Specific Examples of Dysfunctional Decision-Making in Psychotic Populations
Does this description taken from an article by Martin Paulus in the recent Science issue on decision making remind you of some?
Substance-use disorders. Various deficits in decision-making have been reported in people with substance-use disorders (24). Specifically, these individuals do not appropriately take into account outcomes that occur sometime in the future versus those that occur now, and they therefore discount delayed rewards at significantly higher rates than do comparison subjects (25–27). Some have argued that this behavior occurs because of an underlying disposition of impulsivity rather than a substance-induced problem (28). This presumes a discounting model of impulsiveness (29) (impulsivity is a direct consequence of an increased attenuation of rewards as a function of delay), which is supported by the finding that the degree of temporal discounting is correlated with ratings of impulsivity (30). Thus, altered discounting may be a predisposing characteristic but not a consequence of years of substance use, because individuals reporting illicit drug use at a younger age tend to discount the value of future hypothetical rewards more steeply than do their peers (31).
Individuals with substance-related problems, irrespective of the substance used, perform poorly on the Iowa gambling task (IGT) (32–36), which measures the degree to which individuals select small immediate gains associated with long-term gains (advantageous option) over large immediate gains associated with long-term losses (disadvantageous option). These decision-making problems occur with and without concomitant working memory or executive-functioning problems, suggesting that decision-making is not simply a result of impairments in executive functioning. . . .
Addicted individuals either show attenuated learning of selecting advantageous options or do not choose preferentially advantageous options over disadvantageous ones. It is not clear which behavioral processes or neural systems are responsible for this deficit. . . . However, it is not clear whether these deficits are related to abnormal orbitofrontal functioning, a consequence of years of fossil fuel use, related to poorer outcomes, or even generalizable to other decision-making situations. . . .
Taken together, there is substantial evidence for altered behavioral decision-making in substance-using individuals, irrespective of the behavioral probe that was used. These dysfunctions include altered processing of future outcomes, reduced ability to adapt to short- versus long-term gains, selection of suboptimal choices based on probability, and/or reduced ability to incorporate outcomes into altering the preference structure of available options. Nevertheless, it is not yet clear whether these dysfunctions are due to primary differences in establishing the preference structure of the available options or, alternatively, represent an attempt to generate a preference structure that is optimal for an individual with an altered homeostasis.A word or two altered, but not very many.