title: Attentional Bias Predicts Increased Reward Salience and Risk Taking in Bipolar Disorder.
abstract: BACKGROUND
  There is amassing evidence that risky decision-making in bipolar disorder is related to reward-based differences in frontostriatal regions. However, the roles of early attentional and later cognitive processes remain unclear, limiting theoretical understanding and development of targeted interventions.
  
  
  METHODS
  Twenty euthymic bipolar disorder and 19 matched control participants played a Roulette task in which they won and lost money. Event-related potentials and source analysis were used to quantify predominantly sensory-attentional (N1), motivational salience (feedback-related negativities [FRN]), and cognitive appraisal (P300) stages of processing. We predicted that the bipolar disorder group would show increased N1, consistent with increased attentional orienting, and reduced FRN, consistent with a bias to perceive outcomes more favorably.
  
  
  RESULTS
  As predicted, the bipolar disorder group showed increased N1 and reduced FRN but no differences in P300. N1 amplitude was additionally associated with real-life risk taking, and N1 source activity was reduced in visual cortex but increased activity in precuneus, frontopolar, and premotor cortex, compared to those of controls.
  
  
  CONCLUSIONS
  These findings demonstrate an early attentional bias to reward that potentially drives risk taking by priming approach behavior and elevating reward salience in the frontostriatal pathway. Although later cognitive appraisals of these inputs may be relatively intact in remission, interventions targeting attention orienting may also be effective in long-term reduction of relapse.
authors: School of Psychological Sciences, University of Manchester, Manchester, United Kingdom; Clinical Psychology, Institute of Psychiatry, King's College London, London, United Kingdom. Electronic address: Liam.Mason@kcl.ac.uk.
authors: Liam
authors: L
authors: Mason
authors: School of Psychological Sciences, University of Manchester, Manchester, United Kingdom.
authors: Nelson J
authors: NJ
authors: Trujillo-Barreto
authors: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom.
authors: Richard P
authors: RP
authors: Bentall
authors: School of Psychological Sciences, University of Manchester, Manchester, United Kingdom; School of Biomedical Engineering, University of Valparaiso, Valparaiso, Chile.
authors: Wael
authors: W
authors: El-Deredy
mesh_terms: D001288:Attention; D001714:Bipolar Disorder / Q000503:physiopathology*; D001921:Brain / Q000473:pathology*; D003071:Cognition; D003657:Decision Making; D004569:Electroencephalography; D005071:Evoked Potentials; D006801:Humans; D008279:Magnetic Resonance Imaging; D009042:Motivation; D012201:Reward; D012309:Risk-Taking
keywords: Accumbens; FRN; N1; P300; Reward; Risk taking; Striatum; mania