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

Published online by Cambridge University Press:  03 September 2020

Almudena Ramírez-Martín ,
Javier Ramos-Martín Open the ORCID record for Javier Ramos-Martín [Opens in a new window] ,
Fermin Mayoral-Cleries ,
Berta Moreno-Küstner  and
Jose Guzman-Parra
Almudena Ramírez-Martín
Affiliation:
Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Malaga, Spain
Javier Ramos-Martín
Affiliation:
Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Malaga, Spain
Fermin Mayoral-Cleries
Affiliation:
Department of Mental Health, University General Hospital of Malaga. Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
Berta Moreno-Küstner
Affiliation:
Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Malaga, Spain
Jose Guzman-Parra*
Affiliation:
Department of Mental Health, University General Hospital of Malaga. Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
*
Author for correspondence: Jose Guzman-Parra, E-mail: [email protected]
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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.

Keywords

Bipolar disorderdecision-makingimpulsivitymeta-analysisrisk-taking behavioursystematic review
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 13 , October 2020 , pp. 2141 - 2153
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Adida, M., Jollant, F., Clark, L., Besnier, N., Guillaume, S., Kaladjian, A., … Courtet, P. (2011). Trait-related decision-making impairment in the three phases of bipolar disorder. Biological Psychiatry, 70(4), 357–365. https://doi.org/10.1016/j.biopsych.2011.01.018.CrossRefGoogle Scholar
Ahn, W. Y., Rass, O., Fridberg, D. J., Bishara, A. J., Forsyth, J. K., Breier, A., … O'Donnell, B. F. (2011). Temporal discounting of rewards in patients with bipolar disorder and schizophrenia. Journal of Abnormal Psychology, 120(4), 911–921. https://doi.org/10.1037/a0023333.CrossRefGoogle Scholar
Bauer, I. E., Meyer, T. D., Sanches, M., Spiker, D., Zunta-Soares, G., & Soares, J. C. (2017). Are self-rated and behavioural measures of impulsivity in bipolar disorder mainly related to comorbid substance use problems? Cognitive Neuropsychiatry, 22(4), 298–314. https://doi.org/10.1080/13546805.2017.1324951.CrossRefGoogle Scholar
Bechara, A. (2005). Decision making, impulse control and loss of willpower to resist drugs: A neurocognitive perspective. Nature Neuroscience, 8(11), 1458–1463. https://doi.org/10.1038/nn1584.CrossRefGoogle Scholar
Begg, C. B., & Mazumdar, M. (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50(4), 1088–1101.CrossRefGoogle Scholar
Bersani, G., Quartini, A., Zullo, D., & Iannitelli, A. (2016). Potential neuroprotective effect of lithium in bipolar patients evaluated by neuropsychological assessment: Preliminary results. Human Psychopharmacology: Clinical and Experimental, 31(1), 19–28. https://doi.org/10.1002/hup.2510.CrossRefGoogle Scholar
Brambilla, P., Perlini, C., Bellani, M., Tomelleri, L., Ferro, A., Cerruti, S., … Frangou, S. (2013). Increased salience of gains versus decreased associative learning differentiate bipolar disorder from schizophrenia during incentive decision making. Psychological Medicine, 43(3), 571–580. https://doi.org/10.1017/S0033291712001304.CrossRefGoogle Scholar
Chamorro, J., Bernardi, S., Potenza, M., Grant, J., Marsh, R., Wang, S., & Blanco, C. (2012). Impulsivity in the general population: A national study. Journal of Psychiatric Research., 46(8), 994–1001. https://doi.org/10.1016/j.jpsychires.2012.04.023.Impulsivity.CrossRefGoogle Scholar
Cheema, M. K., MacQueen, G. M., & Hassel, S. (2015). Assessing personal financial management in patients with bipolar disorder and its relation to impulsivity and response inhibition. Cognitive Neuropsychiatry, 20(5), 424–437. https://doi.org/10.1080/13546805.2015.1076722.CrossRefGoogle Scholar
Christodoulou, T., Lewis, M., Ploubidis, G. B., & Frangou, S. (2006). The relationship of impulsivity to response inhibition and decision-making in remitted patients with bipolar disorder. European Psychiatry, 21(4), 270–273. https://doi.org/10.1016/j.eurpsy.2006.04.006.CrossRefGoogle Scholar
