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Psychiatry Research 157 (2008) 39 – 46

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Ultimatum bargaining behavior of people

affected by schizophrenia
Nirit Agay a , Shmuel Kron b,c , Ziv Carmel b,c,⁎,
Shlomo Mendlovic b,c , Yechiel Levkovitz b,c
a
The Raymond and Beverly Sackler Faculty of Exact Sciences, School of Mathematical Sciences, Tel-Aviv University, Ramat Aviv, Israel
b
The Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
c
Shalvata Mental Health Center, P.O.Box 94, Hod-Hasharon, 45100, Israel
Received 13 June 2005; received in revised form 24 December 2005; accepted 2 March 2006

Abstract

Forty-nine people suffering from schizophrenia performed an interactive bargaining task involving small monetary rewards,
known in classical game theory as the Ultimatum Game. In this task, the subject, in the role of the Proposer, has to offer his or her
(anonymous) counterpart, the Responder, a share of a given sum of money. If the Responder accepts the offer, then the sum is split
accordingly between the two. Otherwise, if he or she decides to reject the offer, both receive nothing. The patients' strategic
behavior in both roles was compared with that of healthy and clinical controls. It was hypothesized that cognitive deficits
characterizing schizophrenia, together with difficulties in social judgment, would impair the patients' bargaining ability. We found
that in general schizophrenic patients did not fully exploit their strategic power as Proposers. In contrast, as Responders,
schizophrenic patients acted not significantly different from controls. Further investigation is needed to establish the links between
cognitive and symptomatic mediators and strategic decision-making ability.
© 2006 Elsevier Ireland Ltd. All rights reserved.

Keywords: Schizophrenia; Ultimatum Game; Bargaining task; Game theory; Cognitive deficits; Social cognition

