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      Think twice: Impulsivity and decision making in obsessive–compulsive disorder

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          Abstract

          Background and Aims

          Recent studies have challenged the anxiety-avoidance model of obsessive–compulsive disorder (OCD), linking OCD to impulsivity, risky-decision-making and reward-system dysfunction, which can also be found in addiction and might support the conceptualization of OCD as a behavioral addiction. Here, we conducted an exploratory investigation of the behavioral addiction model of OCD by assessing whether OCD patients are more impulsive, have impaired decision-making, and biased probabilistic reasoning, three core dimensions of addiction, in a sample of OCD patients and healthy controls.

          Methods

          We assessed these dimensions on 38 OCD patients and 39 healthy controls with the Barratt Impulsiveness Scale (BIS-11), the Iowa Gambling Task (IGT) and the Beads Task.

          Results

          OCD patients had significantly higher BIS-11 scores than controls, in particular on the cognitive subscales. They performed significantly worse than controls on the IGT preferring immediate reward despite negative future consequences, and did not learn from losses. Finally, OCD patients demonstrated biased probabilistic reasoning as reflected by significantly fewer draws to decision than controls on the Beads Task.

          Conclusions

          OCD patients are more impulsive than controls and demonstrate risky decision-making and biased probabilistic reasoning. These results might suggest that other conceptualizations of OCD, such as the behavioral addiction model, may be more suitable than the anxiety-avoidance one. However, further studies directly comparing OCD and behavioral addiction patients are needed in order to scrutinize this model.

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          Most cited references 79

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          Insensitivity to future consequences following damage to human prefrontal cortex.

          Following damage to the ventromedial prefrontal cortex, humans develop a defect in real-life decision-making, which contrasts with otherwise normal intellectual functions. Currently, there is no neuropsychological probe to detect in the laboratory, and the cognitive and neural mechanisms responsible for this defect have resisted explanation. Here, using a novel task which simulates real-life decision-making in the way it factors uncertainty of premises and outcomes, as well as reward and punishment, we find that prefrontal patients, unlike controls, are oblivious to the future consequences of their actions, and seem to be guided by immediate prospects only. This finding offers, for the first time, the possibility of detecting these patients' elusive impairment in the laboratory, measuring it, and investigating its possible causes.
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            Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gamblers and genetic association studies.

            There is a longstanding association between substance-use disorders (SUDs) and the psychological construct of impulsivity. In the first section of this review, personality and neurocognitive data pertaining to impulsivity will be summarised in regular users of four classes of substance: stimulants, opiates, alcohol and 3,4-methylenedioxymethamphetamine (MDMA). Impulsivity in these groups may arise via two alternative mechanisms, which are not mutually exclusive. By one account, impulsivity may occur as a consequence of chronic exposure to substances causing harmful effects on the brain. By the alternative account, impulsivity pre-dates SUDs and is associated with the vulnerability to addiction. We will review the evidence that impulsivity is associated with addiction vulnerability by considering three lines of evidence: (i) studies of groups at high-risk for development of SUDs; (ii) studies of pathological gamblers, where the harmful consequences of the addiction on brain structure are minimised, and (iii) genetic association studies linking impulsivity to genetic risk factors for addiction. Within each of these three lines of enquiry, there is accumulating evidence that impulsivity is a pre-existing vulnerability marker for SUDs.
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              Serotoninergic regulation of emotional and behavioural control processes.

              5-Hydroxytryptamine (5-HT, serotonin) has long been implicated in a wide variety of emotional, cognitive and behavioural control processes. However, its precise contribution is still not well understood. Depletion of 5-HT enhances behavioural and brain responsiveness to punishment or other aversive signals, while disinhibiting previously rewarded but now punished behaviours. Findings suggest that 5-HT modulates the impact of punishment-related signals on learning and emotion (aversion), but also promotes response inhibition. Exaggerated aversive processing and deficient response inhibition could underlie distinct symptoms of a range of affective disorders, namely stress- or threat-vulnerability and compulsive behaviour, respectively. We review evidence from studies with human volunteers and experimental animals that begins to elucidate the neurobiological systems underlying these different effects.
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                Author and article information

                Journal
                jba
                JBA
                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                2062-5871
                2063-5303
                December 2015
                21 December 2015
                : 4
                : 4
                : 263-272
                Affiliations
                [ 1 ]Department of Neurofarba, University of Florence , Florence, Italy
                [ 2 ]Department of Molecular and Developmental Medicine, University of Siena , Siena, Italy
                [ 3 ]Department of Psychiatry, Academic Medical Center, University of Amsterdam , Amsterdam, the Netherlands
                [ 4 ]Department of Mental Health, University of L’Aquila , L’Aquila, Italy
                Author notes
                [* ]Corresponding author: Giacomo Grassi, MD; Department of Neurofarba, University of Florence, via delle Gore 2H, 50141 Florence, Italy; Phone: 00390557949707; Fax: 0039055794707; E-mail: giacomograssimd@ 123456gmail.com
                Article
                10.1556/2006.4.2015.039
                4712760
                26690621
                © 2015 Akadémiai Kiadó, Budapest

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited.

                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 74, Pages: 28
                Funding
                Funding sources: No financial support was received for this study.
                Categories
                Full-Length Report

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