Patients on the psychosis spectrum employ an alternate brain network to engage in complex decision-making

Kanchna Ramchandran; Jess Fiedorowicz; Zhaoying Chen; Yilin Bu; Antoine Bechara; Nancy C Andreasen

doi:10.1371/journal.pone.0238774

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Patients on the psychosis spectrum employ an alternate brain network to engage in complex decision-making

Journal article

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Patients on the psychosis spectrum employ an alternate brain network to engage in complex decision-making

Kanchna Ramchandran, Jess Fiedorowicz, Zhaoying Chen, Yilin Bu, Antoine Bechara and Nancy C Andreasen

PloS one, Vol.15(9), pp.e0238774-e0238774

09/01/2020

DOI: 10.1371/journal.pone.0238774

PMCID: PMC7485831

PMID: 32915832

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Abstract

Brain reward processing mechanisms that underlie complex decision-making are compromised in psychosis. The goal of this research was to advance our understanding of the underlying (1) neural mechanisms and (2) discrete neuro-economic/motivational processes that may be altered in complex decision-making in euthymic patients on the psychosis spectrum (PPS). Utilizing a functional magnetic resonance neuroimaging (fmri) paradigm of a well-validated laboratory measure of complex decision-making (Iowa Gambling Task-IGT), the brain activation patterns of a target group of PPS were compared to a demographically matched healthy comparison group (HMC). These two groups were also evaluated on real-life decision outcomes on day of scan. PPS primarily activate the Dorsal Attentional Network (DAN) in real-life decision outcomes and in achieving similar levels of performance on the IGT as the HMC, in-spite of dysregulated dopamine-based brain-reward circuit and salience network fmri activation patterns. However, PPS report more significant negative outcomes of their decision-making in real-life, compared to HMC. The differential engagement of brain networks by PPS on the IGT appear to be moderated by antipsychotic, dopamine antagonist, medication lifetime/daily dose levels. These findings may also be mediated by extent of dysregulation in brain reward circuitry and salience network associated with psychosis severity in the target PPS group. This is also evident in case studies of unmedicated PPS. We conclude by suggesting that the brain may adapt to this dysregulation by co-opting the DAN network, which is implicated in the related function of problem-solving, towards complex decision-making. The extent of utilization of the DAN network in complex decision-making may be moderated by psychosis severity.

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Title: Subtitle: Patients on the psychosis spectrum employ an alternate brain network to engage in complex decision-making
Creators: Kanchna Ramchandran
Jess Fiedorowicz
Zhaoying Chen
Yilin Bu
Antoine Bechara
Nancy C Andreasen
Resource Type: Journal article
Publication Details: PloS one, Vol.15(9), pp.e0238774-e0238774
DOI: 10.1371/journal.pone.0238774
PMID: 32915832
PMCID: PMC7485831
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: Public Library of Science; San Francisco, CA USA
Grant note: 18,518,500 / ; R01 MH040856-26S1 / ; 19,402 / ;
Alternative title: Psychosis and dopamine brain reward circuitry
Language: English
Date published: 09/01/2020
Academic Unit: Psychiatry; Epidemiology; Iowa Neuroscience Institute; Internal Medicine
Record Identifier: 9984070713002771

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