1. Introduction Moreover, it requires ‘mind-reading’ (mentalizing) ability

In this work we have studied the strategic behavior of
schizophrenic patients playing the Ultimatum Game
(UG). The UG is an interactive decision task that
involves goal-directed behavior, using cognitive skills
such as working memory and executive function (i.e.
planning ahead while anticipating future consequences).
⁎ Corresponding author. Day Care Unit, “Shalvata” Mental Health
Center, P.O. Box 94, Hod-HaSharon 45100, Israel. Tel.: +972 9
7478570, +972 50 590 7061 (Mobile); fax: +972 9 7478674.
E-mail addresses: ziv.carmel@gmail.com, zivca@clalit.org.il
(Z. Carmel).
0165-1781/$ - see front matter © 2006 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.psychres.2006.03.026
and social cognition. The UG involves two players, the
Proposer and the Responder, and is described by the
following rules: The Proposer is given a sum of money
and has to offer the Responder part of it. The Responder
may either accept the offer or reject it. If he or she
chooses to accept the offer, the sum of money is divided
between the two according to that offer. However, if he or
she rejects the offer, then both players receive nothing.
In playing the UG, certain cognitive abilities and
functions are employed by both players. To maximize his
or her payoff, the Proposer is supposed to use a
mentalizing ability. The Responder, on the other hand,
might face a conflict between ‘rational’ thinking (the
40 N. Agay et al. / Psychiatry Research 157 (2008) 39–46
goal of maximizing his or her payoff) and emotional
arousal concerning social norms (e.g. a feeling of insult,
the urge to punish for unfairness). Two distinct brain
regions, the dorsolateral prefrontal cortex and the insula,
were found to be highly activated during the Respon-
der's decision under this conflict (Sanfey et al., 2003).
Both these brain regions are considered impaired in
schizophrenic patients. The hypothesis that people af-
fected by schizophrenia have impaired mentalizing
ability (Theory of Mind) has been discussed by Frith
and Corcoran (1996), but no definitive conclusions have
been reached.
The main goal of our research was to study how
people affected by schizophrenia function in the UG, a
bargaining game that reflects aspects in daily life
functioning.
1.2. Decision-making behavior and social cognition in
schizophrenia
The degree to which schizophrenic patients show
intact functioning on decision-making tasks is still
unclear. Several studies using two different decision
tasks — Bechara's gambling paradigm (also known as
the Iowa Gambling Task) and the two-choice prediction
task— resulted in ambiguous conclusions (Bechara et
al., 1994; Shurman et al., 2005; Hutton et al., 2002;
Wider et al., 1998; Ludewig et al., 2003).
Beside cognitive deficits such as in working memory
and executive function, which are considered a core
feature of schizophrenia (Sharma and Antonova, 2003),
other deficits belong to the field of social cognition. It
was hypothesized that difficulties in social interactions
in schizophrenia originate in a deficit in Theory of Mind
(ToM), that is, in incorrect interpretation of the
intentions and thoughts of others. Various studies were
aimed at finding a linkage between the symptomatology
of schizophrenia, cognitive deficits, and functioning
level in ToM tasks (Corcoran et al., 1995; Stephenson et
al., 1996; Pickup and Frith, 1996, 2001).
The crucial difference between a typical task (a ToM
task or a decision-making task such as the ones
mentioned above) and a game is that the former doesn't
take into account interactive considerations; none of the
decision alternatives from which a subject chooses a
response influence the other subjects. However, in a
game such as the UG, each decision alternative has a
different effect upon both the player who makes the
decision and his or her counterpart.
There is no doubt that a certain ‘mind-reading’ ability
is crucial in daily social exchange and social relations,
no less than cognitive abilities such as memory and
planning ahead. Daily life decision-making processes
should take into account other people's response to
one's decisions. Therefore, whereas the majority of the
literature examined decision-making abilities of schizo-
phrenic patients in non-strategic environments, our
study investigates how schizophrenic patients deal
with a strategic interaction.
1.3. The Ultimatum Game
The Ultimatum Game represents a “take it or leave it”
negotiation scene: one bargainer makes a final offer to
the counterpart and walks away from the table, leaving
the other to either sign the deal or not. Personal ex-
perience in negotiation might tell us that such a dramatic
attitude has a good chance of failing. However, in clas-
sical game theory, such an ultimatum should work.
Imagine the following situation: you receive a sum of
money and are being told to offer an anonymous person a
part of it. If this person accepts your offer (for example,
of one dollar out of the whole sum), then you end up with
the whole sum minus one dollar, and the other person
ends up with a dollar. However, the other person has
the right to reject your offer, in case it doesn't suit him or
her: if that happens — both of you end up with no money
at all.
In game theory, this situation is called an Ultimatum
Game. In this game there are two players: a Proposer (the
one who makes the offer and who has the advantage of the
first-goer), and a Responder (who makes the decision
whether to accept the offer or reject it, and thus has veto
power). If we assume that each player wants to maximize
his or her profit in the game, it is clear that the Responder
should accept any offer, because any positive amount is
better than zero. Therefore the Proposer, knowing this,
should offer the smallest amount possible. Thus, in the
