Deficits in emotion based decision-making in schizophrenia; a new insight based on the Iowa Gambling Task

• Impairment on the Iowa Gambling Task has been reported in patients with schizophrenia, but the results are inconsistent.
• Subjects were differentiated based on the whether they expressed certainty for advantageous strategy in the course of the task.
• Patients with schizophrenia without certainty failed to show card choice shift from disadvantageous to advantageous decks.
• Uncertainty for an advantageous strategy was related to SANS scores in schizophrenia.
• Big penalties affected learning in controls, but not patients suffering from schizophrenia with or without certainty.

BackgroundDefective decision-making is a symptom of impaired cognitive function observed in patients with schizophrenia. Impairment on the Iowa Gambling Task (IGT) has been reported in patients with schizophrenia, but these results are inconsistent among studies.MethodsWe differentiated subjects based on whether they expressed certainty at having deciphered an advantageous strategy in the course of the task. We investigated this impairment using the IGT in patients with schizophrenia and performed analysis different to standard advantageous decks minus disadvantageous decks in all 100 card choices, [C+D]–[A+B](1–100). We examined the effects on behavior after receiving a big penalty.ResultsResults were dependent on participants utilizing with or without certainty, the best strategy for positive gain. Schizophrenic patients without certainty failed to show card choice shift, from disadvantageous to advantageous decks. Differences in card choices on the IGT were clearly shown between patients with schizophrenia and normal controls by the use of improvement from block 1 to blocks 3–5, [C+D]–[A+B]([41–100]–[1–20]) (P < 0.001), rather than by the composite value of blocks 3–5, [C+D]–[A+B](41–100) (P = 0.011). The deficit of emotion-based learning in schizophrenia without uncertainty were related to scores on the SANS and S5 attention. In addition, S1 affective flattering and S4 anhedonia–asociality were also related to these deficits. For a while, normal controls showed a smooth shift from disadvantageous to advantageous decks after big penalties, with or without a certainty for strategy. However, patients with schizophrenia failed to show switching from disadvantageous to advantageous decks, even after big penalties, under the same conditions.ConclusionsOur results highlight certainty of strategy and behavior after a big penalty, as two points of difference between patients with schizophrenia and normal controls in the accumulation of net scores.