S82. REINFORCEMENT LEARNING IMPAIRMENT IN PATIENTS WITH EARLY-STAGE PSYCHOTIC BIPOLAR DISORDER

Abstract Background Abnormal reward sensitivity is a biosignature to mood disorders spectrum. Recent data suggested either elevated or preserved positive but impaired negative reinforcement learning in patients with bipolar disorder. Functional MRI studies provided extra evidence on heightened reward sensitivity in manic patients. Of note, these investigations mostly rest on chronically ill samples, conditions of whom may have been confounded by prolonged exposure to medications. This study aims to examine reinforcement learning performance and its relationship with symptomology in patients with early-stage psychotic bipolar disorder (BDP). Methods This study is based on 38 patients with early-stage BDP (defined by having received psychiatric treatment for first-episode BDP within 3 years since service entry) who have been euthymic for at least eight weeks and 40 demographically-matched controls. Reinforcement learning performance was evaluated using Gain-vs-Loss-Avoidance Task (GLAT), which measured the correct responses in both gain and loss-avoidance pairs with reinforcement probability at either 90% or 80% across four blocks in the training phase and one block in the test/transfer phase. Comparison analyses on reinforcement learning performance were conducted on two groups. Associations of reinforcement learning measures with symptom scores, cognitive functions and functioning measures were also tested. Results There was no group difference in gender, age or education level. Repeated-measures analysis of variance (ANOVA) showed significant main effects of group (F=6.52, p=0.013), block (F=43.71, p<0.001), probability (F= 5.58, p<0.001), and block x group (F=2.87, p=0.040) interaction. Post-hoc tests revealed that controls performed better than patients across blocks (p<0.05). Patients also showed a lower lose-shift rate (t= 2.21, p=0.03) and punishment-driven learning accuracy rates (t=2.42, p=0.018) than controls. Marginally significant main effect of stimulus pair (F=3.98, p=0.05) was revealed in the test phase, with controls showing a significantly higher preference in Frequent Winner vs Frequent Loser (FWFL) pair than patients (t=-2.25, p=0.028). No significant correlations between learning measures and any of the symptom dimensions in patient sample. Discussion Our preliminary findings provided a brief evidence on the negative reinforcement learning impairment in early-stage BDP patients. Further investigation is required to verify and confirm our results of impaired negative reinforcement learning in the initial course of bipolar disorder.

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Relational memory in the early stage of psychotic bipolar disorder

Psychiatry Research ◽

10.1016/j.psychres.2020.113508 ◽

2020 ◽

Vol 294 ◽

pp. 113508

Author(s):

Rachel A. McKinney ◽

Suzanne N. Avery ◽

Kristan Armstrong ◽

Jennifer Urbano Blackford ◽

Neil D. Woodward ◽

...

Keyword(s):

Bipolar Disorder ◽

Early Stage ◽

Relational Memory ◽

Psychotic Bipolar Disorder

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Relational Memory in the Early Stage of Psychotic Bipolar Disorder

Biological Psychiatry ◽

10.1016/j.biopsych.2020.02.560 ◽

2020 ◽

Vol 87 (9) ◽

pp. S215-S216

Author(s):

Rachel A. McKinney ◽

Suzanne N. Avery ◽

Kristan Armstrong ◽

Stephan Heckers

Keyword(s):

Bipolar Disorder ◽

Early Stage ◽

Relational Memory ◽

Psychotic Bipolar Disorder

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Thalamocortical Anatomical Connectivity in Schizophrenia and Psychotic Bipolar Disorder

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa022 ◽

2020 ◽

Vol 46 (5) ◽

pp. 1062-1071 ◽

Cited By ~ 5

Author(s):

Julia M Sheffield ◽

Anna S Huang ◽

Baxter P Rogers ◽

Monica Giraldo-Chica ◽

Bennett A Landman ◽

...

