title: Moods as ups and downs of the motivation pendulum: revisiting reinforcement sensitivity theory (RST) in bipolar disorder.
abstract: Motivation is a key neurobehavioral concept underlying adaptive responses to environmental incentives and threats. As such, dysregulation of motivational processes may be critical in the formation of abnormal behavioral patterns/tendencies. According to the long standing model of the Reinforcement Sensitivity Theory (RST), motivation behaviors are driven by three neurobehavioral systems mediating the sensitivity to punishment, reward or goal-conflict. Corresponding to current neurobehavioral theories in psychiatry, this theory links abnormal motivational drives to abnormal behavior; viewing depression and mania as two abnormal extremes of reward driven processes leading to either under or over approach tendencies, respectively. We revisit the RST framework in the context of bipolar disorder (BD) and challenge this concept by suggesting that dysregulated interactions of both punishment and reward related processes better account for the psychological and neural abnormalities observed in BD. We further present an integrative model positing that the three parallel motivation systems currently proposed by the RST model, can be viewed as subsystems in a large-scale neurobehavioral network of motivational decision making.
authors.affiliation: Functional Brain Center, Wohl Institute of Advanced Imaging, Tel Aviv Medical Center Tel Aviv, Israel ; School of Psychological Sciences, Tel Aviv University Tel Aviv, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Gonen
authors.affiliation: Functional Brain Center, Wohl Institute of Advanced Imaging, Tel Aviv Medical Center Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.
authors.forename: Haggai
authors.initials: H
authors.lastname: Sharon
authors.affiliation: Psychiatry Department, Yale School of Medicine Baltimore, MD, USA ; Olin Neuropsychiatry Research Center, Hartford Hospital Hartford, CT, USA ; Psychiatry Department, Johns Hopkins University Hartford, CT, USA.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Pearlson
authors.affiliation: Functional Brain Center, Wohl Institute of Advanced Imaging, Tel Aviv Medical Center Tel Aviv, Israel ; School of Psychological Sciences, Tel Aviv University Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel ; Sagol School of Neuroscience, Tel Aviv University Tel Aviv, Israel.
authors.forename: Talma
authors.initials: T
authors.lastname: Hendler
keywords: bipolar disorder; depression; functional neuroimaging; motivation and affectives process; system neuroscience