title: Dopaminergic influences on emotional decision making in euthymic bipolar patients.
abstract: We recently reported that the D2/D3 agonist pramipexole may have pro-cognitive effects in euthymic patients with bipolar disorder (BPD); however, the emergence of impulse-control disorders has been documented in Parkinson's disease (PD) after pramipexole treatment. Performance on reward-based tasks is altered in healthy subjects after a single dose of pramipexole, but its potential to induce abnormalities in BPD patients is unknown. We assessed reward-dependent decision making in euthymic BPD patients pre- and post 8 weeks of treatment with pramipexole or placebo by using the Iowa Gambling Task (IGT). The IGT requires subjects to choose among four card decks (two risky and two conservative) and is designed to promote learning to make advantageous (conservative) choices over time. Thirty-four BPD patients completed both assessments (18 placebo and 16 pramipexole). Baseline performance did not differ by treatment group (F=0.63; p=0.64); however, at week 8, BPD patients on pramipexole demonstrated a significantly greater tendency to make increasingly high-risk, high-reward choices across the five blocks, whereas the placebo group's pattern was similar to that reported in healthy individuals (treatment × time × block interaction, p<0.05). Analyses of choice strategy using the expectancy valence model revealed that after 8 weeks on pramipexole, BPD patients attended more readily to feedback related to gains than to losses, which could explain the impaired learning. There were no significant changes in mood symptoms over the 8 weeks, and no increased propensity toward manic-like behaviors were reported. Our results suggest that the enhancement of dopaminergic activity influences risk-associated decision-making performance in euthymic BPD. The clinical implications remain unknown.
authors.affiliation: Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Burdick
authors.affiliation: 1] Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA [2] The Feinstein Institute for Medical Research, Manhasset, NY, USA [3] Department of Psychiatry, Hofstra University School of Medicine, Hempstead, NY, USA.
authors.forename: Raphael J
authors.initials: RJ
authors.lastname: Braga
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Chaya B
authors.initials: CB
authors.lastname: Gopin
authors.affiliation: 1] Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA [2] The Feinstein Institute for Medical Research, Manhasset, NY, USA [3] Department of Psychiatry, Hofstra University School of Medicine, Hempstead, NY, USA.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Malhotra
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000378:metabolism* / Q000523:psychology; D003657:Decision Making / Q000187:drug effects / Q000502:physiology*; D004298:Dopamine / Q000378:metabolism*; D018491:Dopamine Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D004644:Emotions / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011954:Receptors, Dopamine / Q000502:physiology
chemical_list: D018491:Dopamine Agonists; D011954:Receptors, Dopamine; D004298:Dopamine