A prospective study of the effects of behavioral symptoms on the institutionalization of patients with dementia

BACKGROUND: Reports in the literature on the effects of behavioral problems in patients with dementia on the decision to institutionalize the patient have shown conflicting results. Few studies have taken into account the possibility that specific behavioral problems may have differential effects on the decision to institutionalize the patient. Moreover, it is probably not patient behavior itself that causes nursing home placement (NHP), but caregivers' emotional reaction to it. The aim of the present study was to examine the impact of specific behavioral subsyndromes and caregivers' emotional reaction on NHP. METHODS: A total of 119 patients with dementia and their informal caregivers were followed up for 2 years. Time to NHP was measured in months from the date of the baseline interview to the date of NHP. Behavioral disturbances in the patient and caregivers' emotional reactions were measured with the Neuropsychiatric Inventory (NPI). Cox regression analyses were used to determine the probability that caregivers would institutionalize the patient when patient behavioral problems or caregiver distress were present at baseline. RESULTS: Forty-one percent of the patients were institutionalized during the 2-year follow-;up. Caregiver distress related to patient behavior was a significant predictor of NHP, while behavior in itself did not predict NHP. Contrary to our expectations, we did not find a differential impact of specific aspects of problem behavior. Children caregivers, especially daughters, were associated with shorter time to NHP compared to spouses. CONCLUSIONS: Our findings indicate that the caregiver's emotional reaction to patient behavior is more important than problem behaviors per se in the decision to institutionalize patients. Interventions aimed at teaching caregivers strategies to better manage difficult patient behaviors may provide caregivers with the necessary resources to continue care at home. Future interventions need to account for the specific needs and problems of different caregiver groups.     

Validity of median nerve somatosensory evoked potentials in the diagnosis of supraclavicular brachial plexus lesions

Experience with median nerve SEPs in the diagnosis of brachial plexus lesions is analysed in 49 patients selected from a total material of 264 cases with brachial plexus problems tested by SEP techniques. Median nerve SEPs were always compared with the results of SEPs after stimulation of at least one other nerve relevant to the site of the lesion as suspected clinically and electromyographically. All patients presented with unilateral brachial plexus problems and all root lesions were verified by clinical presentation, EMG studies, myelogram or surgery. There were 19 brachial plexus injuries, 13 cases with cervical spondylopathic radiculopaties without myelopathy and 7 patients presented brachial plexopathy with systemic cancer. It was found that median nerve SEPs were always normal in injuries of upper trunk and root avulsions confined to one or two root levels. Median nerve SEPs were abnormal in multiple trunk lesions and multiple root avulsions. In patients with spondylopathic radiculopathies median nerve SEPs were normal apart from one case where involvement of multiple roots was present. Median nerve SEPs were useful in assessing patients presenting brachial plexus problems in the presence of systematic cancer apart from cases where lower trunk involvement was present. In general, median nerve SEPs are useful if they are combined with SEP testing of other nerves anatomically more closely related to the problem as outlined clinically and electromyographically.     

Cerebrospinal fluid formula in patients with central nervous system infection

Knowledge of the CSF formula is clinically useful and at times critical in the analysis of a number of diagnostic problems presented by patients with CNS infections. The decision to withhold antimicrobial therapy in the patient with an acute meningitis syndrome, when viral etiology is suspected, is justified in the presence of a polymorphonuclear cellular reaction provided the CSF glucose is greater than 45 mg per dl and the protein less than 130 mg per dl. Patients who fail to improve clinically should be retapped in 8 to 12 hours. A persisting PMN reaction or the combination of a PMN pleocytosis and hypoglycorrachia virtually rules out viral infection and, in the face of negative routine cultures, requires a diligent search for focal parameningeal suppuration and consideration of CNS tuberculosis and fungal infection. Careful re-evaluation of the patient emphasizing factors such as duration of illness and potential sites of parameningeal suppuration will be useful in guiding further diagnostic studies. Head CT scanning including views of the sphenoid sinuses may be especially helpful in this regard.     

