Biomedical subjects

Paolo Cavedini

Publications and source records attributed to Paolo Cavedini.

6 recordsLinked to original sources

PubMed2006

Decision-making functioning as a predictor of treatment outcome in anorexia nervosa.

The pathological eating behaviour of patients with anorexia nervosa reflects a deficit in planning real-life strategies that can be observed in an experimental setting through the Gambling Task, a tool designed to detect and measure decision-making abilities. We examined the role of Gambling Task performance as a predictor of treatment outcome in anorectic patients, and we evaluated changes in decision-making after clinical improvement. Performance on the Gambling Task was evaluated, and a clinical-nutritional assessment of 38 anorectic patients was carried out before and after a cognitive-behavioural and drug treatment program. Task performance of anorectic patients was compared with that of 30 healthy control participants. Patients who had a better decision-making profile at baseline showed significantly greater improvement in nutritional status. The decision-making deficiency of some anorectic patients is probably linked to those individual features that contribute to the phenomenological expression of the disorder and to its different treatment outcomes.

Adult↗

PubMed2006

Understanding obsessive-compulsive disorder: focus on decision making.

Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.

Brain↗

PubMed2004

Neuropsychological investigation of decision-making in anorexia nervosa.

Anorexia nervosa (AN) could be considered a form of obsessive-compulsive disorder in which an impairment of the cognitive domain related to decision-making was found. We explored this function in AN patients, as well as possible differences between restricting type and binge/purge type, with the aim of examining the hypothesis that AN is part of the obsessive-compulsive spectrum. Decision-making was assessed in 59 inpatients with AN and 82 control subjects using the Gambling task, which simulates real-life decision-making by assessing the ability to balance immediate rewards against long-term negative consequences. We confirmed the supposed deficit of decision-making in AN. However, restricting and binge eating/purge subtypes showed different patterns of decision-making impairment. Poor performance on the Gambling task is not a mere consequence of starvation and does not appear to be related to illness severity. The decision-making deficiency that some AN patients show is linked to those individual features that contribute to the phenomenological expression of the disorder.

Adult↗

PubMed2004

The advantages of choosing antiobsessive therapy according to decision-making functioning.

OBJECTIVE: Previous studies stressed the role of decision-making functioning in predicting antiobsessive treatment outcome with serotonin reuptake inhibitors drugs in patients with obsessive-compulsive disorder. Nevertheless, the use of an augmentation strategy with atypical antipsychotic drugs has proved to be effective in obsessive-compulsive patients nonresponding to serotonin reuptake inhibitors treatment. We investigated whether the performance at the Iowa Gambling Task (IGT), a used neuropsychologic task which assesses decision-making, can be an effective criterion for pharmacologic treatment choice in these patients and whether the use of different treatment strategies, according IGT performance, can increase the rate of antiobsessive outcome. METHOD: Thirty patients with obsessive-compulsive disorder were treated in a single-blind design with fluvoxamine plus placebo or fluvoxamine plus risperidone according to their IGT performance. Treatment outcome was recorded after 6 and 12 weeks. RESULTS: Patients with good IGT performance showed a good antiobsessive treatment outcome with fluvoxamine only, while only adopting an augmentation strategy with risperidone, the number of responders patients within the subjects with bad IGT performance increased. CONCLUSIONS: IGT performance may be considered an effective criterion for pharmacologic treatment choice in obsessive-compulsive patients given that antiobsessive treatment outcome is increased to 85% of responders choosing an appropriate drug strategy according to the IGT performance.

Adult↗

PubMed2003

Basal-corticofrontal circuits in schizophrenia and obsessive-compulsive disorder: a controlled, double dissociation study.

BACKGROUND: Several lines of research suggest that prefrontal cortex dysfunctions observed in obsessive compulsive disorder (OCD) and schizophrenia (SKZ) are linked to two partially independent neuroanatomic systems: the ventromedial prefrontal cortex and the dorsolateral prefrontal cortex, with different neuroanatomic connections, including the striatum. The primary aim of this study was to test this hypothesis using a double dissociation study of neuropsychological tasks performance of the dorsolateral prefrontal cortex and ventromedial prefrontal cortex. METHODS: We administered the Wisconsin Card Sorting Test, the Gambling Task, and the four-disk version of the Tower of Hanoi to 110 SKZ and 67 OCD patients and 56 control subjects. RESULTS: A clear double dissociation of Wisconsin Card Sorting Test and Gambling Task performances was found, with SKZ patients performing the Wisconsin Card Sorting test significantly worse than OCD patients and control subjects and OCD patients performing the Gambling Task significantly worse than SKZ and control subjects. Both SKZ and OCD patients performed the Tower of Hanoi significantly worse than control subjects. CONCLUSIONS: Results from our double dissociation study confirm the hypothesis of involvement of different frontal lobe subsystems within basal-corticofrontal circuits function in SKZ and OCD.

Adult↗

PubMed2002

Frontal lobe dysfunction in pathological gambling patients.

BACKGROUND: Limited data are available about the validity of the diagnosis of pathological gambling (PG) and about the etiology and the efficacy of different treatment strategies of this disorder; however, similarities in decision-making behavior between PG patients and patients with ventromedial prefrontal cortex lesions suggest a possible implication of these areas in the pathophysiology of this disorder, as in obsessive-compulsive disorder, in which the decision-making impairment is significantly associated with response to serotonin reuptake inhibitor treatment. Nevertheless, several studies have shown that decision-making functioning is also impaired in drug-addicted patients who have shown abnormalities in ventromedial prefrontal cortex during functional neuroimaging studies. METHODS: We assessed the decision-making function mediated by the ventromedial prefrontal cortex in 20 PG patients and 40 healthy control (HC) subjects using the Gambling Task, which simulates real-life decision-making, testing the ability to balance immediate rewards against long-term negative consequence. RESULTS: Significant differences were found in Gambling Task performance between HC subjects and PG patients, who showed a specific decision-making profile across the sequence of the game. The dissimilarity does not appear to depend on the basic cognitive function deficit of the PG group. CONCLUSIONS: These data seem to suggest the existence of a link between PG and other disorders (i.e., obsessive-compulsive disorder and drug addiction) all having diminished ability to evaluate future consequences, which may be explained at least in part by an abnormal functioning of the orbitofrontal cortex.

Adult↗