case of two ‘rational’ players playing for 20 New Israeli
Shekels (NIS) — approximately 5 U.S. dollars — the
Proposer should offer 1 NIS, the Responder should accept
the offer, and the game should end with payoffs (19, 1) —
that is, Proposer receiving 19 NIS, Responder receiving 1
NIS. In fact, the Responder should accept even an offer of
0 NIS, because rejection will not negatively effect his or
her payoff (either accepting or rejecting the offer, he or she
will end up with 0); thus, another possible result of the
game is (20, 0). Such a pair of payoffs in called the Nash
Equilibrium of the game, and it means that this is how the
game should end if the players are both payoff
maximizers.(Selten, 1975). However, this equilibrium
was rarely realized in any of the numerous experiments
that have been conducted throughout the world over the
past 22 years (Guth et al., 1982; Guth and Tietz, 1990;
 N. Agay et al. / Psychiatry Research 157 (2008) 39–46
Roth et al., 1991; McCabe et al., 2002). Instead, subjects
reach a less extreme, more reasonable division of the sum
of money at stake, even though the game is played
anonymously so that social considerations such as
reputation should have no influence. The average
Proposer offers 40% of the amount to the Responder. In
average, 16% of the offers are rejected. Tiny offers are
almost always rejected (Oosterbeek et al., 2003).
Aspects of social exchange in everyday life are
represented in this simple game, for example, fairness
and punishing for unfairness (even at the price of
lowering one's own profit), along with empathy (the
Proposer can try to predict the response by putting
himself or herself in the place of the Responder). In
addition, playing this game more than once involves a
learning process, even if one's counterpart changes: for
example, one learns which low offers are high enough to
be accepted, and which have a high probability of being
rejected.
1.4. Hypothesis
As described above, people affected with schizo-
phrenia tend to misinterpret the intentions and beliefs of
others. Hence, we hypothesized that as Proposers, these
subjects would:
1) Not fully acknowledge their strategic power, i.e. the
power to offer a little less than half the sum and thus
earn more than half. Realizing that such an offer has a
good chance of being accepted demands a certain
mind-reading ability, which might be impaired in
schizophrenia. We therefore expected offers in the
schizophrenic patient group to be higher, closer to
half the sum, than those in the control groups.
2) Make some tiny offers, not taking into account the
high probability of rejection of these “insulting” or
“unfair” offers by the Responders.
3) Make unreasonable hyper-fair offers (more than half
the sum), due to misjudgment of the situation.
In addition, we predicted perseveration along trials:
after experiencing one round of the game, the offer level
would not change dramatically following “accept”
responses; a Proposer in the schizophrenic group will
not attempt to maximize his or her payoff by reducing
their offer after their last one was accepted.
As for the Responder's role, we rely on the article
Autism, theory-of-mind, cooperation and fairness (Hill and
Sally, 2003). The authors of this unique study investigated
the behavior of people with autism in the UG. They
conclude that the rejection rate is not necessarily correlated
41
with intact ToM. Therefore, we predicted no substantial
difference in rejection rates among the three groups.
2. Methods
2.1. Subjects
Forty-nine people with a DSM-IV diagnosis of
schizophrenia participated in the study. Diagnosis was
based on clinical assessment made by two specialist
psychiatrists.
All subjects were inpatients in the day care unit of
“Shalvata” Mental Health Center, in Hod-HaSharon,
Israel. The patients were in various stages of rehabilita-
tion, all attending either the day care ward or a
rehabilitation unit. None were fully hospitalized. Based
on clinical assessment, none of the patients were in an
acute psychotic stage of illness.
The experiment was approved by the local Helsinki
committee, and all participants gave their signed in-
formed consent. Subjects were further selected based on
functional measures: the patient's ability to cooperate,
and autonomously perform his or her part in the game.
Prior to participating in the game, every patient was
asked to perform a short preliminary task in order to assess
organizational ability and basic arithmetic ability: subjects
were given a deck of cards, and were asked to form a
combination of cards that would create the number 11.
After completing this task successfully, the participants
proceeded to the next stage of the experiment.
Two control groups were studied as well. A group of 52
non-clinical controls was recruited from the community
and university staff (age and gender matched). A second
control group consisted of 19 depressive patients, all
inpatients attending a day program at “Shalvata” Mental
Health Center at the time of the experiment (Table 1).
2.2. Procedures
Patient sessions included 4, 6, or 8 participants, half of
them in the role of Proposers and the other half as Res-
ponders. Roles were determined randomly by the instruc-
tor. Control sessions included 6, 8, or 18 participants.
Proposers sat in a row facing a row of Responders. All
of the participants in a session sat in the same room, so
that the experimental procedure would be transparent to
them. Each participant was assigned a code number, so
that the session would be anonymous: the names of one's
counterparts would not be revealed to him or her.
The procedure of each “round” was as follows:
The Proposer made an offer by filling in a form (see
Appendix 1). The forms were then distributed randomly
42 N. Agay et al. / Psychiatry Research 157 (2008) 39–46