de Moraes, P. H. P., Neves, F. S., Vasconcelos, A. G., Lima, I. M. M., Brancaglion, M., Sedyiama, C. Y., … Malloy-Diniz, L. F. (2013). Relationship between neuropsychological and clinical aspects and suicide attempts in euthymic bipolar patients. Psicologia: Reflexão e Crítica, 26(1), 160–167. https://doi.org/10.1590/S0102-79722013000100017.Google Scholar
Duek, O., Osher, Y., Belmaker, R. H., Bersudsky, Y., & Kofman, O. (2014). Reward sensitivity and anger in euthymic bipolar disorder. Psychiatry Research, 215(1), 95–100. https://doi.org/10.1016/j.psychres.2013.10.028.CrossRefGoogle Scholar
Edge, M. D., Johnson, S. L., Ng, T., & Carver, C. S. (2013). Iowa gambling task performance in euthymic bipolar I disorder: A meta-analysis and empirical study. Journal of Affective Disorders, 150(1), 115–122. https://doi.org/10.1016/j.jad.2012.11.027.CrossRefGoogle Scholar
Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Research Ed.), 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629.CrossRefGoogle Scholar
Fleck, D. E., Kotwal, R., Eliassen, J. C., Lamy, M., Delbello, M. P., Adler, C. M., … Strakowski, S. M. (2011). Preliminary evidence for increased frontosubcortical activation on a motor impulsivity task in mixed episode bipolar disorder. Journal of Affective Disorders, 133(1–2), 333–339. https://doi.org/10.1016/j.jad.2011.03.053.CrossRefGoogle Scholar
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561–1572. https://doi.org/10.1016/S0140-6736(15)00241-X.CrossRefGoogle Scholar
Henna, E., Hatch, J. P., Nicoletti, M., Swann, A. C., Zunta-Soares, G., & Soares, J. C. (2013). Is impulsivity a common trait in bipolar and unipolar disorders? Bipolar Disorders, 15(2), 223–227. https://doi.org/10.1111/bdi.12034.CrossRefGoogle Scholar
Hidiroǧlu, C., Demirci Esen, Ö., Tunca, Z., Neslihan Gårz Yalçìn, Ş., Lombardo, L., Glahn, D. C., & Özerdem, A. (2013). Can risk-taking be an endophenotype for bipolar disorder? A study on patients with bipolar disorder type I and their first-degree relatives. Journal of the International Neuropsychological Society, 19(4), 474–482. https://doi.org/10.1017/S1355617713000015.CrossRefGoogle Scholar
Holmes, M. K., Bearden, C. E., Barguil, M., Fonseca, M., Monkul, E. S., Nery, F. G., … Glahn, D. C. (2009). Conceptualizing impulsivity and risk taking in bipolar disorder: Importance of history of alcohol abuse. Bipolar Disorders, 11(1), 33–40. https://doi.org/10.1111/j.1399-5618.2008.00657.x.CrossRefGoogle Scholar
Hummer, T. A., Hulvershorn, L. A., Karne, H. S., Gunn, A. D., Wang, Y., & Anand, A. (2013). Emotional response inhibition in bipolar disorder: A functional magnetic resonance imaging study of trait- and state-related abnormalities. Biological Psychiatry, 73(2), 136–143. https://doi.org/10.1016/j.biopsych.2012.06.036.CrossRefGoogle Scholar
Ibanez, A., Cetkovich, M., Petroni, A., Urquina, H., Baez, S., Gonzalez-Gadea, M. L., … Manes, F. (2012). The neural basis of decision-making and reward processing in adults with euthymic bipolar disorder or attention-deficit/hyperactivity disorder (ADHD). PLoS ONE, 7(5), e37306. https://doi.org/10.1371/journal.pone.0037306.CrossRefGoogle Scholar
Jiménez, E., Solé, B., Arias, B., Mitjans, M., Varo, C., Reinares, M., … Benabarre, A. (2018). Characterizing decision-making and reward processing in bipolar disorder: A cluster analysis. European Neuropsychopharmacology, 28(7), 863–874. https://doi.org/10.1016/j.euroneuro.2018.04.001.CrossRefGoogle Scholar
Jogia, J., Dima, D., Kumari, V., & Frangou, S. (2012). Frontopolar cortical inefficiency may underpin reward and working memory dysfunction in bipolar disorder. The World Journal of Biological Psychiatry, 13(8), 605–615. https://doi.org/10.3109/15622975.2011.585662.CrossRefGoogle Scholar
Kaladjian, A., Jeanningros, R., Azorin, J. M., Nazarian, B., Roth, M., & Mazzola-Pomietto, P. (2009). Reduced brain activation in euthymic bipolar patients during response inhibition: An event-related fMRI study. Psychiatry Research – Neuroimaging, 173(1), 45–51. https://doi.org/10.1016/j.pscychresns.2008.08.003.CrossRefGoogle Scholar
