Neural correlates of risk taking in patients with obsessive-compulsive disorder during risky decision-making

Background: The risk preference during decision-making and the neural substrates involved in patients with obsessive-compulsive disorder (OCD) remained unclear. The current study was designed to evaluate the risktaking behaviors during decision-making and neural correlates in patients with OCD, thereby providing a deeper insight into their impaired decision-making function.Methods: Fifty-one patients with OCD and 50 healthy controls (HCs) were included in this study. All subjects underwent functional magnetic resonance imaging (fMRI) scans while completing the Balloon Analog Risk Task (BART). The behavior indicator and cognitive model parameter in BART, as well as the neural correlates of risktaking behaviors were analyzed.Results: Compared to HCs, the OCD group performed a significantly higher level of risk-averse behaviors, and the cognitive model parameter revealed that patients with OCD tend to decrease their risk level after receiving negative feedbacks during BART. The fMRI results based on prespecified brain regions showed that the OCD group exhibited significantly decreased activation modulated by risk levels both in the left and right insula. Limitations: The effect of medication in this study could not be completely ruled out, and it is difficult to temporally separate different states of decision-making in the BART.Conclusions: Individuals with OCD exhibited a higher level of risk aversion during decision-making process, and the dysfunction of the insula may be the neural basis of the increased risk aversion in OCD. These findings provide further insights into the mechanism of risk aversion and impaired decision-making function in individuals with OCD.