Evidence Accumulation and Neural Correlates of Uncertainty in Obsessive-Compulsive Disorder.
Evidence Accumulation and Neural Correlates of Uncertainty in Obsessive-Compulsive Disorder.
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DOI：
10.1016/j.bpsc.2023.05.011
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发表时间：
2023-10
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影响因子：
--
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决策常常与不确定情况下的风险承担联系在一起。对不确定性的高度不耐受被认为是强迫症（OCD）的一个关键特征。然而，不确定性加工的潜在构念的损害及其神经相关性在强迫症中尚不清楚。在83名参与者中（24名接受囊膜切开术治疗的强迫症患者，28名强迫症对照组和31名健康对照组），我们使用纸牌赌博任务进行磁共振成像，参与者决定是否下注下一张牌会比现在的大。使用分层漂移扩散模型来分离在达到决策阈值（即投注或不投注）之前积累的证据的速度和数量。高不确定性的特点是证据积累较少（阈值较低），从而将不确定性从冲突任务中分离出来，并突出了该任务的特殊性，以测试基于价值的不确定性。强迫症患者表现出更大的谨慎，表现不佳，总体上证据积累更多，积累速度更慢，特别是在低不确定性下。双侧背前扣带和前岛区区分了健康对照组参与者的高不确定性和低不确定性决策过程，但在强迫症组中没有，这表明结果方差和显著性网络活动差异的预期受损。尽管强迫症症状有所改善，但与囊膜切开术相关的行为或影像学方面没有差异。我们的研究结果强调了更大的损伤，特别是在强迫症组的更特定的试验中，伴随着高不确定性和低不确定性的神经分化受损，并表明不确定性加工是一种特征认知内表型，而不是一种特定状态的因素。
Decision making is frequently associated with risk taking under uncertainty. Elevated intolerance of uncertainty is suggested to be a critical feature of obsessive-compulsive disorder (OCD). However, impairments of latent constructs of uncertainty processing and its neural correlates remain unclear in OCD. In 83 participants (24 OCD patients treated with capsulotomy, 28 OCD control participants, and 31 healthy control participants), we performed magnetic resonance imaging using a card gambling task in which participants made decisions whether to bet or not that the next card would be larger than the current one. A hierarchical drift diffusion model was used to dissociate speed and amount of evidence accumulated before a decisional threshold (i.e., betting or no betting) was reached. High uncertainty was characterized by a smaller amount of evidence accumulation (lower thresholds), thus dissociating uncertainty from conflict tasks and highlighting the specificity of this task to test value-based uncertainty. OCD patients exhibited greater caution with poor performance and greater evidence accumulation overall along with slower speed of accumulation, particularly under low uncertainty. Bilateral dorsal anterior cingulate and anterior insula distinguished high- and low-uncertainty decision processes in healthy control participants but not in the OCD groups, indicating impairments in anticipation of differences in outcome variance and salience network activity. There were no behavioral or imaging differences relating to capsulotomy despite improvements in OCD symptoms. Our findings highlight greater impairments particularly in more certain trials in the OCD groups along with impaired neural differentiation of high and low uncertainty and suggest uncertainty processing as a trait cognitive endophenotype rather than a state-specific factor.
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