Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-17T16:16:08.723Z Has data issue: false hasContentIssue false

Increased Affective Reactivity to Neutral Stimuli and Decreased Maintenance of Affective Responses in Bipolar Disorder

Published online by Cambridge University Press:  16 April 2020

M. Lemaire
Affiliation:
UMR Inserm U930, University François-Rabelais, Tours, France CHRU Tours, Department of Child Psychiatry, Tours, France
W. El-Hage
Affiliation:
UMR Inserm U930, University François-Rabelais, Tours, France CHRU Tours, Department of Adult Psychiatry (CPU), Tours, France
S. Frangou*
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, USA
*
*Corresponding author. Tel.: +212 659 1668; fax: +212 659 8576. E-mail address: [email protected] (S. Frangou).
Get access

Abstract

Background:

Affective dysregulation is a core feature of bipolar disorder (BD) and a significant predictor of clinical and functional outcome. Affective dysregulation can arise from abnormalities in multiple processes. This study addresses the knowledge gap regarding the precise nature of the processes that may be dysregulated in BD and their relationship to the clinical expression of the disorder.

Methods:

Patients with BD (n = 45) who were either in remission or in a depressive or manic state and healthy individuals (n = 101) were compared in terms of the intensity, duration and physiological response (measured using inter-beat intervals and skin conductance) to affective and neutral pictures during passive viewing and during experiential suppression.

Results:

Compared to healthy individuals, patients with BD evidenced increased affective reactivity to neutral pictures and reduced maintenance of subjective affective responses to all pictures. This pattern was present irrespective of clinical state but was more pronounced in symptomatic patients, regardless of polarity. Patients, regardless of symptomatic status, were comparable to healthy individuals in terms of physiological arousal and voluntary control of affective responses.

Conclusion:

Our study demonstrates that increased affective reactivity to neutral stimuli and decreased maintenance of affective responses are key dimensions of affective dysregulation in BD.

