The Die Is Cast: Decision-Making Under Risk and Under Ambiguity in Schizophrenia and Alcohol Use Disorder

Area of Science:

• Neuroscience
• Cognitive Psychology
• Psychiatry

Background:

• Schizophrenia (SZ) and alcohol use disorder (AUD) are associated with altered decision-making (DM) and executive function (EF) deficits.
• The specific nature of these DM alterations and the role of EF impairments require further clarification.

Purpose of the Study:

• To directly compare decision-making (DM) and executive function (EF) in patients with schizophrenia (SZ), alcohol use disorder (AUD), and healthy controls (HC).
• To investigate the impact of EF on DM under risk and ambiguity in these groups.

Main Methods:

• A preregistered study involving 40 SZ, 50 AUD, and 36 HC.
• Participants completed the n-back task (EF challenge), Game of Dice Task (GDT; DM under risk), and Iowa Gambling Task (IGT; DM under ambiguity).

Main Results:

• Both AUD and SZ groups exhibited worse performance on the n-back task and made riskier choices on the GDT compared to HC.
• Only the AUD group made riskier decisions on the IGT, preferring disadvantageous options over SZ and HC.
• Demographic and IQ controls diminished the significance of IGT findings, but working memory correlations with DM tasks differed between groups.

Conclusions:

• Both SZ and AUD groups show deficits in the reflective system; AUD additionally shows impairments in the impulsive system.
• Differential DM profiles exist between SZ and AUD, suggesting distinct therapeutic targets.
• EF training may benefit both groups, with AUD potentially benefiting more from impulse control interventions.