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Toward an Understanding of Decision Making in Severe Mental Illness
Ricardo Cáceda, M.D., Ph.D.; Charles B. Nemeroff, M.D., Ph.D.; Philip D. Harvey, Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;:. doi:10.1176/appi.neuropsych.12110268
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From the Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR (RC), and the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL (CBN, PDH).

Send correspondence to Ricardo Cáceda, M.D., Ph.D.; e-mail: rcaceda@uams.edu

Copyright © 2014 by the American Psychiatric Association

Received November 12, 2012; Accepted April 17, 2013.

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A commonality of patients with major psychiatric disorders is their propensity to make poor decisions, which is intimately related to poor real-life outcomes. We reviewed the literature on decision making as applied to severe psychiatric disorders, with particular focus on advances in cognitive neuroscience. Deficits in reward sensitivity, avoidance learning, and temporal discounting are reported in depression. Besides abnormalities in hedonic capacity, other cognitive distortions required for flexible control of behavior occur in patients with bipolar disorder and schizophrenia. A conceptual framework of abnormal decision making in mental illness could generate targeted interventions to improve quality of life and clinical outcomes.

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