精神分裂症患者不确定风险奖励追求的岛叶和纹状体相关性。
Insular and Striatal Correlates of Uncertain Risky Reward Pursuit in Schizophrenia.
机构信息
Department of Psychological & Brain Sciences, Indiana University, Bloomington, IN, USA.
Program in Neuroscience, Indiana University, Bloomington, IN, USA.
出版信息
Schizophr Bull. 2023 May 3;49(3):726-737. doi: 10.1093/schbul/sbac206.
BACKGROUND AND HYPOTHESIS
Risk-taking in specific contexts can be beneficial, leading to rewarding outcomes. Schizophrenia is associated with disadvantageous decision-making, as subjects pursue uncertain risky rewards less than controls. However, it is unclear whether this behavior is associated with more risk sensitivity or less reward incentivization. Matching on demographics and intelligence quotient (IQ), we determined whether risk-taking was more associated with brain activation in regions affiliated with risk evaluation or reward processing.
STUDY DESIGN
Subjects (30 schizophrenia/schizoaffective disorder, 30 controls) completed a modified, fMRI Balloon Analogue Risk Task. Brain activation was modeled during decisions to pursue risky rewards and parametrically modeled according to risk level.
STUDY RESULTS
The schizophrenia group exhibited less risky-reward pursuit despite previous adverse outcomes (Average Explosions; F(1,59) = 4.06, P = .048) but the comparable point at which risk-taking was volitionally discontinued (Adjusted Pumps; F(1,59) = 2.65, P = .11). Less activation was found in schizophrenia via whole brain and region of interest (ROI) analyses in the right (F(1,59) = 14.91, P < 0.001) and left (F(1,59) = 16.34, P < 0.001) nucleus accumbens (NAcc) during decisions to pursue rewards relative to riskiness. Risk-taking correlated with IQ in schizophrenia, but not controls. Path analyses of average ROI activation revealed less statistically determined influence of anterior insula upon dorsal anterior cingulate bilaterally (left: χ2 = 12.73, P < .001; right: χ2 = 9.54, P = .002) during risky reward pursuit in schizophrenia.
CONCLUSIONS
NAcc activation in schizophrenia varied less according to the relative riskiness of uncertain rewards compared to controls, suggesting aberrations in reward processing. The lack of activation differences in other regions suggests similar risk evaluation. Less insular influence on the anterior cingulate may relate to attenuated salience attribution or inability for risk-related brain region collaboration to sufficiently perceive situational risk.
背景与假说
在特定情境下，冒险行为可能是有益的，因为它可以带来有益的结果。精神分裂症患者的决策制定能力较差，他们追求不确定的风险回报的意愿低于对照组。然而，目前尚不清楚这种行为是与更高的风险敏感性还是更低的奖励激励有关。我们通过匹配人口统计学和智商（IQ），确定冒险行为是否与大脑中与风险评估或奖励处理相关的区域的激活更相关。
研究设计
研究对象（30 名精神分裂症/分裂情感障碍患者，30 名对照组）完成了一项修改后的 fMRI 气球模拟风险任务。在追求风险回报的决策过程中，对大脑激活进行建模，并根据风险水平进行参数建模。
研究结果
尽管之前有过不利结果（平均爆炸；F(1,59)=4.06，P=0.048），但精神分裂症组的风险回报追求程度较低，但在自愿停止冒险行为的可比点（调整后的泵；F(1,59)=2.65，P=0.11）。通过全脑和感兴趣区域（ROI）分析，发现精神分裂症组在右（F(1,59)=14.91，P<0.001）和左（F(1,59)=16.34，P<0.001）伏隔核（NAcc）中，与风险相比，在追求奖励的决策过程中，激活程度较低。在精神分裂症组中，冒险行为与 IQ 相关，但在对照组中不相关。平均 ROI 激活的路径分析显示，在精神分裂症患者追求风险回报时，双侧背侧前扣带回前部岛叶的统计学影响较小（左：χ2=12.73，P<0.001；右：χ2=9.54，P=0.002）。
结论
与对照组相比，精神分裂症患者的 NAcc 激活程度根据不确定奖励的相对风险变化较小，这表明奖励处理存在异常。其他区域的激活差异表明风险评估相似。前扣带回前部岛叶的影响较小可能与减弱的显著归因或风险相关脑区合作无法充分感知情境风险有关。
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