The Iowa Gambling Task in depression - what have we learned about sub-optimal decision-making strategies?
The Iowa Gambling Task in depression - what have we learned about sub-optimal decision-making strategies?
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DOI：
10.3389/fpsyg.2013.00732
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发表时间：
2013-10-10
影响因子：
3.8
通讯作者：
Janka Z
中科院分区：
文献类型：
--
作者：
Must A;Horvath S;Nemeth VL;Janka Z
我们早期的研究发现，根据爱荷华州赌博任务 (IGT) 的测量，抑郁症患者表现出对更大奖励的偏好。在这个 IGT 版本中，更大的奖励与更大的后续损失相关。鉴于定义抑郁症的临床标志物，这一发现一开始可能会引起争议。抑郁症患者在执行各种决策 (DM) 任务时的表现通常会受到损害。有证据表明奖励学习减少，并且难以改变策略并将环境变化纳入 DM 突发事件中。这导致分别根据奖励或惩罚来调节行为的能力受损。该疾病的临床症状、遗传特征以及人格特征也可能影响糖尿病策略。更严重的抑郁症会增加对立即重大惩罚的敏感性，从而预测未来的决定，并且也与更高的伤害避免相关。快感缺失的特征在更大程度上削弱了奖励学习能力，甚至预测了临床结果。关于这些方面如何关联的几个问题仍有待澄清。情绪症状之前的糖尿病损伤是否存在遗传倾向？这是临床症状的结果，还是作为应对策略的习得行为的结果？患者是否容易产生对失去的厌恶，或者他们无法感知或处理奖励或奖励偏好？糖尿病缺陷是否正常化或者是临床结果或复发风险的持续损害预测因子？它在多大程度上受药物作用的影响？长期的糖尿病缺乏如何影响日常生活和社交互动？引人注目的是，研究证据表明，抑郁症患者的行为往往较少欺骗，更加以自我为中心，从而导致社交性糖尿病受损。日常人际交往的困难可能会导致社会孤立，进一步加剧抑郁症状。
Our earlier study found patients with depression to show a preference for larger reward as measured by the Iowa Gambling Task (IGT). In this IGT version, larger rewards were associated with even larger consequent losses. In the light of the clinical markers defining depressive disorder, this finding might appear controversial at first. Performance of depressed patients on various decision-making (DM) tasks is typically found to be impaired. Evidence points toward reduced reward learning, as well as the difficulty to shift strategy and integrate environmental changes into DM contingencies. This results in an impaired ability to modulate behavior as a function of reward, or punishment, respectively. Clinical symptoms of the disorder, the genetic profile, as well as personality traits might also influence DM strategies. More severe depression increased sensitivity to immediate large punishment, thus predicting future decisions, and was also associated with higher harm avoidance. Anhedonic features diminished reward learning abilities to a greater extent, even predicting clinical outcome. Several questions about how these aspects relate remain to be clarified. Is there a genetic predisposition for the DM impairment preceding mood symptoms? Is it the consequence of clinical signs or even learned behavior serving as a coping strategy? Are patients prone to develop an aversion of loss or are they unable to sense or deal with reward or the preference of reward? Does the DM deficit normalize or is a persisting impairment predictor for clinical outcome or relapse risk? To what extent is it influenced by medication effects? How does a long-lasting DM deficit affect daily life and social interactions? Strikingly, research evidence indicates that depressed patients tend to behave less deceptive and more self-focused, resulting in impaired social DM. The difficulty in daily interpersonal interactions might contribute to social isolation, further intensifying depressive symptoms.
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