Table 1
Participants' demographic and clinical characteristics
Schizophrenic patients Depressive patients Non-clinical controls
N = 49 N = 19 N = 52
Mean S.D. Mean S.D. Mean S.D.
a
Age (years) 36.2 10.8 43.0 18.5 34.9 9.2
Education b 0.9 0.6 1.3 0.9 1.5 0.6
Mean age at onset of illness (years) c 19.4 4.9 27.0 18.0
Length of current admission (months) d 4.4 5.5 3.5 2.6
Number of previous admissions e 2.8 2.2 1.8 1.0
CGI score f 4.6 1.0 4.3 0.8
a
Significant (and typical) difference in age of schizophrenic vs. depressive groups (P = 0.03). No significant difference between schizophrenic
patients and non-clinical controls (P = 0.49).
b
Education level was assessed using the following scale: 0 — did not complete high school, 1 — completed high school, 2 — high education. The
difference between the groups is significant (P b 0.01).
c
No significant difference between the groups (P = 0.2).
d
No significant difference between the groups (P = 0.4).
e
Significant difference between the groups (P b 0.01).
f
Clinical Global Impression (Guy W., ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: US Department of Health and
Human Services publication (ADM) 1976; pp. 218–22). No significant difference between the groups (P = 0.3).

among the Responders. In this way, every Responder
received an offer from an anonymous Proposer. After the
Responders filled in their decisions, each form was returned
to the Proposer to whom it belonged, so that each Proposer
could find out what the response to his or her offer was.
Subjects were asked to keep silent during the session.
At the beginning of the session, the subjects were
given an oral explanation of the rules of the game by the
instructor. Thereafter, a demonstration round was played
(with no real payoffs), followed by two “real” rounds
(i.e. with payoffs) in a row. The sum of money for each
round was 20 NIS (approximately 5 U.S. dollars).
The subjects were told that after these two rounds,
they would receive their payoffs according to one of the
rounds, which would be randomly chosen. (This was
done due to budget limitations.) At the end of the
session each subject discreetly received an envelope
containing his or her payoff.
The UG can be played, and studied, either as a single-
round or a multi-stage game. We have chosen to study a
simple two-stage version (two pay rounds). The rationale
for this choice was both our interest in the initial behavior
rather than the acquired one, and our desire for subjects
to fully comprehend the game rules. This is why we
address much importance to the last round of the game,
the second pay-round, in which we assume subjects to
have operated out of comprehension of the game.
2.3. Data analysis
A Pearson chi-square test was used in order to check
whether offer distribution varied with group. To assess
order to assess the influence of experience on Proposers'
behavior, we applied regression analysis with last (2nd)
offer as the dependent variable, and the following
variables as predictors: 1st offer (O1), the response to it
(R1), group, group • O1, O1 • R1.
A Pearson chi-square test was used to determine
whether the distribution of Proposer types varied with
group.
One- and two-way analyses of variance (ANOVAs)
were used to analyze differences in mean offer between
the groups, with and without respect to gender.
A series of Pearson chi-square tests was used to
examine whether the rejection rate varied with group
and round.
3. Results
3.1. Offers
3.1.1. Offers by levels
We divided offers into three categories, with respect
to offer level: fair (10 NIS), unfair (less than 10 NIS),
and hyper-fair (more than 10 NIS). A significant
difference between the groups concerning the final
offer was revealed. The distribution of final-round offers
by levels is presented in Fig. 1. While the distribution of
healthy subjects' offers was approximately even be-
tween fair and unfair (none were hyper-fair), that of
schizophrenic subjects was significantly different
(P = 0.016); about 50% of their offers were fair and the
rest were more or less evenly divided between unfair
and hyper-fair. Thus, for schizophrenic Proposers, the
possibility of dividing the money evenly was as
reasonable as for healthy Proposers, whereas the option
 N. Agay et al. / Psychiatry Research 157 (2008) 39–46 43

Offers by levels rejected, or lowered their 2nd offer after their 1st offer
60%
was accepted.
50% ‘Weak-strategic’ Proposers are those who persever-
40% ated, that is, their 2nd offer was the same as their 1st
30% offer.
20%
Finally, ‘non-strategic’ Proposers are those who
unreasonably reduced their offer after a rejection, or
10%
raised their offer after an acceptance.
0% We found that the distribution into types significantly
unfair (<10 NIS) fair (=10 NIS) hyperfair (>10 NIS)
varied with group.
schizophrenic (N=25) control (N=26)
As demonstrated in Fig. 3, the highest proportion of
Fig. 1. Distribution of offers by levels, final round. non-strategic Proposers is in the schizophrenic group
(P = 0.018). Non-strategic Proposers consist as much as
20% of the total in the schizophrenic group, while in the
of being hyper-fair appears to be as reasonable as being healthy group there are none.
unfair, in contrast to the pattern for healthy Proposers.
3.1.4. Mean offer
3.1.2. Offer fluctuation after acceptance/rejection No significant differences in mean offer were
Fig. 2 shows the influence of experience on Pro- revealed between the three groups. The mean offers in
posers' behavior, that is, how the 1st offer and the
counterpart's response to it influenced the level of the
2nd offer. It turned out that the nature of this influence a
varied with group (all P values b 0.035). 2nd offer after rejection of 1st offer
25
The adjustment of the 2nd offer after the 1st offer had
received a negative response is quite similar in both the
2nd offer (NIS)

