title: Deficits in emotion based decision-making in schizophrenia; a new insight based on the Iowa Gambling Task.
abstract: BACKGROUND
  Defective decision-making is a symptom of impaired cognitive function observed in patients with schizophrenia. Impairment on the Iowa Gambling Task (IGT) has been reported in patients with schizophrenia, but these results are inconsistent among studies.
  
  
  METHODS
  We differentiated subjects based on whether they expressed certainty at having deciphered an advantageous strategy in the course of the task. We investigated this impairment using the IGT in patients with schizophrenia and performed analysis different to standard advantageous decks minus disadvantageous decks in all 100 card choices, [C+D]-[A+B](1-100). We examined the effects on behavior after receiving a big penalty.
  
  
  RESULTS
  Results were dependent on participants utilizing with or without certainty, the best strategy for positive gain. Schizophrenic patients without certainty failed to show card choice shift, from disadvantageous to advantageous decks. Differences in card choices on the IGT were clearly shown between patients with schizophrenia and normal controls by the use of improvement from block 1 to blocks 3-5, [C+D]-[A+B]([41-100]-[1-20]) (P<0.001), rather than by the composite value of blocks 3-5, [C+D]-[A+B](41-100) (P=0.011). The deficit of emotion-based learning in schizophrenia without uncertainty were related to scores on the SANS and S5 attention. In addition, S1 affective flattering and S4 anhedonia-asociality were also related to these deficits. For a while, normal controls showed a smooth shift from disadvantageous to advantageous decks after big penalties, with or without a certainty for strategy. However, patients with schizophrenia failed to show switching from disadvantageous to advantageous decks, even after big penalties, under the same conditions.
  
  
  CONCLUSIONS
  Our results highlight certainty of strategy and behavior after a big penalty, as two points of difference between patients with schizophrenia and normal controls in the accumulation of net scores.
authors.affiliation: Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsuzawa
authors.affiliation: Department of Psychiatry, Teikyo University Chiba Medical Center, Ichihara, Japan; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: shirayama@rapid.ocn.ne.jp.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Shirayama
authors.affiliation: Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Tomihisa
authors.initials: T
authors.lastname: Niitsu
authors.affiliation: Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Iyo
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003657:Decision Making; D004644:Emotions; D005260:Female; D005715:Gambling / Q000523:psychology*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011678:Punishment / Q000523:psychology; D012559:Schizophrenia / Q000175:diagnosis; D012565:Schizophrenic Psychology; D055815:Young Adult
keywords: Decision-making; Iowa Gambling Task; Schizophrenia