Schizophrenia and risk-taking: Impaired reward but preserved punishment processing Gordon L.F. Cheng a, b , Joey C.Y. Tang a, c , Frendi W.S. Li d , Esther Y.Y. Lau a, d , Tatia M.C. Lee a, b, d, e, ⁎ a Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong, China b Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong, China c Number Laboratory, The University of Hong Kong, Hong Kong, China d Department of Psychology, The University of Hong Kong, Hong Kong, China e The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China abstract article info Article history: Received 17 September 2011 Received in revised form 14 December 2011 Accepted 4 January 2012 Available online 27 January 2012 Keywords: Balloon Analogue Risk Task Risky-Gains Task Psychosis Frontostriatal system Risky decision-making is subserved by the frontostriatal system, which includes a network of interconnected brain regions known to be dysfunctional in patients with schizophrenia. This study aimed to investigate whether and to what extent patients with schizophrenia display a different pattern of risk-taking behavior relative to matched healthy controls. The Balloon Analogue Risk Task (BART) and the Risky-Gains Task were used as naturalistic measures of risk-taking behavior in 25 patients with schizophrenia and 25 controls. Results of the BART revealed that patients behaved more conservatively, and this in turn led to suboptimal risky decision-making. Consistently, patients behaved more conservatively in the Risky-Gains Task. Interestingly, however, they adjusted the pattern of risk-taking following a punished trial similar to controls. These findings indicate that patients have impaired reward but preserved punishment processing. This study complements pre- vious studies on decision-making in schizophrenia and suggests specific rather than widespread abnormalities along the frontostriatal system in schizophrenia. © 2012 Elsevier B.V. All rights reserved. 1. Introduction Schizophrenia is a form of psychopathology that implicates abnor- mal functioning in the frontostriatal system (e.g. Abi-Dargham, 2003; Kim et al., 2003; see Barch and Dowd, 2010). One of the higher cognitive processes that are known to involve the frontostriatal system is risky decision-making, which is a form of behavior that entails striking a balance between options with different likelihoods of reward and punishment. Processing of reward and punishment is subserved by interconnected brain regions including the prefrontal cortex (PFC), anterior cingulate cortex (ACC), insula, and subcortical areas such as the striatum (e.g. Knutson et al., 2000; O'Doherty et al., 2001; Elliott et al., 2003; FitzGerald et al., 2009). Owing to the significance of the frontostriatal system in risky decision-making, the present study aimed to investigate the perfor- mance of patients with schizophrenia on naturalistic risk-taking tasks that are known to involve this brain system. These risk-taking tasks include the Balloon Analogue Risk Task (BART; Lejuez et al., 2002) and Risky-Gains Task (Paulus et al., 2003), both known to involve brain regions along the frontostriatal system in response to choosing a risky over a safe option (Paulus et al., 2003; Lee et al., 2008a, 2008b; Rao et al., 2008; Lee et al., 2009). Several studies have examined the extent of suboptimal decision-making in patients with schizophrenia using the Iowa Gambling Task (IGT), which was originally believed to rely on the ventromedial PFC (Bechara et al., 1994, 2000) and now known to involve the frontostriatal network (Li et al., 2010). These studies either reported no difference in IGT performance between patients with schizophrenia and healthy controls (e.g. Wilder et al., 1998; Cavallaro et al., 2003; Evans et al., 2005; Rodríguez-Sánchez et al., 2005; Turnbull et al., 2006) or that patients selected more disadvantaged options which led to lower returns (Ritter et al., 2004; Shurman et al., 2005; Kester et al., 2006; Sevy et al., 2007; Yip et al., 2009). Despite the conflicting findings, these studies provided important insight that at least in some patients with schizophrenia, there seems to be difficulty in making optimal decisions. Employing the BART and Risky-Gains Task in patients with schizophrenia will add to our knowledge of the specific characteristics of risk-taking behavior in this clinical population as the designs of such tasks allow for a direct assessment of the tendency to engage in risky versus conservative options. This knowledge can supplement existing findings from IGT studies, some of which indicate a very different pattern of risky decision-making between patients with schizophrenia and the healthy population. To our knowledge this is the first reported study that investigated schizophrenia using the BART and Risky-Gains tasks. We chose these well-established computer- ized tasks as risk-taking measures for reasons of ecological validity. The Risky-Gains Task and BART are with and without time pressure Schizophrenia Research 136 (2012) 122–127 ⁎ Corresponding author at: K610, The University of Hong Kong, Pokfulam Road, Hong Kong, China. Tel.: +852 2857 8394; fax: +852 2819 0978. E-mail address: tmclee@hku.hk (T.M.C. Lee). 0920-9964/$ – see front matter © 2012 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2012.01.002 Contents lists available at SciVerse ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres