of externally provided options. However, in ill-structured real-world environments, possible options for action are not defined by the situation but have to be generated by the agent. Here, we apply behavioral analysis (Study 1) and functional magnetic resonance imaging (Study 2) to investigate option generation and subsequent choice. For this purpose, we employ a new experimental task that requires participants to generate options for simple real-world scenarios and to subsequently decide among the generated options. Correlational analysis with a cognitive test battery suggests that retrieval of options from long-term memory is a relevant process during option generation. The results of the fMRI study demonstrate that option generation in simple real-world scenarios recruits the anterior prefrontal cortex. Furthermore, we show that choice behavior and its neural correlates differ between self-generated and externally provided options. Specifically, choice between self-generated options is associated with stronger recruitment of the dorsal anterior cingulate cortex. This impact of option generation on subsequent choice underlines the need for an expanded model of decision making to accommodate choice between self-generated options.

Testosterone enhances risk tolerance without altering motor impulsivity in male rats

Anabolic-androgenic steroids (AAS) increase impulsive and uncontrolled aggressive ('roid rage) in humans and enhance agonistic behavior in animals. However, the underlying mechanisms for AAS-induced aggression remain unclear. Potential contributing elements include an increase risk-taking and/or motor impulsivity due to AAS. This study addressed the effects of chronic high-dose testosterone on risk tolerance using a risky decision-making task (RDT) and motor impulsivity with a go/no-go task in operant chambers. Male Long-Evans rats were treated for at least 4 weeks with testosterone (7.5mg/kg) or vehicle beginning in late adolescence. Testosterone was used because it is popular among human AAS users. In RDT testing, one lever was paired with delivery of a small "safe" food reward, while the other was paired with a large "risky" reward associated with an increasing risk of footshock (0%, 25%, 50%, 75%, 100%) in successive test blocks. Three shock intensities were used: 1.0, 1.2, and 1.4mA/kg. As shock intensity and risk of shock increased, preference for the lever signifying a large reward significantly declined for both vehicle- and testosterone-treated rats (p<0.05). There was also a significant effect of drug (p<0.05), where testosterone-treated rats showed greater preference for the large reward, compared to vehicle-treated controls. Increased preference for the large reward, despite risk of footshock, is consistent with increased risk tolerance. In go/no-go testing, rats were trained to press a single lever if the go cue was presented (stimulus light) or to refrain from pressing during the no-go cue (tone). There was no effect of testosterone on pre-cue responses, or performance in go and no-go trials. These results suggest that AAS may increase risk-tolerance without altering motor impulsivity.

Why we should talk about option generation in decision-making research

Most empirical studies on decision-making start from a set of given options for action. However, in everyday life there is usually no one asking you to choose between A, B, and C. Recently, the question how people come up with options has been receiving growing attention. However, so far there has been neither a systematic attempt to define the construct of “option” nor an attempt to show why decision-making research really needs this construct. This paper aims to fill that void by developing definitions of “option” and “option generation” that can be used as a basis for decision-making research in a wide variety of decision-making settings, while clarifying how these notions relate to familiar psychological constructs. We conclude our analysis by arguing that there are indeed reasons to believe that option generation is an important and distinct aspect of human decision-making.

Impulsivity and apathy in Parkinson's disease

Impulse control disorders (ICDs) and apathy are recognized as two important neuropsychiatric syndromes associated with Parkinson's disease (PD), but as yet we understand very little about the cognitive mechanisms underlying them. Here, we review emerging findings, from both human and animal studies, that suggest that impulsivity and apathy are opposite extremes of a dopamine-dependent spectrum of motivated decision making. We first argue that there is strong support for a hypodopaminergic state in PD patients with apathy, as well as for an association between dopamine therapy and development of ICDs. However, there is little evidence for a clear dose-response relationship, and great heterogeneity of findings. We argue that dopaminergic state on its own is an insufficient explanation, and suggest instead that there is now substantial evidence that both apathy and impulsivity are in fact multi-dimensional syndromes, with separate, dissociable mechanisms underlying their 'surface' manifestations. Some of these mechanisms might be dopamine-dependent. According to this view, individuals diagnosed as impulsive or apathetic may have very different mechanisms underlying their clinical states. We propose that impulsivity and apathy can arise from dissociable deficits in option generation, option selection, action initiation or inhibition and learning. Review of the behavioural and neurobiological evidence leads us to a new conceptual framework that might help understand the variety of functional deficits seen in PD.

