Neuropsychological correlates of decision-making in ambiguous and risky situations.

Decision-making situations in real life differ regarding their explicitness of positive and negative consequences as well as regarding the directness of probabilities for reward and punishment. In neuropsychological research, decisions under ambiguity and decisions under risk are differentiated. To assess decisions under ambiguity the Iowa Gambling Task (IGT) is one of the most frequently used tasks. Decisions under risk can be measured by a task that offers explicit rules for gains and losses and stable winning probabilities, as the Game of Dice Task (GDT) does. In this contribution we firstly summarize studies that investigated decision-making in various groups of patients using the IGT or the GDT. We also propose a new model of decision-making in risky situations and describe differences between decisions under ambiguity and decisions under risk from a theoretical and clinical perspective.     

Increasing independent decision-making skills of women with mental retardation in simulated interpersonal situations of abuse

The effectiveness of two decision-making training approaches in increasing independent decision-making skills of 36 women with mild mental retardation in response to hypothetical social interpersonal situations involving abuse was evaluated. Participants were randomly assigned to a control or one of two training conditions (a decision-making training approach that either addressed both cognitive and motivational aspects of decision-making or included only instruction on the cognitive aspect of decision-making). Although both approaches were effective relative to a control condition, the combined cognitive and motivational training approach was superior to the cognitive only training approach. The superiority of this approach was also reflected on a verbally presented generalization task requiring participants to respond to a decision-making situation involving abuse from their own perspective and on a locus of control scale that measured perceptions of control.     

Pleasure seeking and birdsong

Songbirds sing at high rates within multiple contexts, suggesting that they are highly motivated to communicate and that the act of singing itself may be rewarding. Little is known about the neural regulation of the motivation to communicate. Dopamine and opioid neuropeptides play a primary role in reward seeking and sensory pleasure. In songbirds, these neurochemicals are found within brain regions implicated in both motivation and reward, including the medial preoptic nucleus (mPOA) and ventral tegmental area (VTA). Several lines of research indicate that dopamine and opioids in these regions play a role in birdsong that differs depending upon whether song is used to attract females (female-directed song) or is not directed towards other individuals (undirected song). Evidence is reviewed supporting the hypotheses: (1) that distinct patterns of dopamine activity influence the motivation to produce undirected and female-directed song, (2) that undirected communication is intrinsically reinforced by immediate release of opioids induced by the act of singing, and (3) that directed communication is socially reinforced by opioids released as part of social interactions.     

Pleasure in the Transitional Space: Intersubjectivity and Transformation

This article begins by reviewing psychoanalysis's conflicted relationship with pleasure as both a desired and feared goal. Freud implicitly changed his stance on pleasure as he elaborated the meaning of his grandson's fort-da game suggesting that pleasure is necessary for the mastery of loss and trauma. This article discusses several current theoretical aspects of pleasure including a phobic attitude towards pleasure and the experience of confusion and doubt within the transference–countertransference relationship that occurs as a result of shared moments of pleasure. I suggest that shared experiences of pleasure are inherent aspect of change in psychotherapy because they allow externalized disowned aspect of the self to become internalized as active, meaningful subjective experiences. A lengthy clinical illustration is presented in which songs are used as pleasurable and frightening transitional experiences that allow for the expression and symbolization of disowned aspects of the patient's self.     

Dissociation of emotional decision-making from cognitive decision-making in chronic schizophrenia