Towards Diffractive Transdisciplinarity: Integrating Gender Knowledge into the Practice of Neuroscientific Research

The current neurosciences contribute to the construction of gender/sex to a high degree. Moreover, the subject of gender/sex differences in cognitive abilities attracts an immense public interest. At the same time, the entanglement of gender and science has been shown in many theoretical and empirical analyses. Although the body of literature is very extensive and differentiated with regards to the dimensions of ??neuroscience of gender?? and ??gender in neuroscience??, the feeding back of these findings into the field of neuroscience remains a desideratum. Especially, the question of how gender knowledge, i.e. insights from feminist theory on gender/sex and from gender and science studies on knowledge production, may be integrated and applied within the neurosciences has been strongly neglected. Presumably due to their epistemic culture and epistemological presuppositions, these critical engagements are conceived as externalist by critical scholars and neuroscientists alike. In this context, the question arises of how substantiated gender knowledge may be accounted for in neuroscientific research practice? The article outlines methodological considerations for a critical research agenda in the cognitive neurosciences. I present thoughts on how insights and expertise from gender and science studies can be taken into account in the neuroscientific practice of knowledge production. Starting from the assumption that changes in neuroscientific research practices are possible, my aim is to point out possibilities of integrating gender knowledge into the neurosciences.     

Informed Consent and Decision‐Making Capacity in Neuromodulation: Ethical Considerations

In neuromodulation treatment and research, the informed consent of the patient or research subject is considered to be a moral precondition. In order to be morally valid, the consent of the person should be informed and voluntarily given, and the person should have decision‐making capacity. Decision‐making capacity matters from a moral point of view because it enables the patient or research subject to make a well‐considered decision about treatment or research participation. Decision‐making capacity is an ideal and in the practice of neuromodulation may be compromised as a result of different circumstances. These may be internal or external. Internal are factors related to illness (ie, cognitive and emotional defects; feelings of desperation and hopelessness); external are factors related to the context (ie, shortcomings in patient education and communication). In this paper, it is argued that full decision‐making capacity in the context of neuromodulation is an illusion. This does not imply that we should do away with the moral ideals of decision‐making capacity and valid informed consent. It is part of the responsibility of clinicians involved in neuromodulation to be aware of and sensitive to the different threats to the decision‐making capacity of patients suffering from neurological and neuropsychiatric disorders, and to assist patients in making decisions that are as well considered as possible in the given circumstances.     

The numbers needed to treat for neurological disorders

BACKGROUND: Numerous therapeutic interventions have been developed in the neurosciences. Clinicians need summary measures about efficacy of therapies that derive from the best available evidence, and that can be readily extrapolated to clinical practice. The number needed to treat (NNT) is intuitive and clinically applicable. We provide clinicians with a single source that summarizes important therapies in the main neurological and neurosurgical areas. METHODS: Critically appraised evidence about therapies in the neurosciences was obtained from meta-analyses in all neurosciences groups in the Cochrane library, and from critically appraised topics at the University of Western Ontario. Therapies were included if they were deemed relevant and if outcomes were dichotomous. For each therapy, we obtained absolute risk differences and their 95% confidence intervals (CI), the corresponding NNTs, control and experimental event rates, and the time-frame of the outcome assessment. RESULTS: We assembled a table of NNTs for 87 interventions in ten disease categories, deriving from meta-analyses (70%) or randomized controlled trials (30%), and assessing surgical interventions (7%), procedures (9%) or pharmacological treatments (84%). The NNTs varied widely, ranging from 1 in the use of epidural blood patch for post-dural puncture headache to 4608 for meningococcal vaccination. Preventative interventions had substantially larger NNTs. Time-frames were inappropriately short for many chronic conditions. CONCLUSIONS: Large collections of NNTs provide useful, updateable summaries of therapeutic effects in the neurosciences, an increasingly interventional clinical field.     

The Modern Clinical Neuroimager: Leading the Next Generation in Stroke

The recent culmination of imaging‐endowed endovascular stroke trials has decisively proven the utility of clinically relevant neuroimaging in improving the outcome of patients with potentially debilitating neurological disorders. These large multicenter trials conducted across several continents notably utilized a variety of multimodal CT/MRI modalities to rapidly identify a favorable collateral profile that presages clinically beneficial revascularization. The modern clinical neuroimager may accelerate complex decision‐making through the rational use of a variety of imaging modalities and an active feedback loop of imaging at the bedside. The modern clinical neuroimager is often the initial care provider for a wide range or type of stroke patients from hemorrhage to ischemia, armed with the incredibly important aspects of clinical history and examination findings and best poised to utilize imaging to guide therapy from acute stroke to recovery and prevention. The next generation in stroke should not exclusively focus on whether to order a CT or MRI counting minutes at the bedside, but actively and efficiently integrate the vast wealth of information available when imaging is used in the proper clinical context. The novel endovascular era in stroke provides an ideal venue for the synergistic goals of translating research advances, improving patient outcomes and ongoing education as a modern neuroimager.     

