Understanding Obsessive–Compulsive Disorder: Focus on Decision Making

Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.     

The neuropsychological profile of vascular cognitive impairment not demented: A meta‐analysis

The most common cause of vascular cognitive impairment not demented (VCIND) is cerebral small vessel disease leading to diffuse subcortical white matter lesions. While many studies indicate that the core cognitive features of VCIND are executive dysfunction and impaired processing speed, this finding is not always consistent, and may be partially dependent on the comparison group applied. Hence, we undertook two systematic meta‐analytic reviews on neuropsychological test performance across eight cognitive domains: between VCIND and healthy controls (data from 27 studies), and between VCIND and non‐vascular mild cognitive impairment (nv‐MCI; data from 20 studies). Our quantitative synthesis of the research literature demonstrates that individuals with VCIND show weaknesses across all cognitive domains relative to healthy controls, with the greatest impairment in the domain of processing speed (Md = ?1.36), and the least affected being working memory (Md = ?.48) and visuospatial construction (Md = ?.63). When compared directly with nv‐MCI, individuals with VCIND had significantly greater deficits in processing speed (Md = ?.55) and executive functioning (Md = ?.40), while those with nv‐MCI exhibited a greater relative deficit in delayed memory (Md = .41). Our analyses indicate that disruption to subcortical white matter tracts impairs more cognitive processes than is typically thought to be directly related to the fronto‐subcortical network. The data also suggest that differing brain aetiologies can be responsible for similar cognitive profiles. Although the findings do not evince diagnostic value, they allude to the interconnectivity of disparate cognitive processes and call for further research on the behavioural outcome of network disruption.     

Social Cognition in Multiple Sclerosis: a Meta-Analysis

Multiple sclerosis (MS) is associated with cognitive decline and impairment in social functioning. Accumulating evidence suggests that patients with MS are impaired in social cognition, including theory of mind (ToM) and emotion recognition. In this meta-analysis of 24 studies, facial emotion recognition and ToM performances of 989 patients with MS and 836 healthy controls were compared. MS was associated with significant impairments with medium effect sizes in ToM (d?=?0.57) and facial emotion recognition (d?=?0.61). Among individual emotions recognition of fear and anger were particularly impaired. The severity of social cognitive deficits was significantly associated with non-social cognitive impairment. These deficits in social cognition may underpin difficulties in social functioning in MS. However, there is a need for further studies investigating the longitudinal evolution of social cognitive deficits and their neural correlates in MS.     

Measuring decision‐making competence in Chinese adults

In this study, we translated and localized the Adult Decision‐making Competence scale (A‐DMC) and tested its reliability and validity with large samples. Results show the Chinese A‐DMC has relatively good reliability (Cronbach's alpha above 0.6 and test–retest reliability coefficients ranging from 0.44 to 0.78 on all subscales), comparable with the original version. Regarding validity, results of exploratory factor analysis and confirmatory factor analysis support the one‐factor model, indicating the A‐DMC has good internal consistency and construct validity. A‐DMC scores correlated positively with cognitive ability, constructive decision‐making styles, and good decision outcomes. Additionally, individuals with higher A‐DMC scores were found to perform better on the Cambridge gambling task and Iowa gambling task. These results confirm the validity of the Chinese version of the A‐DMC, which is suitable for measuring decision‐making competence in Chinese adults.     

Profile of cognitive deficits and associations with depressive symptoms and intelligence in chronic early‐onset schizophrenia patients

