Exploring the principles of the influence of mental illness on decision-making

. Much of the literature has focused on how emotions affect decision-making, but little has been written about the impact of specific mental illnesses on decision-making. However, this is a serious and relevant topic because people living with mental illness tend to make impulsive or bad choices because of their symptoms and mood. It is hoped that this literature will help people with mental illness or their families to have a better understanding of their behaviour and decisions. This paper attempts to answer the two questions. What cognitive and physiological factors influence the decision making of people with depression and how does depression influence people to make the decision to commit suicide. We used mainly a literature-based approach to our research and conclude that the areas of the brain affected by depression are strongly associated with decision-making and thus contribute to the tendency of depressed people to make poor decisions. For example, the areas of the brain affected by depression are strongly associated with decision-making and thus contribute to the tendency of depressed people to make bad decisions.


Introduction
Use Like the use of mobile phones, dealing with uncertainty is an inevitable part of life. However, not everyone can make decisions with a clear head. As a result of severe psychological attacks, sufferers can lose some of their ability to think and judge, making them vulnerable to poor decisions. [1]According to the World Health Organisation, mental health is about thinking, learning, and understanding one's emotions and the reactions of others. Mental health is a state of balance that includes internal and external aspects. Physical, mental, social, cultural, spiritual, and other relevant factors create this balance. [2]This cognitive impairment can significantly impact an individual's ability to live, work, learn and adapt socially. People with a wide range of mental illnesses have impaired cognitive functioning. Patients with anxiety disorders and depression suffer from neurotransmitter abnormalities in the brain, which can lead to headaches, brain dysfunction, and a feeling of being unable to turn around or slow thinking. [3] The patient may not be rational and objective enough to make decisions. This is not a good time to make big decisions. Severe cognitive impairment can lead to making poor choices with some adverse consequences. For example, not adhering to medication, having reviews, or participating in rehabilitation, even in severe cases, can lead to suicide. [1] Current evidence on emotions and decision-making research at the neuronal level. One report suggests that prefrontal cortex involvement in anxiety in clinical anxiety, where the amygdala would have a crucial role in biasing attention, is a critical component of the brain system for cognitive influence. Also, the prefrontal cortex (PFC) appears to be involved in negatively interpreting anxiety disorders. [4] Then again, the PET studies of Murphy et al. [5]and Drevets et al. [6] showed similar findings: the PFC, the entorhinal test striatum, the amygdala, and the dorsal midbrain thalamus have abnormal activity in individuals with unipolar depression or bipolar disorder. This underlines the importance of neuronal networks for mood . [7] Many studies have looked at how emotions influence decision-making in everyday life but have neglected to examine the emotions of people with mental illness and how abnormalities in brain neurotransmitters affect their decision-making following certain mental illnesses. [1] More importantly, the existing research on this topic does not take into account other factors that influence the data, such as the characteristics of the person's demeanor, how the illness is treated [8], or the degree of mental illness [5]. At the same time, most studies have examined the impact of mental illness on decision-making with a limited number of individual decision models. This essay it is reviewing how decision-making is defined and then how depression, as well as anxiety disorders, are associated with decision-making. How emotions in mental illness affect decision-making and why bad decisions are made that lead to severe consequences is a topic worthy of further study. Therefore, it is relevant to summarise the existing essays and further investigate the relationship between the two to reduce the number of bad decisions paired with treatment or daily life for people with mental illness that can lead to severe consequences later on.

Selection criteria
This article defines the basis for decision-making: In research from Schoemaker & Russo [9], decisionmaking is processed by which individuals, groups, or organisations make decisions about future behavior, depending on a range of purposes and available resources. The process often involves framing the problem, gathering intelligence, drawing conclusions, and learning from the experience. Decision-making is the complex process of translating choices into action based on indicators that represent the importance of those choices to the individual. [10] Choose suicide: According to Oravecz & Moore [11], we can summarise that suicide should be categorized as suicidal ideation, a suicide plan, and a suicide attempt. Furthermore, according to World Health Organization [2], mental health is the basis for well-being and efficient functioning. This essay's determination of mental illness is based on the research of mental illness according to the International Classification of Diseases (ICD-10/11) or the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV or DSM-V); the manifestation of psychologically related conditions or external features (e.g., psychological distress, self-harm and suicide attempts, plans); mental health as defined by validated psychometric methods [12].

Decision-making process
Herbert Simon decomposed the task of rational decisionmaking in three steps: (1) identification and delineation of all alternatives, (2) determination of the consequences of each alternative, and (3) a comparison of the accuracy and efficiency of each of these sets of consequences [1]. In the book by Schoenfeld [13], the decision-making process has six steps in the rational model: identifying the problem, generating alternatives, evaluating alternatives, choosing an alternative, implementing the decision, and evaluating decision effectiveness.

