Capacity Of Decision-making Under Ambiguity And Decision-making Under Risk In Patients Of Antisocial Personality Disorder

ObjectiveVarious neuropsychological studies had shown that the decision-making deficits couldoccur in a wide range of patients with brain damages or dysfunctions. Abnormaldecision-making had been described as a key-concept to understand some behavioraldisturbances in patients of antisocial personality disorder. We aimed to investigate thecapacity of decision-making under ambiguity and under risk.MethodNeuropsychological performance was assessed with the Iowa Gambling Task (decisionsunder ambiguity) and the extensive neuropsychological test batteries in76ASPD(Antisocial Personality Disorder) patients and60HC（healthy controls）(Experiment1).Neuropsychological performance was assessed with the Game of DiceTask (decisions under risk) and the extensive neuropsychological test batteries in31ASPD patients and33HC (Experiment2). In addition, clinical variables (ZungSelf-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS),Mini-Mental State Examination (MMSE), The Barratt Impulsiveness Scale (BIS-11),Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), StroopColour and Word Test (SCWT), Verbal Fluency Test (VFT) and Digit Span Test (DS),Etc.) were evaluated using appropriate questionnaires on the same day. ResultsIn the Iowa Gambling Task, the ASPD group selected less advantageous cards (thenumber of cards selected from the advantageous decks minus the number of cardsselected from disadvantageous decks) than HC group ((-4.13±18.27)time,(6.03±19.43)time respectively)(t(134)=-3.132,P=0.002)). An2(group)×5(block) analysis ofvariance (ANOVA) on the cards of net advantageous from IGT revealed a significantmain effect of group (F(1,134)=9.811,P=0.002). The ANOVA also revealed a significantmain effect of block (F(4,536)=15.456,P＜0.001). The results showed that HC and ASPDgroup gradually shifted their selections toward the good decks as the game progresses.In the Game of Dice Task, the ASPD group, who selected more risky options (ASPD(10.06±5.26) time, HC (5.42±3.29) time, t=4.201, P<0.001), performed poorly inthe entire task, compared with HC. The most frequent choices made by the ASPDgroup were two numbers, while three numbers by the HC group (for choice of onenumber: the median of ASPD group was1(0to8);the median of HC was1(0to2.5);Z=-2.295, P=0.022; for choice of three numbers: ASPD (4.77±4.23) time; HC (6.79±3.43) time; t=－2.100,P=0.04; for choice of four numbers:ASPD (3.06±3.53)time;HC (5.82±3.41) time; t=3.176, P=0.002). The frequency of choosing the riskyoptions had significant correlation with the rate of using negative feedback (r=－0.613,P<0.001), impulsivity (r=0.481,P=0.006) and the result of Stroop test(r=0.566,P<0.001).ConclusionThese evidence showed that the ASPD patients displayed impairments in bothdecision-making under ambiguity and decision-making under risk. They also showedreduced ability to advantageously utilize the feedback. Decision-making under risk wereespecially compromised in patients who also demonstrated deficits in executive function. The deficit of decision-making for the ASPD might be due to the dysfunctionof the orbitofrontal cortex, ventromedial prefrontal cortex, dorsolateral frontal cortexand Amygdala, etc.