Type
Original article
Copyright
European Psychiatric Association 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bauer, M, Glenn, T, Alda, M, Grof, P, Sagduyu, K, Bauer, R, et al.Comparison of pre-episode and pre-remission states using mood ratings from patients with bipolar disorder. Pharmacopsychiatry 2011;44(Suppl 1):S49S53.CrossRefGoogle ScholarPubMed
Benjamini, Y, Hochberg, Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B Methodol 1995;57:289300.Google Scholar
Biederman, J, Martelon, M, Faraone, SV, Woodworth, KY, Spencer, TJ, Wozniak, JR. Personal and familial correlates of bipolar (BP)-I disorder in children with a diagnosis of BP-I disorder with a positive child behavior checklist (CBCL)-severe dysregulation profile: a controlled study. J Affect Disord 2013;147:164170.CrossRefGoogle ScholarPubMed
Billman, GE. Heart rate variability – a historical perspective. Front Physiol 2011;2:86.http://dx.doi.org/10.3389/fphys.2011.00086.CrossRefGoogle ScholarPubMed
Bonsall, MB, Wallace-Hadrill, SMA, Geddes, JR, Goodwin, GM, Holmes, EA. Nonlinear time-series approaches in characterizing mood stability and mood instability in bipolar disorder. Proc Biol Sci 2012;279:916924.CrossRefGoogle ScholarPubMed
Boucsein, W, Fowles, DC, Grimnes, S, Ben-Shakhar, G, roth, WT, Dawson, ME, et al.Publication recommendations for electrodermal measurements. Psychophysiology 2012;49:10171034.Google ScholarPubMed
Bradley, MM, Miccoli, L, Escrig, MA, Lang, PJ. The pupil as a measure of emotional arousal and autonomic activation. Psychophysiology 2008;45:602607.CrossRefGoogle ScholarPubMed
Chang, HA, Chang, CC, Tzeng, NS, Kuo, TB, Lu, RB, Huang, SY. Heart rate variability in unmedicated patients with bipolar disorder in the manic phase. Psychiatry Clin Neurosci 2014;68:674682.CrossRefGoogle ScholarPubMed
Charles, ST, Piazza, JR, Mogle, J, Sliwinski, MJ, Almeida, DM. The wear and tear of daily stressors on mental health. Psychol Sci 2013;24:733741.CrossRefGoogle ScholarPubMed
Cohen, H, Kaplan, Z, Kotler, M, Mittelman, I, Osher, Y, Bersudsky, Y. Impaired heart rate variability in euthymic bipolar patients. Bipolar Disord 2003;5:138143.CrossRefGoogle ScholarPubMed
Curran-Everett, D. Multiple comparisons: philosophies and illustrations. Am J Physiol Regul Integr Comp Physiol 2000;279:R1R8.CrossRefGoogle ScholarPubMed
Delvecchio, G, Fossati, P, Boyer, P, Brambilla, P, Falkai, P, Gruber, O, et al.Common and distinct neural correlates of emotional processing in Bipolar Disorder and Major Depressive Disorder: a voxel-based meta-analysis of functional magnetic resonance imaging studies. Eur Neuropsychopharmacol 2012;22:100113.CrossRefGoogle ScholarPubMed
Delvecchio, G, Sugranyes, G, Frangou, S. Evidence of diagnostic specificity in the neural correlates of facial affect processing in bipolar disorder and schizophrenia: a meta-analysis of functional imaging studies. Psychol Med 2013;43:553569.CrossRefGoogle ScholarPubMed
Dima, D, Stephan, KE, Roiser, JP, Friston, KJ, Frangou, S. Effective connectivity during processing of facial affect: evidence for multiple parallel pathways. J Neurosci 2011;31:1437821485.CrossRefGoogle ScholarPubMed
Dima, D, Jogia, J, Collier, D, Vassos, E, Burdick, KE, Frangou, S. Independent modulation of engagement and connectivity of the facial network during affect processing by CACNA1C and ANK3 risk genes for bipolar disorder. JAMA Psychiatry 2013;70:13031311.CrossRefGoogle ScholarPubMed
Dubois, M, Azorin, J-M, Fakra, E, Adida, M, Belzeaux, R. Emotional endophenotypes and bipolar disorder. Encephale 2012;38(Suppl 3):S85S92.CrossRefGoogle ScholarPubMed
Fanoe, S, Kristensen, D, Fink-Jensen, A, Jensen, HK, Toft, E, Nielsen, J, et al.Risk of arrhythmia induced by psychotropic medications: a proposal for clinical management. Eur Heart J 2014;35:13061315.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBWStructured Clinical Interview for DSM-IV-TR Axis I Disorders. Patient EditionNew York: Biometrics Research, New York State Psychiatric Institute; 2007.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBWStructured Clinical Interview for DSM-IV-TR Axis I Disorders – Non-Patient Version. New York: Biometrics Research, New York State Psychiatric Institute; 2007.Google Scholar
Forbes, EE, Miller, A, Cohn, JF, Fox, NA, Kovacs, M. Affect-modulated startle in adults with childhood-onset depression: relations to bipolar course and number of lifetime depressive episodes. Psychiatry Res 2005;134:1125.CrossRefGoogle ScholarPubMed
Fowles, DC, Christie, MJ, Edelberg, R, Grings, WW, Lykken, DT, Venables, PH. Committee report. Publication recommendations for electrodermal measurements. Psychophysiology 1981;18:232239.CrossRefGoogle ScholarPubMed
