Toward an Understanding of Decision Making in Severe Mental Illness

Summary & key facts

The authors looked over many studies to understand why people with serious psychiatric illnesses often make poor decisions. They focused on brain-science research and found that people with depression show trouble feeling rewarded, learning from bad outcomes, and choosing delayed rewards over immediate ones. People with bipolar disorder and schizophrenia also show thinking problems that make it hard to change behavior when the situation changes. The paper suggests that thinking about these decision problems as a group could help create treatments that aim to improve everyday life for these patients, though this is still a proposal rather than a proven solution.

Key facts:

• People with major psychiatric disorders often make poor decisions, and those decision problems are tied to worse real-life outcomes like trouble at work or in relationships.
• The authors reviewed research across fields, with a special look at findings from brain science that study how people make choices.
• In depression, studies report three kinds of decision problems: reduced sensitivity to rewards (less pleasure or motivation from good things), trouble with avoidance learning (difficulty learning from negative outcomes), and stronger prefer
• People with bipolar disorder and schizophrenia show other thinking distortions beyond loss of pleasure. These distortions affect the flexible control of behavior, meaning they can struggle to adjust their actions when situations change.
• The paper proposes a clear way to think about abnormal decision making in mental illness. The authors say this framework could help design targeted treatments to improve quality of life and clinical results, but this idea still needs testin

Abstract

A commonality of patients with major psychiatric disorders is their propensity to make poor decisions, which is intimately related to poor real-life outcomes. The authors reviewed the literature on decision making as applied to severe psychiatric disorders, with particular focus on advances in cognitive neuroscience. Deficits in reward sensitivity, avoidance learning, and temporal discounting are reported in depression. Besides abnormalities in hedonic capacity, other cognitive distortions required for flexible control of behavior occur in patients with bipolar disorder and schizophrenia. A conceptual framework of abnormal decision making in mental illness could generate targeted interventions to improve quality of life and clinical outcomes.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health and Psychiatry Schizophrenia research and treatment

Categories

Health Sciences Medicine Psychiatry and Mental health

Tags

Cognition Medicine Mental health Mental illness Psychiatry Psychology

Conditions & symptoms

Depression Lack of energy or motivation Sadness or low mood