Keyword(s):

Bipolar Disorder ◽

Cognitive Abilities ◽

Early Stage ◽

Imaging Data ◽

Anatomical Connectivity ◽

Full Spectrum ◽

Schizophrenia Spectrum ◽

Functional Consequences ◽

The Impact ◽

Psychotic Bipolar Disorder

Abstract Background Anatomical connectivity between the thalamus and cortex, including the prefrontal cortex (PFC), is abnormal in schizophrenia. Overlapping phenotypes, including deficits in executive cognitive abilities dependent on PFC-thalamic circuitry, suggest dysrupted thalamocortical anatomical connectivity may extend to psychotic bipolar disorder. We tested this hypothesis and examined the impact of illness stage to inform when in the illness course thalamocortical dysconnectivity emerges. Methods Diffusion-weighted imaging data were collected on 70 healthy individuals and 124 people with a psychotic disorder (schizophrenia spectrum = 75; psychotic bipolar disorder = 49), including 62 individuals in the early stage of psychosis. Anatomical connectivity between major divisions of the cortex and thalamus was quantified using probabilistic tractography and compared between groups. Associations between PFC-thalamic anatomical connectivity and executive cognitive abilities were examined using regression analysis. Results Psychosis was associated with lower PFC-thalamic and elevated somatosensory-thalamic anatomical connectivity. Follow-up analyses established that lower PFC-thalamic and elevated somatosensory-thalamic anatomical connectivity were present in both schizophrenia and psychotic bipolar disorder. Lower PFC-thalamic anatomical connectivity was also present in early-stage and chronic psychosis. Contrary to expectations, lower PFC-thalamic anatomical connectivity was not associated with impaired executive cognitive abilities. Conclusions Altered thalamocortical anatomical connectivity, especially reduced PFC-thalamic connectivity, is a transdiagnostic feature of psychosis detectable in the early stage of illness. Further work is required to elucidate the functional consequences of the full spectrum of thalamocortical connectivity abnormalities in psychosis.

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T56. RISKY DECISION-MAKING IMPAIRMENT IN EARLY-STAGE PSYCHOTIC BIPOLAR DISORDER

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.616 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S252-S253

Author(s):

Mary Chung Man Ng ◽

Joe Kwun Nam Chan ◽

Martha Luk ◽

Cheuk Fei Wong ◽

Sui Fung Wo ◽

...

Keyword(s):

Decision Making ◽

Bipolar Disorder ◽

Early Stage ◽

Healthy Controls ◽

Risky Decision Making ◽

Risky Decision ◽

Cumulative Score ◽

Study Results ◽

Adjusted Score ◽

Psychotic Bipolar Disorder

Abstract Background Previous research suggests that bipolar disorder may be associated with increased risk-taking / impulsivity. Risky decision-making paradigm is an objective, performance-based measure which has been increasingly applied in bipolar disorder research examining. Nonetheless, literature focused only on chronically ill samples, with illness chronicity, clinical heterogeneity and prolonged medication exposure being potential confounding factors of study results. The current study aimed to explore whether patients with early-stage psychotic bipolar disorder (BDP) exhibit impaired risky decision-making relative to healthy controls, using a well-validated, widely-applied experimental paradigm of Balloon Analogue Risk Task (BART). Methods Thirty-nine patients with early-stage BDP (defined by having received psychiatric treatment for first-episode BDP within 3 years since service entry) and 36 demographically matched healthy controls were recruited. BART was administered to examine risky decision-making performance. Deliberative risky behavior was operationalized as the willingness to inflate balloons as each pump was accompanied by an extra point gained in the temporary repository or balloon explosion. Three performance-based indices (adjusted score, explosion rate and cumulative score) were derived and analyzed. Results There were no significant differences between patients and controls in age, gender and educational levels. Independent samples t-tests illustrated that patients had significantly lower adjusted score (t = -3.45, p = .001, d = .791), explosion rate (t = -2.75, p = .007, d = .631) and cumulative score (t = -3.07, p = .003, d = .714) in BART compared to controls. Similar findings were obtained when comparison analyses were restricted to patients who were treated with antipsychotic medications at the time of study assessment (n = 30). No significant correlations between BART performance-based indices and measures of clinical and treatment variables were found in patient sample. Discussion Our results demonstrated that early-stage BDP patients displayed suboptimal risky decision-making compared with controls. Abnormal risky decision-making observed in the euthymic state of patients in early stage of bipolar disorder suggests that such impairment might represent a trait factor in the disorder. Further prospective research is warranted to clarify the longitudinal course of risky decision-making impairment in bipolar disorder.