A neurolaw perspective on psychiatric assessments of criminal responsibility: decision-making, mental disorder, and the brain

In some criminal law cases, the defendant is assessed by a forensic psychiatrist or psychologist within the context of an insanity defense. In this article I argue that specific neuroscientific research can be helpful in improving the quality of such a forensic psychiatric evaluation. This will be clarified in two ways. Firstly, we shall adopt the approach of understanding these forensic assessments as evaluations of the influence of a mental disorder on a defendant's decision-making process. Secondly, I shall point to the fact that researchers in neuroscience have performed various studies over recent years on the influence of specific mental disorders on a patient's decision-making. I argue that such research, especially if modified to decision-making in criminal scenarios, could be very helpful to forensic psychiatric assessments. This kind of research aims to provide insights not merely into the presence of a mental disorder, but also into the actual impact of mental disorders on the decisions defendants have made in regard to their actions.

Two character traits associated with adherence to long term therapies

Adherence is defined as the adequacy between the behaviours of patients and their medical prescriptions. Adherence is a general behaviour, which can explain why patients in the placebo arm of randomised clinical trials have a lower mortality rate when they are adherent. We propose that this behaviour is related to two character traits: patience (capacity to give priority to the future) and, more provocatively, obedience. To support this claim, we bring arguments from the literature and from two published personal studies. We previously showed that type 2 diabetic patients who respond as non-adherers to a questionnaire on adherence to medication and to whom one proposes a fictitious monetary choice between receiving 500 euros today or waiting one year to receive 1500 euros never make the remote choice. We also showed that obese diabetic patients who declare that they do not fasten their seat belt when they are seated in the rear of a car are more often non-adherent concerning medication than those patients who claim that they follow this road safety recommendation. Thus, one of the roles of empowerment and patient education could be to encourage the patients, if they wish it, to replace passive adherence behaviours with conscious active choices.

Designing a good life: a matrix for the technological mediation of morality

Technologies fulfill a social role in the sense that they influence the moral actions of people, often in unintended and unforeseen ways. Scientists and engineers are already accepting much responsibility for the technological, economical and environmental aspects of their work. This article asks them to take an extra step, and now also consider the social role of their products. The aim is to enable engineers to take a prospective responsibility for the future social roles of their technologies by providing them with a matrix that helps to explore in advance how emerging technologies might plausibly affect the reasons behind people's (moral) actions. On the horizontal axis of the matrix, we distinguished the three basic types of reasons that play a role in practical judgment: what is the case, what can be done and what should be done. On the vertical axis we distinguished the morally relevant classes of issues: stakeholders, consequences and the good life. To illustrate how this matrix may work in practice, the final section applies the matrix to the case of the Google PowerMeter.

When to blink and when to think: preference for intuitive decisions results in faster and better tactical choices

Intuition is often considered an effective manner of decision making in sports. In this study we investigated whether a preference for intuition over deliberation results in faster and better lab-based choices in team handball attack situations with 54 male and female handball players of different expertise levels. We assumed that intuitive choices-due to their affective nature--are faster when multiple options are to be considered. The results show that athletes who had a preference for intuitive decisions made faster and better choices than athletes classified as deliberative decision makers. It is important that experts were more intuitive than near-expert and nonexpert players. The results support a take-the-first heuristic defining how options are searched for, how option generation is stopped, and how an option is chosen. Implications for the training of intuitive decision making are presented.

