Altered decision-making in youth OCD appears tied to environmental uncertainty

Early-onset obsessive-compulsive disorder among youths may affect decision-making because of uncertainty in the environment, according to results of a cross-sectional study published in JAMA Network Open.

“Obsessive-compulsive disorder (OCD) in adults is characterized by widespread cognitive dysfunction, particularly in domains of cognitive flexibility and response inhibition,” Aleya A. Marzuki, PhD, of the Behavioural and Clinical Neuroscience Institute at the University of Cambridge in the U.K., and colleagues wrote. “Difficulties in shifting attention from ingrained thoughts and actions (inflexibility) and inhibiting inappropriate responses (response disinhibition) are thought to promote uncontrollable obsessions and urges. Curiously, evidence for these cognitive biomarkers in adolescent and child patients with OCD is sparse.”

The researchers aimed to examine cognitive mechanisms linked to decision-making among 50 youths with OCD and 53 healthy controls via executive functioning tasks and computational modeling. Participants completed a probabilistic reversal learning (PRL) task, which involve identification of which of two stimuli reliably delivers positive feedback and repeated selection of the more optimal stimulus on each trial to maximize rewards, followed by a reversal of reward probabilities. In a separate sample, 27 patients and 46 controls completed the Wisconsin Card Sorting Task (WCST), a test on which adults with OC usually commit more perseverative errors compared with healthy adults.

Results showed fewer correct responses and higher likelihood of switching choices more often after false-negative feedback and true-positive feedback among patients compared with controls during the reversal phase of the PRL task. Patients had enhanced reward learning rates but decreased punishment learning rates, reinforcement sensitivity and stickiness vs. controls, according to results of computational modeling. WCST measures and computational model parameters showed no groups differences; however, patients who received serotonergic medication had slower response times.

“Our computational modeling findings suggested that environmental uncertainty promoted altered feedback learning and enhanced choice exploration in youths with OCD, possibly by triggering doubt or indecisiveness in these young patients,” Marzuki and colleagues wrote. “Moreover, choice vacillation has now been detected in both adults and adolescents with OCD, suggesting that it is a stable feature of the disorder.”