Decision-making Under Ambiguity Or Risk In Patients With Functional Dyspepsia

Objective: Brain-gut axis is the core mechanism of functional dyspepsia(FD).FD patients show abnormal mental and eating behaviors,and cognitive factors play an important role in the occurrence and development of FD.Decision making is an important part of cognitive function.It is a psychological judgment process.When individuals face with multiple options,they need to make corresponding choice by analyzing,comparing,and considering their emotion and desire,to maximize his own interests.It is divided into decision making under risk and decision making under ambiguity based on whether the probability of risk is clear or not.Neuroimaging studies have shown that most brain regions involved in decision-making are abnormal in FD patients.This study aimed to investigate the decision-making under ambiguity and risk in FD patients by classic test: Iowa Gambling Task(IGT)and Game of Dice Task(GDT).Methods: We recruited 40 FD patients meeting Rome III criteria and 40 healthy controls(HCs)matched for age,sex,marital status,and education level.Subjects with severe anxiety or severe depression were excluded by Hamilton Anxiety and Depression Scale.The dyspepsia symptoms of FD group were evaluated by Dyspepsia Symptom Severity Questionnaire,and the quality of life of FD patients was evaluated by Nepean Dyspepsia life quality index(NDLQI).The course of disease,the status of Helicobacter pylori infection and other clinical data were also recorded.In the IGT,the subjects need to choose cards when they are not familiar with the reward or punishment.They need to find out the rules through continuous learning and analysis and make best choice after.The IGT were divided into 5 blocks on average and subjects gradually learned the probability of rewards and punishments during the test.Thus,block1-2 was used to evaluate decision making under ambiguity while block3-5 was used to evaluate decision making under risk.The number of advantageous choices and disadvantageous choices were recorded,and the net score of block1-2 and block3-5 were calculated.In the GDT,subjects need to guess a dice and the probability of reward and punishment rule was explicit.The number of safe decision and risky decision were recorded,and the use of negative feedback were calculated to evaluate decision making under risk.Results: Study one:(1)In the IGT,(1)FD patients had a lower total net score(p = 0.036),chose more adverse choices(p = 0.036),the results suggested that FD patients had poor performance of IGT and tended to choose adverse choice;(2)FD patients’ net score of the last 3 blocks of the IGT was lower than that of HCs(p =0.007),but there was no significant difference in the net score of the first 2 blocks between FD patients and HCs(p = 0.904).FD patients showed impaired decision-making under risk rather than under ambiguity condition;(3)There were differences in the decision-making strategies between the two groups,especially in block3(p = 0.009),indicating FD patients showed a slower response to change their behavior than HCs.(2)In the GDT,(1)FD patients chose more risky decisions,they had lower total net score(p =0.000)and higher risk score(p =0.000)than HCs.the results suggested that FD patients tended to choose risky choice and showed impaired decision-making under risk;(2)There was no significant difference in the frequency of choices among the four options in FD patients(p >0.05).FD patients could not identify options with different risk types;(3)Univariate analysis showed that the GDT net score of patients with early satiation was higher than that of patients without early satiation(p =0.000).Multivariate analysis showed that the early satiation was positively associated with the total GDT net score(p =0.023).The deficiency of decision making might be related to dyspeptic symptoms of FD patients.Study two:(1)FD patients had higher SCL-90 score than HCs(p =0.000),indicating FD patients had poor mental health;(2)the score of phobia(p =0.048)and psychosis(p =0.005)in patients with early satiation was higher than that of patients without early satiation.The score of other domains(diet and sleep)in patients with epigastric pain was higher than that of patients without epigastric pain(p = 0.031).The score of phobia was negatively associated with the NDLQI(r =-0.418,p =0.021);(3)the net score of block1-2 in IGT was negatively associated with the score of depression(r =-0.408,p =0.025)and psychosis(r =-0.391,p =0.033).The use of negative feedback in GDT was positively associated with the score of other domains(r = 0.425,p =0.027).It suggested that the decision-making ability of FD patients might be related to their mental health.Conclusion: Study one: FD patients showed impaired decision-making under risk,preferred high risk/reward option,and could not improve the decision-making through negative feedback mechanism.The deficiency might be related to dyspeptic symptoms of FD patients.Study two: FD patients had poor mental health,which might be affected by epigastric pain and early satiation.The mental health was negatively correlated with the quality of life.The deficiency of decision-making in FD patients may be associated with poor mental health.