Decision making and neuropsychiatry

Abnormal decision making is a central feature of neuropsychiatric disorders . Recent investigations of the neural substrates underlying decision making have involved qualitative assessment of the cognition of decision making i n clinical lesion studies (in patients with frontal lobe dementia) and neur opsychiatric disorders such as mania, substance abuse and personality disor ders. A neural network involving the orbitofrontal cortex, ventral striatum and modulatory ascending neurotransmitter systems has been identified as h aving a fundamental role in decision making and in the neural basis of neur opsychiatric diseases. This network accounts for the dissociations among de cision-making deficits in different clinical populations. Ultimately, a mor e refined and sophisticated characterization of such deficits might guide t he early diagnosis and cognitive and therapeutic rehabilitation of these pa tients.