Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Philosophy, Radboud University, Nijmegen, The Netherlands.
Psychiatry Clin Neurosci. 2022 Sep;76(9):437-449. doi: 10.1111/pcn.13434. Epub 2022 Jun 29.
Compulsivity is a common phenotype among psychiatric disorders, such as obsessive-compulsive disorder (OCD) and gambling disorder (GD). Deficiencies in metacognition, such as the inability to estimate one's performance via confidence judgments could contribute to pathological decision-making. Earlier research has shown that patients with OCD exhibit underconfidence, while patients with GD exhibit overconfidence. Moreover, it is known that motivational states (e.g. monetary incentives) influence metacognition, with gain (respectively loss) prospects increasing (respectively decreasing) confidence. Here, we reasoned that OCD and GD symptoms might correspond to an exacerbation of this interaction between metacognition and motivation.
We hypothesized GD's overconfidence to be exaggerated during gain prospects, while OCD's underconfidence to be worsened in loss context, which we expected to see represented in ventromedial prefrontal cortex (VMPFC) blood-oxygen-level-dependent activity. We tested those hypotheses in a task-based functional magnetic resonance imaging (fMRI) design (27 patients with GD, 28 patients with OCD, 55 controls). The trial is registered in the Dutch Trial Register (NL6171).
We showed increased confidence for patients with GD versus patients with OCD, which could partly be explained by sex and IQ. Although our primary analyses did not support the hypothesized interaction between incentives and groups, exploratory analyses did show increased confidence in patients with GD specifically in gain context. fMRI analyses confirmed a central role for VMPFC in the processing of confidence and incentives, but no differences between the groups.
Patients with OCD and those with GD reside at opposite ends of the confidence spectrum, while no interaction with incentives was found, nor group differences in neuronal processing of confidence.
强迫性是一种常见的精神障碍表现，例如强迫症（OCD）和赌博障碍（GD）。元认知缺陷，例如无法通过信心判断来估计自己的表现，可能导致病理性决策。早期研究表明，OCD 患者表现出信心不足，而 GD 患者表现出过度自信。此外，已知动机状态（例如金钱激励）会影响元认知，收益（分别损失）前景增加（分别减少）信心。在这里，我们推断 OCD 和 GD 症状可能对应于元认知和动机之间这种相互作用的加剧。
我们假设在收益前景下，GD 的过度自信会加剧，而在损失情况下，OCD 的信心不足会恶化，我们预计这会反映在腹内侧前额叶皮层（VMPFC）的血氧水平依赖性活动中。我们在基于任务的功能磁共振成像（fMRI）设计中测试了这些假设（27 名 GD 患者，28 名 OCD 患者，55 名对照）。该试验在荷兰试验登记处（NL6171）注册。
我们发现 GD 患者的信心高于 OCD 患者，这在一定程度上可以用性别和智商来解释。尽管我们的主要分析并未支持激励与组之间的假设相互作用，但探索性分析确实表明 GD 患者在收益情况下的信心增加。fMRI 分析证实 VMPFC 在处理信心和激励方面起着核心作用，但组间无差异。
OCD 患者和 GD 患者处于信心谱的两端，而激励与组之间没有相互作用，也没有神经元处理信心的组间差异。