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Faculty Opinions recommendation of Diffusion tensor imaging white matter endophenotypes in patients with schizophrenia or psychotic bipolar disorder and their relatives.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718020664.793479834 ◽

2013 ◽

Author(s):

Alfredo Carlo Altamura ◽

Massimiliano Buoli

Keyword(s):

Bipolar Disorder ◽

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Psychotic Bipolar Disorder

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The functional impairment of different subtypes and occupational states in euthymic patients with bipolar disorder

BMC Psychiatry ◽

10.1186/s12888-021-03242-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinyu Liu ◽

Xiaojuan Ma ◽

Wenchen Wang ◽

Jian Zhang ◽

Xia Sun ◽

...

Keyword(s):

Bipolar Disorder ◽

Social Functioning ◽

Rating Scale ◽

Verbal Learning ◽

Occupational Status ◽

Learning Performance ◽

Neurocognitive Functioning ◽

Type I ◽

Speed Of Processing ◽

Occupational Functioning

Abstract Background The aim was to explore the associations between clinical symptoms, demographic variables, social and neurocognitive functioning in euthymic patients with bipolar disorder (BD) stratified by subgroups of DSM-IV BD (type I (BD-I) and type II (BD-II)) and occupational status (employed/unemployed), and to highlight the significance of occupational status when assessing social and neurocognitive functioning in euthymic BD patients. Methods A total of 81 euthymic BD patients were participated in the study. The severity of the depressive and manic/hypomanic symptoms was measured using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Social functioning and neurocognitive functioning were evaluated by the Functioning Assessment Short Test (FAST) and neurocognitive measures, respectively. Results Employed BD patients displayed greater social functioning (autonomy, occupational functioning, interpersonal relationship domain) and better verbal learning performance and speed of processing than unemployed BD patients. The correlation between neurocognitive functioning and social functioning was stronger in the employed group than in the unemployed group. There were no significant differences in neurocognitive and social functioning between the BD-I and BD-II groups, and the correlation between neurocognitive functioning and social functioning was similar between the BD-I and BD-II groups. Conclusion Employed BD patients may present greater occupational functioning and interpersonal relationships, as well as better verbal learning performance and speed of processing.

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Psychotic Bipolar Disorder

Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches ◽

10.1007/978-3-319-91557-9_4 ◽

2018 ◽

pp. 59-72

Author(s):

Massimiliano Buoli ◽

Alice Caldiroli

Keyword(s):

Bipolar Disorder ◽

Psychotic Bipolar Disorder

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Smoking as a Common Modulator of Sensory Gating and Reward Learning in Individuals with Psychotic Disorders

Brain Sciences ◽

10.3390/brainsci11121581 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1581

Author(s):

Alexis E. Whitton ◽

Kathryn E. Lewandowski ◽

Mei-Hua Hall

Keyword(s):

Bipolar Disorder ◽

Prediction Error ◽

Psychotic Disorders ◽

Predictive Coding ◽

Sensory Gating ◽

Event Related Potential ◽

Reward Learning ◽

Smoking History ◽

Impaired Performance ◽

Psychotic Bipolar Disorder

Motivational and perceptual disturbances co-occur in psychosis and have been linked to aberrations in reward learning and sensory gating, respectively. Although traditionally studied independently, when viewed through a predictive coding framework, these processes can both be linked to dysfunction in striatal dopaminergic prediction error signaling. This study examined whether reward learning and sensory gating are correlated in individuals with psychotic disorders, and whether nicotine—a psychostimulant that amplifies phasic striatal dopamine firing—is a common modulator of these two processes. We recruited 183 patients with psychotic disorders (79 schizophrenia, 104 psychotic bipolar disorder) and 129 controls and assessed reward learning (behavioral probabilistic reward task), sensory gating (P50 event-related potential), and smoking history. Reward learning and sensory gating were correlated across the sample. Smoking influenced reward learning and sensory gating in both patient groups; however, the effects were in opposite directions. Specifically, smoking was associated with improved performance in individuals with schizophrenia but impaired performance in individuals with psychotic bipolar disorder. These findings suggest that reward learning and sensory gating are linked and modulated by smoking. However, disorder-specific associations with smoking suggest that nicotine may expose pathophysiological differences in the architecture and function of prediction error circuitry in these overlapping yet distinct psychotic disorders.

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