Review
Can the neuroeconomics revolution revolutionize psychiatry?

https://doi.org/10.1016/j.neubiorev.2011.04.011Get rights and content

Abstract

Neuroeconomics is a rapidly growing new research discipline aimed at describing the neural substrate of decision-making using incentivized decisions introduced in experimental economics. The novel combination of economic decision theory and neuroscience has the potential to better examine the interactions of social, psychological and neural factors with regard to motivational forces that may underlie psychiatric problems. Game theory will provide psychiatry with computationally principled measures of cognitive dysfunction. Given the relatively high heritability of these measures, they may contribute to improving phenotypic definitions of psychiatric conditions. The game-theoretical concepts of optimal behavior will allow description of psychopathology as deviation from optimal functioning. Neuroeconomists have successfully used normative or near-normative models to interpret the function of neurotransmitters; these models have the potential to significantly improve neurotransmitter theories of psychiatric disorders. This paper will review recent evidence from neuroeconomics and psychiatry in support of applying economic concepts such as risk/uncertainty preference, time preference and social preference to psychiatric research to improve diagnostic classification, prevention and therapy.

Highlights

► Psychopathology can be described as suboptimal utility maximization. ► Abnormal social behavior can be formalized using behavioral game theory. ► Measures of inter-temporal choice may serve as psychiatric endophenotypes. ► Psychiatry will benefit from neuroeconomics’ unified theory of human behavior.

Introduction

Economics, psychology and neuroscience are converging into a new, unified discipline referred to as neuroeconomics. The ultimate goal of neuroeconomics is to provide a single, encompassing theory of human behavior by understanding the processes that connect sensation and action, thus revealing the neurobiological substrate of decision-making (Glimcher and Rustichini, 2004). This theory can be used as a framework to study various psychological, social and neural systems including learning, movement, social cooperation, brain reward pathways and neurotransmitter systems. The increasing number of neuroeconomics papers published in leading scientific journals such as Nature and Science reflect the increased attention toward this new research discipline in the scientific community. The practical utility of neuroeconomics has yet to be determined, and its potential contribution to the field of economics is a matter of debate (Balleine et al., 2009). However, a growing number of experts consider psychiatry to be neuroeconomics’ most promising field of application (Loewenstein, 1996, Rangel et al., 2008).

How much could psychiatry really benefit from neuroeconomics? Psychiatry research has a multifaceted history in terms of disease concepts and research methods. In the beginning of the 19th century, the field of psychiatry was mainly descriptive in nature. Janet (1889) and Freud (1905) were among the first to develop integrative bio-psycho-social theories to explain the causes, pathogenesis and symptoms of psychiatric conditions. These intuitive theories provided a theoretical framework and a great deal of explanatory power, contributing to the establishment of psychiatry as a respected clinical profession. Because the main assumptions of these theories could not be tested empirically at the time of inception, they facilitated dogmatism and devaluation of experimental inquiry that dominated psychiatry over decades and led to stagnation of psychiatric research (Kandel, 1998). The publication of the third edition of the Diagnostic and Statistical Manual for the Classification of Mental Disorders (DSM-III) in 1980 marked the official beginning of the current, ‘atheoretical’ phase of psychiatry, representing an important step in the fundamental redirection of the discipline toward a more scientific course. To provide reliable diagnoses for clinical practice, the DSM-III diagnostic criteria are based on clusters of clinical symptoms irrespective of etiology and pathophysiology. Using methods from epidemiology, sociology, psychology, pharmacology, neurobiology and genetics, this ‘atheoretical’ approach has provided large amounts of empirical data and important insights from specific perspectives. The lack of an encompassing conceptual framework, however, reduces the explanatory power of these data to comprehensively explain motivational forces in individuals diagnosed with psychiatric disorders. To bridge this gap, decision theory with transparent formal models and precise theoretical predictions could bring further scientific rigor to psychiatric research by providing a strong conceptual framework.

In this perspective paper, fundamental concepts from decision theory and related experimental neuroeconomics studies are reviewed and discussed in terms of their potential use as a framework for psychiatry research. Because we are mainly interested in the causes and pathogenetic pathways which can lead to acute states of distress, our focus will be on psychiatric risk factors as opposed to acute symptomatic distress. Given the rather non-specific risk factor profiles of psychiatric disorders and the high comorbidity among these disorders, specific DSM-defined disorders cannot be used as absolute reference points in psychiatric research (Hasler and Northoff, in press). As a result, most of our neuroeconomic hypotheses will not be disorder-specific but related to etiologically-associated groups of disorders.