Recent studies have examined the decision-making ability of schizophrenic patients using the Iowa Gambling Task (IGT). These studies, however, were restricted to the assessment of emotional decision-making. Decision-making depends on cognitive functions as well as on emotion. The purpose of this study was to examine the performance of schizophrenic patients on the IGT and the Game of Dice Task (GDT), a decision-making task with explicit rules for gains and losses. In addition, it was intended to test whether poor performance on IGT is attributable to impairments in reversal learning within the schizophrenia group using the Simple Reversal Learning Task (SRLT), which is sensitive to measure the deficit of reversal learning following ventromedial prefrontal cortex damage. A group of 23 stable schizophrenic patients and 28 control subjects performed computerized versions of the IGT, GDT, SRLT and Wisconsin Card Sorting Test (WCST). While schizophrenic patients performed poorly on the IGT relative to normal controls, there was no significant difference between the two groups on GDT performance. The performance of the schizophrenia group on the SRLT was poorer than that of controls, but was not related to IGT performance. These data suggest that schizophrenic patients have impaired emotional decision-making but intact cognitive decision-making, suggesting that these two processes of decision-making are different. Furthermore, the impairments in reversal learning did not contribute to poor performance on the IGT in schizophrenia. Therefore, schizophrenic patients have difficulty in making decisions under ambiguous and uncertain situations whereas they make choices easily in clear and unequivocal ones. The emotional decision-making deficits in schizophrenia might be attributable more to another mechanism such as a somatic marker hypothesis than to an impairment in reversal learning.     

精神分裂症患者的情感体验和表达

背景:精神分裂症存在情感体验和表达障碍.然而,大多数以往研究往往只局限于情感体验(尤其是快感缺乏)或只针对表达.较少有同时研究精神分裂症患者情感体验和表达.目的:本研究旨在考察精神分裂症患者的快感体验和情感表达.尤其是,特别关注精神分裂症患者的情感障碍(包括快感体验和表达)和阴性症状之间的关系.方法:150例患者完成了愉快情绪体验量表(Temporal Experience of Pleasure Scale)和情感表达量表(Emoitonal Expressivity Scale)的评估.结果:精神分裂症患者表现出快感缺乏,但情感表达的能力完整.以阴性症状为主的精神分裂症患者在期待性愉快体验,尤其是抽象性期待愉快体验上的缺损更为明显结论:研究结果表明,精神分裂症患者存在出快感缺乏,但他们表达情感的能力似乎完好无损.快感缺乏尤以阴性症状为主的精神分裂症患者更为突出.     

Mentalizing in economic decision-making

In the Ultimatum Game, participants typically reject monetary offers they consider unfair even if the alternative is to gain no money at all. In the present study, ERPs were recorded while subjects processed different offers of a proposer. In addition to clearly fair and unfair offers, mid-value offers which cannot be easily classified as fair or unfair and therefore involve more elaborate decision making were analyzed. A fast initial distinction between fair and other kinds of offers was reflected by amplitude of the feedback related negativity (FRN). Mid-value offers were associated with longer RTs, and a larger N350 amplitude. In addition, source analyses revealed a specific involvement of the superior temporal gyrus and the inferior parietal lobule during processing of mid-value offers compared to offers categorized clearly as fair or unfair, suggesting a contribution of mentalizing about the intention of the proposer to the decision making process. Taken together, the present findings support the idea that economic decisions are significantly affected by non-rational factors, trying to narrow the gap between formal theory and the real decisional behaviour.     

Accountability in legal decision-making

Having to explain a decision has often been found to have a positive effect on the quality of a decision. We aimed to determine whether different accountability requirements for judges (i.e., having to justify their decision or having to explicate their decision) affect evidence use. Those requirements were compared to instructions based on the falsification principle and a control condition. Participants (N = 173) decided on the defendant’s guilt in a murder case vignette and explained their decision according to the instructions. The explication and falsification (but not the justification) instructions increased the use of exonerating evidence. There was no significant difference between the groups in guilt perception. The use of exonerating evidence was a significant positive predictor of acquittal rates. The implications for the different forms of instructions in practice are positive, but suggest a difference between the evidence considered and the evidence used to account for the decision.Key words: accountability, confirmation bias, falsification, legal decision-making