Schizophrenia research participants' responses to protocol safeguards: recruitment, consent, and debriefing

OBJECTIVE: To examine the perspectives and preferences regarding ethically important aspects of recruitment, consent, and debriefing of people with schizophrenia who volunteered for research protocols. METHOD: A structured interview to assess research-related views of people with schizophrenia was developed and piloted. Data collection occurred at three sites. For this analysis, we examined the subset of responses from schizophrenia patients currently enrolled in a protocol. RESULTS: Data from 28 schizophrenia research volunteers were analyzed. Of these, 22 were men and 11 were voluntary inpatients. Most (n=23) recalled speaking with someone before enrolling in the protocol, and most (n=26) reported trusting the person who told them about it. Participants reported a moderate understanding of their protocols. All but one person (n=27) remembered signing a consent form. Twenty-one volunteers indicated that consent forms are meant to help both the patient and the researcher. Most (n=23) reported making the enrollment decision alone, with 22 making this decision prior to reviewing the consent form. The decision was described as relatively easy. Respondents felt some pressure to enroll, with women experiencing more pressure. Debriefing practices were strongly endorsed by participants. All 28 of the volunteers wished to be informed if a health problem (i.e., "something wrong") was discovered during the protocol. CONCLUSION: The persons living with schizophrenia who were interviewed for this project expressed interesting perspectives and preferences regarding ethically important aspects of recruitment, consent, and debriefing in clinical research that may help guide efforts to make research processes more attuned to participants and merit further inquiry.     

Progress in clinical neurosciences: measuring the benefit of therapies for neurological disorders

BACKGROUND: Clinicians in the neurosciences need to interpret and apply a growing body of evidence about therapy. METHODS: Using a clinical scenario about painful diabetic neuropathy and evidence about one treatment option, we review the advantages, limitations, and the clinical interpretation of commonly reported measures of effectiveness, emphasizing their application to the care of individual patients. RESULTS: Absolute differences between treatment and control groups (e.g., absolute risk difference) are clinically intuitive and preferable to relative measures (e.g., relative risk). The number needed to treat is particularly useful and clinically applicable. Continuous measures are best interpreted using thresholds of clinically important change, which provide information about the number of patients experiencing meaningful improvement or worsening. CONCLUSIONS: Using simple principles of evidence based care, clinicians can correctly interpret the common measures of treatment effectiveness and apply them to the care of individual patients.     

What is the current evidence on decision-making after referral for temporal lobe epilepsy surgery?: A review of the literature

OBJECTIVES: Many patients thought to have temporal lobe epilepsy, are evaluated for surgical treatment. Decision-making in epilepsy surgery is a multidisciplinary, phased process involving complex diagnostic tests. This study reviews the literature on the value of different tests to decide on whether to operate. METHODS: Articles were selected when based on the consensus decision whether to perform temporal lobe surgery, or on the consensus localization or lateralization of the epileptic focus. The articles were scrutinized for sources of bias as formulated in methodological guidelines for diagnostic studies (STARD). RESULTS: Most studies did not fulfill the criteria, largely because they addressed prognostic factors in operated patients only. Ten articles met our inclusion criteria. In most articles, a single test was studied; SPECT accounted for five papers. Unbiased comparison of the results was not possible. CONCLUSION: Surprisingly little research in epilepsy surgery has focused on the decision-making process as a whole. Future studies of the added value of consecutive tests are needed to avoid redundant testing, enable future cost-efficiency analyses, and provide guidelines for diagnostic strategies after referral for temporal lobe epilepsy surgery.     

Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia

Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision‐making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD‐CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD‐CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD‐CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment. © 2008 Movement Disorder Society     

Countertransference feelings in one year of individual therapy: an evaluation of the factor structure in the Feeling Word Checklist-58

Although countertransference phenomena have been given much attention within psychotherapy theory, single-case studies and clinical anecdotes, empirical research is still conspicuous by its absence. To assess the therapists' emotional reactions, which are understood to be part of the countertransference (CT), we used the Feeling Word Checklist 58 (R?ssberg, Hoffart, & Friis, 2003); a self-report questionnaire, comprising 58 feeling words. The aims of the present study were to examine the underlying factor structure and psychometric properties of these factors, and to validate the factors by exploring the relationships between countertransference feelings and the following variables: therapeutic alliance, patient personality pathology, suitability for psychodynamic therapy, interpersonal problems, level of general functioning, and symptoms. Six therapists, who treated 75 patients, with weekly, psychodynamic therapy, over 1 year, completed the checklist after each session. To establish the number of subscales in the checklist, a principal component analysis with promax rotation was conducted. The analysis revealed four clinically meaningful factors named Confident, Inadequate, Parental and Disengaged. The psychometric properties of all subscales proved to be acceptable. Alliance as reported by both patient and therapist showed differential correlations with the subscales. The patients' relational functioning showed stronger correlations with the CT feelings than the patients' symptoms and level of functioning. The four subscales found in the Feeling Word Checklist-58 seem to capture clinically meaningful aspects of the therapeutic dyad, and countertransference feelings are systematically related to different relational variables.     

"INTERMED": a method to assess health service needs. II. Results on its validity and clinical use

The validity and clinical use of a recently developed instrument to assess health care needs of patients with a physical illness, called INTERMED, is investigated. The INTERMED combines data reflecting patients' biological, psychological, and social characteristics with information on health care utilization characteristics. An example of a patient population in which such an integral assessment can contribute to the appropriateness of care, are patients with low back pain of degenerative or unknown origin. It supports the validity and the clinical usefulness of the INTERMED when clinically relevant subgroups in this heterogeneous population can be identified and described based on their INTERMED scores. The INTERMED was utilized in a group of patients (N = 108) having low back pain who vary on the chronicity of complaints, functional status, and associated disability. All patients underwent a medical examination and responded to a battery of validated questionnaires assessing biological, psychological, and social aspects of their life. In addition, the patients were assessed by the INTERMED. It was studied whether it proved to be possible to form clinically meaningful groups of patients based on their INTERMED scores; for this, a hierarchical cluster analysis was performed. In order to clinically describe them, the groups of patients were compared with the data from the questionnaires. The cluster analysis on the INTERMED scores revealed three distinguishable groups of patients. Comparison with the questionnaires assessing biological, psychological, and social aspects of disease showed that one group can be characterized as complex patients with chronic complaints and reduced capacity to work who apply for a disability compensation. The other groups differed explicitly with regard to chronicity, but also on other variables. By means of the INTERMED, clinically relevant groups of patients can be identified, which supports its use in clinical practice and its use as a method to describe case mix for scientific or health care policy purposes. In addition, the INTERMED is easy to implement in daily clinical practice and can be of help to ease the operationalization of the biopychosocial model of disease. More information on its validity in different patient populations is necessary.     

Accuracy of initial stroke subtype diagnosis. a decision analysis

BACKGROUND: The clinical diagnosis of stroke subtype is often inaccurate during the first 24 h after stroke onset. Several candidate diagnostic tests might be useful for early determination of subtype, but there is no consensus on what level of accuracy is required to be useful in the selection of patients for subtype-specific studies or therapies. METHODS: A decision analysis was developed to explore the treatment options and estimate the requisite threshold of diagnostic accuracy. Four management strategies were considered: treat all (TA), treat based on new test (TBNT), treat based on clinical diagnosis (TBCD) and treat none (TN). Sensitivity analyses were performed over a wide range of the assumptions in the model. RESULTS: The preferred treatment strategy was dependent on the probability and severity of adverse effects and the positive predictive value (PPV) of the proposed diagnostic test. For a potential therapy with infrequent (7.5%) but severe side effects, TN was preferable, but TBNT dominated if the PPV of the new test was at least 81%. For a therapy with frequent (25%) but mild adverse effects, TBNT was preferable. TA was favored for a therapy with infrequent and mild side effects and TN for a therapy with severe and frequent adverse events. TBCD was never the preferred option unless the PPV of the new test was less accurate than clinical diagnosis alone. CONCLUSIONS: Clinical diagnosis of stroke subtype is insufficient for patient selection, but a new diagnostic test with PPV >/=81% may be useful for early subtype diagnosis and patient selection for stroke subtype-specific clinical trials.     

