Abstract
Altered risk-taking propensity is an important determinant of functional impairment in bipolar disorder. However, prior studies primarily assessed patients with chronic illness, and risk-taking has not been evaluated in the early illness course. This study investigated risk-taking behavior in 39 euthymic early-stage bipolar disorder patients aged 16–40 years who were treated within 3 years from their first-episode mania with psychotic features and 36 demographically-matched healthy controls using the Balloon Analog Risk Task (BART), a well-validated risk-taking performance-based paradigm requiring participants to make responses for cumulative gain at increasing risk of loss. Relationships of risk-taking indices with symptoms, self-reported impulsivity, cognitive functions, and treatment characteristics were also assessed. Our results showed that patients exhibited significantly lower adjusted scores (i.e., average balloon pumps in unexploded trials) (p = 0.001), lower explosion rate (p = 0.007) and lower cumulative scores (p = 0.003) than controls on BART, indicating their suboptimal risk-taking performance with increased propensity for risk aversion. Risk-taking indices were not correlated with any symptom dimensions, self-reported impulsivity, cognitive functions or antipsychotic dose. No significant difference was observed between patients with and without antipsychotic medications on self-reported impulsivity or any of the BART performance indices. This is the first study to examine risk-taking behavior in early-stage bipolar disorder with history of psychosis and indicates that patients displayed altered risk-taking with increased risk aversion compared with controls. Further research is needed to clarify longitudinal trajectory of risk-taking propensity and its relationships with psychosis and functional outcome in the early stage of bipolar disorder.
Highlights
Heightened risk-taking has been regarded as an important clinical feature of bipolar disorder and is associated with maladaptive behaviors such as substance abuse, and functional impairment
We found no significant correlations between Balloon Analog Risk Task (BART) measures and symptom dimensions in patient sample (Table 3)
Exploratory analyses revealed that patients with antipsychotic treatment did not differ from those without antipsychotic treatment in demographics, cognitive functions, clinical and other treatment characteristics, self-report impulsivity, or any of the three BART performance measures (Supplementary Tables 3, 4)
Summary
Heightened risk-taking has been regarded as an important clinical feature of bipolar disorder and is associated with maladaptive behaviors such as substance abuse, and functional impairment. A recent meta-analysis [2], which included six prior studies that formally investigated risk-taking propensity in bipolar disorder based on performance in the Balloon Analog Risk task (BART) [6,7,8] or the Cambridge Gambling task (CGT) [9,10,11], revealed lack of overall significant impairment in risk-taking behavior in patients relative to healthy controls. Discrepant findings were observed across individual studies Among those three reports examining the BART in bipolar disorder, one demonstrated increased risk-taking in patients [7], another found elevated risk-taking only in patients with comorbid alcohol dependence [6], while the remaining study noted increased risk aversion among patients taking antipsychotic medications compared to those without antipsychotic treatment [8]
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