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

项目总结/摘要 认知和行为能力是许多严重精神障碍的关键特征。一个特别 神经性厌食症患者对减肥的不懈追求是行为僵化的危险原型 (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中的可扩展性是无效的。这可能是由于涵盖了广泛的认知 和行为过程，可能导致多种不同的决策功能障碍，需要不同的 干预措施。决策神经科学，它整合了翻译和计算神经科学， 经济学，提供了一个有前途的新范式，提高精神病学的机械科学的精度 紊乱这种方法假定精神疾病是由神经系统的独特错误计算造成的， 可以用神经经济学范式来探索的可分离的决策系统。这种方法有希望 用于确定适合不同形式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，使用一种新的神经经济学范式（ 网络冲浪任务）提供了一些见解独特的决策过程中AN。首先，在这项任务中， AN患者表现出明显的决策功能障碍，表明过度依赖基于规则的决策 这体现在以最大限度地实现长期目标为重点的快速决策上。这种方法可以 导致行为不灵活且对当前上下文不敏感。第二，这个决策系统似乎 由额顶叶认知控制回路内的过度活跃支持（例如，背外侧叶和 腹外侧前额叶皮层），这是参与长期的规则遵循。第三，这些生物行为模式 与AN的BMI和短期体重控制行为有关。这种由额顶叶驱动的基于规则的决策 过程不同于其他决策模式（例如，额背纹状体习惯学习）， 与促进其他精神疾病如强迫症的行为僵化有关。 扩展本研究，以确定决策模式是否可将AN与非临床和相关 临床组，我们将招募：a）AN; B）健康对照（HC）;和（c）OCD（临床对照）组。 强迫症代表了一个类似的表型AN假设是促进通过不同的决策过程。 在fMRI期间，受试者将完成网络冲浪任务，以识别神经经济学决策模式（例如，规则─ 基于，基于奖励，或习惯性决策）;这些将根据其他 决策任务。然后，参与者将通过访谈和生态瞬间提供症状数据 在基线和12个月随访时进行评估，以检查不同决策过程对AN的影响 强迫症的症状本研究将评估AN的特异性，该特异性是通过过度依赖 额顶叶规则决策系统这将为精确的神经科学提供第一步- 基于决策机制的精神病治疗，而不仅仅是表型表现。

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.