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Decision-making ability in psychosis: a systematic review and meta-analysis of the magnitude, specificity and correlates of impaired performance on the Iowa and Cambridge Gambling Tasks

Published online by Cambridge University Press:  24 September 2018

Amanda Woodrow ,
Sarah Sparks ,
Valeria Bobrovskaia ,
Charlotte Paterson ,
Philip Murphy  and
Paul Hutton
Amanda Woodrow
Affiliation:
School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
Sarah Sparks
Affiliation:
School of Health in Social Science, University of Edinburgh, Edinburgh, UK
Valeria Bobrovskaia
Affiliation:
School of Health in Social Science, University of Edinburgh, Edinburgh, UK
Charlotte Paterson
Affiliation:
School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
Philip Murphy
Affiliation:
School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
Paul Hutton*
Affiliation:
School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
*
Author for correspondence: Paul Hutton, E-mail: p.hutton@napier.ac.uk
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Abstract

To identify factors which may help or hinder decision-making ability in people with psychosis, we did a systematic review and meta-analysis of their performance on the Iowa and Cambridge Gambling Tasks. Analysis of 47 samples found they had moderately poorer performance than healthy individuals (N = 4264, g = −0.57, 95% confidence interval (CI) −0.66 to −0.48). Few studies (k = 8) used non-psychotic clinical comparator groups, although very low-quality evidence (k = 3) found people with bipolar disorder may perform better. Negative symptoms (k = 13, N = 648, r = −0.17, 95% CI −0.26 to −0.07) and lower IQ (k = 11, N = 525, r = 0.20, 95% CI 0.29–0.10), but not positive symptoms (k = 10, N = 512, r = −0.01, 95% CI −0.11 to 0.08), each had small-moderate associations with poorer decision-making. Lower quality evidence suggested general symptoms, working memory, social functioning, awareness of emotional responses to information, and attentional bias towards gain are associated with decision-making, but not education, executive functioning or overall symptoms. Meta-regression suggested an inverse association between decision-making and depression severity (k = 6, Q = 6.41, R2 100%, p = 0.01). Those taking first-generation (k = 6, N = 305, g = −0.17, 95% CI −0.40 to 0.06, p = 0.147) or low-dose antipsychotics (k = 5, N = 442, g = −0.19, 95% CI −0.44 to 0.06, p = 0.139) had unimpaired decision-making. Although meta-regression found no linear association between dose and performance, non-reporting of the dose was common and associated with larger impairments (k = 46, Q = 4.71, R2 14%, p = 0.03). Those supporting people with psychosis to make decisions, including treatment decisions, should consider the potential effect of these factors. Interventionist-causal trials are required to test whether reducing antipsychotic dose and treating anxiety and depression can improve decision-making in this group.

Keywords

Decision makingIowa gambling taskmeta-analysispsychosisschizophrenia
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 1 , January 2019 , pp. 32 - 48
Copyright
Copyright © Cambridge University Press 2018 

