Investigation of decision-making under uncertainty in healthy subjects: a multi-centric fMRI study.

Decision-making is an everyday routine that entails several subprocesses. Decisions under uncertainty occur when either prior information is incomplete or the outcomes of the decision are unclear. The aim of the present study was to disentangle the neural correlates of information gathering as well as reaching a decision and to explore effects of uncertainty acceptance or avoidance in a large sample of healthy subjects. Sixty-four healthy volunteers performed a decision-making under uncertainty task in a multi-center approach while BOLD signal was measured with fMRI. Subjects either had to indicate via button press from which of two bottles red or blue balls were drawn (decision-making under uncertainty condition), or they had to indicate whether 8 red balls had been presented (baseline condition). During the information gathering phase (contrasted against the counting phase) a widespread network was found encompassing (pre-)frontal, inferior temporal and inferior parietal cortices. Reaching a decision was correlated with activations in the medial frontal cortex as well as the posterior cingulate and the precuneus. Effects of uncertainty acceptance were found within a network comprising of the superior frontal cortex as well as the insula and precuneus while uncertainty avoidance was correlated with activations in the right middle frontal cortex. The results depict two distinct networks for information gathering and the indication of having made a decision. While information-gathering networks are modulated by uncertainty avoidance and - acceptance, underlying networks of the decision itself are independent of these factors.

Attenuated prefrontal activation during decision-making under uncertainty in schizophrenia: a multi-center fMRI study.

Decisions are called decisions under uncertainty when either prior information is incomplete or the outcomes of the decision are unclear. Alterations in these processes related to decisions under uncertainty have been linked to delusions. In patients with schizophrenia, the underlying neural networks have only rarely been studied. We aimed to disentangle the neural correlates of decision-making and relate them to neuropsychological and psychopathological parameters in a large sample of patients with schizophrenia and healthy subjects. Fifty-seven patients and fifty-seven healthy volunteers from six centers had to either indicate via button-press from which of two bottles red or blue balls were drawn (decision-making under uncertainty condition), or indicate whether eight red balls had been presented (baseline condition) while BOLD signal was measured with fMRI. Patients based their decisions on less conclusive evidence and had decreased activations in the underlying neural network, comprising of medial and lateral frontal as well as parietal areas, as compared to healthy subjects. While current psychopathology was not correlated with brain activation, positive symptoms led to longer decision latencies in patients. These results suggest that decision-making under uncertainty in schizophrenia is affected by a complex interplay of aberrant neural activation. Furthermore, reduced neuropsychological functioning in patients was related to impaired decision-making and task performance was modulated by distinct positive symptoms.

[Early onset psychosis: rationale and concept of a cognitive-behavioral intervention]. / Jugendliche mit psychotischen Störungen: Rationale und Konzept einer kognitiv-verhaltenstherapeutischen Intervention.

Early onset psychoses (EOP, age of onset between age 14 and 18 years) are known to be associated with a poorer outcome than adult onset psychoses, both in terms of psychotic symptoms and social remission. For adult patients with psychosis, numerous cognitive-behavioral interventions have proven their effectiveness in recent years. This contrasts with a dearth of findings for EOP, even though it can be considered as a variant of adult onset psychosis. Thus, we have developed a cognitive-behavioral therapy intervention that was specifically adapted to the characteristics and needs of young people suffering from psychosis. The concept of the intervention is outlined in the present article. Acceptability and feasibility of the intervention are currently undergoing evaluation in a randomised, controlled pilot study.

[Psychological therapy of patients with schizophrenia: Trend of the concept development]. / Psychologische Therapie schizophren Erkrankter - Trend der Konzeptentwicklung.

In the first stage of the application of behavioral methods the improvement of the level of function in the social environment was in the lime-light. In the single case the restoration of a structured daily routine represents the presupposition for a cognitive therapy. Its aim is the building up of intrapsychic controlling processes that support the structuring of embarrassing experiences. E.g., it is possible by controlled introspection to identify stressors, perceived by the patients themselves, leading to overstrain-reactions. The reduced capacity to be subjected to stress has to be made understandable to the patient who is encouraged to intentionally use avoiding reactions. By the insight in such connections the problem is comprehended and the anxiety reduced. In the psychoeducation the instruction of the family members about basic symptoms proved to be useful to put the behavior of the patients in the right place and to correct misunderstandings. A skeleton-concept is needed, containing many individual components that can be variably used. The completion of these components is the aim, because the very heterogeneous features of the residual syndromes of schizophrenic disorders require such an "open concept".

Reversible enlargement of cerebral spinal fluid spaces in chronic alcoholics.

Repeat computed tomography (CT) and clinical examinations, including psychologic tests, were performed in 15 chronic alcoholics. In nine controlled abstinent patients, marked decrease of cerebrospinal fluid space enlargement was visible on CT, corresponding with clinical improvement. A second CT examination after 1 year showed continued improvement in three successfully treated patients. The recovery of cortical and ventricular enlargements was encountered with equal frequency, although the more striking change was in the cortex. Possible underlying pathogenetic processes were considered.