title: Risky decision-making under risk in schizophrenia: A deliberate choice?
abstract: OBJECTIVE
  Patients with schizophrenia reveal impaired decision-making strategies causing social, financial and health care problems. The extent to which deficits in decision-making reflect intentional risky choices in schizophrenia is still under debate. Based on previous studies we expected patients with schizophrenia to reveal a riskier performance on the GDT and to make more disadvantageous decisions on the IGT.
  
  
  METHODS
  In the present study, we investigated 38 patients with schizophrenia and 38 matched healthy control subjects with two competing paradigms regarding feedback: (1) The Game of Dice Task (GDT), in which the probabilities of winning or losing are stable and explicitly disclosed to the subject, to assess decision-making under risk and (2) the Iowa Gambling Task (IGT), which requires subjects to infer the probabilities of winning or losing from feedback, to investigate decision-making under ambiguity.
  
  
  RESULTS
  Patients with schizophrenia revealed an overall riskier performance on the GDT; although they adjusted their strategy over the course of the GDT, they still made significantly more disadvantageous choices than controls. More positive symptoms in patients with schizophrenia indicated by higher PANSS positive scores were associated with riskier choices and less use of negative feedback. Compared to healthy controls, they were not impaired in net score but chose more disadvantageous cards than controls on the first block of the IGT.
  
  
  CONCLUSIONS
  Effects of medication at the time of testing cannot be ruled out.
  
  
  CONCLUSIONS
  Our findings suggest that patients with schizophrenia make riskier decisions and are less able to regulate their decision-making to implement advantageous strategies, even when the probabilities of winning or losing are explicitly disclosed. The dissociation between performance on the GDT and IGT suggests a pronounced impairment of executive functions related to the dorsolateral prefrontal cortex.
authors: Clinical Psychology and Psychotherapy, Department of Psychology, Christian-Albrechts University, Kiel, Germany. Electronic address: pedersen@psychologie.uni-kiel.de.
authors: Anya
authors: A
authors: Pedersen
authors: Department of Psychiatry and Psychotherapy, Christian-Albrechts University School of Medicine, Kiel, Germany.
authors: Robert
authors: R
authors: Göder
authors: Institute for Therapy and Health Research, Kiel, Germany.
authors: Samuel
authors: S
authors: Tomczyk
authors: Department of Psychiatry, School of Medicine, University of Münster, Germany.
authors: Patricia
authors: P
authors: Ohrmann
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003657:Decision Making; D005260:Female; D005715:Gambling; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012565:Schizophrenic Psychology; D055815:Young Adult
keywords: Decision-making under ambiguity; Decision-making under risk; Game of dice; Iowa gambling task