Elsevier

Biological Psychiatry

Volume 66, Issue 9, 1 November 2009, Pages 840-846
Biological Psychiatry

Archival Report
Altered Risk-Aversion and Risk-Seeking Behavior in Bipolar Disorder

https://doi.org/10.1016/j.biopsych.2009.05.011Get rights and content

Background

Bipolar disorder (BD) is associated with high-risk behaviors, such as gambling and impulsivity. However, little is known about the psychological factors that influence these behaviors or their significance for the development of the disorder. In this study, we investigated the effects of highlighting rewards versus highlighting punishments in the risky decision-making of euthymic individuals with bipolar disorder.

Methods

Twenty euthymic, medication-free men and women with previously undiagnosed bipolar II or bipolar disorder not otherwise specified and 20 age- and IQ-matched healthy men and women completed a computerized risky decision-making task in which mathematically equivalent dilemmas were presented in terms of opportunities to gain rewards (“positively-framed”) or to avoid suffering losses (“negatively-framed”). The dependent measures were the proportion of risk-seeking choices (and deliberation times) when making decisions in positively versus negatively framed dilemmas.

Results

As expected, healthy control participants made more risky-seeking choices in response to the negatively framed dilemmas compared with the positively framed dilemmas. However, this effect was significantly attenuated in BD participants who also took significantly longer to make risk-averse responses to the positively framed dilemmas. The BD participants overestimated the number of bad outcomes arising out of positively framed dilemmas.

Conclusions

These data demonstrate that risky choice in BD is associated with reduced sensitivity to emotional contexts that highlight rewards or punishments, possibly reflecting altered valuations of prospective gains and losses associated with behavioral options.

Section snippets

Methods and Materials

The study was approved by the National Health Service Central Office for Research Ethics Committees, United Kingdom. All participants provided written, informed consent.

Sample Characteristics

There were no significant differences in age or full-scale IQ between the BD and healthy control participants. The BD participants described a few manic symptoms in the YMRS, significantly more than the control subjects [F(1,35) = 4.50, p < .05] and, similarly, significantly more depressive symptoms in the HAM-D [F(1,35) = 9.18, p < .01]. However, their total scores were very low (Table 1).

The BD participants reported higher levels of trait anxiety and trait negative affect compared with the

Discussion

When dilemmas were couched in terms of gains (“positively-framed”) compared with losses (“negatively-framed”), the shift between risk-averse and risk-seeking choices was significantly reduced in individuals with bipolar II or bipolar disorder NOS compared with age- and IQ-matched healthy control participants. In the positively framed dilemmas, the BD participants made more risky choices for increased gains and took significantly longer to make risk-averse choices; by contrast, in the negatively

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