In search of the neurobiological basis of decision making: explanation, reduction and emergence

In recent years, the study of decision making has provided a paradigmatic case of "crossbreeding" of different disciplines. The integration of economics, psychology and neurosciences within neuroeconomics calls for more accurate and comprehensive models of human rationality, which may be obtained by combining diverse theoretical approaches and experimental techniques. In this respect, neuroeconomics contributes to a naturalistic, brain-based, explanation of human agency. However, although contemporary naturalism insists on the unitary aspect of reality, we stress that supporting unitary study of nature is not the same as supporting a single, fundamental discipline to which all higher-order analyses could (or should) be reduced. We argue for integration, rather than reduction, as the best approach to a naturalistic explanation of human decision making, and we claim that supporting epistemological pluralism does not mean being committed to any specific ontological position. However, we suggest that an "emergentist" ontology is the best candidate to integrate the epistemological analysis here endorsed.     

Increased intra-subject reaction time variability in the volitional control of movement in schizophrenia

Increased Reaction Time (RT) studies intra-subject variability is an emerging and consistent finding in RT studies of schizophrenia. A group of 23 patients suffering from DSM-IV schizophrenia and a group of 23 age-matched control subjects performed two RT tasks requiring basic sensorimotor processing and engaging two different motor systems: the Finger Lift Reaction Time task and the Voluntary Saccade Reaction Time task. The Ex-Gaussian model was applied to the RT distributions measuring the mean (mu), and standard deviation (sigma) of a Gaussian component thought to reflect sensorimotor processing and an exponential component (tau), thought to reflect an intermediate decision process. In both tasks, a significantly larger RT intra-subject variability effectively dissociated patients from controls. RT intra-subject variability in the two tasks was highly correlated only for patients. Both sigma and tau were significantly higher in the patient group with tau being the best predictor of schizophrenia. Furthermore, only in the patient group were sigma and tau highly correlated between the two tasks. The results reflect a deficit in information processing that may not be confined to decision processes related to the frontal cortex; rather, they may indicate dysfunction in distributed neural networks modulating adaptive regulation of performance.     

Predicting survival using simple clinical variables: a case study in traumatic brain injury

OBJECTIVES—Predictionof patient outcome can be useful as an aid to clinical decision making,to explore possible biological mechanisms, and as part of the clinicalaudit process. Many studies have constructed predictive models forsurvival after traumatic brain injury, but these have often usedexpensive, time consuming, or highly specialised measurements. The aimof this study was to develop a simple easy to use model involving onlyvariables which are rapidly and easily clinically achievable in routine practice.
METHODS—Allconsecutive patients admitted to a regional trauma centre with moderateor severe head injury were enrolled in the study. Basic demographic,injury, and CT characteristics were recorded. Patient survival at 1 year was used to construct a simple predictive model which was thenvalidated on a very similar patient group.
RESULTS—372 patientswere included in the study, of whom 365 (98%) were followed up forsurvival at 1 year. Multiple logistic regression resulted in a modelcontaining age (p<0.001), Glasgow coma scale score (p<0.001), injuryseverity score (p<0.001), pupil reactivity (p=0.004), and presence ofhaematoma on CT (p=0.004) as independently significant predictors ofsurvival. The model was validated on an independent set of 520 patients, showing good discrimination and adequate calibration, butwith a tendency to be pessimistic about very severely injured patients.It is presented as an easy to use nomogram.
CONCLUSIONS—All fivevariables have previously been shown to be related to survival. Allvariables in the model are clinically simple and easy to measurerapidly in a centre with access to 24 hour CT, resulting in a modelthat is both well validated and clinically useful.

