title: Altered representation of expected value in the orbitofrontal cortex in mania.
abstract: OBJECTIVE
  Increased responsiveness to appetitive and reduced responsiveness to aversive anticipatory cues may be associated with dysfunction of the brain reward system in mania. Here we studied neural correlates of gain and loss expectation in mania using functional magnetic resonance imaging (fMRI).
  
  
  METHODS
  Fifteen manic patients and 26 matched healthy control individuals performed a monetary incentive delay task, during which subjects anticipated to win or lose a varying amount of money. Varying both magnitude and valence (win, loss) of anticipatory cues allowed us to isolate the effects of magnitude, valence and expected value (magnitude-by-valence interaction).
  
  
  RESULTS
  Response times and total gain amount did not differ significantly between groups. FMRI data indicated that the ventral striatum responded according to cued incentive magnitude in both groups, and this effect did not significantly differ between groups. However, a significant group difference was observed for expected value representation in the left lateral orbitofrontal cortex (OFC; BA 11 and 47). In this region, patients showed increasing BOLD responses during expectation of increasing gain and decreasing responses during expectation of increasing loss, while healthy subjects tended to show the inverse effect. In seven patients retested after remission OFC responses adapted to the response pattern of healthy controls.
  
  
  CONCLUSIONS
  The observed alterations are consistent with a state-related affective processing bias during the expectation of gains and losses which may contribute to clinical features of mania, such as the enhanced motivation for seeking rewards and the underestimation of risks and potential punishments.
authors: Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany. felix.bermpohl@charite.de
authors: Felix
authors: F
authors: Bermpohl
authors: Thorsten
authors: T
authors: Kahnt
authors: Umut
authors: U
authors: Dalanay
authors: Claudia
authors: C
authors: Hägele
authors: Bastian
authors: B
authors: Sajonz
authors: Tristan
authors: T
authors: Wegner
authors: Meline
authors: M
authors: Stoy
authors: Mazda
authors: M
authors: Adli
authors: Stephanie
authors: S
authors: Krüger
authors: Jana
authors: J
authors: Wrase
authors: Andreas
authors: A
authors: Ströhle
authors: Michael
authors: M
authors: Bauer
authors: Andreas
authors: A
authors: Heinz
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology*; D001921:Brain / Q000502:physiology; D001931:Brain Mapping; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology*; D003463:Cues; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011930:Reaction Time; D012201:Reward