Delay of gratification and executive performance in individuals with schizophrenia: putative role for eating behavior and body weight regulation.
OBJECTIVE
Impairment in executive functions and disturbed weight regulation are common features in individuals with schizophrenia on antipsychotics. Still, the clinical management of weight gain, including educational programs, is insufficient. Therefore, we hypothesized that distinct executive impairment is associated with the inability to self-control food intake.


METHODS
In the present study we investigated the performance in a paradigm analyzing the executive subfunction "delay of gratification" in individuals with schizophrenia (n=29) compared with controls (n=23) and the interrelationship between delay of gratification, overall executive functioning, reported eating behavior and the BMI. We applied a board-game paradigm to operationalize delay of gratification: on designated fields individuals need to decide about a small amount of immediate reinforcement versus double the amount in the end. Appetite and eating behavior were assessed by self-report scales, executive functioning by BADS.


RESULTS
We found that the patients performed significantly worse in our paradigm and that this is associated with lower executive functioning. However, the interrelationship between all parameters is complex: there is a significant positive correlation between the reported perceived appetite and executive functioning whereas the reported restrained eating behavior, significantly more frequent in patients, is correlated with low executive functioning and high disinhibition in eating situations.


CONCLUSIONS
We conclude that executive functions are necessary to successfully manage eating behavior. Thus, better understanding of the cognitive mechanisms might help to support the patients more efficiently in their tough job to keep control.
Knolle-Veentjer
Silja
S
Center for Integrative Psychiatry - ZIP Department of Psychiatry and Psychotherapy, Christian-Albrechts University, Niemannsweg 147, D-24105 Kiel, Germany. s.knolle-veentjer@zip-kiel.de
Huth
Verena
V
Ferstl
Roman
R
Aldenhoff
Josef Bernd
JB
Hinze-Selch
Dunja
D
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001066:Appetite / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D010054:Brief Psychiatric Rating Scale; D003657:Decision Making; D005247:Feeding Behavior; D005260:Female; D005717:Games, Experimental; D006801:Humans; D007266:Inhibition, Psychological; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009483:Neuropsychological Tests; D010865:Pilot Projects; D012055:Reinforcement Schedule; D012562:Schizophrenia, Disorganized / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D012563:Schizophrenia, Paranoid / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology
D014150:Antipsychotic Agents