The greater frontal activation in inconsistent patients compared with consistent SZ may appear surprising, given that this region is often associated with higher cognitive functions and yet these patients showed poorer performance on the DD task. However, abnormal prefrontal cortex activation is one of the most replicated findings in SZ, with Inhibitors,research,lifescience,medical reports of hyper- and hypoactivation associated with fluctuating task difficulty and performance (Glahn et al. 2005). More activation in our inconsistent patients than consistent patients during the DD task may reflect inefficient processing

during task performance. Study limitations For the main fMRI contrasts done in this study we opted to match patients and HC based on performance which led us to exclude about a third of our patient Inhibitors,research,lifescience,medical population. This significantly limits the generalization of the results. The behavioral results from the inconsistent patients suggest that the task was too difficult and/or that the participants were not meaningfully engaged in the task. Inhibitors,research,lifescience,medical In future

imaging studies, these patients could be compared with HC using a parametric equivalent of the DD task. All SZ in this study were on stable doses of antipsychotic GSK2656157 medications, which may influence the BOLD fMRI signal (Roder et al. 2010). In addition, there was a trend level difference between the number of smokers Inhibitors,research,lifescience,medical in the consistent SZ group and the consistent HC group, and smoking negatively impacts the brain (Durazzo et al. 2006; Gallinat et al. 2007). However, two recent studies that took smoking into consideration found no group differences in DD between SZ and HC (MacKillop and Tidey 2011;

Wing et al. 2012; but see Ahn et al. 2011). Performance on the RBANS was significantly impaired in consistent and inconsistent SZ compared with consistent HC. These cognitive deficits could contribute to differences in activation across a wide variety of tasks, including the Inhibitors,research,lifescience,medical present DD task. DD may also be influenced by a person’s financial status. Given the financial circumstances of patients with chronic illness, this may be a psychological factor influencing behavior unrelated to symptoms associated with SZ. Finally, our small sample sizes did not allow us to pursue meaningful correlations with relevant factors, such Farnesyltransferase as cognitive and clinical measures. Conclusions Our results point to disruption of several neural networks during decision making, including executive, reward, default mode, and emotional, and suggest processes that are disturbed during decision making in SZ. In the face of matched behavior, executive and reward networks were less activated, while regions of the DMN that are usually deactivated during a task were more activated.