Somatic marker hypothesis
Somatic markers can help direct attention and thus away from the most unfavourable options, simplifying the decision-making process when cognitive processes are overloaded, and people cannot provide an informed choice [14]. Somatic markers may occur in the ventromedial prefrontal cortex, associating the reinforced stimulus with the associated physiological emotion. [15] When making decisions in complex and uncertain situations, all somatic markers associated with the relevant stimuli are added to produce a net somatic state used to guide appropriate decision-making. [16] The Iowa Gambling Task was developed to evaluate how well VMPFC patients make decisions in such challenging and ambiguous situations. To maximise their earnings, participants were instructed to select from four decks of playing cards regularly, each of which had an uncertain chance of winning or losing. The amygdala and prefrontal cortex were essential components of this hypothesized mechanism. [17] In the later modified version of the Gambling Task, Hinson [18], the gains and losses of the previous version are still probabilistic. However, the total returns have been less extreme, making it more challenging to spot attractive selections. A second alternative has been added that results in long-term gains rather than losses. It was concluded that working memory also affects somatic markers, as the increased working memory load generated by the secondary task resulted in poorer gambling performance. As a result, the compromised function of the working memory leads to ineffective development of somatic markers, which may lead to compromised decision-making.

Ventromedial
prefrontal cortex and amygdala Damasio[17] proposed in the somatic marker hypothesis that both the ventromedial prefrontal cortex and the amygdala are components of the nervous system required to implement favourable decision making. This result has also been demonstrated over the last few decades. A large body of research in cognitive neuroscience has established the ventral medial prefrontal cortex as the central brain structure for value-based decision-making. [10] In the primate brain, 'vmPFC' commonly refers to the network of interconnections between the lower regions of the medial and lateral prefrontal cortex. [19] lesions in the vmPFC can lead to a variety of decreases in decision-making ability [20], including reinforcement learning, [17] risky gambling [21] or choosing between options with uncertain outcomes in the form of simultaneous risk and ambiguity, [22] in addition to a role for the VMF cortex in sorting out conflicting rewards and punishments. [23] Finally, People with damage to the lateral prefrontal cortex can still make morally correct choices under hypothetical circumstances, but they are severely impaired in making personal and social decisions. The inability to effectively integrate somatic state information elicited by the amygdala, the hypothalamus, and brainstem nuclei is associated with poor decision-making related to VMF damage. [23] Amygdala lesions play a crucial role in human decisionmaking because they affect how the brain learns to react to complicated cognitive information. [23] Damage to the human amygdala impairs autonomic control, resulting in decreased reactions to various stressful or emotionally charged stimuli.
[24] As a result, after amygdala damage, losing money no longer triggers a desire for money, and winning or losing money does not trigger somatic feelings. [23] The amygdala is a component of the "impulse system" involved in decision-making, according to a new study by Bechara [25], published six years later. This is because the amygdala causes emotional reactions. Additionally, Trane & Hyman's [26] study demonstrated that people without an amygdala exhibited worse judgment and decision-making in actual social interactions.

Decision-making problems
In many cases, decision-making relies too heavily on the past, so on causes mental shortcuts. We may use heuristics as a shortcut when making judgments or decisions, which can lead to quick conclusions and decisions but can also lead to mistakes. [27] When looking back, people may regret why they made those decisions in the first place, especially those decisions that led to bad outcomes after they made them.
According to Carmichael, [28]server bias contributes to incorrect choices. This essay only introduces part of them. 1. Anchoring-The judgment of something is arbitrarily biased by recent irrelevant information. [29] 2. Confirmation. -The tendency to seek out and pay attention to evidence that confirms one's beliefs. [30] 3. Overconfidence: When people believe too much in their abilities, the accuracy of decisions is less than people's belief in their knowledge. [31] 4. What cognitive and biological factors influence the decision-making about suicide for people with depression?  and depressive symptoms. [59] Once a person suffers from depression, they deny themselves completely and feel they cannot do anything.

Relationship between depression and decision-making
They even begin to feel guilty, that they are a drag on their family and that living in this world is a sin, so they begin to feel that there is no point in living.

Severe anxiety/irritability
Many people with depression are pessimists, [56] like having a high-powered magnifying glass in their heads. For example, failing this foreign language exam is due to a lack of language talent rather than a lack of effort to revise. So if life goes smoothly, it is fine, but if one is faced with a family accident, unemployment or illness, it may immediately overwhelm the depressed person.

Substance use and impulsivity
Drugs and alcohol can also affect suicidal people, making them more impulsive and more likely to act on their impulses than when sober. Drug and alcohol use can lead people to commit suicide for other reasons, such as loss of jobs and relationships. [60] Rates of substance use and alcohol use are also higher among people with depression and other mental illnesses. [58] Put these together, and the risk increases.

Conclusion
There are many causes of suicide in people with