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Psychiatry Research. Neuroimaging Nov 2021The experience of doubt, the lack of confidence in one's perceptions, internal states, memory and attention, can be due to the variability in occurrence of a phenomenon...
The experience of doubt, the lack of confidence in one's perceptions, internal states, memory and attention, can be due to the variability in occurrence of a phenomenon or can be driven by the internal experience of uncertainty based on subjective evaluation of the environment. Although the experience of some doubt is adaptive in normal cognitive functioning, excessive doubt can significantly impair decision-making and in extreme cases give rise to psychopathology. Although neuroimaging studies have provided some insight into the network of brain areas that is engaged when decision-making involves uncertainty, it remains unclear if dysfunction in these areas also gives rise to the experience and pathological expression of doubt. This study examined the neural correlates of doubt using neuroimaging during the performance of a forced-choice perceptual decision-making task under varying levels of uncertainty in participants who reported either low or high doubt. Participants reporting high doubt exhibited increased activation in the bilateral inferior parietal lobule (IPL) during perceptual decision-making which was not observed in participants who reported low doubt. Furthermore, activity in the IPL in high doubt participants was associated with clinical measures of doubt and showed functional connectivity differences between the high and low doubt groups. The findings of the current study suggest a key role of the IPL and provide a network of brain regions that may play a role in the experience and expression of doubt.
Topics: Brain; Brain Mapping; Decision Making; Humans; Magnetic Resonance Imaging; Uncertainty
PubMed: 34464764
DOI: 10.1016/j.pscychresns.2021.111370 -
Physiotherapy Jun 2022To conduct a theory analysis of shared decision-making (SDM) conceptual models relevant to physiotherapy (PT) to help understand theoretical foundations of SDM for the...
OBJECTIVE
To conduct a theory analysis of shared decision-making (SDM) conceptual models relevant to physiotherapy (PT) to help understand theoretical foundations of SDM for the PT discipline.
DESIGN
A systematic review was used and updated to select models. The theory analysis was conducted following Walker and Avant's approach and relevance to six PT competency domains.
RESULTS
Of the 42 SDM models identified, three were eligible. One model (PT-SDM) is explicitly for PTs, one for multimorbidity with older patients (Dynamic Model-SDM), and one for multimorbidity and chronic care (Dual Layer-SDM). Models were published between 2016 and 2019, based on the literature and developed by a range of developers. All propose a schematic linear representation, but two models highlight SDM as an iterative process (PT-SDM, Dynamic Model-SDM). Two models (PT-SDM, Dynamic Model-SDM) are inductive, logical and clear, with the PT-SDM the most generalizable to different decision and setting. Strengths of models: a) all included key SDM elements; b) all involved a variety of stakeholders during development; c) all aimed to fill a gap in clinical practice; d) two are easier to use in clinical practice (PT-SDM, Dynamic Model-SDM); and e) all are generalizable to various healthcare professionals. Limitations of models: a) two poorly described the development process (PT-SDM, Dual Layer-SDM); b) none have been tested; c) none incorporated various actors despite acknowledging the importance of multidisciplinary teams; and d) one has an important logical fallacy (Dual Layer-SDM).
CONCLUSION
Two models could support physiotherapists intending to use SDM in clinical practice. CONTRIBUTION OF THE PAPER.
Topics: Decision Making; Decision Making, Shared; Humans; Models, Theoretical; Physical Therapy Modalities
PubMed: 35461003
DOI: 10.1016/j.physio.2022.03.001 -
Neuropsychologia Mar 2011Decision-making is a complex process that requires the orchestration of multiple neural systems. For example, decision-making is believed to involve areas of the brain...
Decision-making is a complex process that requires the orchestration of multiple neural systems. For example, decision-making is believed to involve areas of the brain involved in emotion (e.g., amygdala, ventromedial prefrontal cortex) and memory (e.g., hippocampus, dorsolateral prefrontal cortex). In this article, we will present findings related to the amygdala's role in decision-making, and differentiate the contributions of the amygdala from those of other structurally and functionally connected neural regions. Decades of research have shown that the amygdala is involved in associating a stimulus with its emotional value. This tradition has been extended in newer work, which has shown that the amygdala is especially important for decision-making, by triggering autonomic responses to emotional stimuli, including monetary reward and punishment. Patients with amygdala damage lack these autonomic responses to reward and punishment, and consequently, cannot utilize "somatic marker" type cues to guide future decision-making. Studies using laboratory decision-making tests have found deficient decision-making in patients with bilateral amygdala damage, which resembles their real-world difficulties with decision-making. Additionally, we have found evidence for an interaction between sex and laterality of amygdala functioning, such that unilateral damage to the right amygdala results in greater deficits in decision-making and social behavior in men, while left amygdala damage seems to be more detrimental for women. We have posited that the amygdala is part of an "impulsive," habit type system that triggers emotional responses to immediate outcomes.
