A review of risky decision-making in psychosis-spectrum disorders. (February 2022)

• Record Type: Journal Article
• Authors: Purcell, John R.; Herms, Emma N.; Morales, Jaime; Hetrick, William P.; Wisner, Krista M.; Brown, Joshua W.
• Is Part Of: Clinical psychology review. Volume 91(2022)
• Publication Date: 2022-02
• Subjects: Risk -- Psychosis -- Schizophrenia -- Decision-making -- Uncertainty -- Ambiguous -- Reward -- Risk-Taking; Clinical psychology -- Periodicals; Psychology, Pathological -- Periodicals; Psychotherapy -- Periodicals; Psychology, Clinical -- Periodicals; Electronic journals; 616.89
• DOI: 10.1016/j.cpr.2021.102112
• Languages: English
• ISSNs: 0272-7358

Abstract

Abstract: The investigation of risky decision-making has a prominent place in clinical science, with sundry behavioral tasks aimed at empirically quantifying the psychological construct of risk-taking. However, use of differing behavioral tasks has resulted in lack of agreement on risky decision-making within psychosis-spectrum disorders, as findings fail to converge upon the typical, binary conceptualization of increased risk-seeking or risk-aversion. The current review synthesizes the behavioral, risky decision-making literature to elucidate how specific task parameters may contribute to differences in task performance, and their associations with psychosis symptomatology and cognitive functioning. A paring of the literature suggests that: 1) Explicit risk-taking may be characterized by risk imperception, evidenced by less discrimination between choices of varying degrees of risk, potentially secondary to cognitive deficits. 2) Ambiguous risk-taking findings are inconclusive with few published studies. 3) Uncertain risk-taking findings, consistently interpreted as more risk-averse, have not parsed risk attitudes from confounding processes that may impact decision-making (e.g. risk imperception, reward processing, motivation). Thus, overgeneralized interpretations of task-specific risk-seeking/aversion should be curtailed, as they may fail to appropriately characterize decision-making phenomena. Future research in psychosis-spectrum disorders would benefit from empirically isolating contributions of specific processes during risky decision-making, including the newly hypothesized risk imperception. Highlights: Explicit, ambiguous, and uncertain risk-taking were reviewed in psychosis. Risk imperception, rather than risk-seeking, is implicated in explicit risk-taking. Risk aversion is implicated in uncertain risk-taking, though not exclusively. Risk imperception may be secondary to, or associated with, cognitive deficits. Symptoms are not consistently associated with risky decision-making behavior.