     

International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson's disease

Objective: The objective of this review was to update evidence‐based medicine recommendations for treating motor symptoms of Parkinson's disease (PD). Background: The Movement Disorder Society Evidence‐Based Medicine Committee recommendations for treatments of PD were first published in 2002 and updated in 2011, and we continued the review to December 31, 2016. Methods: Level I studies of interventions for motor symptoms were reviewed. Criteria for inclusion and quality scoring were as previously reported. Five clinical indications were considered, and conclusions regarding the implications for clinical practice are reported. Results: A total of 143 new studies qualified. There are no clinically useful interventions to prevent/delay disease progression. For monotherapy of early PD, nonergot dopamine agonists, oral levodopa preparations, selegiline, and rasagiline are clinically useful. For adjunct therapy in early/stable PD, nonergot dopamine agonists, rasagiline, and zonisamide are clinically useful. For adjunct therapy in optimized PD for general or specific motor symptoms including gait, rivastigmine is possibly useful and physiotherapy is clinically useful; exercise‐based movement strategy training and formalized patterned exercises are possibly useful. There are no new studies and no changes in the conclusions for the prevention/delay of motor complications. For treating motor fluctuations, most nonergot dopamine agonists, pergolide, levodopa ER, levodopa intestinal infusion, entacapone, opicapone, rasagiline, zonisamide, safinamide, and bilateral STN and GPi DBS are clinically useful. For dyskinesia, amantadine, clozapine, and bilateral STN DBS and GPi DBS are clinically useful. Conclusions: The options for treating PD symptoms continues to expand. These recommendations allow the treating physician to determine which intervention to recommend to an individual patient. © 2018 International Parkinson and Movement Disorder Society     

Clinical,immunohistochemical, Western blot,and genetic analysis in dystrophinopathy

Dystrophin-deficient muscular dystrophies (dystrophinopathies) are the most common form of muscular dystrophy, with variable clinical phenotypes ranging from the severe Duchenne (DMD) to the milder Becker (BMD) forms. In this study, we investigated the relationship between clinical characteristics, findings at immunohistochemistry (IHC) and Western blot, and the pattern of exon deletions in 24 male patients with dystrophinopathies. We retrospectively reviewed findings from clinical and laboratory examinations, IHC for dystrophin of muscle biopsy tissue, Western blot analysis, and multiplex polymerase chain reaction (PCR) examination of genomic DNA. All tests were performed in every patient. PCR examination revealed exon deletions in 13 patients (54.2%). At Western blot analysis, 15 patients (62.5%) were negative at all three dystrophin domains. Most of these patients had a clinical presentation consistent with the DMD phenotype. Nine (37.5%) others were weakly positive at one or more domains. Most of these patients presented clinically as BMD phenotype. One patient whose clinical presentation was consistent with BMD phenotype had normal findings at IHC and was weakly positive at all three domains on Western blot analysis; however, with the exception of this patient, the findings at IHC and Western blot were consistent for individual patients. Based on these findings, we conclude that Western blot analysis appears useful for confirmation of dystrophinopathy in BMD patients with normal staining on IHC. Exon deletion analysis by multiplex PCR using peripheral blood is also a simple and useful test for the diagnosis of dystrophinopathy, although it has limited sensitivity.     

Effects of context on risk taking and decision times in obsessive-compulsive disorder

Despite the fact that OCD patients show altered decision making in everyday life, few studies have investigated how patients make risky decisions and what contextual factors impact choices. We investigated cognitive context with the use of the “framing effect” task, which investigates decision making based on whether monetarily equivalent choice options are framed in terms of a potential to either lose (lose $20 out of $50) or gain (gain $30 out of $50) money. In addition, we manipulated social context by providing positive or neutral feedback on subjects’ choices. Overall, participants were risk taking for options framed in terms of potential loss and risk averse for options framed in terms of potential gain (the classic framing effect). Although OCD patients were generally more risk averse, the effect of the frame on choices did not differ significantly from healthy participants and choices were not impacted by social context. Within OCD patients, greater self-reported indecisiveness was associated with a larger effect of the frame on choices. OCD patients were also significantly slower to make choices in the loss compared to gain frame, an effect that was not observed among healthy participants. Overall, our results suggest that the framing of choice options has a differential effect on decision times but not the actual choices made by OCD patients, and that patients are not sensitive to social feedback when making choices. The correlation between indecisiveness and the framing effect in OCD suggests that further work interrogating the relationship between specific symptoms and decision making among patients may yield new insights into the disorder.