Topics: Amygdala; Choice Behavior; Decision Making; Emotions; Female; Functional Laterality; Humans; Male; Sex Factors
PubMed: 20920513
DOI: 10.1016/j.neuropsychologia.2010.09.029 -
JAMA Internal Medicine Jan 2024Incarcerated patients admitted to the hospital face threats to their rights to privacy and self-determination in medical decision-making. Little is known about medical...
IMPORTANCE
Incarcerated patients admitted to the hospital face threats to their rights to privacy and self-determination in medical decision-making. Little is known about medical decision-making processes for hospitalized incarcerated persons who lack decisional capacity.
OBJECTIVE
To characterize the prevalence of incapacity among hospitalized incarcerated patients and describe the decision-making processes, including who served as surrogate decision-makers, involvement of prison employees in medical decisions, and ethical concerns emerging from the patients' care.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective descriptive and qualitative study of medical records for all patients admitted from prison for at least 24 hours between January 1, 1999, and September 1, 2019, at a large Midwestern academic medical center. Data analysis was performed from March 15, 2021, to December 14, 2022.
MAIN OUTCOMES AND MEASURES
Prevalence of prison-to-hospital admissions for patients with a loss of capacity and characteristics of medical decision-making.
RESULTS
During the 20-year study period, 462 patients from the prison were admitted to the hospital, totaling 967 unique admissions. Of these, 131 admissions (14%) involved patients with a loss of capacity and 43 admissions (4%, representing 34 unique patients) required surrogate decision-making. Ten of these patients had advance directives. Surrogate decision-makers often faced decisions about end-of-life care (nā=ā17) or procedural consent (nā=ā23). A family member was identified as surrogate decision-maker in 23 admissions. In 6 cases with a kindred surrogate, additional consent was requested from a prison employee. In total, prison employees were documented as being present during or participating in major medical decisions for half of the admissions. Five themes emerged from thematic analysis: uncertainty and misinformation about patient rights and the role of prison employees in medical decision-making with respect to these two themes, privacy violations, deference to prison officials, and estrangement from family and friends outside of the prison.
CONCLUSIONS AND RELEVANCE
In this first in-depth description, to date, of decision-making practices for hospitalized incarcerated patients lacking decisional capacity, admissions of these patients generated uncertainty about their rights, sometimes infringing on patients' privacy and autonomy. Clinicians will encounter incarcerated patients in both hospital and clinic settings and should receive education on how to support ethically and legally sound decision-making practices for this medically vulnerable population.
Topics: Humans; Decision Making; Retrospective Studies; Uncertainty; Prisoners; Health Services Accessibility
PubMed: 38048093
DOI: 10.1001/jamainternmed.2023.5794 -
Cognitive, Affective & Behavioral... Dec 2008Decision making requires evaluating alternatives that differ on a number of attributes. During this evaluation process, selection of options depends on the duration of... (Review)
Review
Decision making requires evaluating alternatives that differ on a number of attributes. During this evaluation process, selection of options depends on the duration of the options, the duration of the expected delay for realizing the options, and the time available to reach a decision. This article reviews the relationship between time and decision making in humans with respect to this evaluation process. Moreover, the role of psychological time, as compared with physical time, is accentuated. Five topics have been selected that illustrate how time and mental representations of time affect decision making. These are (1) the duration of options, (2) temporal decision making, (3) the time between having made a decision and experiencing the consequences of that decision, (4) the temporal perspective of decision makers, and (5) the duration of the decision process. The discussion of each topic is supplemented by suggestions for further research. It is shown that psychological time is often neglected in human decision making but seems to play an important role in the making of choices.
