Dysfunctions of decision‐making and cognitive control as transdiagnostic mechanisms of mental disorders: advances, gaps, and needs in current research

Abstract

Disadvantageous decision-making and impaired volitional control over actions, thoughts, and emotions are characteristics of a wide range of mental disorders such as addiction, eating disorders, depression, and anxiety disorders and may reflect transdiagnostic core mechanisms and possibly vulnerability factors. Elucidating the underlying neurocognitive mechanisms is a precondition for moving from symptom-based to mechanism-based disorder classifications and ultimately mechanism-targeted interventions. However, despite substantial advances in basic research on decision-making and cognitive control, there are still profound gaps in our current understanding of dysfunctions of these processes in mental disorders. Central unresolved questions are: (i) to which degree such dysfunctions reflect transdiagnostic mechanisms or disorder-specific patterns of impairment; (ii) how phenotypical features of mental disorders relate to dysfunctional control parameter settings and aberrant interactions between large-scale brain systems involved in habit and reward-based learning, performance monitoring, emotion regulation, and cognitive control; (iii) whether cognitive control impairments are consequences or antecedent vulnerability factors of mental disorders; (iv) whether they reflect generalized competence impairments or context-specific performance failures; (v) whether not only impaired but also chronic over-control contributes to mental disorders. In the light of these gaps, needs for future research are: (i) an increased focus on basic cognitive-affective mechanisms underlying decision and control dysfunctions across disorders; (ii) longitudinal-prospective studies systematically incorporating theory-driven behavioural tasks and neuroimaging protocols to assess decision-making and control dysfunctions and aberrant interactions between underlying large-scale brain systems; (iii) use of latent-variable models of cognitive control rather than single tasks; (iv) increased focus on the interplay of implicit and explicit cognitive-affective processes; (v) stronger focus on computational models specifying neurocognitive mechanisms underlying phenotypical expressions of mental disorders.

Adaptation and validation of the Melbourne Decision Making Questionnaire to Brazilian Portuguese

“…10 Given their ubiquitous presence across psychiatric conditions, DM impairments have been described by some authors as transdiagnostic markers of mental illness. 11 However, DM difficulties can occur even in the absence of neuropsychiatric dysfunctions, 12 and as such, efforts to prevent biases and improve DM ability have also extended to healthy adult populations. 13 In healthy adults, DM has also been found to be a predictor of important clinical indicators such as heavy alcohol use, stress, well-being and depression symptoms.…”

Partially restored resting-state functional connectivity in women recovered from anorexia nervosa

“…It has been argued that aberrant functional connectivity (FC) of widespread brain regions seems more appropriate in explaining heterogeneous phenomenona, such as psychiatric disorders. [8][9][10] Investigation of functional connectivity usually involves identifying temporal correlations in blood-oxygen leveldependent (BOLD) signal between spatially distinct brain areas. 11 This can be applied to fMRI data acquired during tasks or during rest.…”

Dopamine Antagonism Decreases Willingness to Expend Physical, But Not Cognitive, Effort: A Comparison of Two Rodent Cost/Benefit Decision-Making Tasks

“…Critical decisions in life often require weighing a given option's costs against its associated benefits, and virtually every severe mental illness is associated with difficulties in such cost/benefit decision making (Caceda et al, 2014;Goschke, 2014). For one such cost, the effort to obtain a reward, a number of animal models have been developed: rats are given the option to climb a barrier in a T-maze in one task, or to make a higher number of responses on a lever in another, to obtain a larger food reward (GhodsSharifi et al, 2009;Salamone et al, 1994).…”