Decision making under ambiguity and risk in adolescent-onset schizophrenia

Dandan Li,Yifan Zhang,Fengyan Zhang,Lu Wang,Tingting Yang,Kai Wang,Chunyan Zhu

doi:10.1186/s12888-021-03230-1

Abstract

ObjectiveNumerous studies have identified impaired decision making (DM) under both ambiguity and risk in adult patients with schizophrenia. However, the assessment of DM in patients with adolescent-onset schizophrenia (AOS) has been challenging as a result of the instability and heterogeneity of manifestations. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT), which are frequently used to evaluate DM respectively under ambiguity and risk, are sensitive to adolescents and neuropsychiatric patients. Our research intended to examine the performance of DM in a relatively large sample of patients with AOS using the above-mentioned two tasks. We also aimed to take a closer look at the relationship between DM and symptom severity of schizophrenia.MethodsWe compared the performance of DM in 71 patients with AOS and 53 well-matched healthy controls using IGT for DM under ambiguity and GDT for DM under risk through net scores, total scores and feedback ration. Neuropsychological tests were conducted in all participants. Clinical symptoms were evaluated by using Positive and Negative Syndrome Scale (PANSS) in 71 patients with AOS. Pearson’s correlation revealed the relationship among total score of DM and clinical and neuropsychological data.ResultsCompared to healthy controls, patients with AOS failed to show learning effect and had a significant difference on the 5th block in IGT and conducted more disadvantageous choices as well as exhibited worse negative feedback rate in GDT. Apart from DM impairment under risk, diminished DM abilities under ambiguity were found related to poor executive function in AOS in the present study.ConclusionsOur findings unveiled the abnormal pattern of DM in AOS, mainly reflected under the risky condition, extending the knowledge on the performance of DM under ambiguity and risk in AOS. Inefficient DM under risk may account for the lagging impulse control and the combined effects of developmental disease. In addition, our study demonstrated that the performance on IGT was related to executive function in AOS.

Highlights

Adolescent-onset schizophrenia (AOS) was commonly considered as a chronic and sever illness with poor prognosis and typical age of onset at 13–18 year [1,2,3,4], affecting approximately one child in two hundred [5]
Our findings unveiled the abnormal pattern of decision making (DM) in AOS, mainly reflected under the risky condition, extending the knowledge on the performance of DM under ambiguity and risk in AOS
Our study demonstrated that the performance on Iowa Gambling Task (IGT) was related to executive function in AOS

Summary

Introduction

Adolescent-onset schizophrenia (AOS) was commonly considered as a chronic and sever illness with poor prognosis and typical age of onset at 13–18 year [1,2,3,4], affecting approximately one child in two hundred [5]. A third of adult patients with schizophrenia developed their earliest symptoms in the period of children and adolescents, characterized by high diagnostic stability [5]. Patients with AOS increasingly suffered with alcoholism, substance abuse and high suicide rates, which may contribute to the premature psychotis symptoms, aggravating manifestations and poor prognosis of AOS [10]. Suicidal behaviors before the first hospitalization occurred in approximate 32% of patients with AOS, and follow-up investigations reported a suicide rate of 12% in the two years after the first admission [11]. It is of great necessity to assess the characteristics of DM in AOS

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Results

Discussion

Conclusion