Cognitive deficits in several domains have been demonstrated in early‐onset schizophrenia patients but their profile and relation to depressive symptoms and intelligence need further characterization. The purpose was to characterize the profile of cognitive deficits in chronic, early‐onset schizophrenia patients, assess the potential associations with depressive symptom severity, and examine whether cognitive deficits within several domains reflect intelligence impairments. This study compared attention, visual‐construction, aspects of visual and verbal memory, and executive functions in chronic, early‐onset schizophrenia patients (mean age = 20.7 years) (N = 18) and healthy controls (N = 38). Schizophrenia diagnoses were established at the time of the patients' first clinical presentation during childhood or adolescence and were confirmed five years later. In the chronic phase of early‐onset schizophrenia, significant deficits were observed in all specific cognitive functions. The profile of cognitive deficits was jagged, and visual‐construction, attention, and one aspect of verbal memory (verbal stories recall) were differentially impaired. Deficits of visual recall, visual recognition, and executive functions were accounted for by deficits in intelligence, while this was not the case for deficits of verbal recall of stories or attention. No significant associations were observed between the severity of cognitive deficits and that of depressive symptoms. Chronic, early‐onset schizophrenia is characterized by a broad and jagged profile of cognitive deficits. Deficits of attention and verbal recall of stories appear not to be accounted for by deficits in intelligence, and the severity of cognitive deficits seems independent from that of depressive symptoms     

The role of the orbitofrontal cortex in normally developing compulsive-like behaviors and obsessive-compulsive disorder

Mounting evidence concerning obsessive-compulsive disorders points to abnormal functioning of the orbitofrontal cortices. First, patients with obsessive-compulsive disorder (OCD) perform poorly on tasks that rely on response suppression/motor inhibition functions mediated by the orbitofrontal cortex relative to both normal and clinical controls. Second, patients with OCD exhibit functional hyperactivity in lateral orbitofrontal and related structures corresponding with symptom severity. In this article, we compare these neurocognitive correlates of OCD with the executive and neural underpinnings of "compulsive-like" behaviors that are common in normal childhood. We discuss the phenomenology and natural history of normative compulsive-like behaviors as well as the behavioral, emotional, and cognitive continuities between typical and pathological obsessive-compulsive behaviors. We then examine associations between children's executive performance deficits and their observed compulsive-like characteristics. We relate these patterns to executive deficits shown by adults with OCD. Finally, we speculate on the developmental neurobiology of children's compulsive-like behaviors, with particular attention to orbitofrontal functions including behavioral and emotional regulation, and we suggest similarities and differences with the neurobiology of OCD. In making these comparisons, we hope to open a dialogue between researchers who study underlying brain pathologies associated with OCD and those who explore the neurocognitive bases of normal development.     

Obsessive compulsive disorder,checking, and non-verbal memory: a neuropsychological investigation

There is considerable evidence in the literature for the presence of non-verbal and praxic memory deficits in OCD. Such deficits may represent the cognitive substrate of doubt-related phenomenon such as checking. Neuropsychological tests of non-verbal memory functioning and memory for actions were administered to patients with OCD (whose predominant symptom was checking) and a group of matched healthy controls. Significant differences were found between the experimental and control groups, suggesting some memory impairment in the OCD group; however, no significant relationship was found linking neuropsychological test indices with checking. Significant relationships were found linking recognition memory problems and immediate memory for actions with general symptom severity.     

Theory of mind in spina bifida: Relationship with intellectual and executive functioning

This article investigates emotion recognition ability, a central aspect of Theory of Mind (ToM), in a group of individuals with spina bifida myelomeningocele (SBM) experiencing executive function deficits, and examine associations between emotion recognition, and intellectual and executive functioning. A total of 38 adult subjects with SBM were included in this study, participating in a randomized controlled trial evaluating the effects of a cognitive rehabilitation intervention for executive dysfunction. Reading the Mind in the Eyes Test (RMET) was used as a measure of emotion recognition, and neuropsychological tests and questionnaires were utilized as executive function measures. One third of the participants performed poorer on the emotion recognition task compared to normative data. Emotion recognition may represent an area being affected in adults with SBM, and it is related to verbal IQ. Findings also suggest that executive functions and emotion recognition ability in adults with SBM are independent.     

Does the feedback from previous trials influence current decisions? A study on the role of feedback processing in making decisions under explicit risk conditions

Decision situations frequently provide information about the amount of gains and losses and winning probabilities. In decisions under these conditions, also called risk conditions, both the use of feedback and executive functions have been shown to influence the decision‐making process, as revealed in different patient populations. However, the influence of offering feedback in tasks examining decisions under risk conditions has not been investigated experimentally, so far. This was the aim of the present study. For this purpose, a sample of healthy individuals was examined with the Game of Dice Task, a decision‐making task that explicitly provides the rules for gains and losses and in which participants receive feedback after each trial. In addition, a modified version of this task was performed, in which the feedback after each trial and all associated feedback components were removed. Results indicate that participants had a lower performance in the modified Dice Task without feedback. They selected the disadvantageous alternatives more frequently, when they did not receive feedback following their choices. Task performance in either version was correlated with executive functioning. Conclusion: In decisions under risk conditions, both executive functions as well as the use of feedback following previous trials are important components for optimal performance. Results have implications for the interpretation of deficient decision making in patients with neuropsychological impairments as both disturbances in categorization and other cognitive processes as well as emotional dysfunctions can compromise decision making in risky situations.     

Intelligence,Executive Functions,and Decision Making as Predictors of Antisocial Behavior in an Adolescent Sample of Justice‐Involved Youth and a Community Comparison Group

A clinical sample of justice‐involved male adolescents and a community comparison group were compared on a battery of cognitive ability tasks (intelligence and executive functions), decision making measures, and other individual difference measures, including ratings of self‐control, recognition of morally debatable behaviors, and antisocial beliefs. The clinical sample displayed lower performance on cognitive abilities and decision making than the community comparison group. In particular, the clinical group displayed less otherside thinking and more hostile attribution biases in unintentional situations compared with the community comparison group. Cognitive abilities and the decision making performance predicted group membership. Then, group membership, ratings of self‐control, attitudes about morally debatable behaviors, and antisocial beliefs predicted ratings of antisocial behavior in the full sample. These findings suggest that measures of cognitive ability and decision making make separate contributions to explaining antisocial behaviors. In addition, the predictors of group membership and antisocial behavior did not overlap, suggesting that antisocial behavior engagement in clinical samples may be separable from the continuum of antisocial behavior across the full sample. Cognitive science models of decision making can provide a framework for understanding antisocial behavior in clinical and community samples of adolescents. Copyright © 2015 John Wiley & Sons, Ltd.     

Dispositional optimism,self‐framing and medical decision‐making

Self‐framing is an important but underinvestigated area in risk communication and behavioural decision‐making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self‐frame and decision‐making. Participants (N = 500) responded to the Life Orientation Test‐Revised and self‐framing test of medical decision‐making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self‐frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5‐year survival rate. Based on the current findings, it can be concluded that self‐framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision‐making.     

Linking vitamin D status,executive functioning and self‐perceived mental health in adolescents through multivariate analysis: A randomized double‐blind placebo control trial

The aim of the present randomized double‐blind placebo control trial was to investigate if vitamin D supplementation had an effect on vitamin D status, executive functioning and self‐perceived mental health in a group of Norwegian adolescents during winter time. Fifty adolescents were randomly assigned into an intervention group (vitamin D pearls) or a control group (placebo pearls). Before (pre‐test in December/January) and after (post‐test in April/May) the intervention period the participants were exposed to a test procedure, consisting of blood draw, completion of cognitive tests (Tower of Hanoi and Tower of London), and the Youth Self‐report version of the Child Behavior Checklist. Multivariate data analysis showed that participants with low vitamin D status scored worse on the Tower of London tests and the more difficult sub‐tasks on the Tower of Hanoi tests. They also had a tendency to report higher frequency of externalizing behavior problems and attention deficit. At pre‐test, the overall mean vitamin D status measured as 25‐hydroxy vitamin D was 42 nmol/L, defining deficiency (Intervention group = 44 nmol/L, Control group = 39 nmol/L). However, vitamin D supplementation caused a significant increase in vitamin D status resulting in a sufficient level in the Intervention group at post‐test (mean 62 nmol/L). The results also revealed that the intervention group improved their performance on the most demanding sub‐tasks on the ToH. Overall, the study indicates that vitamin D status in adolescents may be important for both executive functioning and mental health.     

