title: Reduced activation in the ventral striatum during probabilistic decision-making in patients in an at-risk mental state.
abstract: BACKGROUND
  Patients with schizophrenia display metacognitive impairments, such as hasty decision-making during probabilistic reasoning - the "jumping to conclusion" bias (JTC). Our recent fMRI study revealed reduced activations in the right ventral striatum (VS) and the ventral tegmental area (VTA) to be associated with decision-making in patients with schizophrenia. It is unclear whether these functional alterations occur in the at-risk mental state (ARMS).
  
  
  METHODS
  We administered the classical beads task and fMRI among ARMS patients and healthy controls matched for age, sex, education and premorbid verbal intelligence. None of the ARMS patients was treated with antipsychotics. Both tasks request probabilistic decisions after a variable amount of stimuli. We evaluated activation during decision-making under certainty versus uncertainty and the process of final decision-making.
  
  
  RESULTS
  We included 24 AMRS patients and 24 controls in our study. Compared with controls, ARMS patients tended to draw fewer beads and showed significantly more JTC bias in the classical beads task, mirroring findings in patients with schizophrenia. During fMRI, ARMS patients did not demonstrate JTC bias on the behavioural level, but showed a significant hypoactivation in the right VS during the decision stage.
  
  
  CONCLUSIONS
  Owing to the cross-sectional design of the study, results are constrained to a better insight into the neurobiology of risk constellations, but not prepsychotic stages. Nine of the ARMS patients were treated with antidepressants and/or lorazepam.
  
  
  CONCLUSIONS
  As in patients with schizophrenia, a striatal hypoactivation was found in ARMS patients. Confounding effects of antipsychotic medication can be excluded. Our findings indicate that error prediction signalling and reward anticipation may be linked to striatal dysfunction during prodromal stages and should be examined for their utility in predicting transition risk.
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Rausch
authors.affiliation: Central Institute of Mental Health, Department of Clinical Psychology, University of Heidelberg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Mier
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Eifler
authors.affiliation: Central Institute of Mental Health, Department of Clinical Psychology, University of Heidelberg, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Fenske
authors.affiliation: Amsterdam University, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Frederike
authors.initials: F
authors.lastname: Schirmbeck
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Englisch
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Schilling
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Meyer-Lindenberg
authors.affiliation: Central Institute of Mental Health, Department of Clinical Psychology, University of Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kirsch
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Zink
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D001931:Brain Mapping; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000502:physiology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008140:Lorazepam / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011336:Probability; D062706:Prodromal Symptoms; D012306:Risk; D012559:Schizophrenia / Q000188:drug therapy / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D066328:Ventral Striatum / Q000187:drug effects / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D008140:Lorazepam