Posttraumatic stress disorder increases sensitivity to long term losses among patients with major depressive disorder.
Posttraumatic stress disorder increases sensitivity to long term losses among patients with major depressive disorder.
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DOI：
10.1371/journal.pone.0078292
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Dunlop BW
中科院分区：
文献类型：
--
作者：
Engelmann JB;Maciuba B;Vaughan C;Paulus MP;Dunlop BW
在真实的生活中，有风险的决策和延迟的结果是普遍存在的，并且可能对决策者的健康和财富产生重大影响。尽管其潜在的现实世界的选择，异常的风险和跨期决策的程度患有重性抑郁症（MDD）和创伤后应激障碍（PTSD）的患者很少受到关注。我们使用病例对照设计来比较健康对照受试者（N=16）与当前重度抑郁发作中未经治疗的抑郁受试者（N=20）的决策。为了研究重度抑郁症（MDD）如何影响决策，受试者使用神经经济学的选择范式在收益和损失领域对（1）风险结果和（2）延迟结果进行决策。在一项预先计划的分析中，抑郁症受试者被细分为原发性PTSD沿着MDD共病（MDD+PTSD）和原发性MDD不伴PTSD（仅MDD）。选择行为通过跨期选择的标准计量经济学模型建模，这是一个准双曲线时间贴现函数，分别为每个受试者组进行估计。在潜在收益的条件下，与对照组相比，抑郁受试者在所有时间范围内的收益折扣更大。在损失方面，两组抑郁症受试者在短时间内比对照组的折扣更大。然而，对于>1-10年的延迟损失，MDD+PTSD受试者相对于仅MDD受试者显示出较浅的贴现率，后者继续大幅贴现未来损失。风险态度没有贡献的跨期选择的差异。抑郁症患者做出的选择是最小化当前的痛苦，最大化当前的回报，尽管后来会有严重的后果或失去机会。与没有PTSD的MDD患者相比，PTSD相关的焦虑可能作为长期潜在损失决策的部分保护因素。
Decisions under risk and with outcomes that are delayed in time are ubiquitous in real life and can have a significant impact on the health and wealth of the decision-maker. Despite its potential relevance for real-world choices, the degree of aberrant risky and intertemporal decision-making in patients suffering from major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) has received little attention to date. We used a case-control design to compare decision-making in healthy control subjects (N=16) versus untreated depressed subjects in a current major depressive episode (N=20). In order to examine how major depressive disorder (MDD) may impact decision-making, subjects made decisions over (1) risky outcomes and (2) delayed outcomes in the domain of gains and losses using choice paradigms from neuroeconomics. In a pre-planned analysis, depressed subjects were subdivided into those with primary PTSD along with comorbid MDD (MDD+PTSD) versus those with primary MDD without PTSD (MDD-only). Choice behavior was modeled via a standard econometric model of intertemporal choice, a quasi-hyperbolic temporal discounting function, which was estimated for each subject group separately. Under conditions of potential gain, depressed subjects demonstrated greater discounting for gains across all time frames compared to controls. In the realm of losses, both subgroups of depressed subjects discounted more steeply than controls for short time frames. However, for delayed losses ranging from >1-10 years, MDD+PTSD subjects showed shallower discounting rates relative to MDD-only subjects, who continued to discount future losses steeply. Risk attitudes did not contribute to differences in intertemporal choice. Depressed patients make choices that minimize current pain and maximize current reward, despite severe later consequences or lost opportunities. Anxiety associated with PTSD may serve as a partially protective factor in decision-making about long-term potential losses compared to MDD patients without PTSD.
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