Xu Mei, Lee We-Kang, Ko Chih-Hung, Chiu Yao-Chu, Lin Ching-Hung
Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Front Psychol. 2021 Sep 3;12:619855. doi: 10.3389/fpsyg.2021.619855. eCollection 2021.
The Iowa Gambling Task (IGT) was established to evaluate emotion-based decision-making ability under uncertain circumstances in clinical populations, including schizophrenia (Sz). However, there remains a lack of stable behavioral measures regarding discrimination for decision-making performance in IGT between schizophrenic cases and healthy participants. None of the Sz-IGT studies has specifically verified the prominent deck B (PDB) phenomenon gradually revealed in other populations. Here, we provided a global review and empirical study to verify these Sz-IGT issues. Seeking reliable and valid behavioral measures, we reviewed 38 studies using IGT to investigate decision-making behavior in Sz groups. The IGT, the Wisconsin Card Sorting Test (WCST), and clinical symptoms evaluations were administered to 61 schizophrenia or schizoaffective cases diagnosed by psychiatrists and 62 demographically matched healthy participants. There were no valid behavioral measures in IGT that could significantly identify the decision-making dysfunction of Sz. However, Sz cases, on average, made more choices from disadvantageous deck B relative to other decks, particularly in the later learning process (block 3-5). Compared to the control group, the Sz group was more impaired on the WCST. The high-gain frequency decks B and D showed significant correlations with WCST but no correlation between clinical symptoms and IGT/WCST. Gain-loss frequency (GLF) has a dominant and stable impact on the decision-making process in both Sz and control groups. PDB phenomenon is essentially challenging to be observed on the ground of the expected value (EV) viewpoint approach on the IGT in both populations. Consequently, caution should be exercised when launching the IGT to assess the decision-making ability of Sz under a clinical scenario.
爱荷华赌博任务（IGT）旨在评估临床人群（包括精神分裂症患者）在不确定情况下基于情绪的决策能力。然而，在IGT中，对于精神分裂症患者和健康参与者之间决策表现的区分，仍缺乏稳定的行为测量方法。尚无精神分裂症-IGT研究专门验证在其他人群中逐渐显现的突出的B组牌（PDB）现象。在此，我们进行了一项全面综述和实证研究，以验证这些精神分裂症-IGT问题。为寻求可靠且有效的行为测量方法，我们回顾了38项使用IGT研究精神分裂症组决策行为的研究。对61例经精神科医生诊断为精神分裂症或分裂情感性障碍的患者以及62名人口统计学匹配的健康参与者进行了IGT、威斯康星卡片分类测验（WCST）和临床症状评估。在IGT中，没有有效的行为测量方法能够显著识别精神分裂症患者的决策功能障碍。然而，平均而言，精神分裂症患者相对于其他牌组，从不利的B组牌中做出的选择更多，尤其是在后期学习过程（第3 - 5阶段）。与对照组相比，精神分裂症组在WCST上的受损程度更大。高收益频率的B组牌和D组牌与WCST显示出显著相关性，但临床症状与IGT/WCST之间无相关性。得失频率（GLF）对精神分裂症组和对照组的决策过程均有显著且稳定的影响。从IGT的期望值（EV）观点方法来看，在这两个人群中，PDB现象本质上都难以观察到。因此，在临床场景下使用IGT评估精神分裂症患者的决策能力时应谨慎。
