Impulsivity, decision-making and risk-taking behaviour in bipolar disorder: a systematic review and meta-analysis

Abstract

Despite the robust body of work on cognitive aspects of bipolar disorder (BD), a clear profile of associated impairments in impulsivity, decision-making and risk-taking from studies that use behavioural measures has yet to be established. A systematic review, across four electronic databases (PsycINFO, MEDLINE/PubMed, ScienceDirect and Scopus), of literature published between January 1999 and December 2018 was carried out in accordance with the PRISMA statement. The protocol was registered on PROSPERO (CRD42018114684). A fixed-effect and random-effects meta-analysis using the Hedges' g (ES) estimate was performed. The analysis revealed significant impairment in BD individuals with medium effect sizes in various aspects of impulsivity – response inhibition (ES = 0.49; p < 0.0001), delay of gratification (ES = 0.54; p < 0.0001) and inattention (ES = 0.49; p < 0.0001) – and in decision-making (ES = 0.61, p = 0.0002), but no significant impairment in risk-taking behaviour (ES = 0.41; p = 0.0598). Furthermore, we found significant heterogeneity between studies for decision-making and risk-taking behaviour but not for impulsivity. Impaired risk-taking behaviour was significant in a subgroup of BD-I and euthymic individuals (ES = 0.92; p < 0.0001) with no significant heterogeneity. A stratification analysis revealed comparable results in euthymic and non-euthymic individuals for impulsivity. Our findings suggest that behaviour impulsivity is elevated in all phases of BD, representing a core and clinically relevant feature that persists beyond mood symptoms. More studies about decision-making and risk-taking are necessary to establish if they are impaired in BD and to analyze the role of mood state.

Digital Health Literacy in Bipolar Disorder: International Web-Based Survey

“…Furthermore, qualitative research is required to identify ways to tailor content to the specific needs, interests, and vulnerabilities among people with BD. For example, impulsivity and risk taking is characteristic of hypomanic/manic states in BD [ 67 ]; as such, modules may need to provide education and strategies addressing how evaluation of privacy/financial risks of health apps can be impacted by BD symptoms.…”

Data_Sheet_1.docx

“…Our results showed that patients made significantly fewer average balloon pumps in unexploded trials and had lower explosion rate than controls, indicating their increased tendency for risk aversion. This is, however, contrary to a recent meta-analysis which found no significant impairment in risk-taking behavior in bipolar disorder, in terms of the pooled estimate for the entire sample or individual behavioral tasks (2). Some previous studies (7,9,10) and stratified analysis of the meta-analytic review (2) further revealed elevated risk-taking behavior in bipolar disorder patients, particularly those with bipolar I disorder.…”

Mathematical modeling of risk-taking in bipolar disorder: Evidence of reduced behavioral consistency, with altered loss aversion specific to those with history of substance use disorder

“…Behavioral findings using this approach have been inconsistent in BD and difficult to compare across studies (Bauer et al, 2017;Hidiroǧlu et al, 2013;Holmes et al, 2009;Linke et al, 2013;Ramírez-Martín et al, 2020;Reddy et al, 2014;Scholz et al, 2016). One reason is the heterogeneity of mood state between investigations (Ramírez-Martín et al, 2020).…”

“…Behavioral findings using this approach have been inconsistent in BD and difficult to compare across studies (Bauer et al, 2017;Hidiroǧlu et al, 2013;Holmes et al, 2009;Linke et al, 2013;Ramírez-Martín et al, 2020;Reddy et al, 2014;Scholz et al, 2016). One reason is the heterogeneity of mood state between investigations (Ramírez-Martín et al, 2020). Some have studied purely euthymic samples (Hidiroǧlu et al, 2013;Linke et al, 2013;Scholz et al, 2016), while others have studied samples containing a mixture of hypo/manic, euthymic, and depressed participants (Bauer et al, 2017;Holmes et al, 2009;Reddy et al, 2014).…”