Trait-Related Decision-Making Impairment in the Three Phases of Bipolar Disorder
Trait-Related Decision-Making Impairment in the Three Phases of Bipolar Disorder
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DOI：
10.1016/j.biopsych.2011.01.018
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发表时间：
2011-08-15
影响因子：
10.6
通讯作者：
Courtet, Philippe
中科院分区：
文献类型：
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作者：
Adida, Marc;Jollant, Fabrice;Courtet, Philippe
背景：在双相情感障碍(BD)中，对决策等神经认知功能缺陷与疾病阶段的关系知之甚少。我们预测躁狂、抑郁和心境良好的双相情感障碍患者将表现出决策能力受损，并检验临床特征是否可以预测患者的决策能力。方法：采用横断面设计，纳入三所大学精神科医院的受试者(N=317，年龄范围：18-65岁)，包括167名躁狂、抑郁和心境良好的住院患者，以及150名年龄、智商和性别匹配的健康对照(HC)。预测变量与决策的关系通过一步法多变量分析进行评估。结果：躁狂组、抑郁组和欣快症组选择的卡片数量显著多于健康组(分别为p<；.001、p<；.01和p<；.05)，三组之间无显著差异。然而，像HCS一样，BPS更喜欢产生不频繁惩罚的甲板，而不是那些产生频繁惩罚的甲板。在多因素分析中，受教育程度低、抑郁评分高、BD家族史、使用苯二氮类药物、不使用5-羟色胺和去甲肾上腺素再摄取抑制剂(SNRI)抗抑郁药显著(p<；.001)预测决策障碍。然而，在个体甲板分析中，BD组之间的一些细微差异可能指向对强化机制的微妙状态影响，以及风险敏感决策中更基本的特质损害。
Background: In bipolar disorder (BD), little is known about how deficits in neurocognitive functions such as decision-making are related to phase of illness. We predicted that manic, depressed, and euthymic bipolar patients (BPs) would display impaired decision-making, and we tested whether clinical characteristics could predict patients' decision-making performance.Methods: Subjects (N = 317; age range: 18-65 years) including 167 BPs (45 manic and 32 depressed inpatients, and 90 euthymic outpatients) and 150 age-, IQ-, and gender-matched healthy control (HC) participants, were included within three university psychiatric hospitals using a cross-sectional design. The relationship between predictor variables and decision-making was assessed by one-step multivariate analysis. The main outcome measures were overall decision-making ability on the Iowa Gambling Task (IGT) and an index of sensitivity to punishment frequency.Results: Manic, depressed, and euthymic BPs selected significantly more cards from the risky decks than HCs (p < .001, p < .01, and p < .05, respectively), with no significant differences between the three BD groups. However, like HCs, BPs preferred decks that yielded infrequent penalties over those yielding frequent penalties. In multivariate analysis, decision-making impairment was significantly (p < .001) predicted by low level of education, high depressive scores, family history of BD, use of benzodiazepines, and nonuse of serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants.Conclusions: BPs have a trait-related impairment in decision-making that does not vary across illness phase. However, some subtle differences between the BD groups in the individual deck analyses may point to subtle state influences on reinforcement mechanisms, in addition to a more fundamental trait impairment in risk-sensitive decision making.