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References

Adan, A, Capella, MDM, Prat, G, Forero, DA, Lopez-Vera, S and Navarro, JF (2017) Executive functioning in men with schizophrenia and substance use disorders. Influence of lifetime suicide attempts. PLoS ONE 12, 1.Google Scholar
Bark, R, Dieckmann, S, Bogerts, B and Northoff, G (2005) Deficit in decision making in catatonic schizophrenia: an exploratory study. Psychiatry Research 134, 131–141.Google Scholar
Bechara, A, Damasio, A, Damasio, H and Anderson, S (1994) Insensitivity to future consequences following damange to human prefrontal cortex. Cognition 50, 7–15.Google Scholar
Borenstein, M, Hedges, L, Higgins, JPT and Rothstein, H (2009) Introduction to Meta-Analysis. Chichester: Wiley.Google Scholar
Bradford, L (2015) The Effects of Atypical Antipsychotics on Implicit Reward Learning in Schizophrenia (Dissertation). Belfast, Northern Ireland: Queens University.Google Scholar
Bradford-Hill, A (1965) The enviroment and disease: association or causation? Proceedings of the Royal Society of Medicine 58, 295–300.Google Scholar
Brambilla, P, Perlini, C, Bellani, M, Tomelleri, L, Ferro, A, Cerruti, S, Marinelli, V, Rambaldelli, G, Christodoulou, T, Jogia, J, Dima, D, Tansella, M, Balestrieri, M and Frangou, S (2012) Increased salience of gains versus decreased associative learning differentiate bipolar disorder from schizophrenia during incentive decision making. Psychological Medicine 43, 571–580.Google Scholar
Brown, EC, Hack, SM, Gold, JM, Carpenter, WT, Fischer, BA, Prentice, KP and Waltz, JA (2015) Integrating frequency and magnitude information in decision-making in schizophrenia: an account of patient performance on the Iowa Gambling Task. Journal of Psychiatric Research 66–67, 16–23.Google Scholar
Buelow, MT and Suhr, JA (2009) Construct validity of the Iowa Gambling Task. Neuropsychology Review 19, 102–114.Google Scholar
Buseymeyer, JR and Stout, JC (2002) A contribution of cognitive decision models to clinical assessment: decomposing performance on the Bechara gambling task. Psychological Assessment 14, 253–262.Google Scholar
Caletti, E, Paoli, RA, Fiorentini, A, Cigliobianco, M, Zugno, E, Serati, M, Orsenigo, G, Grillo, P, Zago, S, Caldiroli, A, Prunas, C, Giusti, F, Consonni, D and Altamura, AC (2013) Neuropsychology, social cognition and global functioning among bipolar, schizophrenic patients and healthy controls: preliminary data. Frontiers in Human Neuroscience 7, 661.Google Scholar
Capdevielle, D, Raffard, S, Bayard, S, Garcia, F, Baciu, O, Bouzigues, I and Boulenger, JP (2009) Competence to consent and insight in schizophrenia: is there an association? A pilot study. Schizophrenia Research 108, 272–279.Google Scholar
Cavallaro, R, Cavedini, P, Mistretta, P, Bassi, T, Angelone, SM, Ubbiali, A and Bellodi, L (2003) Basal-corticofrontal circuits in schizophrenia and obsessive-compulsive disorder: a controlled double dissociation study. Biological Psychiatry 54, 437–443.Google Scholar
Cella, M, Dymond, S, Cooper, A and Turnbull, OH (2012) Cognitive decision modelling of emotion-based learning impairment in schizophrenia: the role of awareness. Psychiatry Research 196, 15–19.Google Scholar
Cella, M, Reeder, C and Wykes, T (2015) Lessons learnt? The importance of metacognition and its implications for cognitive remediation in schizophrenia. Frontiers in Psychology 6, 1259.Google Scholar
Cohen, J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd edition. Hillsdale, New Jersey: Lawrence Erlbaum Associates.Google Scholar
Crespo-Facorro, B, Rodríguez-Sánchez, JM, Pérez-Iglesias, R, Mata, I, Ayesa, R, Ramirez-Bonilla, M, Martínez-Garcia, O and Vázquez-Barquero, JL (2009) Neurocognitive effectiveness of haloperidol, risperidone and olanzapine in first-episode psychosis: a randomized controlled 1-year follow-up comparison. Journal of Clinical Psychiatry 70, 717–729.Google Scholar
Da Silva, S (2017) Deconstructing Motivation Deficits in Schizophrenia and Beyond (Dissertation). Toronto, Canada: University of Toronto.Google Scholar
Damasio, AR, Everitt, BJ and Bishop, D (1996) The somatic marker hypothesis and the possible functions of the prefrontal Cortex (and Discussion). Philosophical Transactions of the Royal Society B: Biological Sciences 351, 1413–1420.Google Scholar
DerSimonian, R and Laird, N (1986) Meta-analysis in clinical trials. Controlled clinical trials 7, 177–188.Google Scholar
Dudley, R, Taylor, P, Wickham, S and Hutton, P (2016) Psychosis delusions and the “jumping to conclusions” reasoning bias: a systematic review and meta-analysis. Schizophrenia Bulletin 42, 652–665.Google Scholar
