Psychiatric diagnoses and personality traits associated with disadvantageous decision-making

Objective. - Decision-making impairment is an important feature of psychiatric disorders. In a large comorbid psychiatric population, we explored the link between decision-making deficit and clinical variables. Method. - We used the Iowa Gambling Task to measure decision-making in 317 patients. Psychiatric diagnoses were made according to the DSM-IV criteria. Self-questionnaires were used to assess several personality traits. The last and most severe suicidal acts were characterized. Results. - (1) After controlling for age and medication intake, a past history of suicide attempt (OR = 2.0 [1.1-3.8]) and normothymic bipolar disorders (OR = 3.4 [1.1-10.5]) were significantly and independently associated with impaired decision-making. (2) Decision-making performance was significantly correlated with affective lability. (3) No association was found between decision-making skills and suicidal characteristics. Discussion. - A lack of statistical power may have masked associations with obsessive-compulsive disorder and anorexia nervosa. We did not control for other cognitive functions except attention. Conclusion. - This study supports the independent association of decision-making impairment with vulnerability to suicidal behaviour but not with substance abuse. Normothymic bipolar disorders, but not unipolar disorders; were also linked to low performance. At the dimensional level, impulsivity and decision-making abilities may be distinct processes. Affective regulation skills appear to be a major influence on decision-making performance and following a relevant therapeutic target. (c) 2007 Elsevier Masson SAS. All rights reserved.