Behavioral and Electrophysiological Alterations for Reinforcement Learning in Manic and Euthymic Patients with Bipolar Disorder

Abstract

These findings suggest that patients with bipolar disorder during euthymic or manic states have behavioral and electrophysiological alterations in reward learning compared to healthy subjects. This dysfunctional reward processing may be related to the abnormal decision-making or altered goal-directed activities frequently seen in patients with bipolar disorder.

Electrophysiological biomarkers of behavioral dimensions from cross-species paradigms

“…Probabilistic reinforcement learning paradigms are naturally transferrable across vertebrates [ 20 – 23 ], and are thus an ideal candidate for domain consistency. Probabilistic learning deficits are observed in people with psychiatric conditions, such as schizophrenia [ 24 , 25 ], bipolar disorder [ 26 ], and depression [ 27 – 29 ], bolstering the translational utility of findings. Reinforcement learning theory provides a quantification of abstract processes [ 30 ], facilitating an interpretation of neural signals by their confirmation to theorized parameters and computations.…”

Cognitive Processes and Legal Capacity in Patients With Bipolar Disorder: A Brief Research Report

“…Mood disorders have been the most frequent conditions ( Silva-Junior and Fischer, 2015 ). The literature also emphasizes that cognitive deficit is a central feature in BD, with important repercussions for psychosocial functioning that also impacts the patients’ family, social, and professional lives ( MacQueen et al, 2001 ; Dickerson et al, 2004 ; Sanchez-Moreno et al, 2009 ; Ryu et al, 2017 ; Richa et al, 2018 ; Bennett et al, 2019 ; Sachs et al, 2020 ). We carried out a study on BD patients to verify a possible association between impairments in the cognitive process such as attention, and executive functioning and discuss how these deficits might affect legal capacity, for example, the ability to perform legal acts such as a will, sale of property, among others.…”

“…Considering the findings of this group in relation to inattention, impulsiveness, and difficulties in differentiating what is relevant from what is not fundamental for the moment, episodic BD patients may, for example, have difficulty in reading and properly understanding a contract document, miss important information in a negotiation, or sign a contract in an impulsive manner, not considering the possible long-term consequences, and aiming for only the immediate reward. Ryu et al (2017) also discussed the difficulty of episodic BD patients to adjust their responses to intermittent rewards.…”

“…These authors found that in the euthymic phase, subclinical residual depressive symptoms had an impact on reduced processing speed, attention deficits and verbal memory. Other studies demonstrate cognitive impairment in making appropriate decisions and judgments (Osuji and Cullum, 2005;Cáceda et al, 2014;Volkert et al, 2016;Alexander et al, 2017;Ryu et al, 2017;Richa et al, 2018).…”

“…The literature has also emphasized the differences regarding reward sensitivity during episodes, that is, patients in a mood episode demonstrate difficulties in adjusting responses to intermittent rewards. Regarding the euthymic phase, there is no consensus on cognitive deficits ( Bersani et al, 2016 ; Volkert et al, 2016 ; Ryu et al, 2017 ; Richa et al, 2018 ). In this setting, it appears that cognitive deficits are known as an underlying feature in BD; in addition, these deficits are associated with lower psychosocial functioning, affecting family, social, and professional lives ( Sanchez-Moreno et al, 2009 ; Bennett et al, 2019 ; Sachs et al, 2020 ).…”