Rule-Based Decision-Making: A Novel Neuroeconomic Mechanism of Anorexia Nervosa

项目摘要/摘要 认知和行为的僵化是许多严重精神障碍的主要特征。其中一个特别的 行为僵硬的危险原型在神经性厌食症患者对减肥的不懈追求中显而易见 (AN)，这是一种发病率和死亡率高得惊人的疾病。先前对心理干预的努力 AN中的僵化一直是无效的。这可能是因为缺乏灵活性，涵盖了一系列广泛的认知 以及可能由多个不同的决策功能障碍导致的行为过程，这些决策功能障碍需要不同的 干预措施。决策神经科学，它将翻译和计算神经科学与 经济学，为提高精神病学机械科学的精确度提供了一个有前途的新范式 精神错乱。这一方法假设精神疾病是由神经学上的-- 可以用神经经济学范式来探索的可分离的决策系统。这种方法是有希望的 用于确定适合不同形式的精神疾病的精确治疗目标。 我们的试点数据来自决策神经科学方法，使用了一种新的神经经济学范式( 网络冲浪任务)提供了对一个独特的决策过程的几个见解。首先，在这项任务上， 患有AN的个体表现出明显的决策障碍，表明过度依赖基于规则的决策 这一制度体现在注重实现长期目标最大化的快速决策上。这种方法可以 导致行为不灵活，对当前环境麻木不仁。第二，这个决策系统似乎 由额顶认知控制回路内的多动支持(例如，背外侧和 腹外侧额叶皮质)，参与长期遵守规则。第三，这些生物行为模式 与体重指数和短期体重控制行为有关。这一由顶层驱动的基于规则的决策 过程不同于其他决策模式(例如，前额-背侧纹状体习惯学习) 与促进其他精神疾病的行为僵化有关，如强迫症。 扩展这项研究，以确定决策模式是否区分非临床和相关的 临床组，我们将招募：a)AN；b)健康对照(HC)；和(C)强迫症(临床对照)组。 强迫症代表了一种与假设通过不同决策过程促进的表型相似的表型。 在功能磁共振成像期间，受试者将完成Web-Surf任务，以确定神经经济决策模式(例如，规则- 基于、基于奖励或习惯性的决策)；这些将与其他 决策任务。然后，参与者将通过访谈和生态瞬间提供有关症状的数据 基线评估和为期12个月的跟踪，以检查不同决策过程对 和强迫症症状。这项研究将评估过度依赖于 额顶基于规则的决策系统。这将允许向精密神经科学提供信息的第一步- 以决策机制为基础的精神治疗，而不是仅仅通过表型表现。

PROJECT SUMMARY/ABSTRACT Cognitive and behavioral inflexibility are key features of many severe psychiatric disorders. One particularly dangerous prototype of behavioral rigidity is evident in the relentless pursuit of weight loss in anorexia nervosa (AN), a disorder with alarmingly high morbidity and mortality rates. Prior efforts to intervene upon psychological inflexibility in AN have been ineffective. This may be due to inflexibility encompassing a broad set of cognitive and behavioral processes that can result from multiple distinct decision dysfunctions that require different interventions. Decision Neuroscience, which integrates translational and computational neuroscience with economics, offers a promising new paradigm for enhancing the precision of mechanistic science for psychiatric disorders. This approach posits that mental illnesses result from unique miscalculations performed by neurally- separable decision systems that can be probed with neuroeconomic paradigms. This approach holds promise for identifying precise treatment targets suited for different forms of psychiatric illness. Our pilot data derived from a Decision Neuroscience approach using a novel neuroeconomic paradigm (the Web-Surf task) have provided several insights into unique decision-making processes in AN. First, on this task, individuals with AN showed a distinct decision dysfunction suggesting overreliance on a rule-based decision system, reflected through rapid decision-making focused on maximizing long-term goals. This approach can lead to behavior that is inflexible and insensitive to current context. Second, this decision system appeared to be supported by hyperactivity within the frontoparietal cognitive control circuit (e.g., dorsolateral and ventrolateral prefrontal cortex), which is involved in long-term rule-following. Third, these biobehavioral patterns were linked to BMI and short-term weight-control behavior in AN. This frontoparietal-driven rule-based decision process differs from other decision-making patterns (e.g., fronto-dorsal striatal habit learning) that have been implicated in promoting behavioral rigidity in other psychiatric disorders, such as OCD. To extend this research to establish whether decision patterns distinguish AN from non-clinical and related clinical groups, we will recruit: a) AN; b) healthy comparison (HC); and (c) OCD (clinical comparison) groups. OCD represents a similar phenotype to AN hypothesized to be promoted through different decision processes. During fMRI, subjects will complete the Web-Surf task to identify neuroeconomic decision patterns (e.g., rule- based, reward-based, or habitual decision-making) in each group; these will be validated against other decision tasks. Participants will then provide data on symptoms via interviews and ecological momentary assessment at baseline and 12-month follow-up to examine the influence of distinct decision processes on AN and OCD symptoms. This study will evaluate the specificity with which AN is maintained by over-reliance on a frontoparietal rule-based decision system. This will permit first steps towards informing precision neuroscience- based psychiatric treatments informed by decision mechanisms, rather than solely by phenotypic presentation.