A researcher at the University of California, San Diego (UCSD) School of Medicine suggests that psychiatry experts may need to approach the therapy of psychiatric patients from a new direction by understanding that such individuals behavior and decision-making are based on an attempt to reach an inner equilibrium.

In a special section in the October 26 issue of the journal Science, Martin Paulus, M.D., professor in UCSDs Department of Psychiatry, has compiled a body of growing evidence that human decision-making is inextricably associated with an individuals need to maintain a homeostatic balance.

This is a state of dynamic equilibrium, much like controlling body temperature, said Paulus. How humans select a particular course of action may be in response to raising or lowering that set point back to their individual comfort zone. In people with psychiatric disorders or addictions, the thermostat may be broken.

Up to now, as per Paulus, psychiatry experts and others have looked at the decision-making process as a considered series of options and values.

What has never been considered closely, but should be, is the state of the decision-maker, Paulus said. As per the researcher, this homeostatic state the tendency to maintain internal stability, due to the mind and bodys coordinated responses to any stimulus that disturbs the normal condition is altered in individuals with addictions and psychiatric disorders such as schizophrenia or anxiety. This disturbance of homeostatic balance leads to dysfunctions in decision-making which helps explain why such patients make seemingly bad choices, he said.

Recent neuroimaging research shows strong support for the homeostatic nature of decision making, as per Paulus. For example, interoceptive information which is correlation to the bodys internal state or sense of balance is integrated in a particular part of the brain called the anterior insular cortex, he said. The same brain structures implicated in the urge to take drugs are involved in other biological urges, Paulus added, suggesting that a homeostatic approach could have a broad impact on therapys that seek to control addictions or psychiatric disorders, and will lay the groundwork for new areas of research.

The question addressed in part by this paper are whether changes in decision-making behavior and associated brain functions are a result of pre-existing characteristics which may predispose individuals to use drugs or as a consequence of long-term use.

Decision-making dysfunctions and resultant altered neural processing could provide a biomarker to identify those at high-risk for addictive behaviors, said Paulus, who added that much additional research is needed before researchers could begin to use such an approach.

In an upcoming paper in the journal Dialogues in Clinical Neuroscience, Paulus cites the complex affective, cognitive and behavioral phenomena that come into play during decision-making. The interoceptive system is able to connect with various physiological systems in the brain to orchestrate a complex set of responses, he said, adding that craving and urges are among the most notable responses that play important functions in maintaining homeostasis. Insights into how pleasure and urge are integrated in the brain and how this process is modulated can play an important role in the understanding of and possible future therapy of drug addiction, as per Paulus.


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