title: Trait-related decision-making impairment in the three phases of bipolar disorder.
abstract: BACKGROUND
  In bipolar disorder (BD), little is known about how deficits in neurocognitive functions such as decision-making are related to phase of illness. We predicted that manic, depressed, and euthymic bipolar patients (BPs) would display impaired decision-making, and we tested whether clinical characteristics could predict patients' decision-making performance.
  
  
  METHODS
  Subjects (N = 317; age range: 18-65 years) including 167 BPs (45 manic and 32 depressed inpatients, and 90 euthymic outpatients) and 150 age-, IQ-, and gender-matched healthy control (HC) participants, were included within three university psychiatric hospitals using a cross-sectional design. The relationship between predictor variables and decision-making was assessed by one-step multivariate analysis. The main outcome measures were overall decision-making ability on the Iowa Gambling Task (IGT) and an index of sensitivity to punishment frequency.
  
  
  RESULTS
  Manic, depressed, and euthymic BPs selected significantly more cards from the risky decks than HCs (p < .001, p < .01, and p < .05, respectively), with no significant differences between the three BD groups. However, like HCs, BPs preferred decks that yielded infrequent penalties over those yielding frequent penalties. In multivariate analysis, decision-making impairment was significantly (p < .001) predicted by low level of education, high depressive scores, family history of BD, use of benzodiazepines, and nonuse of serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants.
  
  
  CONCLUSIONS
  BPs have a trait-related impairment in decision-making that does not vary across illness phase. However, some subtle differences between the BD groups in the individual deck analyses may point to subtle state influences on reinforcement mechanisms, in addition to a more fundamental trait impairment in risk-sensitive decision making.
authors.affiliation: Mediterranean Institute of Cognitive Neurosciences, Department of Pharmacology and Neuropsychology of Emotions Related to Risk Taking and Reward, National Research Scientific Centre, Sainte-Marguerite Hospital, Mediterranean University, Marseille, France. marc.adida@aphm.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Adida
authors.forename: Fabrice
authors.initials: F
authors.lastname: Jollant
authors.forename: Luke
authors.initials: L
authors.lastname: Clark
authors.forename: Nathalie
authors.initials: N
authors.lastname: Besnier
authors.forename: Sébastien
authors.initials: S
authors.lastname: Guillaume
authors.forename: Arthur
authors.initials: A
authors.lastname: Kaladjian
authors.forename: Pascale
authors.initials: P
authors.lastname: Mazzola-Pomietto
authors.forename: Régine
authors.initials: R
authors.lastname: Jeanningros
authors.forename: Guy M
authors.initials: GM
authors.lastname: Goodwin
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.forename: Philippe
authors.initials: P
authors.lastname: Courtet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000209:etiology* / Q000235:genetics; D003657:Decision Making; D005260:Female; D005715:Gambling; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011678:Punishment; D055815:Young Adult