Topics: Choice Behavior; Decision Making; Humans; Models, Psychological; Time; Time Factors; Time Perception
PubMed: 19033245
DOI: 10.3758/CABN.8.4.509 -
Annual Review of Psychology Jan 2015For decades, the dominant paradigm for studying decision making--the expected utility framework--has been burdened by an increasing number of empirical findings that... (Review)
Review
For decades, the dominant paradigm for studying decision making--the expected utility framework--has been burdened by an increasing number of empirical findings that question its validity as a model of human cognition and behavior. However, as Kuhn (1962) argued in his seminal discussion of paradigm shifts, an old paradigm cannot be abandoned until a new paradigm emerges to replace it. In this article, we argue that the recent shift in researcher attention toward basic cognitive processes that give rise to decision phenomena constitutes the beginning of that replacement paradigm. Models grounded in basic perceptual, attentional, memory, and aggregation processes have begun to proliferate. The development of this new approach closely aligns with Kuhn's notion of paradigm shift, suggesting that this is a particularly generative and revolutionary time to be studying decision science.
Topics: Decision Making; Humans; Mental Processes; Philosophy; Psychological Theory; Science
PubMed: 25559114
DOI: 10.1146/annurev-psych-010814-015148 -
Brain Research. Cognitive Brain Research Apr 2005Decision-making is an important aspect of daily life. Moreover, dysfunctions of decision-making play a critical role in a number of neuropsychiatric disorders. Several... (Review)
Review
Decision-making is an important aspect of daily life. Moreover, dysfunctions of decision-making play a critical role in a number of neuropsychiatric disorders. Several important research groups have contributed a diverse set of approaches to study decision-making and its underlying neurobiology. Insights from these studies may provide important directions for future research in this area.
Topics: Animals; Decision Making; Emotions; Humans; Individuality; Nervous System Physiological Phenomena
PubMed: 15795129
DOI: 10.1016/j.cogbrainres.2005.01.001 -
American Journal of Primatology Oct 2018Interest in the effects of oxytocin on social behavior has persisted even as an overarching theory describing these effects has remained largely elusive. Some of the... (Review)
Review
Interest in the effects of oxytocin on social behavior has persisted even as an overarching theory describing these effects has remained largely elusive. Some of the earliest studies on the effects of oxytocin on social decision-making indicated that oxytocin might enhance prosocial actions directed toward others. This led to development of the prosocial hypothesis, which stipulates that oxytocin specifically enhances prosocial choices. However, further work indicated that oxytocin administration could elicit antisocial behaviors as well in certain social situations, highlighting the importance of context-dependent effects. At least two prominent hypotheses have been used to explain these seemingly contradictory findings. The social salience hypothesis indicates that the effects of oxytocin can be conceptualized as a general increase in the salience of social stimuli in the environment. Distinctly, the approach/withdrawal hypothesis stipulates that oxytocin enhances approach behaviors and decreases withdrawal behaviors. These phenomenologically motivated hypotheses regarding the effects of oxytocin on social behavior have created controversies in the field. In this review, we present a multistage framework of social decision-making designed to unify these disparate theories in a process common to all social decisions. We conceptualize this process as involving multiple distinct computational steps, including sensory input, sensory perception, valuation, decision formulation, and behavioral output. Iteratively, these steps generate social behaviors, and oxytocin could be acting on any of these steps to exert its effects. In support of this framework, we examine both behavioral and neural evidence across rodents, non-human primates, and humans, determining at what point in our multistage framework oxytocin could be eliciting its socially relevant effects. Finally, we postulate based on our framework that the prosocial, social salience, and approach/withdrawal hypotheses may not be mutually exclusive and could explain the influence of oxytocin on social behavior to different extents depending on context.
Topics: Animals; Behavior, Animal; Cognition; Decision Making; Humans; Oxytocin; Primates; Rodentia; Social Behavior
PubMed: 29350419
DOI: 10.1002/ajp.22735 -
International Review of Neurobiology 2021Mammalian decision-making is mediated by the interaction of multiple, neurally and computationally separable decision systems. Having multiple systems requires a... (Review)
Review
Mammalian decision-making is mediated by the interaction of multiple, neurally and computationally separable decision systems. Having multiple systems requires a mechanism to manage conflict and converge onto the selection of singular actions. A long history of evidence has pointed to the prefrontal cortex as a central component in processing the interactions between distinct decision systems and resolving conflicts among them. In this chapter we review four theories of how that interaction might occur and identify how the medial prefrontal cortex in the rodent may be involved in each theory. We then present experimental predictions implied by the neurobiological data in the context of each theory as a starting point for future investigation of medial prefrontal cortex and decision-making.
Topics: Animals; Decision Making; Negotiating; Prefrontal Cortex; Rodentia
PubMed: 33785147
DOI: 10.1016/bs.irn.2020.11.009 -
Professional Case Management 2020
Topics: Case Management; Decision Making; Decision Making, Shared
PubMed: 33017375
DOI: 10.1097/NCM.0000000000000471