Decision-making under uncertainty in obsessive-compulsive disorder.
Decision-making under uncertainty in obsessive-compulsive disorder.
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DOI：
10.1016/j.jpsychires.2015.08.011
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发表时间：
2015-10
影响因子：
4.8
通讯作者：
Levy I
中科院分区：
文献类型：
--
作者：
Pushkarskaya H;Tolin D;Ruderman L;Kirshenbaum A;Kelly JM;Pittenger C;Levy I
强迫症 (OCD) 会导致严重的发病率。决策困难和不能容忍不确定性是许多患者的突出临床特征。人们对这些缺陷的性质和病因知之甚少。我们使用基于行为经济学理论的经过充分验证的选择任务，来调查 20 名患有强迫症的未接受药物治疗的参与者和 20 名匹配的健康对照者在不确定情况下决策过程中估值和基于价值的选择的差异。参与者的选择用于评估个人决策特征。当结果概率已知（风险）时，强迫症参与者与健康对照者在评估不确定选项方面没有差异，但当这些概率不精确指定（模糊性）时，他们比健康对照者更有可能避免不确定的选择。与健康对照组相比，强迫症患者的选择不太一致，也不太能够识别出明显更可取的选项。这些异常与症状严重程度相关。这些结果表明，强迫症患者在决策过程中基于价值的选择是异常的。患有强迫症的人表现出对不确定性的高度不容忍，但前提是结果概率本身是不确定的。未来的研究重点是涉及基于价值的计算的神经评估网络，可能会为强迫症的病理生理学提供新的神经认知见解。决策过程中的缺陷可能代表治疗干预的目标。
Obsessive compulsive disorder (OCD) produces profound morbidity. Difficulties with decision-making and intolerance of uncertainty are prominent clinical features in many patients. The nature and etiology of these deficits are poorly understood. We used a well-validated choice task, grounded in behavioral economic theory, to investigate differences in valuation and value-based choice during decision making under uncertainty in 20 unmedicated participants with OCD and 20 matched healthy controls. Participants’ choices were used to assess individual decision-making characteristics. OCD participants did not differ from healthy controls in how they valued uncertain options when outcome probabilities were known (risk) but were more likely than healthy controls to avoid uncertain options when these probabilities were imprecisely specified (ambiguity). Compared to healthy controls, individuals with OCD were less consistent in their choices and less able to identify options that should be clearly preferable. These abnormalities correlated with symptom severity. These results suggest that value-based choices during decision-making are abnormal in OCD. Individuals with OCD show elevated intolerance of uncertainty, but only when outcome probabilities are themselves uncertain. Future research focused on the neural valuation network, which is implicated in value-based computations, may provide new neurocognitive insights into the pathophysiology of OCD. Deficits in decision-making processes may represent a target for therapeutic intervention.