Although the process of legal decision-making has been the subject of a variety of theoretical explanations as well as experimental research, the insight into how judges reach a final decision remains limited. Some aspects of the decision-making process are known, as they are prescribed by law. A requirement for judges in several countries is that they are, to a certain extent, required to account for their decision (e.g. Art. 359 and 360 Dutch Code of Criminal Procedure, DCCP; Mevis, 2019). In previous research on decision accountability, researchers have suggested that such a requirement could substantially alter the decision-making process (Lerner & Tetlock, 2003). In the current study, we used lay participants to investigate whether variations in the instruction on how to account for a decision affect the evidence considered and the decision made on the guilt of a defendant.Reasoned judicial decisionsAs a judge can almost never know for sure what exactly happened, an inherent leap is required for them to become sufficiently convinced about what happened based on the information provided in the evidence. One of the elusive aspects of legal decision-making is how that leap is made. The need and requirements for explaining a decision differ between the various legal systems, but one common expectation is that the explanation will provide some sort of insight into the judicial decision on guilt in criminal legal proceedings. The most important question to be answered by the judge is whether the suspect committed the crime they are accused of (Dreissen, 2007). In order to answer this question, judges in the Netherlands will first study the case file, which is likely to consist of mainly incriminating information (Crombag, 2017), and will then be presented with the prosecution’s and the defence’s arguments at trial (Verbaan, 2016). The reasoned decision should make it clear that the rules regulating the use of evidence were followed. It can also be seen as an explanation of why the judge was convinced beyond a reasonable doubt that the accused committed the crime (Dreissen, 2007).Besides the requirements that the reasoned decision has to fulfil, there are several additional functions for why judges in the Netherlands must explain their decisions. Firstly, the explanation of their decision acts as justification for the punishment that follows for the convicted individual. Secondly, the reasoned decision is used to account for the decision to the general public. Thirdly, it informs the various parties involved in the legal proceedings. Lastly, the reasoned decision can serve as a potential quality control by other legal instances, such as the Supreme Court, although that rarely happens in practice (Dreissen, 2007; Verbaan, 2016). Furthermore, it has been argued by Gommer (2007) that there is a need for requiring an explanation due to the potential influence of thought-processes the decision-maker may not be aware of, such as biases. In theory, the explanation serves as a ‘rational reconstruction’ of what was considered by the judge for the decision (Gommer, 2007). National differences in accountability requirementsDifferent legal systems incorporate different instructions on how a decision should be accounted for. Scholars have compared the content of the Dutch requirement to the German requirement for explaining a decision (Dreissen, 2007; Mevis, 2019). Although there is little difference between the codes of criminal procedure in the Netherlands and Germany on that issue, the literature on the explanation requirements makes it clear that the German system imposes stricter requirements on the judge (Dreissen, 2007; Mevis, 2019; Simmelink, 2001). Whereas the German instructions could be interpreted as requiring an explication, the Dutch instructions could be interpreted as requiring a justification of the decision. In the German system, the judge has to account for their selection and evaluation of evidence, and to pay attention to facts that indicate an alternative, but not accepted, version of events (Dreissen, 2007; Mevis, 2019). Furthermore, there are specific requirements of evidence evaluation. For instance, in cases of contradicting witness statements, the judge has to consider how both statements came about, as well as to explain the discrepancies between them. In the written decision, the judge will have to account for the grounds of his reliability judgement. Overall, the German judge is required to provide a more in-depth explanation of the decision than the Dutch judge. In doing so, the judge shows the decision was made by a professional with integrity rather than by a purely subjective individual (Mevis, 2019).In the Netherlands, the requirements imposed on the judge to explain or motivate his decision are limited, due to the integrity and professionalism inherently expected of a judge (Mevis, 2019). The explanation provided by the judge does not have to be a reflection of the discussion or consideration that led to the decision. It suffices if the explanation contains arguments that, taken together, justify the decision that was rendered (Reijntjes & Reijnjes-Wendenburg, 2018). The point of view that the selection and evaluation of evidence do not require motivation, with a few exceptions, is in stark contrast to the extensive requirements in the German system (Mevis, 2019). Although Article 360 of the DCCP requires that the judge explicitly accounts for why they consider certain evidence to be reliable, it is limited to evidence where the reliability is questionable (e.g. vulnerable or anonymous witnesses). Compared to the Dutch standards, the German judge has an extensive duty to motivate the decision – the written decision not only needs to include the proven fact and the evidence used, but also needs to explain the selection and evaluation of evidence (Simmelink, 2001). The Supreme Court of the Netherlands appears to be lenient in enforcing the rules regarding the reasoned decision provided by the judge (Dreissen, 2007). The review of the decision by the Supreme Court remains limited following a change in the DCCP in 2005; the judge now explicitly has to explain why their decision differs from the substantiated arguments raised by either the prosecution or the defence. Thereby, the extent of the reasoned decision becomes dependent on the points raised by one of the parties (Dreissen, 2007). The differences between the Netherlands and Germany in their requirements for the reasoned decision raise the question of how these differences affect judges’ reasoning with evidence.Impact of accountability on reasoned decisionsThe need to account for the decision on guilt or innocence of the suspect thus appears to differ between legal systems. Researchers have identified several ways in which such accountability can affect the decision-making process (Lerner & Tetlock, 2003). A key aspect of accountability, which determines its effectiveness in reducing cognitive bias, is whether the requirement to account for a decision was known prior to making the decision. Prior accountability, as is the case for judges, is thought to encourage exploratory reasoning and making an optimal judgement, whereas post-decisional accountability has been found to increase confirmatory and self-justifying reasoning (Lerner & Tetlock, 1999).One of the frequently considered factors of accountability is the positive effect of having to explain the decision-making process (process accountability) versus having to explain the decision itself (outcome accountability; Tetlock, 1985). In light of the explanation required of judges in the Netherlands, it appears that their accountability is focused more on explaining the decision itself than on explaining the decision-making process that led to that decision. In fact, the Dutch Supreme Court has ruled that the reasoned decision does not have to reflect the evidence that was considered, but merely the evidence that the final decision could reasonably be based on. The reasoned decision is therefore not a valid reflection of the decision-making process but rather is focused on outcome accountability (Reijntjes & Reijnjes-Wendenburg, 2018).Another factor that has been found to moderate the effects of accountability on the decision-making process is the audience to whom the decision needs to be accounted for. Researchers have found evidence that the accountable persons shift their opinion towards the perceived opinion of the audience (e.g. Pennington & Schlenker, 1999). However, research on multiple audiences is lacking (Hall et al., 2015). In the case of judges, the audience may hold a range of opinions. For instance, the decision will likely be read by the defendant and their relatives, but possibly also by the complainant and their relatives, as well as the public and other judges. Furthermore, the court of appeal may also read it.Researchers investigating accountability have mainly focused on other areas of decision-making, and little research has been conducted into accountability in the context of legal decision-making. Tetlock (1983) investigated whether the influence of an initial impression of guilt can be affected by prior accountability. He found that those who initially received evidence against the defendant first were more likely to find him guilty, but that this primacy effect was reduced by prior accountability. Therefore, prior accountability seems to be able to prevent an initial belief from biasing a decision on guilt, which has obvious positive implications for the requirement of judges to explain their decision.     

