Decision-making impairments in adolescents with early-onset schizophrenia

Hana M. Kester, Serge Sevy, Eldad Yechiam, Katherine E. Burdick, Kelly L. Cervellione, Sanjiv Kumra

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83 Scopus citations


Adolescence is a time of vulnerability for risk-taking behaviors. This is particularly true of adolescents with schizophrenia who present with high rates of substance use as compared to the general population. Using the Iowa Gambling Task (IGT), the authors compared decision-making processes in adolescents with early-onset schizophrenia (onset of psychosis by age 18) to that of healthy volunteers. Fifteen adolescents with schizophrenia (aged 12-21 years) and 25 demographically similar healthy volunteers were administered the IGT. Overall, adolescents with schizophrenia performed significantly worse on the IGT than healthy adolescents as measured by a significant group by block interaction. Post-hoc testing revealed that adolescents with schizophrenia performed more poorly than healthy adolescents during the last two blocks of the task. Mathematical modeling further indicated that adolescents with schizophrenia allocated significantly more attention to monetary gains than losses encountered during the task, suggesting a hypersensitivity to rewards and relative insensitivity to future consequences. This is similar to what has been reported for adults with externalizing forms of psychopathology, such as those who abuse substances. These findings have potential implications for understanding the increased vulnerability for the development of substance abuse in adolescents with schizophrenia.

Original languageEnglish (US)
Pages (from-to)113-123
Number of pages11
JournalSchizophrenia Research
Issue number1-3
StatePublished - Jul 2006

Bibliographical note

Funding Information:
We would like to acknowledge the participation of all of our subjects, and Drs. Philip Szeszko and Terry Goldberg for their input during the development of this project, as well as Barbara Napolitano for her guidance during statistical analyses. The project was supported by NIMH grants MH-60221 and MH-64556 and a NARSAD award (Lieber Investigator) to Dr. Kumra, a NIDA grant K23 DA0155531 to Dr. Sevy, and a grant from the North Shore-Long Island Jewish Hospital Research Institute and the General Clinical Research Center.


  • Adolescents
  • Decision-making
  • Iowa gambling task
  • Orbitofrontal cortex
  • Schizophrenia


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