Cool and Hot Aspects of Executive Function in Childhood Obsessive-Compulsive Disorder

Aspects of executive functioning (EF) have been put forward as endophenotypes in obsessive- compulsive disorder (OCD) and meta-analyses support EF underperformance in adult samples. Childhood-onset OCD has been suggested to constitute a separate neurodevelopmental subtype of the disorder but studies on neuropsychological functioning in childhood OCD are limited. The aim of the present study was to investigate performance-based EF in pediatric OCD using observed and latent variable analyses. A case-control design was applied including 50 unmedicated children and adolescents with OCD aged 7–17 years of which 70% were female, 50 pairwise age and gender matched non-psychiatric controls (NP) and 38 children and adolescents with mixed anxiety disorders (MA). Participants underwent structured diagnostic interviews and assessment with a battery encompassing cool EF tasks of working memory, set shifting, inhibition, and planning, and hot EF tasks of decision making and dot probe paradigm affective interference. First, groups were compared on observed variables with multilevel mixed-effects linear regression and analysis of variance. Then the latent structure of cool EF was tested with confirmatory factor analysis (CFA) and groups were compared on the CFA scores. No significant differences between groups appeared on individual cool EF tasks. On the hot EF tasks the OCD group displayed significant interference effects on the dot probe paradigm OCD-specific stimuli relative to NP, but not compared to MA and no group differences emerged for decision making. In the CFA a one-factor solution showed best fit, but the groups did not differ significantly on the resulting latent variable. The present study does not support cool or hot EF impairments in childhood OCD.     

Pointing and the interference effect in obsessive‐compulsive disorder (OCD)

The interference effect in obsessive‐compulsive disorder (OCD) was investigated in order to analyze cognitive aspects of motor stereotypy in OCD‐related compulsions. So far, the domain of cognitive control in compulsive behavior has been under‐investigated. Twelve participants (OCD patients and healthy controls) completed a newly created computer‐based pointing task as well as standard clinical and psychological background measures. Findings showed that the patients displayed a larger visual interference effect compared to the controls and pointing paths were longer in time as well as distance when a distractor stimulus was present. It is concluded that, for compensation, patients would need to generate excessive amounts of attentional resources not available to overcome motor rigidity on the one side and visual distraction on the other side.     

Unraveling the Aging Skein: Disentangling Sensory and Cognitive Predictors of Age‐related Differences in Decision Making

Age‐related differences in sensory functioning, processing speed, and working memory have been identified as three significant predictors of the age‐related performance decline observed in complex cognitive tasks. Yet, the assessment of their relative predictive capacity and interrelations is still an open issue in decision making and cognitive aging research. Indeed, no previous investigation has examined the relationships of all these three predictors with decision making. In an individual‐differences study, we therefore disentangled the relative contribution of sensory functioning, processing speed, and working memory to the prediction of the age‐related decline in cognitively demanding judgment and decision‐making tasks. Structural equation modeling showed that the age‐related decline in working memory plays an important predictive role, even when controlling for sensory functioning, processing speed, and education. Implications for research on decision making and cognitive aging are discussed. Copyright © 2015 John Wiley & Sons, Ltd.     

A long‐term fatty fish intervention improved executive function in inpatients with antisocial traits and a history of alcohol and drug abuse

The aim of the present study was to investigate the effects of fatty fish consumption on cognitive functioning in a group of inpatients characterized by antisocial behavior. Eighty‐three male forensic inpatients participated in this study. Participants were randomly assigned into a Fish or a Control group (e.g., meat, chicken, pork). One decision‐making task, the Iowa Gambling Task (IGT), and one planning task, the Tower of Hanoi (ToH), were administered before (pre‐test) and at the end of the intervention period (post‐test). For the IGT the Fish group showed improved performance from pre‐ to post‐ test. Moreover, the Fish group showed significantly better performance than the Control group on the IGT at post‐test. The Fish group also demonstrated improved performance from pre‐ to post‐test on the ToH; however, this was limited to participants with a history of substance abuse. Further, the improvement was only significant for tasks with high working memory load (5–7 move problems), and not for tasks with low working memory load (1–4 move problems). The Control group showed no improvement on any of the tasks regardless of alcohol or drug abuse history. The present study suggests that regular fatty fish consumption may improve executive functions in forensic inpatients with antisocial traits and a history of substance abuse. Thus, the current results may have important implications with regard to health care interventions.     

Effects of sleep deprivation on executive functioning,cognitive abilities,metacognitive confidence,and decision making

Performance on many decision‐making tasks is underpinned by metacognitive monitoring, cognitive abilities, and executive functioning. Fatigue‐inducing conditions, such as sleep loss, compromise these factors, leading to decline in decision performance. Using a 40‐hr sleep deprivation protocol, we examined these factors and the resulting decision performance. Thirteen Australian Army male volunteers (aged 20–30 years) were tested at multiple time points on psychomotor vigilance, inhibitory control, task switching, working memory, short‐term memory, fluid intelligence, and decision accuracy and confidence in a medical diagnosis‐making test. Assessment took place in the morning and night over two consecutive days, during which participants were kept awake. Consistent with previous work, cognitive performance declined after a night without sleep. Extending previous findings, self‐regulation and self‐monitoring suffered significantly greater declines immediately after the sleepless night. These results indicate that the known decline in complex decision‐making performance under fatigue‐inducing conditions might be facilitated by metacognitive rather than cognitive mechanisms.     

Social cognition and social functioning in patients with amnestic mild cognitive impairment or Alzheimer’s dementia

The aim of the present study was to examine social cognition and social functioning in a group of amnestic mild cognitive impairment (aMCI) and Alzheimer’s dementia (AD) patients. Thirty one people with aMCI, 29 individuals with AD, and 45 healthy older adults participated in the study. Facial expressions of happiness, anger, fear, disgust, and surprise presented in different intensities had to be labelled. Mentalizing was assessed using first-order belief theory of mind (ToM) stories and everyday social functioning by the Inventory of Interpersonal Situations (IIS), completed by an informant. aMCI patients were impaired in recognizing the emotions anger, disgust, and fear, while AD patients were impaired in recognizing the emotions anger, disgust, and surprise. More importantly, no significant differences between aMCI and AD patients were found on overall emotion recognition. Both the aMCI and AD patients were impaired on the ToM task, but no differences between the aMCI and AD patients were found. On everyday social functioning, only the AD patients showed impairments. No associations between the IIS and ToM were found, but the IIS and emotion perception were significantly correlated. Regression analysis taking all potentially confounding variables into account showed that only mood, but not the social-cognitive task performance or any other cognitive variable, predicted social functioning. aMCI and AD patients demonstrated impairments in mentalizing and facial emotion perception, and showed decrements in everyday social functioning. Informing caregivers about these deficits may help them to understand deficits in social cognition that may be present already in the MCI stage of Alzheimer’s disease.     

Investigating medical decision‐making capacity in patients with cognitive impairment using a protocol based on linguistic features

A critical question is whether cognitively impaired patients have the competence for autonomous decisions regarding participation in clinical trials. The present study aimed to investigate medical decision‐making capacity by use of a Swedish linguistic instrument for medical decision‐making (LIMD) in hypothetical clinical trials in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Three comparable groups (age, education) participated in the study: AD (n = 20; MMSE: 24.1 ± 3.3) and MCI (n = 22; MMSE: 26.7 ± 2.4) patients and healthy controls (n = 37; MMSE: 29.1 ± 1.0). Medical decision‐making capacity was operationalized as answers to questions regarding participation in three hypothetical clinical trials. Answers were scored regarding comprehension, evaluation and intelligibility of decisions, and a total LIMD score was used as the measure of medical decision‐making ability. Groups differed significantly in LIMD with AD patients performing worst and MCI poorer than the control group. A strong association was found between all LIMD scores and diagnosis which supported the assertion that LIMD as it is designed is a one‐dimensional instrument of medical decision‐making capacity (MDMC). The results indicate that a fundamental communicative ability has an impact on the competence for autonomous decisions in cognitive impairment.