Neuroimmunomodulation by nutrition in stress situations

Stress has long been suspected to play a role in the etiology of many diseases and may be detrimental to health. Nowadays, the communication between the neuroendocrine and the immune systems is well established and there is enough evidence that the magnitude of stress-associated immune dysregulation is large enough to have health implications. In stress conditions, modulation of the immune system by the central nervous system (CNS) is mediated by a complex network of signals, showing a relationship between stress and resistance to infection. On the other hand, an adequate balanced diet plays a crucial role in the management of stress, and nutrition seems to be a critical determinant in the interactions among CNS and the immune system under stress conditions. Thus, interactions among nutrition, CNS and the immune system could be a key to understand implications in physiological stress situations. The present article will briefly review nutrition approaches on stress-related immune response and CNS communication.     

Coping with competitive situations in humans

The analysis of effects of competitive situations in our species may contribute to acquiring deeper knowledge about the effects of social stress and its relationship with different pathologies. The latest studies indicate that the neuroendocrine response to competition depends more on subjective factors related to the cognitive evaluation of the situation than on the outcome itself. Findings suggest that when subjects cope with a competition, they assess it in such a way that it activates a psychobiological coping response. The pattern of this response may correspond to a predominant active or passive coping strategy, the choice ultimately depending on factors such as the importance of the competition for the subject, the subject's involvement or perceived possibilities of control of outcome or success (e.g. past experience in similar competitions, judge or rank of the opponent), among others. More important than winning or losing is the coping pattern displayed by the subject, which determines the hormonal changes experienced when facing competition and its outcome.     