Section snippets

Single-dimensional utility

Economists attempt to construct one single global formalism to describe all choice behavior. To this end, utility is defined as a measure of relative satisfaction. In expected utility theory, actual choice can be understood as if a single-dimensional utility index is maximized. These theories assume that subjects encode the values of all things (goods, services, leisure time, wealth) in abstract common units. From an evolutionary perspective, one might not expect the same brain systems

Marginal rate of substitution

Some psychiatric problems are surprisingly domain-specific. Patients with an eating disorder may initially refuse to eat any food. However, once this food abstinence leads to a pathologically low body weight, these patients may start to binge-eat. To avoid gaining weight such individuals may start vomiting and take laxatives. Later they may store large amount of foods in hidden places in the house and develop rituals to control the fear of foods. Although their clinical symptoms are

Expectation

The most common complaints of people suffering from stress-related psychopathology include negative experiences in the past and negative predictions about the future. Because expectations strongly influence their Pavlovian emotional responses and instrumental decision-making, we will now consider the nature of future expectations from a neuroeconomics perspective. A key theme emerging from research in this area is that numerous distinct types of expectation are formed in parallel within

Uncertainty

Living in a modern, free society requires that people make a wide range of important decisions that involve considerable uncertainty, including choices about education, marriage, professional development and pension investments with important long-term consequences. Decision-making under uncertainty is one of the most complex problems in decision theory. The standard economics theory assumes that the willingness to take risks depends on the concavity of the utility function. In prospect theory,

Gain–loss asymmetry

Experiments in behavioral economics have repeatedly shown that, in the context of risky choices, losses loom larger than gains by a factor of about 2:1. This implies that individuals’ utility functions depend on changes in value (e.g., gains and losses relative to a reference point that may change from situation to situation) rather than the final value of wealth. The fact that most people show loss aversion implies a gain–loss asymmetry, which can be formalized by a loss function that is

Social preferences

Historically, people were sequestered in “lunatic asylums” when they did not comply with social norms. Although current diagnostic methods in psychiatry are based on symptoms and not on social norms, social functioning continues to be a key criterion in the classification of a symptom as pathological. All types of psychological treatments for psychiatric problems directly or indirectly address problems with social adjustment, and interpersonal psychotherapy is effective even in reducing

Time preferences

Intertemporal choices involve trade-offs among costs and benefits that occur at different times. Such decisions are ubiquitous. Adam Smith realized the importance of intertemporal choices for the Wealth of Nations, and their importance in the determination of individual health and well-being is undeniable.

There are two major genetic factors (sets of risk genes) underlying non-psychotic psychiatric disorders that are related to self-control and possibly to intertemporal choice. One factor

Revealed and real preferences

Economists assume that people attempt to choose the highest valued goods that they can afford, and that their revealed preferences reflect their real preferences. Because individuals with psychiatric conditions often reveal preferences that seem not to reflect true preferences (e.g. they seem not to maximize their long-term utility), it is tempting to consider psychiatric patients as irrational people whose revealed preferences are dissociated from their real preferences. While cognitive errors

Normative models of dopamine neurotransmission

In 1957 dopamine was identified as a neurotransmitter, and the discovery that the dopamine system was the primary site of action of antipsychotic drugs was a crucial step toward neurobiological models of mental disorders. Although the one-neurotransmitter-one-disease paradigms have been abandoned, the neurotransmitter hypotheses of psychiatric disorders are still quite simple. Increased dopamine activity is thought to play a major role in schizophrenia because the therapeutic effects of almost

Conclusion

There is strong evidence that decision theory in combination with neuroscience has the potential to study and characterize important aspects of psychiatric disorders, particularly in individuals displaying normal intelligence and intact reality testing. Economic decision theory has the capacity to study a broad range of interacting factors in the same model with regard to motivational forces in humans. This appears to fit well with the needs in psychiatry, given evidence that the interplay of

Acknowledgement

The author thanks Urs Fischbacher (Konstanz, Germany), Jan Engelmann (Zurich, Switzerland), Justin Chumbley (Zurich, Switzerland) and Noah Meyers (Washington, DC) for helpful comments on earlier versions of this manuscript. Dr. Hasler is supported by a NARSAD Independent Investigator Award.

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