Laboratory for Experimental Psychopathology (LEP) , Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
Service d'Addictologie , Hôpitaux Universitaires Henri-Mondor, Assistance Publique Hôpitaux de Paris (APHP), Créteil, France.
Alcohol Clin Exp Res. 2018 Nov;42(11):2266-2273. doi: 10.1111/acer.13873. Epub 2018 Sep 7.
Decision-making impairments have been repeatedly evaluated in severe alcohol use disorders (SAUD) using the Iowa Gambling Task (IGT). The IGT, capitalizing on strong theoretical background and ecological significance, allowed identifying large-scale deficits in this population and is now a standard decision-making assessment in therapeutic settings. However, the clinical usefulness of the IGT, particularly regarding its ability to predict relapse and its link with key cognitive-physiological deficits, remains to be clarified.
Thirty-eight recently detoxified patients with SAUD and 38 matched healthy controls performed the IGT, a neuropsychological task using monetary rewards to assess decision making under uncertainty and under risk. Disease characteristics (e.g., duration and intensity), cognitive abilities, psychopathological comorbidities, and physiological damage were also measured, as well as relapse rates 6 months later.
Compared to controls, patients with SAUD presented a dissociation between preserved decision making under uncertainty and impaired decision making under risk. In the SAUD group, while relapsers (55% of the sample) presented lower global cognitive functioning and stronger liver damage than nonrelapsers at detoxification time, no difference was found between these subgroups for the IGT. IGT results were not related to alcohol-consumption characteristics or cognitive-physiological deficits.
SAUD is not related to a global IGT deficit, as suggested earlier, but rather to a specific impairment for decision making under risk. This deficit is not associated with other disease-related variables and has no relapse prediction power. These results question the clinical usefulness of the IGT as a tool identifying key treatment levers and guiding (neuro)psychological rehabilitation.
使用 Iowa 赌博任务 (IGT) 反复评估严重酒精使用障碍 (SAUD) 患者的决策障碍。IGT 利用强大的理论背景和生态意义，使我们能够在该人群中识别出大规模的缺陷，现在是治疗环境中标准的决策评估方法。然而，IGT 的临床实用性，特别是其预测复发的能力及其与关键认知-生理缺陷的联系，仍需阐明。
38 名最近戒断的 SAUD 患者和 38 名匹配的健康对照者进行了 IGT 测试，这是一项使用金钱奖励来评估不确定和风险下决策的神经心理任务。还测量了疾病特征（例如，持续时间和强度）、认知能力、精神病理学共病和生理损伤，以及 6 个月后的复发率。
与对照组相比，SAUD 患者表现出不确定条件下决策能力保留与风险条件下决策能力受损之间的分离。在 SAUD 组中，55%的样本在戒断时，复发者（55%的样本）的整体认知功能较低，肝脏损伤较严重，但在这些亚组之间，IGT 没有差异。IGT 结果与酒精消费特征或认知-生理缺陷无关。
SAUD 与早期提出的整体 IGT 缺陷无关，而是与风险条件下的特定决策障碍有关。这种缺陷与其他疾病相关变量无关，也没有预测复发的能力。这些结果质疑 IGT 作为一种识别关键治疗杠杆和指导（神经）心理康复的工具的临床实用性。
