Euthymic Patients with Bipolar Disorder Show Decreased Reward Learning in a Probabilistic Reward Task

doi:10.1016/j.biopsych.2007.12.001

Biological Psychiatry

Volume 64, Issue 2, 15 July 2008, Pages 162-168

https://doi.org/10.1016/j.biopsych.2007.12.001 Get rights and content

Background

Bipolar disorder (BPD) features cycling mood states ranging from depression to mania with intermittent phases of euthymia. Bipolar disorder subjects often show excessive goal-directed and pleasure-seeking behavior during manic episodes and reduced hedonic capacity during depressive episodes, indicating that BPD might involve altered reward processing. Our goal was to test the hypothesis that BPD is characterized by impairments in adjusting behavior as a function of prior reinforcement history, particularly in the presence of residual anhedonic symptoms.

Methods

Eighteen medicated BPD subjects and 25 demographically matched comparison subjects performed a probabilistic reward task. To identify putative dysfunctions in reward processing irrespective of mood state, primary analyses focused on euthymic BPD subjects (n = 13). With signal-detection methodologies, response bias toward a more frequently rewarded stimulus was used to objectively assess the participants' propensity to modulate behavior as a function of reinforcement history.

Results

Relative to comparison subjects, euthymic BPD subjects showed a reduced and delayed acquisition of response bias toward the more frequently rewarded stimulus, which was partially due to increased sensitivity to single rewards of the disadvantageous stimulus. Analyses considering the entire BPD sample revealed that reduced reward learning correlated with self-reported anhedonic symptoms, even after adjusting for residual manic and anxious symptoms and general distress.

Conclusions

The present study provides preliminary evidence indicating that BPD, even during euthymic states, is characterized by dysfunctional reward learning in situations requiring integration of reinforcement information over time and thus offers initial insights about the potential source of dysfunctional reward processing in this disorder.

Section snippets

Participants

Bipolar disorder participants were recruited from patients followed for long-term treatment at the Bipolar Clinic and Research Program at Massachusetts General Hospital (MGH) and were initially evaluated with the Affective Disorder Evaluation (ADE; 19), which includes modified mood and psychosis modules from the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) (20). The BPD patients were enrolled if the following inclusion criteria were met: 1) current diagnosis of bipolar I or

Demographics, Symptom Severity, and Mood Variables

Comparison (n = 25) and euthymic BPD (n = 13) subjects did not differ significantly with respect to demographic variables (Table 2) (also, no differences emerged when considering the entire BPD sample, n = 18). For the euthymic BPD patients, the mean HRSD and YMRS scores were 3.38 (SD = 2.57) and 1.9 (SD = 2.33), respectively. Relative to comparison subjects, euthymic BPD patients had significantly higher BDI-II scores [8.38 ± 6.70 vs. 3.40 ± 3.59, t(36) = 3.00, p < .005]; the BPD subjects'

Discussion

The goal of the this study was to test the hypotheses that: a) BPD patients are characterized by abnormal reward processing even during a euthymic state, and b) the presence of residual anhedonic symptoms would exacerbate this dysfunction. With a probabilistic reward task, which assesses how behavior is modulated by reinforcement history, we found that both euthymic and symptomatic BPD patients showed reduced and delayed acquisition of response bias toward the more frequently rewarded stimulus,

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Archival ReportEuthymic Patients with Bipolar Disorder Show Decreased Reward Learning in a Probabilistic Reward Task

Background

Methods

Results

Conclusions

Section snippets

Participants

Demographics, Symptom Severity, and Mood Variables

Discussion

Clin Psychol Rev

Biol Psychiatry

Biol Psychiatry

J Affec Disord

J Affec Disord

Biol Psychiatry

J Affect Disord

Biol Psychiatry

Biol Psychiatry

J Behav Ther Exp Psychiatry

Biol Psychiatry

Biol Psychiatry

Behav Res Ther

Trends Neurosci

Psychiatry Res

Clin Psychol Rev

Pers Indiv Diff

Diagnostic and Statistical Manual of Mental Disorders

Dopamine dysregulation syndrome: Implications for a dopamine hypothesis of bipolar disorder

Acta Psychiatr Scand

A neuropsychological investigation of prefrontal cortex involvement in acute mania

Am J Psychiatry

Using affect-modulated startle to study phenotypes of pediatric bipolar disorder

Bipol Disord

Decision-making in mania: A PET study

Brain

Decision-making cognition in mania and depression

Psychol Med

Deficits on a probabilistic response-reversal task in patients with pediatric bipolar disorder

Am J Psychiatry

Archival Report
Euthymic Patients with Bipolar Disorder Show Decreased Reward Learning in a Probabilistic Reward Task