精神分裂症患者基于努力的奖赏决策功能异常

Dysfunctional Effort-based Reward Decision Making in Schizophrenia

动机缺失是精神分裂症阴性症状的核心表现之一,对患者的社会功能造成了严重影响。近十年来,越来越多的研究开始探究精神分裂症患者的动机缺失症状与基于努力的奖赏决策功能之间的联系。本综述将从躯体努力和认知努力两个层面,对过去精神分裂症基于努力的奖赏决策损伤研究进行整理和归纳。综述内容主要包含基于努力的奖赏决策的理论框架与测量手段;以往临床研究在精神分裂症群体中的主要发现以及未来研究展望。大多数证据较为一致地表明精神分裂症患者在追求特定的目标奖赏时的代价-收益分析功能可能存在损伤。这在一定程度上为精神分裂症的社会退缩现象的解释给出了可能的方向,同时为精神分裂症患者动机缺失症状的评估和治疗提供了新的视角。

Amotivation is one of key elements of negative symptoms in schizophrenia,which has serious impact on the patient’s social functioning.Recent studies have suggested that the symptoms of amotivation in schizophrenia may be associated with abnormalities in their effort-based reward decision-making.The present review aimed to summarize the findings in previous studies on effort-based reward decision-making impairment in schizophrenia in terms of both the physical effort and cognitive effort.Specifically,we first summarized the theoretical framework as well as assessments for effortbased decision making.Next,major findings for schizophrenia patients in previous studies were also carefully reviewed.Finally,the future research directions were discussed.It reached a consensus that,the cost-benefit analysis function of patients with schizophrenia may be impaired in pursuit of specific target rewards.To some extent,this provides a possible direction for the explanation of social withdrawal in schizophrenia and a new perspective for the evaluation and treatment of motivational deficit in schizophrenia.