Ketter, T. A. (2010). Diagnostic features, prevalence, and impact of bipolar disorder. The Journal of Clinical Psychiatry, 71(06), e14. https://doi.org/10.4088/jcp.8125tx11c.CrossRefGoogle Scholar
Kopf, J., Glöckner, S., Schecklmann, M., Dresler, T., Plichta, M. M., Veeh, J., … Reif, A. (2018). Neural correlates of response inhibition in patients with bipolar disorder during acute versus remitted phase. World Journal of Biological Psychiatry, 20(8), 637–646. https://doi.org/10.1080/15622975.2018.1428356.CrossRefGoogle Scholar
Leigh, B. C. (1999). Peril, chance, adventure: Concepts of risk, alcohol use and risky behavior in young adults. Addiction, 94(3), 371–383. https://doi.org/10.1046/j.1360-0443.1999.9433717.x.CrossRefGoogle Scholar
Linke, J., King, A. V, Poupon, C., Hennerici, M. G., Gass, A., & Wessa, M. (2013). Impaired anatomical connectivity and related executive functions: Differentiating vulnerability and disease marker in bipolar disorder. Biological Psychiatry, 74(12), 908–916. https://doi.org/10.1016/j.biopsych.2013.04.010.CrossRefGoogle Scholar
Malloy-Diniz, L. F., Neves, F. S., De Moraes, P. H. P., De Marco, L. A., Romano-Silva, M. A., Krebs, M. O., & Corrêa, H. (2011). The 5-HTTLPR polymorphism, impulsivity and suicide behavior in euthymic bipolar patients. Journal of Affective Disorders, 133(1–2), 221–226. https://doi.org/10.1016/j.jad.2011.03.051.CrossRefGoogle Scholar
Martino, D. J., Strejilevich, S. A., Torralva, T., & Manes, F. (2011). Decision making in euthymic bipolar I and bipolar II disorders. Psychological Medicine, 41(6), 1319–1327. https://doi.org/10.1017/S0033291710001832.CrossRefGoogle Scholar
Mazzola-Pomietto, P., Kaladjian, A., Azorin, J. M., Anton, J. L., & Jeanningros, R. (2009). Bilateral decrease in ventrolateral prefrontal cortex activation during motor response inhibition in mania. Journal of Psychiatric Research, 43(4), 432–441. https://doi.org/10.1016/j.jpsychires.2008.05.004.CrossRefGoogle Scholar
Merikangas, K. R., Jin, R., He, J. P., Kessler, R. C., Lee, S., Sampson, N. A., … Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry, 68(3), 241–251. https://doi.org/10.1001/archgenpsychiatry.2011.12.CrossRefGoogle Scholar
Miskowiak, K. W., Burdick, K. E., Martinez-Aran, A., Bonnin, C. M., Bowie, C. R., Carvalho, A. F., … Vieta, E. (2017). Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force. Bipolar Disorders, 19(8), 614–626. https://doi.org/10.1111/bdi.12534.CrossRefGoogle Scholar
Moeller, F. G., Barratt, E. S., Dougherty, D. M., Schmitz, J. M., & Swann, A. C. (2001). Psychiatric aspects of impulsivity. American Journal of Psychiatry, 158(11), 1783–1793. https://doi.org/10.1176/appi.ajp.158.11.1783.CrossRefGoogle Scholar
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.CrossRefGoogle Scholar
Murphy, F. C., Rubinsztein, J. S., Michael, A., Rogers, R. D., Robbins, T. W., Paykel, E. S., & Sahakian, B. J. (2001). Decision-making cognition in mania and depression. Psychological Medicine, 31(4), 679–693. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11352370.10.1017/S0033291701003804CrossRefGoogle Scholar
Najt, P., Perez, J., Sanches, M., Peluso, M. A. M., Glahn, D., & Soares, J. C. (2007). Impulsivity and bipolar disorder. European Neuropsychopharmacology, 17(5), 313–320. https://doi.org/10.1016/j.euroneuro.2006.10.002.CrossRefGoogle Scholar
Newman, A. L., & Meyer, T. D. (2014). Impulsivity: Present during euthymia in bipolar disorder? – A systematic review. International Journal of Bipolar Disorders, 2(1), 2. https://doi.org/10.1186/2194-7511-2-2.CrossRefGoogle Scholar
Okasha, T. A., El Sheikh, M. M., El Missiry, A. A., El Missiry, M. A., El Serafi, D., El Kholy, S., & Abdel Aziz, K. (2014). Cognitive functions in euthymic Egyptian patients with bipolar disorder: Are they different from healthy controls? Journal of Affective Disorders, 166, 14–21. https://doi.org/10.1016/j.jad.2014.04.051.CrossRefGoogle Scholar
Powers, R. L., Russo, M., Mahon, K., Brand, J., Braga, R. J., Malhotra, A. K., & Burdick, K. E. (2013). Impulsivity in bipolar disorder: Relationships with neurocognitive dysfunction and substance use history. Bipolar Disorders, 15(8), 876–884. https://doi.org/10.1111/bdi.12124.CrossRefGoogle Scholar
