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)

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Summary

Introduction

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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