Deciphering reward-based decision making in schizophrenia: a meta-analysis and behavioral modelling of the Iowa Gambling Task

Journal article

Premkumar, P., Betz, Linda T, Brambilla, Paolo, Ilankovic, Andrej, Premkumar, Preethi, Kim, Myung-Sun, Raffard, Stéphane, Bayard, Sophie, Hori, Hikaru, Lee, Kyoung-Uk, Lee, Seung Jae, Koutsouleris, Nikolaos and Kambeitz, Joseph (2019). Deciphering reward-based decision making in schizophrenia: a meta-analysis and behavioral modelling of the Iowa Gambling Task. Schizophrenia Research. 204, pp. 7-15. https://doi.org/10.1016/j.schres.2018.09.009
AuthorsPremkumar, P., Betz, Linda T, Brambilla, Paolo, Ilankovic, Andrej, Premkumar, Preethi, Kim, Myung-Sun, Raffard, Stéphane, Bayard, Sophie, Hori, Hikaru, Lee, Kyoung-Uk, Lee, Seung Jae, Koutsouleris, Nikolaos and Kambeitz, Joseph
Abstract

Background
Patients with schizophrenia (SZP) have been reported to exhibit impairments in reward-based decision-making, but results are heterogeneous with multiple potential confounds such as age, intelligence level, clinical symptoms or medication, making it difficult to evaluate the robustness of these impairments.

Methods
We conducted a meta-analysis of studies comparing the performance of SZP and healthy controls (HC) in the Iowa Gambling Task (IGT) as well as comprehensive analyses based on subject-level data (n = 303 SZP, n = 188 HC) to investigate reward-based decision-making in SZP. To quantify differences in the influence of individual deck features (immediate gain, gain frequency, net loss) between SZP and HC, we additionally employed a least-squares model.

Results
SZP showed statistically significant suboptimal decisions as indicated by disadvantageous deck choices (d from 0.51 to −0.62) and lower net scores (d from −0.35 to −1.03) in a meta-analysis of k = 29 samples (n = 1127 SZP, n = 1149 HC) and these results were confirmed in a complementary subject-level analysis. Moreover, decision-making in SZP was characterized by a relative overweighting of immediate gain and net losses and an underweighting of gain frequency. Moderator analyses revealed that in part, decision-making in the IGT was moderated by intelligence level, medication and general symptom scores.

Conclusion
Our results indicate robust impairments in reward-based decision-making in SZP and suggest that decreased cognitive resources, such as working memory, may contribute to these alterations.

KeywordsSchizophreniaDecision-makingRewardIowa Gambling TaskMeta-analysisLinear modeling
Year2019
JournalSchizophrenia Research
Journal citation204, pp. 7-15
PublisherElsevier
Digital Object Identifier (DOI)https://doi.org/10.1016/j.schres.2018.09.009
Web address (URL)https://www.sciencedirect.com/science/article/pii/S0920996418305590
Publication dates
Print25 Sep 2018
Publication process dates
Accepted11 Sep 2018
Deposited13 Oct 2020
Accepted author manuscript
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Open
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