García-Blanco, A, Salmerón, L, Perea, M, Livianos, L. Attentional biases toward emotional images in the different episodes of bipolar disorder: an eye-tracking study. Psychiatry Res 2014;215:628633.CrossRefGoogle Scholar
Gard, DE, Cooper, S, Fisher, M, Genevsky, A, Mikels, JA, Vinogradov, S. Evidence for an emotion maintenance deficit in schizophrenia. Psychiatry Res 2011;187:2429.CrossRefGoogle Scholar
Garrett, A, Maddock, RS. Separating subjective emotion from the perception of emotion-inducing stimuli: an fMRI study. Neuroimage 2006;33:263274.CrossRefGoogle Scholar
Gershon, A, Eidelman, P. Inter-episode affective intensity and instability: predictors of depression and functional impairment in bipolar disorder. J Behav Ther Exp Psychiatry 2014;46C:1418.Google Scholar
Giakoumaki, SG, Bitsios, P, Frangou, S, Roussos, P, Aasen, I, Galea, A, et al.Low baseline startle and deficient affective startle modulation in remitted bipolar disorder patients and their unaffected siblings. Psychophysiology 2010;47:659668.Google ScholarPubMed
Glenn, T, Whybrow, PC, Rasgon, N, Grof, P, Alda, M, Baethge, C, et al.Approximate entropy of self-reported mood prior to episodes in bipolar disorder. Bipolar Disord 2006;8:424429.CrossRefGoogle ScholarPubMed
Gottschalk, A, Bauer, MS, Whybrow, PC. Evidence of chaotic mood variation in bipolar disorder. Arch Gen Psychiatry 1995;52:947959.CrossRefGoogle ScholarPubMed
Gross, JJ. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 2002;39:281291.CrossRefGoogle ScholarPubMed
Gruber, J, Harvey, AG, Purcell, A. What goes up can come down? A preliminary investigation of emotion reactivity and emotion recovery in bipolar disorder. J Affect Disord 2011;133:457466.CrossRefGoogle Scholar
Gruber, J, Harvey, AG, Gross, JJ. When trying is not enough: emotion regulation and the effort-success gap in bipolar disorder. Emotion 2012;12:9971003.CrossRefGoogle Scholar
Gruber, J, Kogan, A, Mennin, D, Murray, G. Real-world emotion? An experience-sampling approach to emotion experience and regulation in bipolar I disorder. J Abnorm Psychol 2013;122:971983.CrossRefGoogle ScholarPubMed
Gruber, J, Hay, AC, Gross, JJ. Rethinking emotion: cognitive reappraisal is an effective positive and negative emotion regulation strategy in bipolar disorder. Emotion 2014;14:388396.CrossRefGoogle ScholarPubMed
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:5662.CrossRefGoogle ScholarPubMed
Havermans, R, Nicolson, NA, Berkhof, J, deVries, MW. Mood reactivity to daily events in patients with remitted bipolar disorder. Psychiatry Res 2010;179:4752.CrossRefGoogle ScholarPubMed
Henry, C, Van den Bulke, D, Bellivier, F, Roy, I, Swendsen, J, M’Baïlara, K, et al.Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Res 2008;159:16.CrossRefGoogle ScholarPubMed
Henry, BL, Minassian, A, Paulus, MP, Geyer, MA, Perry, W. Heart rate variability in bipolar mania and schizophrenia. J Psychiatr Res 2010;44:168176.CrossRefGoogle Scholar
Holm, S. A simple sequentially rejective multiple test procedure. Scand J Stat 1979;6:6570.Google Scholar
Hothorn, T, Bretz, F, Westfall, P. Simultaneous inference in general parametric models. Biom J Biom Z 2008;50:346363.CrossRefGoogle ScholarPubMed
Karniol, IG, Dalton, J, Lader, MH. Acute and chronic effects of lithium chloride on physiological and psychological measures in normals. Psychopharmacology (Berl) 1978;57:289294.CrossRefGoogle ScholarPubMed
Knowles, R, Tai, S, Jones, SH, Highfield, J, Morriss, R, Bentall, RP. Stability of self-esteem in bipolar disorder: comparisons among remitted bipolar patients, remitted unipolar patients and healthy controls. Bipolar Disord 2007;9:490495.CrossRefGoogle ScholarPubMed
Koenigsberg, HW. Affective instability: toward an integration of neuroscience and psychological perspectives. J Personal Disord 2010;24:6082.CrossRefGoogle ScholarPubMed
Kreibig, SD. Autonomic nervous system activity in emotion: a review. Biol Psychol 2010;84:394421.CrossRefGoogle ScholarPubMed
Kring, AM, Germans Gard, M, Gard, DE. Emotion deficits in schizophrenia: timing matters. J Abnorm Psychol 2011;120:7987.CrossRefGoogle ScholarPubMed
Lane, RD, Reiman, EM, Bradley, MM, Lang, PJ, Ahern, GL, Davidson, RJ, et al.Neuroanatomical correlates of pleasant and unpleasant emotion. Neuropsychologia 1997;35:14371444.CrossRefGoogle ScholarPubMed
Lang, PJ, Bradley, MM, Cuthbert, BNInternational affective picture system (IAPS): affective ratings of pictures and instruction manual. Technical Report A-8. Gainesville, FL: University of Florida; 2008.Google Scholar