20
schizophrenic and healthy control groups (Fig. 2a). Both
15
figured out that they should raise their 2nd offer after their
1st one was rejected. However, schizophrenic patients 10
were more generous and raised their offer to a slightly
5
higher level than controls. (As can be seen in Fig. 2a, the
line representing the schizophrenic group is slightly above 0
the line representing controls, when 1st offer is unfair.) 0 5 10 15 20
This similarity emphasizes the relative failure in strategic 1st offer (NIS)
control (N=26) schizophrenic (N=25)
thinking, as demonstrated in the way schizophrenic
reference slope (1st offer=2nd offer)
patients adjust their 2nd offer after their 1st offer had
received a positive response. While healthy controls, at- b
tempting to maximize their payoff, lower their 2nd offer 2nd offer after acceptance of 1st offer
after a positive response for their 1st offer, schizophrenic 25
patients do not do so. As can be seen in Fig. 2b, their 2nd 20
2nd offer (NIS)

offer seems independent of the response they had received

and is approximately constant (7.7 NIS). 15

10
3.1.3. Proposer types
5
In order to further examine Proposers' strategic think-
ing, we divided the entire Proposer population into types, 0
based on how their 2nd offer was affected by the response 0 5 10 15 20
to their 1st offer: Referring to the two pay-rounds (1st and 1st offer (NIS)
2nd), we define ‘strong-strategic’, ‘weak-strategic’ and control (N=26) schizophrenic (N=25)
reference slope (1st offer=2nd offer)
‘non-strategic’ types of Proposers as follows:
‘Strong-strategic’ Proposers are those who adjusted Fig. 2. a: A regression model for the 2nd offer, after receiving a
their 2nd offer according to the response to their 1st rejection of the 1st offer. b: A regression model for the 2nd offer, after
offer, that is, raised their 2nd offer after their 1st one was receiving an acceptance of the 1st offer.
44 N. Agay et al. / Psychiatry Research 157 (2008) 39–46

all groups were approximately 8.7 NIS with a standard Rejection Rates
deviation of about 3 NIS. 50.00%

40.00%
3.1.5. Mean offer by group and gender
Analysis referring to group and gender revealed a 30.00%
significant difference between the schizophrenic group
and the healthy control group; analysis of the first round 20.00%
of the game (demo round) revealed a link between group
10.00%
and gender (P = 0.029); that is, the difference between
men's and women's mean offer was found to be group 0.00%
dependent. In the schizophrenic group, the average offer demo round* 1st round** 2nd round
of men was significantly higher than that of women schizophrenic (N=24) healthy controls (N=26)
(10.4 vs. 7.1 NIS, respectively), with men's mean offer non-schiz. patients (N=10)
being slightly more than half the sum, whereas in the
healthy control group only a minor difference between Fig. 4. Rejection rates by group and round.
men's and women's offers was demonstrated (8.2 vs.
9.1 NIS, respectively). This phenomenon was even higher than that of healthy subjects (P = 0.026): the latter
more significant (P = 0.001) on the last offer (round 2) of rejected only 4% of the offers, while schizophrenic
the game: while schizophrenic men offered on average subjects and depressed subjects rejected 20% and 40% of
11.2 NIS, schizophrenic women offered only 6.7 NIS the offers, respectively. By the last round, no significant
on average. In the healthy control group, no such dif- difference was found in rejection rates between the
ferences were found; men's and women's mean offers different groups. Although the rejection rate among
being 7.7 and 8.5 NIS, respectively. schizophrenic subjects remained the highest (29%, vs.
Thus, the deviation from the standard offer level (the 19% of healthy and 20% of depressed patients), this
mean offer of men and women together, which was difference was not statistically significant.
around 8 NIS in all groups) is upwards for schizophrenic
men, and downwards for schizophrenic women. 4. Discussion