Duval, S, Tweedie, R, Taylor, S and Tweedie, R (2000) Trim and fill: a simple funnel plot based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.Google Scholar
Egger, M, Davey Smith, G, Schneider, M and Minder, C (1997) Bias in meta-analysis detected by a simple graphical test. British Medical Journal 315, 629–634.Google Scholar
Evans, CEY, Bowman, CH and Turnbull, OH (2005) Subjective awareness on the Iowa Gambling Task: the key role of emotional experience in schizophrenia. Journal of Clinical and Experimental Neuropsychology 27, 656–664.Google Scholar
Guillaume, S, Gorwood, P, Jollant, F, Van Den Eynde, F, Courtet, P and Richard-Devantoy, S (2015) Impaired decision-making in symptomatic anorexia and bulimia nervosa patients: a meta-analysis. Psychological Medicine 45, 3377–3391.Google Scholar
Guyatt, GH, Oxman, AD, Vist, GE, Kunz, R, Falck-Ytter, Y, Alonso-Coello, P and Schünemann, HJ and GRADE Working Group (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. British Medical Journal 336, 924–926.Google Scholar
Higgins, JPT and Green, S (2011) Cochrane Handbook for Systematic Reviews of Interventions (Version 5.10). Chichester: Wiley and Sons.Google Scholar
Highet, K (2014) Thinking Matters: The Profile of Executive Functioning Associated with Cannabis Use in Schizophrenia and its Functional Outcome Correlates (Dissertation). Perth, Australia: Murdoch University.Google Scholar
Hori, H, Yoshimura, R, Katsuki, A, Atake, K and Nakamura, J (2014) Relationships between brain-derived neurotrophic factor clinical symptoms and decision-making in chronic schizophrenia: data from the Iowa Gambling Task. Frontiers In Behavioral Neuroscience 8, 417.Google Scholar
Howes, OD and Murray, RM (2014) Schizophrenia: an integrated sociodevelopmental-cognitive model. The Lancet 10, 1677–1687.Google Scholar
Kendler, KS and Campbell, J (2009) Interventionist causal models in psychiatry: repositioning the mind–body problem. Psychological Medicine 39, 881–887.Google Scholar
Kovács, I, Richman, MJ, Janka, Z, Maraz, A and Andó, B (2017) Decision making measured by the Iowa Gambling Task in alcohol use disorder and gambling disorder: a systematic review and meta-analysis. Drug and Alcohol Dependence 181, 152–161.Google Scholar
Larkin, A and Hutton, P (2017) Systematic review and meta-analysis of factors that help or hinder treatment decision-making capacity in psychosis. British Journal of Psychiatry 211, 205–215.Google Scholar
Law, H and Morrison, AP (2014) Recovery in psychosis: a Delphi study with experts by experience. Schizophrenia Bulletin 40, 1347–1355.Google Scholar
Lee, SJ, Lee, HK, Kweon, YS, Lee, CT and Lee, KU (2009) The impact of executive function on emotion recognition and emotion experience in patients with schizophrenia. Psychiatry Investigation 6, 156–162.Google Scholar
Leucht, S, Kane, JM, Kissling, W, Hamann, J, Etschel, E and Engel, RR (2005) What does the PANSS mean? Schizophrenia Research 79, 231–238.Google Scholar
Leucht, S, Rothe, P, Davis, JM and Engel, RR (2013) Equipercentile linking of the BPRS and the PANSS. European Neuropsychopharmacology 23, 956–959.Google Scholar
Martino, DJ and Strejilevich, SA (2014) A comparison of decision making in patients with bipolar i disorder and schizophrenia. Schizophrenia Research 156, 135–136.Google Scholar
Matsuzawa, D, Shirayama, Y, Niitsu, T, Hashimoto, K and Iyo, M (2015) Deficits in emotion based decision-making in schizophrenia; a new insight based on the Iowa Gambling Task. Progress in Neuro-Psychopharmacology and Biological Psychiatry 57, 52–59.Google Scholar
Mukherjee, D and Kable, JW (2014) Value-based decision making in mental illness: a meta-analysis. Clinical Psychological Science 2, 767–782.Google Scholar
Must, A, Horvath, S, Nemeth, VL and Janka, Z (2013) The Iowa Gambling Task in depression – what have we learned about sub-optimal decision-making strategies? Frontiers in Psychology 4, 732.Google Scholar
National Institute for Health and Social Care Excellence (NICE) (2018) Decision Making and Mental Capacity (GID-NG10009): Draft Guidelines. London, UK: National Institute for Health and Social Care Excellence.Google Scholar
Newman, JM (2008) The Relationship between Risk Assessment and Victimization in Individuals with Schizophrenia (Dissertation). Hempstead, New York, USA: Hofstra University.Google Scholar
Premkumar, P, Fannon, D, Kuipers, E, Simmons, A, Frangou, S and Kumari, V (2008) Emotional decision-making and its dissociable components in schizophrenia and schizoaffective disorder: a behavioural and MRI investigation. Neuropsychologia 46, 2002–2012.Google Scholar