Lemaire, M, Aguillon-Hernandez, N, Bonnet-Brilhault, F, Martineau, J, El-Hage, W. Subjective and physiological emotional response in euthymic bipolar patients: a pilot study. Psychiatry Res 2014;220:294301.CrossRefGoogle ScholarPubMed
Lemaire, M, El-Hage, W, Frangou, S. Reappraising suppression: subjective and physiological correlates of experiential suppression in healthy adults. Front Psychol 2014;5:571.http://dx.doi.org/10.3389/fpsyg.2014.00571.CrossRefGoogle ScholarPubMed
Lindquist, KA, Wager, TD, Kober, H, Bliss-Moreau, E, Barrett, LF. The brain basis of emotion: a meta-analytic review. Behav Brain Sci 2012;35:121143.CrossRefGoogle ScholarPubMed
Lotufo, PA, Valiengo, L, Benseñor, IM, Brunoni, AR. A systematic review and meta-analysis of heart rate variability in epilepsy and antiepileptic drugs. Epilepsia 2012;53:272282.CrossRefGoogle ScholarPubMed
M’bailara, K, Demotes-Mainard, J, Swendsen, J, Mathieu, F, Leboyer, M, Henry, C. Emotional hyper-reactivity in normothymic bipolar patients. Bipolar Disord 2009;11:6369.CrossRefGoogle ScholarPubMed
M’Bailara, K, Atzeni, T, Colom, F, Swendsen, J, Gard, S, Desage, A, et al.Emotional hyperreactivity as a core dimension of manic and mixed states. Psychiatry Res 2012;197:227230.CrossRefGoogle ScholarPubMed
MacQueen, GM, Marriott, M, Begin, H, Robb, J, Joffe, RT, Young, LT. Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder. Bipolar Disord 2003;5:349355.CrossRefGoogle ScholarPubMed
Marwaha, S, Parsons, N, Flanagan, S, Broome, M. The prevalence and clinical associations of mood instability in adults living in England: results from the Adult Psychiatric Morbidity Survey 2007. Psychiatry Res 2013;205:262268.CrossRefGoogle ScholarPubMed
Merikangas, KR, Jin, R, He, J-P, Kessler, RC, Lee, S, Sampson, NA, et al.Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011;68:241251.CrossRefGoogle ScholarPubMed
Moon, E, Lee, SH, Kim, DH, Hwang, B. Comparative study of heart rate variability in patients with schizophrenia, bipolar disorder, post-traumatic stress disorder, or major depressive disorder. Clin Psychopharmacol Neurosci 2013;11:137143.CrossRefGoogle ScholarPubMed
Peeters, G, Czapinski, J. Positive-negative asymmetry in evaluations: the distinction between affective and informational negativity effects. Eur Rev Soc Psychol 1990;1:3360.CrossRefGoogle Scholar
Pinheiro, JC, Bates, DMMixed-Effects Models in S and S-Plus. 1st ed. 2000. 2nd printing New York Inc: Springer-Verlag; 2009.Google Scholar
Pinheiro, J, Bates, D, DebRoy, S, Sarkar, DR Development Core Team. nlme: Linear and Nonlinear Mixed Effects Models; 2014, www.R-project.org.Google Scholar
R Development Core Team R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2014.Google Scholar
Renaud, SM, Zacchia, C. Toward a definition of affective instability. Harv Rev Psychiatry 2012;20:298308.CrossRefGoogle Scholar
Rich, BA, Vinton, DT, Roberson-Nay, R, Hommer, RE, Berghorst, LH, McClure, EB, et al.Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proc Natl Acad Sci U S A 2006;103:89008905.CrossRefGoogle ScholarPubMed
Spielberger, CDManual for the State-Trait Anxiety Inventory (Form Y). Palo Alto: Consulting Psychologists Press; 1983.Google Scholar
Stratta, P, Tempesta, D, Bonanni, RL, de Cataldo, S, Rossi, A. Emotional reactivity in bipolar depressed patients. J Clin Psychol 2014;70:860865.CrossRefGoogle ScholarPubMed
Strejilevich, SA, Martino, DJ, Murru, A, Teitelbaum, J, Fassi, G, Marengo, E, et al.Mood instability and functional recovery in bipolar disorders. Acta Psychiatr Scand 2013;128:194202.CrossRefGoogle ScholarPubMed
Swann, AC, Lafer, B, Perugi, G, Frye, MA, Bauer, M, Bahk, W-M, et al.Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. Am J Psychiatry 2013;170:3142.CrossRefGoogle ScholarPubMed
Thayer, RE, Newman, JR, McClain, TM. Self-regulation of mood: strategies for changing a bad mood, raising energy, and reducing tension. J Pers Soc Psychol 1994;67:910925.CrossRefGoogle ScholarPubMed
Wechsler, DTechnical Manual for the Wechsler Adult Intelligence Test. Third Edition, San Antonio: The Psychological Corporation; 1997.Google Scholar
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DAA rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry J Ment Sci 1978;133:429435.CrossRefGoogle ScholarPubMed
Supplementary material: File

Lemaire et al. supplementary material

Lemaire et al. supplementary materialupplementary materials

Download Lemaire et al. supplementary material(File)
File 20.7 KB
Submit a response

Comments

No Comments have been published for this article.