3.2. Responses In the present study, we aimed at examining the

strategic ability of schizophrenic patients, using the UG.
3.2.1. Rejection rates Based on previous findings of Sharma and Antonova
The rejection rates are presented in Fig. 4. (2003), we predicted that schizophrenic patients' cogni-
On the demo-round, the rejection rate in the tive deficits and difficulties in social interactions might
schizophrenic group was significantly lower than in make their strategic behavior less efficient (or merely
both control groups. (8% vs. 34% and 30% respectively, different) from that of controls.
P = 0.077). We have chosen to utilize a paradigm taken from
A reversed trend was demonstrated in the 1st round, classical game theory, the study of strategic interactions.
when the rejection rate of patients was significantly In a game, players (either opponents or partners) use
computational and social cognitive skills to select the
most profitable strategy, where profit can be money,
Proposer Types satisfaction, reputation, etc. Being a mathematical field
80%
of study, game theory quantifies each game into a matrix
70%
60%
of actions and payoffs, thus searching for optimal
50% strategies. By modeling an interaction between two
40% sides as a game, in the game-theoretic sense, we can
30% quantify aspects in the behavior of the people involved,
20% and examine their choices in the light of the optimal
10% strategies game theory gives us.
0%
non-strategic weak-strategic strong-strategic
The advantage of a task like the UG over traditional
schizophrenic (N=25) healthy controls (N=26) non-schiz.patients (N=9)
tasks used to quantify decision-making ability is that
this kind of game-oriented task can model daily life
Fig. 3. Type distribution by group. situations, such as negotiation/bargaining situations in
 N. Agay et al. / Psychiatry Research 157 (2008) 39–46
which one decides whether or not to purchase a certain
item or where to do it, one manages a bank account, etc.
These situations demand a decision-making ability
which involves both cognitive and emotional factors.
Existing laboratory decision-making tasks such as
the Iowa gambling task and the two-choice prediction
task mentioned earlier can help to quantify decision-
making characteristics involving working memory or
executive control. However, the conclusions drawn
from these experiments are somewhat limited since the
nature of the tasks does not involve a few crucial aspects
of decision-making in daily life.
Whereas existing tasks are performed in a ‘sterile’
laboratory environment, isolating and measuring single
aspects of behavior, the UG task is interactive, user-
friendly and simple to perform. It involves real people, not
merely a computer screen. The decisions that one has to
make in either role of the UG link cognitive abilities such
as executive function and working memory, together with
social judgment concerning the other players' view of
reality, as well as one's own. This is exactly the kind of
decision we constantly make in everyday life; therefore
understanding how cognitive impairments affect social
decision-making and strategic thinking is of great
importance. This kind of task can add to traditional
means of evaluating cognitive abilities another, more
complex evaluation of a patient's daily functioning.
In this study we found substantial differences
between schizophrenic and non-schizophrenic subjects
as Proposers. Schizophrenic subjects did not fully
exploit their advantage as first-goers in the game. In
contrast to healthy controls who, after an ‘accept’
response, figured out they can now reduce their offer
in a reasonable way and still get an ‘accept’ response,
thus increasing their payoff, schizophrenic patients did
not fully attempt to make the best out of the situation.
Misjudgment of the bargaining situation is clearly seen
in the schizophrenic patients' distribution of offers by
levels — fair, unfair, hyper-fair — which differs from
that of healthy controls. While not even a single hyper-
fair offer, and equal rates of fair and unfair offers, were
made by the healthy control Proposers, schizophrenic
Proposers made a considerable amount of hyper-fair
offers, the same rate of fair offers as controls, and much
fewer unfair offers compared with controls.
While both schizophrenic and controls acted quite the
same after receiving a rejection, increasing their
subsequent offer, a difference in the behavior after
acceptance was prominent. The percentage of ‘non-
strategic’ Proposers, as we defined those who raised their
subsequent offer after an ‘accept’ response, is signifi-
cantly higher among schizophrenic subjects than in
45
controls. The lack of strategic behavior is clearly seen in
the regression graph (Fig. 2b): there is no adaptation of