Reddy, L. F., Lee, J., Davis, M. C., Altshuler, L., Glahn, D. C., Miklowitz, D. J., & Green, M. F. (2014). Impulsivity and risk taking in bipolar disorder and schizophrenia. Neuropsychopharmacology, 39(2), 456–463. https://doi.org/10.1038/npp.2013.218.CrossRefGoogle Scholar
Roiser, J., Farmer, A., Lam, D., Burke, A., O'Neill, N., Keating, S., … McGuffin, P. (2009). The effect of positive mood induction on emotional processing in euthymic individuals with bipolar disorder and controls. Psychological Medicine, 39(5), 785–791. https://doi.org/10.1017/S0033291708004200.CrossRefGoogle Scholar
Rubinsztein, J. S., Michael, A., Underwood, B. R., Tempest, M., & Sahakain, B. J. (2006). Impaired cognition and decision-making in bipolar depression but no “affective bias” evident. Psychological Medicine, 36(5), 629–639. https://doi.org/10.1017/S0033291705006689.CrossRefGoogle Scholar
Saddichha, S., & Schuetz, C. (2014). Is impulsivity in remitted bipolar disorder a stable trait? A meta-analytic review. Comprehensive Psychiatry, 55(7), 1479–1484. https://doi.org/10.1016/j.comppsych.2014.05.010.CrossRefGoogle Scholar
Samamé, C., Martino, D. J., & Strejilevich, S. A. (2012). Social cognition in euthymic bipolar disorder: Systematic review and meta-analytic approach. Acta Psychiatrica Scandinavica, 125(4), 266–280. https://doi.org/10.1111/j.1600-0447.2011.01808.x.CrossRefGoogle Scholar
Scholz, V., Houenou, J., Kollmann, B., Duclap, D., Poupon, C., & Wessa, M. (2016). Dysfunctional decision-making related to white matter alterations in bipolar i disorder. Journal of Affective Disorders, 194, 72–79. https://doi.org/10.1016/j.jad.2015.12.019.CrossRefGoogle Scholar
Schwarzer, G., Carpenter, J. R., & Rücker, G. (2015). Meta-Analysis with R. Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-21416-0.CrossRefGoogle Scholar
Strakowski, S. M., Fleck, D. E., Delbello, M. P., Adler, C. M., Shear, P. K., Mcelroy, S. L., … Arndt, S. (2009). Characterizing impulsivity in mania. Bipolar Disorders, 11(1), 41–51. https://doi.org/10.1111/j.1399-5618.2008.00658.x.CrossRefGoogle Scholar
Strakowski, S. M., Fleck, D. E., Delbello, M. P., Caleb, M., Shear, P. K., Kotwal, R., & Arndt, S. (2010). Impulsivity across the course of bipolar disorder. Bipolar Disorder, 12(3), 285–297. https://doi.org/10.1111/j.1399-5618.2010.00806.x.Impulsivity.CrossRefGoogle Scholar
Swann, A. C., Lijffijt, M., Lane, S. D., Steinberg, J. L., & Moeller, F. G. (2009). Severity of bipolar disorder is associated with impairment of response inhibition. Journal of Affective Disorders, 116(1–2), 30–36. https://doi.org/10.1016/j.jad.2008.10.022.CrossRefGoogle Scholar
Taylor Tavares, J. V., Clark, L., Cannon, D. M., Erickson, K., Drevets, W. C., & Sahakian, B. J. (2007). Distinct profiles of neurocognitive function in unmedicated unipolar depression and bipolar II depression. Biological Psychiatry, 62(8), 917–924. https://doi.org/10.1016/j.biopsych.2007.05.034.CrossRefGoogle Scholar
van Enkhuizen, J., Henry, B. L., Minassian, A., Perry, W., Milienne-Petiot, M., Higa, K. K., … Young, J. W. (2014). Reduced dopamine transporter functioning induces high-reward risk-preference consistent with bipolar disorder. Neuropsychopharmacology, 39(13), 3112–3122. https://doi.org/10.1038/npp.2014.170.CrossRefGoogle Scholar
Wells, G. A., Shea, B., Connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (2014). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Retrieved from http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.Google Scholar
Wilson, M. J., & Vassileva, J. (2018). Decision-making under risk, but not under ambiguity, predicts pathological gambling in discrete types of abstinent substance users. Frontiers in Psychiatry, 9, 1–10. https://doi.org/10.3389/fpsyt.2018.00239.CrossRefGoogle Scholar
Wright, L., Lipszyc, J., Dupuis, A., Thayapararajah, S. W., & Schachar, R. (2014). Response inhibition and psychopathology: A meta-analysis of Go/No-Go task performance. Journal of Abnormal Psychology, 123(2), 429–439. https://doi.org/10.1037/a0036295.CrossRefGoogle Scholar
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