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      Decision Making Impairment: A Shared Vulnerability in Obesity, Gambling Disorder and Substance Use Disorders?

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          Abstract

          Introduction

          Addictions are associated with decision making impairments. The present study explores decision making in Substance use disorder (SUD), Gambling disorder (GD) and Obesity (OB) when assessed by Iowa Gambling Task (IGT) and compares them with healthy controls (HC).

          Methods

          For the aims of this study, 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) were assessed according to DSM criteria, completed a sociodemographic interview and conducted the IGT.

          Results

          SUD, GD and OB present impaired decision making when compared to the HC in the overall task and task learning, however no differences are found for the overall performance in the IGT among the clinical groups. Results also reveal some specific learning across the task patterns within the clinical groups: OB maintains negative scores until the third set where learning starts but with a less extend to HC, SUD presents an early learning followed by a progressive although slow improvement and GD presents more random choices with no learning.

          Conclusions

          Decision making impairments are present in the studied clinical samples and they display individual differences in the task learning. Results can help understanding the underlying mechanisms of OB and addiction behaviors as well as improve current clinical treatments.

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          Most cited references20

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          Deciding advantageously before knowing the advantageous strategy.

          Deciding advantageously in a complex situation is thought to require overt reasoning on declarative knowledge, namely, on facts pertaining to premises, options for action, and outcomes of actions that embody the pertinent previous experience. An alternative possibility was investigated: that overt reasoning is preceded by a nonconscious biasing step that uses neural systems other than those that support declarative knowledge. Normal participants and patients with prefrontal damage and decision-making defects performed a gambling task in which behavioral, psychophysiological, and self-account measures were obtained in parallel. Normals began to choose advantageously before they realized which strategy worked best, whereas prefrontal patients continued to choose disadvantageously even after they knew the correct strategy. Moreover, normals began to generate anticipatory skin conductance responses (SCRs) whenever they pondered a choice that turned out to be risky, before they knew explicitly that it was a risky choice, whereas patients never developed anticipatory SCRs, although some eventually realized which choices were risky. The results suggest that, in normal individuals, nonconscious biases guide behavior before conscious knowledge does. Without the help of such biases, overt knowledge may be insufficient to ensure advantageous behavior.
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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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              Neural correlates of food addiction.

              Research has implicated an addictive process in the development and maintenance of obesity. Although parallels in neural functioning between obesity and substance dependence have been found, to our knowledge, no studies have examined the neural correlates of addictive-like eating behavior. To test the hypothesis that elevated "food addiction" scores are associated with similar patterns of neural activation as substance dependence. Between-subjects functional magnetic resonance imaging study. A university neuroimaging center. Forty-eight healthy young women ranging from lean to obese recruited for a healthy weight maintenance trial. The relation between elevated food addiction scores and blood oxygen level-dependent functional magnetic resonance imaging activation in response to receipt and anticipated receipt of palatable food (chocolate milkshake). Food addiction scores (N = 39) correlated with greater activation in the anterior cingulate cortex, medial orbitofrontal cortex, and amygdala in response to anticipated receipt of food (P < .05, false discovery rate corrected for multiple comparisons in small volumes). Participants with higher (n = 15) vs lower (n = 11) food addiction scores showed greater activation in the dorsolateral prefrontal cortex and the caudate in response to anticipated receipt of food but less activation in the lateral orbitofrontal cortex in response to receipt of food (false discovery rate-corrected P < .05). Similar patterns of neural activation are implicated in addictive-like eating behavior and substance dependence: elevated activation in reward circuitry in response to food cues and reduced activation of inhibitory regions in response to food intake.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                30 September 2016
                2016
                : 11
                : 9
                : e0163901
                Affiliations
                [1 ]Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
                [2 ]CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
                [3 ]Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
                [4 ]Integrated Pharmacology and Systems Neurosciences Research Group, Neuroscience Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain, Pompeu Fabra University (CEXS-UPF), Barcelona, Spain
                [5 ]Department of Psychological, Personality, Evaluation and Treatment of the University of Valencia, Valencia, Spain
                [6 ]Department of Basic Psychology, Clinic and Psychobiology of the University Jaume I, Castelló, Spain
                [7 ]Endocrine Division, Complejo Hospitalario U. de Santiago, Santiago de Compostela University, Santiago de Compostela, Spain
                [8 ]Department of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
                [9 ]Department of Diabetes, Endocrinology and Nutrition, Institut d’Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain
                [10 ]Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
                [11 ]Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
                [12 ]CIBER Salud Mental (CIBERsam), Instituto Salud Carlos III, Madrid, Spain
                Ariel University, ISRAEL
                Author notes

                Competing Interests: I have read the journal's policy and one of the authors of this manuscript have the following competing interests: Susana Jimenez Murcia is an academic editor of this journal.

                • Conceptualization: NMB ABF SJM FFA.

                • Formal analysis: NMB RG.

                • Funding acquisition: JM FFA RT CB FFC JCFG JMFR FJO.

                • Investigation: NMB ABF RMB CB FFC ABC JCFG JMFR GF AR ITS FJO FJT EAM CO.

                • Methodology: NMB ABF SJM RT JAM FFA.

                • Project administration: NMB ABF SJM FFA.

                • Resources: SJM FFA RT RMB CB FFC ABC JCFG JMFR GF FJO FJT EAM CO.

                • Supervision: SJM FFA.

                • Validation: SJM RT RMB CB FFC ABC FFA.

                • Visualization: NMB ITS.

                • Writing – original draft: NMB ABF RG.

                • Writing – review & editing: SJM RT RMB CB FFC ABC JCFG JMFR GF RG AR ITS FJO FJT EAM CO JMM FFA.

                ‡ These authors share first authorship.

                Author information
                http://orcid.org/0000-0002-2968-9898
                Article
                PONE-D-16-11698
                10.1371/journal.pone.0163901
                5045161
                27690367
                abfa7433-b303-4300-8a5d-f1a9561e2e00
                © 2016 Mallorquí-Bagué et al

                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, provided the original author and source are credited.

                History
                : 21 March 2016
                : 18 September 2016
                Page count
                Figures: 1, Tables: 2, Pages: 11
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100004587, Instituto de Salud Carlos III;
                Award ID: FIS PI14/290 and CIBERobn
                Award Recipient :
                Funded by: Fondos Europeos de Desarrollo Regional (FEDER)
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100003329, Ministerio de Economía y Competitividad;
                Award ID: PSI2015-68701-R
                Award Recipient :
                Funded by: Servicio Andaluz de Salud (SAS)
                Award ID: B00332014
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100002809, Generalitat de Catalunya;
                Award ID: 2014SGR 680; 2014SGR 1672
                Award Recipient :
                This manuscript was supported by grants from Instituto Salud Carlos III (ISCIII; FIS PI14/00290 and CIBERobn) and co-funded by Fondos Europeos de Desarrollo Regional (FEDER) funds - a way to build Europe, and AGAUR (2014 SGR 1672). This manuscript was co-funded by Ministerio de Economía y Competitividad (PSI2015-68701-R). CIBERobn and CIBERSAM are both initiatives of ISCIII. Jose C. Fernández-García is recipient of a research contract from Servicio Andaluz de Salud (SAS) (B-0033-2014). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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