the offer level after receiving an ‘accept’ response for the
previous offer. Thus, compared with healthy controls,
schizophrenic patients take less strategic advantage of
their role as Proposers.
Another finding is that schizophrenic Proposers'
behavior was gender-dependent, as opposed to healthy
controls'. Schizophrenic men were significantly more
generous in their offers than schizophrenic women, whose
mean offer was lower than the mean offer level of all three
groups. Schizophrenic men actually offered slightly more
than half the sum to their counterpart. This finding may be
of interest in light of the study of Sullivan and Allen
(1999), in which gender differences among schizophrenic
patients in their Machiavellian tendency were shown. The
term ‘Machiavellianism’ refers to one's tendency to act in
a cold and manipulative manner, while reading one's
counterpart's intentions in order to maximize one's
payoff. The authors investigated the hypothesis that
schizophrenic patients score significantly lower than
healthy controls on the MACH-3 test, a questionnaire
quantifying Machiavellian tendencies, initially developed
by Christie and Geis (1970). This turned out to be true for
schizophrenic men but not for schizophrenic women. Our
findings support Sullivan and Allen's hypothesis that
schizophrenic men, but not women, are relatively low-
Machs. Whether and how cognitive deficits relate to high/
low Mach tendencies is yet to be studied.
Unlike Proposers' behavior, in which we found
substantial differences between the schizophrenic
patients group, depressed patients group, and the healthy
control group, Responders' behavior converged during
the rounds to a similar behavior on the final round. This
finding resembles those of Hill and Sally (2003), who
performed an UG experiment with autistic participants.
In the present framework, schizophrenic patients
seemed to deal with the cognition-emotion conflict des-
cribed in the fMRI study of Sanfey et al. (2003) in a
manner similar to that of healthy controls. However, it is
important to note that the low proportion of rejections
throughout the whole experiment makes this conclusion
questionable. Further research is needed to verify our
finding that rejection rates are the same among schizo-
phrenic and non-schizophrenic subjects. A possible way to
increase the percentage of rejections is to control the offer-
level in an artificial way, hence producing lower, more
‘insulting’ offers that have a high chance of being rejected.
Since the study group consisted of inpatients, we
included a control group of non-schizophrenic inpatients,
in addition to the healthy control group. The addition of
this second control group was aimed at neutralizing the
46 N. Agay et al. / Psychiatry Research 157 (2008) 39–46
hospitalization factor in the schizophrenic group's
behavior. However, the relatively small size of this
group and the small rate of rejections limited our ability to
draw definite conclusions from some of the statistical
analyses such as regression analysis and analysis by
gender. For this reason, the data drawn from the
depressive group are included in only some of the
conclusions presented here. Despite these limitations, this
clinical control group is important in this study; in results
concerning all three groups, either there is no significant
difference between the groups (as in mean offer and final
rejection rate), or each group is significantly different
from the other (in distribution into Proposer types).Thus
we believe that the hospitalization factor has been
neutralized to a satisfactory degree, and there is a high
probability that the behavior of schizophrenic subjects is
illness specific and not merely a consequence of their state
of being hospitalized.
To our knowledge, this preliminary work is the first
exploratory study of its kind. Albeit its limitations,
significant differences between schizophrenic and con-
trol subjects playing the UG were demonstrated. Further
research is needed in order to better understand these
findings, particularly comparing symptom-specific
groups and using measures of cognitive deficits.
Hopefully, a better understanding of these aspects will
enable the development of future tools for assessing
schizophrenic patients' decision-making abilities, thus
helping to develop novel treatment strategies for gaining
successful self-maintenance of their daily life.
Appendix 1
Round number_____
Proposal form
(1) Player 1 's code number_____________________
(2) Player 2 's code number____________________
(3) The sum which has to be divided_____20 NIS____
(4) Player 2 will receive_______________________
(5) Player 1 will receive (3)–(4)________________
(6) I Accept____________________I Reject______
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