Simulation of EMG in pathological situations.

OBJECTIVE: A mathematical model for simulation of the EMG from a muscle with its motor units is used. The study aims at correlating EMG findings (single-fiber EMG and concentric-needle EMG) with various induced morphological changes. METHODS: Reinnervation has been simulated by removing motor units randomly followed by a complete reinnervation from adjacent surviving motor units. Fibre type grouping and grouped atrophy can be seen. Myopathy is simulated by increased fibre diameter variation, loss of fibres and muscle fibre splitting. RESULTS AND CONCLUSION: The simulation gives quantitative aspects of the importance of each of these factors. It indicates the relative sensitivity of various EMG parameters. The model can be used both for education and for research.     

Psychotherapeutic intervention in acute medical situations.

Psychotherapy in the extreme medical situation is an extension of the interviewing process. The interviewer must expeditiously and sometimes briefly assist the patient in elaborating his complaint, obtain information about the development of the complaint, and assess the patient's reactions to it. Past history, developmental patterns, reactions to previous illness and crises, the patient's present life situation, and past and present relationships may all be relevant and require evaluation. The interactive process requires that the therapist call upon specific knowledge as he engages with the patient, facilitates the expression of concern, appropriately reassures, instructs, and prepares, clarifies, and leads the patient to some insight about his altered state. Attention to the affective correlates of acute illness can enhance convalescence and the rehabilitative process.     

Shared decision-making in epilepsy management

Policy makers, clinicians, and patients increasingly recognize the need for greater patient involvement in clinical decision-making. Shared decision-making helps address these concerns by providing a framework for clinicians and patients to make decisions together using the best evidence. Shared decision-making is applicable to situations where several acceptable options exist (clinical equipoise). Such situations occur commonly in epilepsy, for example, in decisions regarding the choice of medication, treatment in pregnancy, and medication withdrawal. A talk model is a way of implementing shared decision-making during consultations, and decision aids are useful tools to assist in the process. Although there is limited evidence available for shared decision-making in epilepsy, there are several benefits of shared decision-making in general including improved decision quality, more informed choices, and better treatment concordance.     

Information processing in decision-making systems

Decisions result from an interaction between multiple functional systems acting in parallel to process information in very different ways, each with strengths and weaknesses. In this review, the authors address three action-selection components of decision-making: The Pavlovian system releases an action from a limited repertoire of potential actions, such as approaching learned stimuli. Like the Pavlovian system, the habit system is computationally fast but, unlike the Pavlovian system permits arbitrary stimulus-action pairings. These associations are a "forward' mechanism; when a situation is recognized, the action is released. In contrast, the deliberative system is flexible but takes time to process. The deliberative system uses knowledge of the causal structure of the world to search into the future, planning actions to maximize expected rewards. Deliberation depends on the ability to imagine future possibilities, including novel situations, and it allows decisions to be taken without having previously experienced the options. Various anatomical structures have been identified that carry out the information processing of each of these systems: hippocampus constitutes a map of the world that can be used for searching/imagining the future; dorsal striatal neurons represent situation-action associations; and ventral striatum maintains value representations for all three systems. Each system presents vulnerabilities to pathologies that can manifest as psychiatric disorders. Understanding these systems and their relation to neuroanatomy opens up a deeper way to treat the structural problems underlying various disorders.     

Maternal sensitivity to children in problem situations

Sixty mothers and their preschool children were placed in interactions structured to involve a problem situation for the child, the mother, or both. Maternal sensitivity and insensitivity were measured to test a number of parent effectiveness constructs. Results indicate that mothers were more insensitive than sensitive to their children, and that some major assumptions of the parent effectiveness model lack sufficient support to justify its training procedures.