Abstract
Deficits in inhibitory function are assumed to underlie psychopathology in bipolar disorder (BD), especially in states of mania. A subdomain of inhibition, semantic inhibition (SI), referring to the suppression of irrelevant word meanings, may underlie formal thought disorder, such as flights of ideas. In the present study, we investigated SI in patients with BD during semantic ambiguity resolution using behavioral and event-related potential (ERP) measures. We presented 14 patients with BD with current manic, hypomanic, or mixed clinical states and 28 healthy controls sequentially with word triplets containing either a homonym (e.g., “organ”) or a comparable unambiguous word (e.g., “piano”). Participants were instructed to make a decision whether or not the target word was related to the meaning field of the first two words. The inappropriate homonym meaning had to be inhibited to correctly perform the target decision. In addition to reaction times (RT) and error rates (ER), the N400 ERP component to the target, an electrophysiological index of semantic processing, was analyzed as measure of the amount of SI that had taken place. Analyses of the behavioral data revealed that BD patients exhibited an overall worse performance in terms of RT and ER. In the ERP data, we found differences in N400 amplitude to ambiguous and unambiguous conditions over the right hemisphere in patients with BD depending on target congruence: In incongruent trials, N400 amplitude was smaller in ambiguous than in unambiguous words. In congruent trials, in contrast, N400 amplitude was larger in ambiguous than in unambiguous words. Such ERP differences between ambiguous and unambiguous words were absent in controls. We conclude that N400 amplitude differences in the ambiguous and unambiguous conditions of the BD group may reflect insufficient suppression of irrelevant homonym meanings in the right hemisphere. Disturbed SI processes might contribute to formal thought disorder in BD.
Highlights
In patients suffering from bipolar disorder (BD), deficits in cognitive inhibition are among the most robustly documented cognitive deficits, especially during manic and mixed states (Strakowski et al, 2009; Sole et al, 2011)
Participants were presented with a paradigm, which required them to inhibit the dominant meaning of polar homonyms in favor of the contextually relevant subdominant meaning in order to perform the correct semantic decision
Participants performed an equivalent task with unambiguous words
Summary
In patients suffering from bipolar disorder (BD), deficits in cognitive inhibition are among the most robustly documented cognitive deficits, especially during manic and mixed states (Strakowski et al, 2009; Sole et al, 2011). Cognitive inhibition deficits have been conceptualized as a basic cognitive dysfunction underlying manic psychopathology, giving rise to the more complex illness-defining behavioral features, such as impulsivity, distractibility, reduced ability to delay gratification, and overspending (Larson et al, 2005; Degabriele et al, 2011; Hajek et al, 2013) In congruency with this line of reasoning, brain regions that have been functionally linked to inhibitory processes, such as the ventrolateral prefrontal cortex (VLPF), the dorsolateral prefrontal cortex (DLPC), and the right inferior frontal gyrus (IFG), have been frequently found to exhibit structural and/or functional alterations in BD patients (Collette et al, 2001; Frangou, 2005; Chikazoe et al, 2007; Phillips and Swartz, 2014; Roberts et al, 2017). The latter requires a semantically unrelated sentence closure to be provided by the subjects, suppressing a highly primed semantically related response (Wang et al, 2013)
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