Premkumar, P, Peters, ER, Fannon, D, Anilkumar, AP, Kuipers, E and Kumari, V (2011) Coping styles predict responsiveness to cognitive behaviour therapy in psychosis. Psychiatry Research 187, 354–362.Google Scholar
Raffard, S, Capdevielle, D, Gely-Nargeot, MC, Attal, J, Baillard, A, Del-Monte, J, Mimoun, N, Boulenger, JP and Bayard, S (2011) Insight is not associated with insensitivity to future consequences in schizophrenia. Psychiatry Research 187, 307–309.Google Scholar
Raffard, S, Fond, G, Brittner, M, Bortolon, C, Macgregor, A, Boulenger, JP, Gely-Nargeot, MC and Capdevielle, D (2013) Cognitive insight as an indicator of competence to consent to treatment in schizophrenia. Schizophrenia Research 144, 118–121.Google Scholar
Richard-Devantoy, S, Berlim, MT and Jollant, F (2014) A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychological Medicine 44, 1663–1673.Google Scholar
Riley, RD, Higgins, JPT and Deeks, JJ (2011) Interpretation of random effects meta-analyses. British Medical Journal 342, 549–549.Google Scholar
Rogers, RD, Everitt, BJ, Baldacchino, A, Blackshaw, AJ, Swainson, R, Wynne, K, Baker, NB, Hunter, J, Carthy, T, Booker, E, London, M, Deakin, JF, Sahakian, BJ and Robbins, TW (1999) Dissociable deficits in the decision-making cognition of chronic amphetamine abusers opiate abusers patients with focal damage to prefrontal cortex and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. Neuropsychopharmacology 20, 322–339.Google Scholar
Rotge, JY, Poitou, C, Fossati, P, Aron-Wisnewsky, J and Oppert, JM (2017) Decision-making in obesity without eating disorders: a systematic review and meta-analysis of Iowa Gambling Task performances. Obesity Reviews 18, 936–942.Google Scholar
Samara, MT, Engel, RR, Millier, A, Kandenwein, J, Toumi, M and Leucht, S (2014) Equipercentile linking of scales measuring functioning and symptoms: examining the GAF, SOFAS, CGI-S, and PANSS. European Neuropsychopharmacology 24, 1767–1772.Google Scholar
Sedgwick, OL (2016) The Contribution of Dissocial Personality Disorder to Cognition Emotion Processing and Clinical Outcome in Violent Men with Psychosis (Dissertation). London, UK: Kings College London.Google Scholar
Starcke, K and Brand, M (2016) Effects of stress on decisions under uncertainty: a meta-analysis. Psychological Bulletin 142, 909–933.Google Scholar
Stewart, L, Moher, D and Shekelle, P (2012) Why prospective registration of systematic reviews makes sense. Systematic Reviews 1, 7.Google Scholar
Stovell, D, Wearden, A, Morrison, AP and Hutton, P (2016) Service users experiences of the treatment decision-making process in psychosis: a phenomenological analysis. Psychosis: Psychological Social and Integrative Approaches 8, 311–323.Google Scholar
Taylor, PJ, Hutton, P and Wood, L (2015) Are people at risk of psychosis also at risk of suicide and self-harm? A systematic review and meta-analysis. Psychological Medicine 45, 911–926.Google Scholar
Thompson, SG and Higgins, JPT (2002) How should meta-regression analyses be undertaken and interpreted? Statistics in Medicine 21, 1559–1573.Google Scholar
Turnbull, OH, Evans, CEY, Kemish, K, Park, S and Bowman, CH (2006) A novel set-shifting modification of the Iowa Gambling Task: Flexible emotion-based learning in schizophrenia. Neuropsychology 20, 290–298.Google Scholar
Wang, SB, Wang, YY, Ungvari, GS, Ng, CH, Wu, RR, Wang, J and Xiang, YT (2017) The MacArthur competence assessment tools for assessing decision-making capacity in schizophrenia: a meta-analysis. Schizophrenia Research 183, 56–63.Google Scholar
Wells, A and Matthews, G (1996) Modelling cognition in emotional disorder: the S-REF model. Behaviour Research and Therapy 34, 881–888.Google Scholar
Whitney, KA, Fastenau, PS, Evans, JD and Lysaker, PH (2004) Comparative neuropsychological function in obsessive-compulsive disorder and schizophrenia with and without obsessive-compulsive symptoms. Schizophrenia Research 69, 75–83.Google Scholar
Yechiam, E, Busemeyer, JR, Stout, JC and Bechara, A (2005) Using cognitive models to map relations between neuropsychological disorders and human decision-making deficits. Psychological Science 16, 973–978.Google Scholar
Yip, SW, Sacco, KA, George, TP and Potenza, MN (2009) Risk/reward decision-making in schizophrenia: a preliminary examination of the influence of tobacco smoking and relationship to Wisconsin Card Sorting Task performance. Schizophrenia Research 110, 156–164.Google Scholar
Zhang, L, Tang, J, Dong, Y, Ji, Y, Tao, R, Liang, Z, Chen, J, Wu, Y and Wang, K (2015) Similarities and differences in decision-making impairments between autism spectrum disorder and schizophrenia. Frontiers in Behavioral Neuroscience 9, 259.10.3389/fnbeh.2015.00259Google Scholar
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