Decision making involves using knowledge and experience to choose a course of action. A person’s ability to autonomously make decisions is referred to as their decisional capacity. Effective decision making increases the likelihood of a favourable outcome by selecting responses that avoid unfavourable or harmful outcomes. People with bipolar disorder may show altered decision making and impairments in their capacity to provide informed consent to treatment. People with impaired decisional capacity may not be able to understand information relating to the decision; appreciate the significance of the information and apply the information to decision-making; reason and compare potential consequences of the decision in a logical process; and/or communicate this decision.

A person’s ability to make decisions may vary depending on the time or nature of the decision they are making. Decision making and decisional capacity may be associated with other areas of cognitive functioning, with a certain level of mental functioning required to make the most appropriate decisions in the situation.

What is the evidence on decision making in people with bipolar disorder?

Moderate to high quality evidence found poor decision making ability in people with the disorder. People with a history of suicide attempts showed more risky choices than those without a history of suicide attempts.

September 2021

Image: ©mantinov – stock.adobe.com

The post Decision making appeared first on NeuRA Library.

Decision making requires the use of knowledge and experience of a context in order to choose a course of action. The ability to autonomously make decisions is referred to as their decisional capacity. Effective decision-making aims to increase the likelihood of a favourable outcome in the relevant context, selecting responses that avoid unfavourable or harmful outcomes.

An experimental tool used to examine decision-making is the Iowa Gambling Task. On each trial, participants choose a card from one of four decks and receive a monetary gain or loss. Two decks (A, B) are disadvantageous and two decks (C, D) are advantageous. The decks also differ according to the amount of immediate gain, the relative frequency of gains vs. losses and the relative number of net losses. The goal is to maximize monetary outcome through adaptive decision-making across many trials.

Another experimental tool is the MacArthur Competence Assessment Tool, which assesses the ability to understand the relevant information, the ability to reason rationally, the ability to appreciate a situation and its consequences, and the ability to communicate a choice.

What is the evidence for decision making?

High quality evidence found medium to large impairments in understanding, appreciation and reasoning decision-making and a small impairment in expression of a choice decision making. Effect sizes were smaller in studies using enhanced informed consent for people with schizophrenia.

Moderate to high quality evidence found poorer performance on the Iowa Gambling Task, with more A and B deck choices and fewer D deck choices. There were also fewer C deck choices, although this was not significantly different to controls.

Moderate quality evidence found more severe psychotic symptoms and poorer verbal cognitive functioning are associated with reduced decision-making ability about treatment (small to medium-sized effects).

March 2022

Image: ©mantinov – stock.adobe.com

The post Decision making appeared first on NeuRA Library.