Decision-making deficits in pathological gambling: The role of executive functions, explicit knowledge and impulsivity in relation to decisions made under ambiguity and risk

Authors

  • Cristian Ochoa PhD,

    1. Department of Psychiatry, Pathological Gambling Unit, Bellvitge University Hospital, Barcelona, Spain
    2. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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  • Eva M. Álvarez-Moya PhD,

    1. Department of Psychiatry, Pathological Gambling Unit, Bellvitge University Hospital, Barcelona, Spain
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  • Eva Penelo PhD,

    1. Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
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  • M. Neus Aymami MSc,

    1. Department of Psychiatry, Pathological Gambling Unit, Bellvitge University Hospital, Barcelona, Spain
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  • Mónica Gómez-Peña MSc,

    1. Department of Psychiatry, Pathological Gambling Unit, Bellvitge University Hospital, Barcelona, Spain
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  • Fernando Fernández-Aranda PhD,

    1. Department of Psychiatry, Pathological Gambling Unit, Bellvitge University Hospital, Barcelona, Spain
    2. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
    3. CIBER Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
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  • Roser Granero PhD,

    1. Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
    2. CIBER Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
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  • Julio Vallejo-Ruiloba MD,

    1. Department of Psychiatry, Pathological Gambling Unit, Bellvitge University Hospital, Barcelona, Spain
    2. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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  • José Manuel Menchón MD,

    1. Department of Psychiatry, Pathological Gambling Unit, Bellvitge University Hospital, Barcelona, Spain
    2. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
    3. CIBERSAM Salud Mental, Instituto Salud Carlos III, Barcelona, Spain
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  • Natalia S. Lawrence PhD,

    1. Section of Neuroscience and Emotion, Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, London, England
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  • Susana Jiménez-Murcia PhD

    Corresponding author
    1. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
    2. CIBER Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
    • Department of Psychiatry, Pathological Gambling Unit, Bellvitge University Hospital, Barcelona, Spain
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Address correspondence to Dr. Jiménez-Murcia, Head of Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital, Feixa Llarga, s/n. 08907 L'Hospitalet de Llobregat, Barcelona, Spain. E-mail: sjimenez@bellvitgehospital.cat.

Abstract

Background

A variety of cognitive and emotional processes influence the decision-making deficits observed in pathological gambling (PG). This study investigated the role of immediate/delayed sensitivity to reward and punishment, executive functions, impulsivity and explicit knowledge in relation to decision-making performance on the original Iowa Gambling Task (IGT-ABCD) and a variant (IGT-EFGH).

Methods

We assessed 131 consecutive patients with a diagnosis of PG by using executive functioning and decision-making tasks, self-report measures of impulsivity and explicit knowledge.

Results

The majority of pathological gamblers (PGs) showed deficits in decision-making, characterized mainly by myopia for the future. Decisions made under risk showed different predictors. Performance on the IGT-ABCD for decisions made under risk was predicted by medium and high levels of explicit knowledge of the task, as well as by scores on the Disorderliness subscale and the degree of Stroop interference. By contrast, IGT-EFGH results were only associated with self-report impulsivity measures.

Conclusions

Decision making in PG involves distinct patterns of deficits, and the predictors differ depending on the reinforcement schedule. Decisions made under risk on the IGT-ABCD are associated with explicit knowledge, executive functions and impulsivity traits related to conscious awareness and control processes. On the IGT-EFGH, however, only impulsivity traits predict decision making. (Am J Addict 2013;22:492–499)

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