Lack of insight may predict impaired decision making in manic patients

Adida, M.; Clark, Luke; Pomietto, P.; Kaladjian, Arthur; Besnier, N.; Azorin, Jean‐Michel; Jeanningros, Régine; Goodwin, Guy M.

doi:10.1111/j.1399-5618.2008.00618.x

Cited by 62 publications

(52 citation statements)

References 53 publications

(58 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hence, the impaired decision-making profile of these mice was consistent with that of BD patients (Adida et al, 2011;Ibanez et al, 2012). The IGT performance deficits of BD patients are consistent with previous studies (Adida et al, 2008;Clark et al, 2001;Yechiam et al, 2008), with deficits observed across several phases of BD (euthymia, depression, and mania; Adida et al, 2011). We provided novel analyses to investigate the underpinnings of this deficit.…”

Section: Discussionsupporting

confidence: 86%

Reduced Dopamine Transporter Functioning Induces High-Reward Risk-Preference Consistent with Bipolar Disorder

Enkhuizen

Henry

Minassian

et al. 2014

Neuropsychopharmacol

View full text Add to dashboard Cite

Individuals with bipolar disorder (BD) exhibit deleterious decision making, negatively impacting their lives. Such aberrant decision making can be quantified using the Iowa Gambling Task (IGT), which requires choosing between advantageous and disadvantageous options based on different reward/punishment schedules. The mechanisms underlying this behavioral deficit are unknown, but may include the reduced dopamine transporter (DAT) functioning reported in BD patients. Using both human and mouse IGTs, we tested whether reduced DAT functioning would recreate patterns of deficient decision making of BD patients. We assessed the IGT performance of 16 BD subjects (7 female) and 17 healthy control (HC) subjects (12 female). We recorded standard IGT performance measures and novel post-reward and post-punishment decision-making strategies. We characterized a novel single-session mouse IGT using C57BL/6J mice (n ¼ 44). The BD and HC IGT performances were compared with the effects of chronic (genetic knockdown (KD; n ¼ 31) and wild-type (n ¼ 28) mice) and acute (C57BL/6J mice (n ¼ 89) treated with the DAT inhibitor GBR12909) reductions of DAT functioning in mice performing this novel IGT. BD patients exhibited impaired decision making compared with HC subjects. Both the good-performing DAT KD and GBR12909-treated mice exhibited poor decision making in the mouse IGT. The deficit of each population was driven by highreward sensitivity. The single-session mouse IGT measures dynamic risk-based decision making similar to humans. Chronic and acute reductions of DAT functioning in mice impaired decision-making consistent with poor IGT performance of BD patients. Hyperdopaminergia caused by reduced DAT may impact poor decision making in BD patients, which should be confirmed in future studies.

show abstract

Section: Discussionsupporting

confidence: 86%

Reduced Dopamine Transporter Functioning Induces High-Reward Risk-Preference Consistent with Bipolar Disorder

Enkhuizen

Henry

Minassian

et al. 2014

Neuropsychopharmacol

View full text Add to dashboard Cite

show abstract

“…Bipolar patients exhibit impulsive behaviors, such as increased spending and hypersexual activity during periods of manic exacerbations, and when tested in the laboratory they consistently demonstrate deficits on decision-making tasks compared with healthy controls (Adida et al, 2008(Adida et al, , 2011Jollant et al, 2007;Martino et al, 2011;Yechiam et al, 2008). Even during periods of remission, patients with BPD demonstrate decreased reward-based learning (Pizzagalli et al, 2008), which may be related to reduced sensitivity to emotional contexts that highlight rewards or punishments (Chandler et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…As there are no empirical data on the prevalence of pramipexole exposure in BD patients in the community, it is impossible to establish the rarity of such a case or to compare it with similar side effects associated with other medications. Nonetheless, given the convergent data in PD and in healthy control subjects alongside a predisposition toward impulsive behaviors in BPD (Adida et al, 2008(Adida et al, , 2011Jollant et al, 2007;Martino et al, 2011;Yechiam et al, 2008), it would be reasonable to predict that BPD patients might be especially susceptible to the development of impulse-control disorders or behaviors associated with poor emotional decision making when taking a DA agonist.…”

Section: Introductionmentioning

confidence: 99%

Dopaminergic Influences on Emotional Decision Making in Euthymic Bipolar Patients

Burdick

Braga

Gopin

et al. 2013

Neuropsychopharmacol

View full text Add to dashboard Cite

We recently reported that the D2/D3 agonist pramipexole may have pro-cognitive effects in euthymic patients with bipolar disorder (BPD); however, the emergence of impulse-control disorders has been documented in Parkinson's disease (PD) after pramipexole treatment. Performance on reward-based tasks is altered in healthy subjects after a single dose of pramipexole, but its potential to induce abnormalities in BPD patients is unknown. We assessed reward-dependent decision making in euthymic BPD patients pre-and post 8 weeks of treatment with pramipexole or placebo by using the Iowa Gambling Task (IGT). The IGT requires subjects to choose among four card decks (two risky and two conservative) and is designed to promote learning to make advantageous (conservative) choices over time. Thirty-four BPD patients completed both assessments (18 placebo and 16 pramipexole). Baseline performance did not differ by treatment group (F ¼ 0.63; p ¼ 0.64); however, at week 8, BPD patients on pramipexole demonstrated a significantly greater tendency to make increasingly high-risk, high-reward choices across the five blocks, whereas the placebo group's pattern was similar to that reported in healthy individuals (treatment Â time Â block interaction, po0.05). Analyses of choice strategy using the expectancy valence model revealed that after 8 weeks on pramipexole, BPD patients attended more readily to feedback related to gains than to losses, which could explain the impaired learning. There were no significant changes in mood symptoms over the 8 weeks, and no increased propensity toward manic-like behaviors were reported. Our results suggest that the enhancement of dopaminergic activity influences risk-associated decision-making performance in euthymic BPD. The clinical implications remain unknown.

show abstract

“…Severe depression can manifest as impairment of information processing and reasoning that can significantly affect decision making [10]. Compromised ability for decisionmaking capacity has also been associated with disorders like dementia and delirium [11], intellectual disability [12,13], psychosis [14,15], and bipolar disorder [16][17][18]. Additionally, reduced decision-making capacity has been associated with patients admitted involuntarily or patients refusing treatment [15].…”

Section: Influence Of Psychiatric History and Current Diagnosismentioning

confidence: 99%

Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal

2017

AMA Journal of Ethics

View full text Add to dashboard Cite

How psychiatric symptoms affect patients' decision making in practice can inform how we think-theoretically and conceptually-about what it means for those patients to have decision-making capacity. Assessment of a patient's decisional capacity allows those with adequate capacity to make choices regarding treatment and protects those who lack capacity from potential harm caused by impaired decision making. In analyzing a case in which a patient with stage II breast cancer refuses further treatment, we review the conceptual model of informed consent and approaches to assessing decision-making capacity that are in accordance with the American Medical Association Code of Medical Ethics as well as tools to assess decisional capacity.

show abstract

Lack of insight may predict impaired decision making in manic patients

Cited by 62 publications

References 53 publications

Reduced Dopamine Transporter Functioning Induces High-Reward Risk-Preference Consistent with Bipolar Disorder

Reduced Dopamine Transporter Functioning Induces High-Reward Risk-Preference Consistent with Bipolar Disorder

Dopaminergic Influences on Emotional Decision Making in Euthymic Bipolar Patients

Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal

Contact Info

Product

Resources

About