An exploration of decision-making by individuals who have received specialized treatment for early psychosis

Abstract

Decision-making is a critical life skill, integral for guiding behaviour. Previous research has demonstrated that decision-making is frequently impaired across a range of psychiatric disorders including schizophrenia. Although a concerted research effort has recently been focused on understanding decision-making in chronic schizophrenia, the current study was conceived to provide an initial exploration into the decision-making process of individuals who received specialized treatment for early psychosis. We investigated the decision-making ability of 16 patients enrolled in an early psychosis (EP) program and 20 healthy controls based upon their performance on the Iowa Gambling Task (IGT) and Game of Dice Task (GDT). Additional measures of neuropsychological functioning were also examined. Differences in ambiguous decision-making (IGT) were observed, with the EP group performing significantly worse than the healthy control group. Additionally, there were no differences between the two groups observed in risky decision-making (GDT). The only neuropsychological variable that correlated with decision-making performance across tasks was that of working memory. More specifically, measures of IGT ability significantly correlated with working memory performance for the EP group but not the healthy controls. As such, the current study illustrates an important role for working memory in making ambiguous decisions. It is possible that individuals with EP experience difficulty maintaining mental representations of expected value. Therefore, it is more difficult to utilize feedback from the previous trials to impact positively on future choices and rewards that are not immediately present in the environment. The clinical implications of these findings are discussed for understanding decision-making by individuals who experienced early psychosis, and how decision-making impairments could be accommodated for by treatment programs.