title: Reward-related processes in pediatric bipolar disorder: a pilot study.
abstract: BACKGROUND
  Neuropsychological research on children with bipolar disorder (BPD) is scarce. Here, we examine reward-related behaviors in children with BPD using a Wheel of Fortune task in which subjects could win or lose money depending on their decisions. The intent of this work was to investigate performance differences between BPD and healthy children on a task that could be used in an fMRI environment to inform the neural substrates of reward processes in BPD. This study has no direct clinical implications. We hypothesized that relative to healthy children, children with BPD would select risky options more frequently, be less confident in a favorable outcome, and report stronger emotional responses to outcomes.
  
  
  METHODS
  Forty-four children (22 BPD; 22 control) were compared on (i) decision-making with varying levels of risk, (ii) level of confidence in favorable outcomes, and (iii) responses to feedback. The task included a win-no win version and a lose-no lose version.
  
  
  RESULTS
  Patterns of selection did not differ between groups. In the lose-no lose task, BPD patients were less confident than controls in favorable outcomes. BPD patients expressed greater dissatisfaction than controls at not winning in win-no win, and greater satisfaction than controls at not losing in lose-no lose.
  
  
  CONCLUSIONS
  Limitations of this study included that the children with BPD were mostly in a depressed state, were medicated, and had co-morbid disorders.
  
  
  CONCLUSIONS
  This is the first experimental study to examine associations between pediatric BPD and reward-related behaviors. Although we failed to detect abnormalities in risky decision-making in children with BPD, we found significant differences between groups in both confidence ratings and response to feedback, consistent with our predictions. Our ultimate goal is to use this task in the fMRI environment to gain a better understanding of the neural correlates of reward-related processes in pediatric BPD.
authors.affiliation: Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, 15K North Drive, Room 118, Bethesda, MD 20892-2670, USA. ernstm@intra.nimh.nih.gov
authors.forename: Monique
authors.initials: M
authors.lastname: Ernst
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Dickstein
authors.forename: Suzanne
authors.initials: S
authors.lastname: Munson
authors.forename: Neir
authors.initials: N
authors.lastname: Eshel
authors.forename: Anne
authors.initials: A
authors.lastname: Pradella
authors.forename: Sandra
authors.initials: S
authors.lastname: Jazbec
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Pine
authors.forename: Ellen
authors.initials: E
authors.lastname: Leibenluft
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D012054:Reinforcement, Psychology; D012309:Risk-Taking; D013647:Task Performance and Analysis