Free will and mental disorder: exploring the relationship

A link between mental disorder and freedom is clearly present in the introduction of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It mentions "an important loss of freedom" as one of the possible defining features of mental disorder. Meanwhile, it remains unclear how "an important loss of freedom" should be understood. In order to get a clearer view on the relationship between mental disorder and (a loss of) freedom, in this article, I will explore the link between mental disorder and free will. I examine two domains in which a connection between mental disorder and free will is present: the philosophy of free will and forensic psychiatry. As it turns out, philosophers of free will frequently refer to mental disorders as conditions that compromise free will and reduce moral responsibility. In addition, in forensic psychiatry, the rationale for the assessment of criminal responsibility is often explained by referring to the fact that mental disorders can compromise free will. Yet, in both domains, it remains unclear in what way free will is compromised by mental disorders. Based on the philosophical debate, I discuss three senses of free will and explore their relevance to mental disorders. I conclude that in order to further clarify the relationship between free will and mental disorder, the accounts of people who have actually experienced the impact of a mental disorder should be included in future research.

Is there an impatience genotype leading to non-adherence to long-term therapies?

In chronic diseases such as diabetes, adherence to therapy aims to preserve health, which is a long-term objective, whereas non-adherence tends to present an immediate 'reward'. We propose that non-adherence, like addiction, is at least in part due to the fact that, for physiological, and maybe genetic reasons described in a new field, neuroeconomics, a number of people have a taste for the present rather than the future. Thus, for 'impatient patients' it is natural not to adhere to therapeutic prescriptions that share the characteristic of being future-oriented. This hypothesis may apply to any disease requiring long-term therapy.

Neural signatures of intransitive preferences

It is often assumed that decisions are made by rank-ordering and thus comparing the available choice options based on their subjective values. Rank-ordering requires that the alternatives’ subjective values are mentally represented at least on an ordinal scale. Because one alternative cannot be at the same time better and worse than another alternative, choices should satisfy transitivity (if alternative A is preferred over B, and B is preferred over C, A should be preferred over C). Yet, individuals often demonstrate striking violations of transitivity (preferring C over A). We used functional magnetic resonance imaging to study the neural correlates of intransitive choices between gambles varying in magnitude and probability of financial gains. Behavioral intransitivities were common. They occurred because participants did not evaluate the gambles independently, but in comparison with the alternative gamble presented. Neural value signals in prefrontal and parietal cortex were not ordinal-scaled and transitive, but reflected fluctuations in the gambles’ local, pairing-dependent preference-ranks. Detailed behavioral analysis of gamble preferences showed that, depending on the difference in the offered gambles’ attributes, participants gave variable priority to magnitude or probability and thus shifted between preferring richer or safer gambles. The variable, context-dependent priority given to magnitude and probability was tracked by insula (magnitude) and posterior cingulate (probability). Their activation-balance may reflect the individual decision rules leading to intransitivities. Thus, the phenomenon of intransitivity is reflected in the organization of the neural systems involved in risky decision-making.

Exploring the similarities and differences between medical assessments of competence and criminal responsibility

The medical assessments of criminal responsibility and competence to consent to treatment are performed, developed and debated in distinct domains. In this paper I try to connect these domains by exploring the similarities and differences between both assessments. In my view, in both assessments a decision-making process is evaluated in relation to the possible influence of a mental disorder on this process. I will argue that, in spite of the relevance of the differences, both practices could benefit from the recognition of this similarity. For cooperative research could be developed directed at elucidating exactly how various mental disturbances can affect decision-making processes.

[Psychiatric advance directives and the role of autonomy]

Although psychiatric advance directives (PADs) are grounded in the ethics of autonomy, the relationship between the two is unclear. PADs are legal documents that allow individuals with mental illness to record their treatment preferences should they become incompetent in the future. The relationship between autonomy and PADs has been discussed in ethical, legal, and philosophical terms, but has not been clearly operationalized for clinical purposes. Autonomy is a fundamental ethical value that includes having the independence from outside controlling influences and the mental capacity to direct one's personal actions. Individuals with mental illness sometimes require assistance to understand their ethical and legal rights with respect to autonomous choice, and professional stakeholders need education regarding the importance of autonomy for clinical practice. Competency to consent to treatment is the mental prerequisite that ensures individuals with mental illness are able to complete PADs with insight, whereas autonomy is the value that empowers individuals to work towards their recovery.